Four subtypes of adenomyosis assessed by magnetic resonance imaging and their specification.

OBJECTIVE: The aim of the present study was to differentiate and specify the subtypes of adenomyosis. STUDY DESIGN: Surgically treated adenomyosis (n = 152) was subcategorized retrospectively into 4 subtypes on the basis of magnetic resonance imaging geography. Subtype I (n = 59) consisted of adenomyosis that occurs in the uterine inner layer without affecting the outer structures. Subtype II (n = 51) consisted of adenomyosis that occurs in the uterine outer layer without affecting the inner structures. Subtype III (n = 22) consisted of adenomyosis that occurs solitarily without relationship to structural components. Adenomyosis that did not satisfy these criteria composed subtype IV (n = 20). Stepwise logistic regression analysis was used for specification of the subtypes. RESULTS: Subtypes I-III were suggested as a product of direct endometrial invasion, endometriotic invasion from the outside, and de novo metaplasia, respectively. Subtype IV was a heterogeneous mixture of far advanced disease. CONCLUSION: Adenomyosis appears to consist of 3 distinct subtypes of different causes and an additional subtype of indeterminate cause.

Prevention of postlaparoscopic shoulder pain by forced evacuation of residual CO(2).

BACKGROUND AND OBJECTIVES: Shoulder pain is one of the early postlaparoscopic symptoms related to CO(2) used for pneumoperitoneum and remaining in the abdomen. The present study was conducted to validate the hypothesis that complete evacuation of the residual CO(2) would prevent postlaparoscopic shoulder pain. METHODS: Forty consecutive patients, the candidates for gynecologic laparoscopic surgery, were randomly enrolled into one of the following 2 groups. Nineteen patients entered Group I where the residual CO(2) was evacuated by abdominal oppression and served as the study control group. The remaining 21 patients entered Group II, where the residual CO(2) was evacuated by pumping warm saline into the abdomen until it spilled out of the open ports. Nurses, blind to the patient's grouping, recorded shoulder pain VAS scores twice daily. RESULTS: VAS scores in Group I started to increase at Day 1AM, reached a peak at Day 1PM, and decreased gradually thereafter. VAS scores in Group II stayed low throughout the investigation period. The difference was highly significant (P<0.001). CONCLUSIONS: Abdominal filling with saline at the end of laparoscopic surgery effectively evacuates residual CO(2) thus preventing postlaparoscopic shoulder pain.