Less than 15% of apps found were considered potentially useful to ob-gyns. Thus, the obstetrics and gynecology community is in need of an organized effort to identify, review, and determine the accuracy of apps that can potentially improve the performance of health care providers and lead to better patient outcomes. We propose the formation of a committee to guide in this important task.
<p class="a"><strong>Objective:</strong> This work was conducted to study colorectal carcinoma (CRC) in Gharbiah district, Egypt and to verify the effect of age on the treatments and their outcomes.<span><br /> </span><strong>Methods:</strong> <span>B</span>etween 2000 and 2002, 293 cases with CRC were identified in the Gharbiah population based cancer registry (GPBCR); 159 of whom were treated at Tanta Cancer Center (TCC). Patients were grouped into elderly and non-elderly (<span>≥</span> and < 65 years, respectively).<span><br /> </span><strong>Results:</strong> CRC was the 6th cancer in Egypt, representing 4% of the total cancers and 53% of GIT cancers. The median age was 53 years with male predominance. Colon cancers were more common than rectal cancers. Most patients had tumors that were localized, low grade and adenocarcinoma (AC). Constipation, abdominal pains and bleeding per rectum were the commonest complaints. Surgery, radiotherapy and chemotherapy were adopted in 84, 28 and 72% of patients,<span> </span>respectively. The median OS and PFS were 23 and 25 months (95%CI: 17-29 and 11.8-18.2), respectively. Compared to non-elderly, elderly patients were more likely to have rectal tumors, non-AC histology, non-metastatic disease; more comorbidities were less likely to receive chemotherapy particularly in the adjuvant setting (<em><span>P</span></em>< 0.05 for all). The OS and PFS of elderly patients were not statistically different from the non-elderly.<span><br /> </span><strong>Conclusions:</strong> Within the limits of this retrospective trial, elderly patients with CRC tend to have more rectal and non-metastatic cancers. They were more likely to have comorbidities and less likely to receive chemotherapy. However, the OS and DFS were comparable to non-elderly.</p><p><strong><br /></strong></p>
Background and Objectives:Vaginal cuff dehiscence may be a vascular-mediated event, and reports show a higher incidence after robot-assisted total laparoscopic hysterectomy (RATLH), when compared with other surgical routes. This study was conducted to determine the feasibility of using laser angiography to assess vaginal cuff perfusion during RATLH.Methods:This was a pilot feasibility trial incorporating 20 women who underwent RATLH for benign disease. Colpotomy was made with ultrasonic or monopolar instruments, whereas barbed or nonbarbed suture was used for cuff closure. Time of instrument activation during colpotomy was recorded. Images were captured of vaginal cuff perfusion before and after cuff closure. Reviewers evaluated these images and determined areas of adequate cuff perfusion.Results:Indocyanine green (ICG) was visible at the vaginal cuff in all participants. Optimal dosage was determined to be 7.5 mg of ICG per intravenous dose. Mean time to appearance for ICG was 18.4 ± 7.3 s (mean ± SD) before closure and 19.0 ± 8.7 s after closure. No significant difference (P = .19) was noted in judged perfusion in open cuffs after colpotomy with a monopolar (48.9 ± 26.0%; mean ± SD) or ultrasonic (40.2 ± 14.1%) device. No difference was seen after cuff closure (P = .36) when a monopolar (70.9 ± 21.1%) or ultrasonic (70.5 ± 20.5%) device was used. The use of barbed (74.1 ± 20.1%) or nonbarbed (66.4 ± 20.9%) sutures did not significantly affect estimated closed cuff perfusion (P = .19). Decreased cuff perfusion was observed with longer instrument activation times in open cuffs (R2 = 0.3175).Conclusion:Laser angiography during RATLH allows visualization of vascular perfusion of the vaginal cuff. The technology remains limited by the lack of quantifiable fluorescence and knowledge of clinically significant levels of fluorescence.
Surgical adhesions can lead to significant consequences including abdominopelvic pain, bowel obstruction, subfertility, and subsequent surgery. Although laparoscopic surgery is associated with a decreased risk of adhesion formation, methods to further decrease adhesions are warranted. We systematically reviewed literature addressing the management, prevention, and sequelae of adhesions in women undergoing laparoscopic gynecologic surgery. We searched PubMed, EMBASE, EBSCOhost, and Cochrane Central Register of Controlled Trials and found 6566 records. The primary outcome was adhesion formation. The secondary outcomes were abdominopelvic pain, quality of life, subfertility, pregnancy, bowel obstruction, urinary symptoms, and subsequent surgery. After applying inclusion and exclusion criteria, 52 studies remained for qualitative synthesis. Risk of bias assessments were applied independently by 2 authors. There was evidence that Hyalobarrier Gel (Anika Therapeutics, Bedford, MA), HyaRegen NCH Gel (Bilar Medikal, Istanbul, Turkey), Oxiplex/AP Gel (Fziomed, Inc., San Luis Obispo, CA), SprayGel (Confluent Surgical Inc., Waltham, MA), and Beriplast (CSL Behring, LLCm King of Prussia, PA) all decrease the incidence of adhesions. Adept (Baxter, Deerfield, IL) significantly decreased de novo adhesion scores of the posterior uterus. Using an integrated treatment approach to pelvic pain significantly improved pain and quality of life compared with standard laparoscopic treatment. Lastly, Hyalobarrier Gel Endo (Anika Therapeutics, Bedford, MA) placement led to a higher pregnancy rate than no barrier usage. Our findings underscore the need for high-quality trials to evaluate the efficacy of surgical techniques, adhesion barriers, and other treatment modalities on the management and prevention of adhesions and their clinical sequelae. This review was registered on PROSPERO (ID = CRD42017068053).
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