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Journal of Minimally Invasive Gynecology 2020To describe a robotic approach to excision of full-thickness diaphragmatic endometriosis.
STUDY OBJECTIVE
To describe a robotic approach to excision of full-thickness diaphragmatic endometriosis.
DESIGN
Surgical technique demonstration.
SETTING
Symptomatic diaphragmatic endometriosis is commonly associated with lesions that are deeply invasive. In the presence of symptomatic diaphragmatic endometriosis, the posterior diaphragm should be explored.
INTERVENTIONS
This video presents a systematic robotic approach to the excision of diaphragmatic endometriosis, highlighting key anatomic landmarks and technical considerations to complete the procedure safely and effectively. Resection of hepatic ligaments, use of a 30° endoscope, and right lateral access can be used to visualize this anatomic area [1]. The phrenic nerve is rarely identified during laparoscopy, if at all, and an inability to identify this structure during hemidiaphragm resection does not seem to result in significant patient morbidity. After diaphragm resection, the pleural cavity and lung should be systematically inspected to rule out the presence of additional endometriotic lesions. If the long axis of the diaphragmatic defect is parallel to the posterior chest wall and can be closed tension-free, then mesh is not necessary [1]. Insertion of a red rubber catheter into the thorax along with the use of negative pressure suction at the end of closure of the diaphragmatic defect may avoid use of a postoperative chest tube.
CONCLUSION
The use of robotic assistance for resection of diaphragmatic endometriosis makes this procedure easy and safe to perform. Compared with ablative procedures, complete surgical excision offers higher rates of symptom improvement and resolution in patients with diaphragmatic endometriosis.
Topics: Diaphragm; Endometriosis; Female; Humans; Laparoscopy; Robotic Surgical Procedures; Robotics
PubMed: 31487553
DOI: 10.1016/j.jmig.2019.08.025 -
American Journal of Respiratory and... Oct 2021
Topics: Diaphragm; Elasticity Imaging Techniques; Humans; Vibration
PubMed: 34370963
DOI: 10.1164/rccm.202107-1605ED -
Cleveland Clinic Journal of Medicine Dec 2021Long-acting reversible contraceptives (ie, intrauterine devices and the etonogestrel subdermal implant) have become increasingly popular methods of contraception because...
Long-acting reversible contraceptives (ie, intrauterine devices and the etonogestrel subdermal implant) have become increasingly popular methods of contraception because of their convenience and safety profile. At the same time, the use of depot medroxyprogesterone acetate, one of the most prescribed contraceptives in the United States since its approval in 1992, is on the wane. The history and pros and cons of these contraceptive methods are reviewed.
Topics: Contraception; Contraceptive Agents, Female; Female; Humans; Intrauterine Devices; Medroxyprogesterone Acetate; United States
PubMed: 34857607
DOI: 10.3949/ccjm.88a.20110 -
International Journal of Nursing Studies May 2021The accuracy of diaphragm ultrasound for predicting weaning outcome is still debated, despite the publication of numerous studies evaluating this issue. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The accuracy of diaphragm ultrasound for predicting weaning outcome is still debated, despite the publication of numerous studies evaluating this issue.
OBJECTIVE
The aim of this systematic review and meta-analysis was to assess the diagnostic accuracy of diaphragm ultrasound for predicting weaning failure in critically ill patients.
DESIGN AND DATA SOURCES
MEDLINE, Science direct, Cochrane Library, EMBASE and CENTRAL were searched. Two investigators independently selected studies that met the inclusion criteria, and three extracted data and performed a bias analysis using the Quality Assessment of Diagnostic Accuracy Studies-2 instrument. A bivariate model was used to estimate the pooled results for sensitivity, specificity and diagnostic odds ratio. Sources of heterogeneity were explored, and subgroup analyses were performed.
RESULTS
Twenty-eight studies were included in the systematic review, from which 16 studies (816 patients in total) were included in the meta-analysis. The pooled sensitivity, specificity and area under the summary receiver operator characteristic curve were 0.70 (95% CI 0.57-0.80), 0.84 (95% CI 0.73-0.91), and 0.82 (95% Cl 0.78-0.85) for diaphragm thickening fraction, respectively, and 0.71 (95% CI 0.61-0.79), 0.80 (95% CI 0.73-0.86), and 0.82 (95% Cl 0.79-0.86) for diaphragm excursion, respectively. There was substantial heterogeneity among the studies. Meta-regression highlighted significant effects of prevalence of extubation failure, cut-off and risk of bias in flow and timing of the study on diaphragm ultrasound accuracy. By excluding outlier and influential studies, sensitivity was lower and specificity higher for diaphragm thickening fraction.
CONCLUSION
The specificity of diaphragm ultrasound for predicting the risk of extubation failure in critically ill patients was moderate-to-high. However, sensitivity was low because weaning is also affected by non-diaphragm-related factors. Further research in subgroups of critically ill patients applying a homogeneous definition of weaning and uniformly conducted measure is needed to assess the accuracy of diaphragm ultrasound.
CLINICAL TRIAL REGISTRATION
Registered on http://www.crd.york.ac.uk/PROSPERO as CRD42017058028. Tweetable abstract: Diaphragm ultrasound predicts extubation failure with high specificity. Absence of diaphragm dysfunction does not imply no risk of extubation failure.
Topics: Airway Extubation; Diaphragm; Humans; Ultrasonography; Ventilator Weaning; Weaning
PubMed: 33588324
DOI: 10.1016/j.ijnurstu.2021.103890 -
Deutsches Arzteblatt International Nov 2021
Topics: Borrelia Infections; Diaphragm; Humans; Paresis; Thorax
PubMed: 35191374
DOI: 10.3238/arztebl.m2021.0088 -
Neuroreport Aug 2020Diaphragm dysfunction could be induced by sepsis with subsequent ventilatory pump failure that is associated with local infiltration of inflammatory factors in the...
BACKGROUND
Diaphragm dysfunction could be induced by sepsis with subsequent ventilatory pump failure that is associated with local infiltration of inflammatory factors in the diaphragm. It has been shown that the administration of anticonvulsant agent, magnesium sulfate (MgSO4) could decrease systematic inflammatory response. We recently reported that MgSO4 could inhibit macrophages high mobility group box 1 (HMGB1) secretion that confirms its anti-inflammatory properties. Toll-like receptor 4 (TLR4)/nuclear factor-kappa B (NF-κB) signal pathway appears to be involved in the pathology of septic experimental animal's inflammatory response and involve in the pathogenic mechanisms of sepsis-induced diaphragm dysfunction. Thus, in this study, we are aiming to explore whether MgSO4 could ameliorate sepsis-induced diaphragm dysfunction via TLR4/NF-κB pathway in a rodent model with controlled mechanical ventilation (CMV) and subsequent septic challenge.
METHODS
Rats were randomly assigned into (1) control group: having an identical laparotomy but without ligation or puncture in the cecum; (2) CLP group: cecal ligation and puncture (CLP) with continuous saline infusion; (3) CLP + MgSO4 group: CLP with continuous MgSO4 administration; and (4) MgSO4 group: a sham surgery with MgSO4 administration. After surgery, all rats were submitted to CMV for 18 h. After completion of the study protocol, blood inflammatory cytokine/chemokine was detected by ELISA, as well as diaphragm contractility, TLR4, NF-κB (p65), phospho-NF-κB (p65) and HMGB1 protein expression.
RESULTS
The level of inflammatory cytokine/chemokine includes interleukin-6, monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory protein-2 (MIP-2) and HMGB1 in blood were significantly increased at 18-h post-CLP compared with the control group. We found that rats in the CLP group had substantial diaphragm dysfunction with a distinct downshift of the force-frequency curve. Furthermore, expression of HMGB1, TLR4, NF-κB (p65) and phospho-NF-κB (p65) in diaphragm were significantly increased in the CLP group. In contrast, MgSO4 attenuated the septic inflammation reaction in diaphragm and serum and preserved diaphragm function.
CONCLUSION
MgSO4 protects against sepsis-induced diaphragm dysfunction. This may be associated with its anti-inflammatory effect on HMGB1/TLR4/NF-κB signal pathway.
Topics: Animals; Cecum; Diaphragm; HMGB1 Protein; Inflammation; Macrophages; Magnesium Sulfate; NF-kappa B; Rats, Sprague-Dawley; Sepsis; Signal Transduction; Toll-Like Receptor 4
PubMed: 32558672
DOI: 10.1097/WNR.0000000000001478 -
Canadian Association of Radiologists... Aug 2020Traumatic diaphragmatic injury (TDI) is an underdiagnosed condition that has recently increased in prevalence due to its association with automobile collisions. The... (Review)
Review
Traumatic diaphragmatic injury (TDI) is an underdiagnosed condition that has recently increased in prevalence due to its association with automobile collisions. The initial injury is often obscured by concurrent thoracic and abdominal injuries. Traumatic diaphragmatic injury itself is rarely lethal at initial presentation, however associated injuries and complications of untreated TDI such as herniation and strangulation of abdominal viscera have serious clinical consequences. There are 2 primary mechanisms of TDIs: penetrating TDI which tend to be smaller, more difficult to detect, and result in fewer complications; and blunt TDIs which are larger and have higher overall mortality due to associated injuries or delayed complications. The anatomy of thoracic and abdominal cavities distinguishes the epidemiology, pathophysiology, symptoms, treatment, and prognosis of right versus left TDI. Although there is no definitive radiologic sign for diagnosing TDI, many signs have been introduced in the literature and the concurrent presence of multiple signs increases the sensitivity of TDI detection. Conservative versus surgical management depends on mechanism of TDI, side, and most importantly the associated injuries.
Topics: Accidents, Traffic; Autopsy; Contrast Media; Diagnosis, Differential; Diaphragm; Hernia, Diaphragmatic, Traumatic; Humans; Imaging, Three-Dimensional; Injury Severity Score; Multiple Trauma; Tomography, X-Ray Computed
PubMed: 32157897
DOI: 10.1177/0846537120905133 -
National Health Statistics Reports Dec 2023Objective-This report presents national estimates of sexual activity and contraceptive use among males and females ages 15-19 in the United States, based on data from...
Objective-This report presents national estimates of sexual activity and contraceptive use among males and females ages 15-19 in the United States, based on data from the National Survey of Family Growth (NSFG). Methods-NSFG data were collected through in-person interviews with nationally representative samples of males and females ages 15-49 in the household population of the United States. NSFG 2015-2019 interviews were conducted between September 2015 and September 2019 with 21,441 males and females, including 3,812 teenagers (1,894 females and 1,918 males ages 15-19). Estimates include measures of sexual experience and contraceptive use as well as circumstances of first sexual intercourse (sex), attitudes, and probability of a birth during the teen years. Estimates are shown overall and by Hispanic origin and race, age group, parental living arrangements, and maternal characteristics. The report focuses on the period 2015-2019, with trends shown for selected measures for time points 2002, 2006-2010, 2011-2015, and 2015-2019. Results-In 2015-2019, 40.5% of never-married female teenagers (3.8 million), and 38.7% of never-married male teenagers (3.8 million) had ever had vaginal intercourse with an opposite-sex partner. For females this percentage was stable across the four time points, but for males this percentage decreased from the 2002 (45.7%) and 2011-2015 (44.2%) time points. For teen males, use of any contraception at first sex increased across the four time points, from 82.0% in 2002 to 92.1% in 2015-2019, while no consistent trend was seen for teen females. Nearly four out of five female teenagers (77.3%) in 2015-2019 used a method of contraception at first sex. Among female teenagers, ever-use of long-acting reversible contraception, which includes intrauterine devices and contraceptive implants, increased from 5.8% to 19.2% from 2011-2015 to 2015-2019.
Topics: Humans; Male; Adolescent; Female; United States; Contraceptive Agents; Sexual Behavior; Contraception; Sexual Partners; Intrauterine Devices; Contraception Behavior
PubMed: 38170823
DOI: No ID Found -
Journal of Back and Musculoskeletal... 2022To restore core stability, abdominal drawing-in maneuver (ADIM), abdominal bracing (AB), and dynamic neuromuscular stabilization (DNS) have been employed but outcome...
Comparison of core stabilization techniques on ultrasound imaging of the diaphragm, and core muscle thickness and external abdominal oblique muscle electromyography activity.
BACKGROUND
To restore core stability, abdominal drawing-in maneuver (ADIM), abdominal bracing (AB), and dynamic neuromuscular stabilization (DNS) have been employed but outcome measures varied and one intervention was not superior over another.
OBJECTIVE
The purpose of this study was to compare the differential effects of ADIM, AB, and DNS on diaphragm movement, abdominal muscle thickness difference, and external abdominal oblique (EO) electromyography (EMG) amplitude.
METHODS
Forty-one participants with core instability participated in this study. The subjects performed ADIM, AB, and DNS in random order. A Simi Aktisys and Pressure Biofeedback Unit (PBU) were utilized to measure core stability, an ultrasound was utilized to measure diaphragm movement and measure abdominal muscles thickness and EMG was utilized to measure EO amplitude. Analysis of variance (ANOVA) was conducted at P< 0.05.
RESULTS
Diaphragm descending movement and transverse abdominis (TrA) and internal abdominal oblique (IO) thickness differences were significantly increased in DNS compared to ADIM and AB (P< 0.05). EO amplitude was significantly increased in AB compared to ADIM, and DNS.
CONCLUSIONS
DNS was the best technique to provide balanced co-activation of the diaphragm and TrA with relatively less contraction of EO and subsequently producing motor control for efficient core stabilization.
Topics: Abdominal Muscles; Abdominal Oblique Muscles; Diaphragm; Electromyography; Humans; Muscle Contraction; Ultrasonography
PubMed: 34657872
DOI: 10.3233/BMR-210051 -
Nederlands Tijdschrift Voor Geneeskunde Nov 2021Successful contraception is essential and the stable number of abortions illustrate the success of contraception policies in The Netherlands. This article considers...
Successful contraception is essential and the stable number of abortions illustrate the success of contraception policies in The Netherlands. This article considers relevant issues based on the latest NHG Contraception Standard. The patient takes centre stage in the selection of contraceptive and tailor made care is imperative. There are a number of alternative contraceptives each with their own functionality and merits. An important distinction is the use of hormones; the latter in view of the growing awareness of women of the alleged pros or cons of hormones. Important criteria for the choice of contraceptive methods are stage of life, reliability, ease of use, influence on the menstruation cycle, and foremost the personal preference of the woman in question. There are both absolute and relative contra-indications for a number of contraception methods as tabulated in the article.
Topics: Contraception; Contraceptive Agents; Female; Hormones; Humans; Intrauterine Devices; Pregnancy; Reproducibility of Results
PubMed: 34854617
DOI: No ID Found