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Minerva Ginecologica Feb 2020Hysteroscopic septoplasty is a safe and routinely used procedure for the treatment of septate uterus. The aim of this paper is to determine which hysteroscopic technique... (Comparative Study)
Comparative Study
INTRODUCTION
Hysteroscopic septoplasty is a safe and routinely used procedure for the treatment of septate uterus. The aim of this paper is to determine which hysteroscopic technique (scissors, monopolar/bipolar diathermy) is superior for post-treatment reproductive outcome.
EVIDENCE ACQUISITION
Two different hysteroscopic septoplasty instruments (scissors and monopolar/bipolar diathermy) were compared, focusing on the pregnancy outcome. In addition, all published studies and reviews regarding pregnancy outcomes that occurred after operative hysteroscopy using different techniques (bipolar, monopolar electrodes, resectoscope, VERSAPOINTâ„¢ [Ethicon LLC] and scissors) were reviewed. Dichotomous analysis, with use of the Mantel-Haenszel method, was performed for all five outcomes, with fixed effect analysis model and odds ratio (OR) as the effect measure. Analysis details included totals and subtotals with 95% confidence interval. The Multinomial CI package for the R statistical language was also used.
EVIDENCE SYNTHESIS
Out of 26 full-text articles available in the literature, two studies were finally selected as eligible, with a total number of 125 patients. Pregnancy rate for scissors was 88.8% and for resectoscope was 75.6% (OR: 2.13, I2=29%; P=0.23). Delivery rate for scissors was 78.1% and for resectoscope was 75.0% (OR: 1.29, I2=0%; P=0.53). Miscarriage rate for scissors was 21.8% and for resectoscope was 27.1% (OR: 0.78, I2=0%; P=0.53). Preterm delivery rate for scissors was 6.2% and for resectoscope was 6.7% (OR: 0.85, I2=0%; P=0.94). Term delivery rate for scissors was 71.8% and for resectoscope was 66.1% (OR: 1.32, I2=0%; P=0.47). The lack of evidence in literature regarding the potential influence in the reproductive outcome of the instrument used when performing a hysteroscopy to treat a septate uterus became radically clear.
CONCLUSIONS
No statistically significant differences were observed in reproductive outcomes between women treated for septate uterus using resectoscope or scissors.
Topics: Abortion, Spontaneous; Confidence Intervals; Diathermy; Female; Humans; Hysteroscopy; Odds Ratio; Pregnancy; Pregnancy Outcome; Pregnancy Rate; Premature Birth; Surgical Instruments; Term Birth; Treatment Outcome; Uterus
PubMed: 32153162
DOI: 10.23736/S0026-4784.20.04444-5 -
Genes Dec 2021Patent Foramen Ovale (PFO) is a common postnatal defect of cardiac atrial septation. A certain degree of familial aggregation has been reported. Animal studies suggest...
Patent Foramen Ovale (PFO) is a common postnatal defect of cardiac atrial septation. A certain degree of familial aggregation has been reported. Animal studies suggest the involvement of the Notch pathway and other cardiac transcription factors (GATA4, TBX20, NKX2-5) in Foramen Ovale closure. This review evaluates the contribution of genetic alterations in PFO development. We systematically reviewed studies that assessed rare and common variants in subjects with PFO. The protocol was registered with PROSPERO and followed MOOSE guidelines. We systematically searched English studies reporting rates of variants in PFO subjects until the 30th of June 2021. Among 1231 studies, we included four studies: two of them assessed the gene, the remaining reported variants of chromosome 4q25 and the S377G variant, respectively. We did not find any variant associated with PFO, except for the rs2200733 variant of chromosome 4q25 in atrial fibrillation patients. Despite the scarceness of evidence so far, animal studies and other studies that did not fulfil the criteria to be included in the review indicate a robust genetic background in PFO. More research is needed on the genetic determinants of PFO.
Topics: Animals; Foramen Ovale, Patent; GATA4 Transcription Factor; Homeobox Protein Nkx-2.5; Humans; Risk Factors
PubMed: 34946902
DOI: 10.3390/genes12121953 -
Pancreas Oct 2018The evidence on the ability of radiological tests to predict a specific diagnosis and also their aptitude in identifying pathological markers indicative of malignancy in...
The evidence on the ability of radiological tests to predict a specific diagnosis and also their aptitude in identifying pathological markers indicative of malignancy in cystic lesions of the pancreas remains inconclusive. We conducted a systematic review on MEDLINE for the use of computed tomography (CT), magnetic resonance imaging, and positron emission tomography/CT (PET/CT) in the diagnosis and characterization of these cysts. The accuracy of CT scan for reaching a specific diagnosis was 39% to 61.4%, whereas its accuracy for differentiating benign from malignant lesions was 61.9% to 80%. Magnetic resonance imaging showed a better accuracy in identifying a specific diagnosis of 50% to 86%, whereas its accuracy in differentiating benign from malignant lesions was 55.6% to 87%. The use of magnetic resonance imaging was superior to CT scan in identifying septations, mural nodules, and ductal communication. The sensitivity of PET/CT in diagnosing malignancy was 85.7% to 100% with a reported accuracy of 88% to 95%. The evidence gathered from this review suggests that the adequacy of CT imaging in full characterization of pancreatic cysts is suboptimal, and therefore a low threshold for supplementary imaging is advised. The use of PET/CT should be considered in high-risk patients with equivocal findings.
Topics: Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Pancreas; Pancreatic Cyst; Pancreatic Neoplasms; Positron Emission Tomography Computed Tomography; Reproducibility of Results; Sensitivity and Specificity; Tomography, X-Ray Computed
PubMed: 30199486
DOI: 10.1097/MPA.0000000000001134 -
Transplantation Proceedings 2022Adult hepatic mesenchymal hamartoma (HMH) is an extremely rare hepatic tumor. Recurrence following complete resection is uncommon. Liver transplantation (LT) is...
BACKGROUND
Adult hepatic mesenchymal hamartoma (HMH) is an extremely rare hepatic tumor. Recurrence following complete resection is uncommon. Liver transplantation (LT) is described as a possible treatment option in nonresectable HMH. We conducted a systematic review investigating LT in adult HMH followed by a case report describing evidence of extensive recurrence following complete resection of large right-sided HMH requiring LT.
CASE REPORT
A 46-year-old woman with symptomatic large right-hepatic HMH underwent right hemi-hepatectomy with histologic evidence of complete resection. Two and a half years postresection, she presented with abdominal pain and distension; imaging revealed large multi-septated hepatic cystic lesions within the liver suggestive of extensive recurrence of disease with concerns of malignant sarcomatous transformation. After a multidisciplinary team discussion, the lesion was deemed unresectable and the patient was referred for LT. Findings on transplantation included giant multiple hepatic cystic lesions occupying the entire abdomen and histopathological analysis confirmed recurrent HMH with no malignancy. The 6-month follow-up was unremarkable with no signs of postoperative complications or rejection.
CONCLUSION
We identified only 3 reported adult unresectable HMH cases in the English literature requiring LT, with good clinical outcome and no rejection on a 1-year follow-up. To our knowledge, we report the first recurrent HMH that required LT in the English literature. Current evidence suggests possible malignant sarcomatous transformation of those lesions. No guidelines exist on postresection surveillance for HMH; however, given their malignant potential, we suggest a benefit of imaging-based surveillance following HMH resection. Offering LT for nonresectable or recurrent HMH is a feasible treatment modality with a reported good outcome.
Topics: Adult; Female; Hamartoma; Hepatectomy; Humans; Liver Neoplasms; Liver Transplantation; Middle Aged
PubMed: 35842317
DOI: 10.1016/j.transproceed.2022.04.020