ABSTRACT
OBJECTIVES: Diagnosis and treatment of endometriosis may be complex and therefore justify the discussion of therapeutic decisions in a multidisciplinary endometriosis board (MEB). The development of endometriosis regional expert centers requires an assessment of the quality and relevance of MEB. METHODS: Qualitiative retrospective study on patients whose management was discussed in Centre Hospitalier Lyon-Sud between June 2013 and December 2017. RESULTS: Among 376 patients presented in MEB, 309 (80.2%) were painful and 184 (59.5%) had complex endometriosis. A complete clinical evaluation was performed in 120 (38.8%) patients. MRI was performed for 370 (98.4%) patients including 303 (81.9%) with a second reading by an expert radiologist. These second readings allowed a diagnosis correction in 88 (60.7 %) patients with complex endometriosis. MR enterography (27.8 %) and rectal endoscopic sonography (14.4%) were the most frequently used third-line exams to complete the initial imaging of digestive lesion in patients with rectal endometriosis. Surgery was proposed for 199 (52,9%) patients including 108 (58,7%) with complex endometriosis. CONCLUSION: One of the major interests of MEB in endometriosis is the second reading of MRI, which, by identifying complex endometriosis initially undiagnosed or underestimated, enabled to better discuss the benefits/risks of therapeutic choices, and to organize complex surgeries when those were retained. The development of MEB in regional expert centers will contribute to optimizing the relevance of care for patients with endometriosis.
Subject(s)
Endometriosis/diagnosis , Endometriosis/therapy , Interdisciplinary Communication , Endometriosis/complications , Female , France , Humans , Infertility, Female/etiology , Magnetic Resonance Imaging , Pain Management , Rectal Diseases/diagnosis , Rectal Diseases/surgery , Rectal Diseases/therapy , Retrospective Studies , UltrasonographyABSTRACT
OBJECTIVE: To evaluate the ultrasound measurement of the observed-to-expected (o/e) lung-to-head ratio (LHR) and the Quantitative Lung Index (QLI) for the prediction of pulmonary hypoplasia in the pre-viable preterm premature ruptures of membranes (PPROM) before 24 weeks gestational age (GA). METHODS: Thirty-four patients with a PPROM before 24 weeks GA and who delivered a live birth between October 2008 and October 2015 at Croix-Rousse's hospital were included. The measurements of both the LHR (right, left and total) and the QLI (right, left) were retrospectively performed by ultrasounds during the latency period. The observed LHR was divided by the expected LHR, which was obtained from recent literature data. The primary outcome was the onset of a lethal pulmonary hypoplasia. Receiver operating characteristics (ROC) curves assessed the predictive value of these ultrasound measurements for pulmonary hypoplasia. RESULTS: The areas under the ROC curves (AUCs) for the right o/eLHR, the right QLI and the total o/e LHR measured by manually drawing the pulmonary area on the last ultrasound before the delivery, were respectively 0.87 [95% CI: 0.75-1], 0.83 [95% CI: 0.69-0.98] and 0.78 [95% CI: 0.51-1]. Only the total o/e LHR measurements remained associated with lethal pulmonary hypoplasia after adjusting for prematurity and persistent oligohydramnios. CONCLUSION: The right and total o/eLHR and the right QLI measurements might be helpful in predicting pulmonary hypoplasia in pre-viable PPROM.
Subject(s)
Abnormalities, Multiple/diagnostic imaging , Fetal Membranes, Premature Rupture , Infant, Premature, Diseases/diagnostic imaging , Lung Diseases/diagnostic imaging , Lung/abnormalities , Lung/diagnostic imaging , Ultrasonography , Abnormalities, Multiple/mortality , Female , Gestational Age , Head , Humans , Infant, Newborn , Infant, Premature, Diseases/mortality , Lung Diseases/mortality , Oligohydramnios , Pregnancy , Pregnancy Outcome , ROC Curve , Retrospective Studies , Ultrasonography, PrenatalABSTRACT
OBJECTIVE: Adverse event reporting for laparoscopic promontofixation is highly variable and non-standardized in the literature. The aim of this study was to better characterize early postoperative complications of laparoscopic promontofixation for genital prolapse using a standardized reporting methodology. PATIENTS AND METHODS: A retrospective study was conducted on 174 women with genital prolapse undergoing laparoscopic promontofixation from January 2008 to January 2013. Complications arising during the first month after surgery were reviewed according to the Clavien and Dindo classification. RESULTS: At least one postoperative adverse event was reported in 57 out of 174 (33 %) women, grade 1 in 22 patients (13 %), grade 2 in 31 patients (18 %) and grade 3 in 4 patients (2 %). No patient experienced a grade 4 or 5 complication. Fifty-three out of 57 (93 %) complications were grade 1 or 2. The most frequently reported adverse event (n=24; 14 %) was constipation (grade 2). DISCUSSION AND CONCLUSION: Laparoscopic promontofixation is a safe procedure with almost exclusively benign (grade 1 or 2) early complications. The hypothesis of induction or increasing constipation by this type of genital prolapse surgery should be further evaluated.
