Operative treatment of benign ovarian tumours in adolescent patients: laparotomy or laparoscopy?

THE AIM: The aim of the study was a retrospective analysis of operative procedures, laparoscopy or laparotomy, carried out in cases of benign adolescent ovarian tumours. MATERIAL AND METHODS: A retrospective review of 709 patient charts with ovarian tumours, who had undergone surgical interventions at The Department of Surgical Gynaecology and Endoscopy of The Polish Mother's Memorial Hospital--Research Institute in ?ód?--has been conducted. Among groups of girls treated either with laparoscopy or laparotomy, the following parameters were analysed: age of the patients, character of the tumour (based on the pathological result), size of the lesion, type of the surgical procedure, duration of the hospitalisation and postoperative complications. RESULTS: 109 girls had ovarian tumours operated--54 times laparoscopy and 55 laparotomy times were performed. An average age of patients who underwent laparoscopy was 16.2 years, in case of laparotomy: 15.3 years (p > 0.05). An average size of tumours excised in laparotomy was 82 mm (60-190 mm), whereas in laparoscopy 64 mm (30-80 mm) (p > 0.05). The most common laparotomic procedure was the ovarian cystectomy (63%) and cystovariectomy (32%), while during laparoscopy the cystectomy was performed in 92% (p > 0.05). Duration of the laparoscopy was shorter, average was 46.7 min, whereas mean time of laparotomy was 49.2 min (p > 0.05). Also duration of postoperative hospitalisation was longer in case of laparotomy, its average time was 5.4 days in comparison with laparoscopy--2.8 days (p < 0.05). CONCLUSIONS: Laparoscopy performed in adolescents due to benign ovarian tumours seems to be a very safe way of the surgical treatment. Moreover, laparoscopy reduces duration of hospitalisation and convalescence, also giving a nice cosmetic effect.     

Assesment of selected parameters depending on the size of abdominal wall incision in patients subjected to minilaparotomy due to benign gynaecological diseases

OBJECTIVES: Considering the enormous advantages of minimally invasive surgery, attempts to introduce less invasive trans-abdominal incisions might represent an alternative to classic gynecologic surgery. The aim of this study is to assess the feasibility and clinical outcome of minilaparotomy in patients operated due to benign gynecological diseases and to analyze selected parameters with regard to the abdominal wall incision size. DESIGN: In this retrospective study, we have described our experience with 26 patients, undergoing minilaparotomy for benign adnexal or uterine diseases. MATERIAL AND METHODS: 26 patients with benign uterine or adnexal diseases, hospitalized from November 2003 until March 2006 at the Department of Surgical and Endoscopic Gynecology at the Polish Mother's Memorial Hospital--Research Institute in Lód?, had undergone successful surgical treatment by means of minilaparotomy. The following procedures were included in the analysis: myomectomy (17 patients), ovarian cystectomy (3 patients), myomectomy and ovarian cystectomy at the same time (3 patients), bilateral salpingo-oophorectomy (1 patient), supracervical hysterectomy (1 patient) and total abdominal hysterectomy with salpingo--oophorectomy (1 patient). RESULTS: The patients' mean age and BMI were 33.85 years (14-50) and 22.95 (18.73-45.17), respectively. The mean operative time was 72.69 min (45-120). The diameter of trans-abdominal incision was 3-6cm and the mean diameter of removed lesions was 76.88 mm (47-200). The mean intraoperative decrease of haematocrit and haemoglobin value was 4.8% (0.2-12.4) and 1.4 g/dl (0.2-3.7), respectively. Blood transfusion was required in case of 3 patients but only in one case it was caused by intraoperative blood loss. There were no significant intra- or postoperative complications. 16 patients needed analgesics for 2.33 days after surgery. Body temperature up to 38 degrees C was observed in 4 patients for 2.5 days. The average time of hospitalization after the surgery was 4.58 days. We have noted a negative correlation between the size of trans-abdominal incision and several factors: operative time, intraoperative blood loss, period of analgesic therapy and time of hospitalization after the surgery. None of these factors was correlated with patients' age or BMI. One-month follow up after the surgery revealed satisfactory wound healing and no complains in case of all patients. All patients deemed the cosmetic effect of the surgery very good. CONCLUSION: Minilaparotomy seems to be a very simple, useful and safe surgical technique which might be an alternative to laparotomy in the management of benign gynecologic diseases. Minilaparotomy is of great value, especially in situations when laparoscopic or vaginal approach is too complicated or too dangerous due to technical reasons.     

重复胃镜检查的原因分析

0　引言　胃镜检查是上消化道疾病诊断的重要方法之一 .了解重复胃镜检查的原因及结果 ,有利于探讨疾病发生发展的基本规律 ,有利于发现诊断和治疗中存在的问题 ,从而提高对消化疾病的诊治水平 .1　材料和方法1.1　材料　随机抽检 1996 / 1998胃镜检查资料为调查对象7812例 ,其中行 2次以上胃镜检查者 937例 .调查内容包括性别、年龄、职业、主要症状和体征、病程、初步诊断、内镜检查时间、次数、内镜诊断、病理诊断、确诊时间 .1.2　方法　回顾性调查上述材料的临床特征 .列表统计研究对象一般情况的分布状况 ,计算各年龄段比例构成 ,各病…     

Childhood cardiac function after twin-to-twin transfusion syndrome – a 10-year follow up

Aim:  To perform a 10-year follow up of cardiac structure and function after twin-to-twin transfusion syndrome (TTTS) – a severe foetal circulatory complication associated with myocardial hypertrophy in the recipient twin.
Methods:  Cardiac dimensions, systolic and diastolic function as assessed by echocardiography including flow and tissue Doppler velocimetry in 22 healthy survivors of TTTS with a mean age of 9.6 (7.2–11.8) years.
Results:  The donor and recipient twin did not show any differences in end-diastolic ventricular size, interventricular septum thickness, diameter of right ventricular outflow tract, cardiac valves, coronary arteries or in systolic blood flow velocities. However, compared with the donors, the recipients had significantly lower E/A ratios because of lower E-waves in both mitral (−0.15 ± 0.10, p < 0.01) and tricuspid (−0.09 ± 0.07, p < 0.01) valves, indicating reduced early diastolic ventricular fillings compared with donors.
Conclusion:  At school age, twins surviving TTTS had a cardiac structure and function within normal range. There were no differences in heart structure or systolic ventricular function between twins but, compared with the donor twin, we found a reduced early diastolic function in the recipient.     

Risk factors associated with having psoriatic arthritis in patients with cutaneous psoriasis

The aim of this study was to determine if the following characteristics were associated with the presence of psoriatic arthritis in a sample of psoriasis patients: race, family history of psoriasis and psoriatic arthritis, age of onset of psoriasis, smoking, alcohol consumption and the maximum body surface area (BSA) affected by psoriasis. This was a case–control study involving 400 psoriasis patients who attended the Psoriasis and Photo‐medicine clinic in the National Skin Center of Singapore over a 1‐year period. Cases were psoriasis patients with psoriatic arthritis while controls were psoriasis patients without psoriatic arthritis. The diagnosis of psoriatic arthritis was made by rheumatologists and participants completed a self‐administered standardized questionnaire. The maximum BSA involved was determined from the case notes. Psoriatic arthritis was not significantly associated with sex, race, age of onset of psoriasis, a family history of psoriasis, smoking and alcohol consumption but was significantly associated with a family history of psoriatic arthritis (P < 0.001) and the maximum body surface involved (P = 0.05). Using multivariate analysis to control for variables, the presence of psoriatic arthritis was significantly associated with a family history of psoriatic arthritis (odds ratio [OR] = 20.5; 95% confidence interval [CI] = 2.49–169.10) and the maximum BSA involved (OR = 2.52; 95% CI = 1.33–4.75). Indian psoriatic patients were more likely to have psoriatic arthritis compared to the other races. A family history of psoriatic arthritis and a greater maximum body surface involved may be associated with having psoriatic arthritis in this study population of psoriasis patients.     

Magnetic resonance angiography findings in the early post-carotid endarterectomy period

This preliminary study was designed to investigate the ability of multiple axial volume three-dimensional fourier transform (3DFT) time-of-flight (TOF) magnetic resonance angiography (MRA) to depict the carotid bifurcation in the early post-carotid endarterectomy period. Five patients underwent intra-operative digital subtraction angiography (DSA) and carotid MRA within 5 days of carotid endarterectomy. An axial volume fast imaging in steady-state precession (FISP) gradient-echo 3DFT TOF carotid MRA technique in this limited series appeared to display accurately the surgically significant abnormalities at the carotid bifurcation after endarterectomy. However, in normal or near-normal intra-operative DSA studies, overestimation of internal carotid artery stenoses was encountered. Postoperative MRA demonstrates potential as a useful non-invasive investigation after carotid endarterectomy but should be interpreted with caution until larger studies become available.