Bowel endometriosis: diagnosis and management.

The most common location of extragenital endometriosis is the bowel. Medical treatment may not provide long-term improvement in patients who are symptomatic, and consequently most of these patients may require surgical intervention. Over the past century, surgeons have continued to debate the optimal surgical approach to treating bowel endometriosis, weighing the risks against the benefits. In this expert review we will describe how the recommended surgical approach depends largely on the location of disease, in addition to size and depth of the lesion. For lesions approximately 5-8 cm from the anal verge, we encourage conservative surgical management over resection to decrease the risk of short- and long-term complications.

Reverse Vesicouterine Fold Dissection for Laparoscopic Hysterectomy After Prior Cesarean Deliveries.

BACKGROUND: Cesarean delivery adhesions, during laparoscopic hysterectomy, can present surgical challenges, including distortion of anatomy, prolonged operating time, and inadvertent injury to nearby structures. TECHNIQUE: At the time of laparoscopic hysterectomy, in patients with significant adhesions from prior cesarean deliveries, we use a reverse inferior to superior vesicouterine fold dissection to mobilize the scarred bladder. We use this as an alternative to the commonly practiced technique of mobilizing the bladder in a superior to inferior fashion at the time of laparoscopic hysterectomy. EXPERIENCE: Fifty-two patients with a median age of 42.5 years are presented. Forty-eight patients were discharged within 3-6 hours postoperatively. Sixteen patients were discharged with Foley catheters, because they were unable to void within the protocol for a fast-track discharge. The catheters were removed between postoperative days 1 and 5. There were no gastrointestinal or genitourinary complications. One patient experienced a delayed vaginal cuff abscess and bleeding, which were managed conservatively. CONCLUSION: Reverse vesicouterine fold dissection is a useful alternative technique for laparoscopic hysterectomy in women with a history of prior cesarean deliveries.

Media use, face-to-face communication, media multitasking, and social well-being among 8- to 12-year-old girls.

An online survey of 3,461 North American girls ages 8-12 conducted in the summer of 2010 through Discovery Girls magazine examined the relationships between social well-being and young girls' media use--including video, video games, music listening, reading/homework, e-mailing/posting on social media sites, texting/instant messaging, and talking on phones/video chatting--and face-to-face communication. This study introduced both a more granular measure of media multitasking and a new comparative measure of media use versus time spent in face-to-face communication. Regression analyses indicated that negative social well-being was positively associated with levels of uses of media that are centrally about interpersonal interaction (e.g., phone, online communication) as well as uses of media that are not (e.g., video, music, and reading). Video use was particularly strongly associated with negative social well-being indicators. Media multitasking was also associated with negative social indicators. Conversely, face-to-face communication was strongly associated with positive social well-being. Cell phone ownership and having a television or computer in one's room had little direct association with children's socioemotional well-being. We hypothesize possible causes for these relationships, call for research designs to address causality, and outline possible implications of such findings for the social well-being of younger adolescents.