Objective
To compare the efficacy, cost‐effectiveness, and possible complications of operative laparoscopy with laparotomy for treating benign adnexal cystic tumours at a unit in a developing country.
Design
A prospective comparative study.
Setting
Gynaecologic Endoscopy Unit, Assiut University Hospital, Assiut, Egypt.
Subjects
91 women of childbearing age with a clinical, biochemical and transvaginal sonographic diagnosis of benign adnexal cystic tumour.
Interventions
71 patients were allocated to one of two groups according to management approach. The laparoscopy group (A) included 37 patients while the laparotomy group (B) included 34 patients.
Main outcome measures
For each patient, the operating time, intra‐ and postoperative complications, postoperative pain and duration of hospital stay were recorded.
Results
The operating time was significantly shorter in group A (47.8 ± 28.3 min) than in group B (64.9 ± 19.2 min). Intraoperative uncontrolled bleeding occurred in one patient in group A. Postoperative pain was significantly less in group A than in group B (P < 0.001). Postoperative febrile morbidity developed in 12.2% and 31.6% of patients in groups A and B, respectively. The duration of postoperative hospital stay was significantly shorter among patients in group A (49.5 ± 42.6 h) than in group B (124.8 ± 40.9 h) (P < 0.001). Postoperative complications included wound infections: one case in group A and three in group B.
Conclusions
Laparoscopic management of benign cystic adnexal masses is a fast and safe procedure with minimal intra‐ and postoperative complications compared with laparotomy. Its use in developing countries with limited resources is cost‐effective, given appropriate selection of cases and experienced endoscopists.
Background: This study compared the efficacy and safety of CsA
monotherapy with eltrombopag (E-PAG) + CsA combined treatment in
children with severe aplastic anemia (SAA). Method: The study including
30 children had SAA. Ten were a retrospective cohort treated with CsA
monotherapy. The other 20 were prospective cohort received E-PAG + CsA .
All patients were evaluated for partial (PR) and complete (CR)
hematological response at 3, 6, and 12 months. overall response (OR),
overall survival rates (OS) and treatment safety. Results: OR for the
E-PAG patients was 40% after three months of therapy. At six months,
this had increased to 75 % with significantly higher CR rate (40%)
than in the CsA group (p = 0.0001). After a year of treatment, the CR
for the E-PAG regimen had increased to 50% and the OR to 85%, compared
to 20% in the CsA group (p = 0.0001). The OS at 12 months was 100% in
the E-PAG group compared to 80% in the CsA cohort. At 24 months, the OS
in the E-PAG group was 90%. Conclusion: CsA + E-PAG was found to be a
safe and effective alternative treatment for children with SAA
particularly in countries with limited resources.
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