Combined laparoscopic and cystoscopic approach in large deep infiltrating endometriosis of the bladder.

Resection of endometriosis nodules infiltrating the bladder is routinely performed by laparoscopy. However, laparoscopic resection may lead to inadvertent loss of healthy bladder tissue. Conversely, when bladder nodules are treated by cystoscopy alone, resection may be incomplete. A combined laparoscopic-cystoscopic approach allows safe and controlled resection. The video reports the procedure performed in a 33 year-old primipara who presented with a 40mm bladder nodule. The laparoscopic step is carried out by the gynecologist, who separates the bladder from the uterus and opens the vesico-vaginal space. Concomitantly, the urologist identifies and circumscribes the nodule's limits by cystoscopy. Then, the gynecologist identifies the circular incision previously performed, and completes the resection. The bladder defect is sutured. Early and mid-term postoperative outcomes were uneventful. In patients with large nodules of the bladder, combined laparoscopic-cystoscopic approach allows complete resection of endometriosis lesion, preserves healthy bladder tissue and avoids inadvertent injury of ureters.

Iron chelation in transfusion-dependent thalassemia with chronic hepatitis.

In this study maximum urinary iron elimination with continuous desferrioxamine subcutaneous infusion was obtained in thalassemia major patients with chronic persistent or active hepatitis with lower doses (60 mg/kg) than those necessary in patients without hepatitis (80 mg/kg). Since dose-response curves were highly variable the treatment schedule should be tailored to the individual needs of each patient. Both groups may achieve iron balance but chronic hepatitis patients have more frequently a net urinary iron excretion. In patients with chronic hepatitis no correlation was found between serum ferritin levels or serum ferritin/aspartate aminotransferase ratios and transfusional iron overload while serum ferritin/aspartate aminotransferase ratios were seen to be correlated with liver iron stores.