Combined Hysteroscopic and Laparoscopic Approach to a Complicated Case of Asherman's Syndrome

Az adverz gyógyszerreakciók különféle klinikai megjelenési formái alapján a kiváltó gyógyszerre nehéz következtetni. A gyanúba vett gyógyszerek elhagyása után fellépő javulás vagy az empirikus tapasztalat, esetleg irodalmi adatok alapján lehet a felelős gyógyszert feltételezni. A gyógyszerérzékenység bizonyítása bonyolult, jól átgondolt orvosi tevékenység útján lehetséges, és azokban az esetekben szükséges, amikor a gyanús gyógyszer más vegyületcsoportba tartozó szerrel nem helyettesíthető, és a betegnek feltétlenül szükséges szednie. A jelen közlemény célja egy eset kapcsán körvonalazni azokat a lehetőségeket és veszélyeket, melyek a kivizsgálás során alkalmazhatók, illetve megjelenhetnek. A kivizsgálás során használt módszerek a gyanúba vett gyógyszerekkel – lamotrigin, risperidon, sertralin – zopiclonum, atorvastatin elvégzett epicutan teszt során egyedül a sertralin adott a multiform tünetekkel azonos pozitív reakciót. A pozitív bőrteszt területéről készült hisztológiai vizsgálat eredménye visszautalt az eredetileg észlelt klinikai formára (erythema exsudativum multiforme Stevens–Johnson-szindróma). A beteg bipoláris affektív zavara miatt a negatív bőrtesztet adó készítményekkel per os provokáció történt, ez azonban a beteg számára kockázatos, de az egyetlen megbízható és biztos módszer. Az elvégzett per os expozíció során a törzsön a lamotrigintől már tört adag bevételét követően három órán belül diffúz erythema, 12 órán belül az alkalmazott szteroid- és antihisztamin-kezelés ellenére scarlatiniform exanthema jelent meg. Az eset érdekessége, hogy a gyanúba vett gyógyszerek során epicutan teszttel egy gyógyszer érzékenysége igazolódott, azonban a másik gyanúba vett készítménnyel végzett pozitív per os expozíciós próba is váratlanul tünetet provokált (scarlatiniform, azonnali reakciót). Megállapítható, hogy csupán egy bizonyos módszer még a klinikai képpel való egyező eredmény alapján sem elegendő adverz gyógyszerreakció provokáló tényezőjének bizonyítására.

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Laparoscopic Approach to Pancreatic Disease

Journal of Long-Term Effects of Medical Implants ◽

10.1615/jlongtermeffmedimplants.v14.i1.20 ◽

2004 ◽

Vol 14 (1) ◽

pp. 13-22 ◽

Cited By ~ 1

Author(s):

Adrian Park ◽

Gina L Adrales

Keyword(s):

Laparoscopic Approach ◽

Pancreatic Disease

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Primary laparoscopic approach to repair perforated peptic ulcer. A retrospective cohort study

Minerva Chirurgica ◽

10.23736/s0026-4733.20.08287-5 ◽

2020 ◽

Vol 75 (6) ◽

Author(s):

Gianrocco Manco ◽

Stefania Caramaschi ◽

Giovanni Rolando ◽

Marzio Malagoli ◽

Giuliana Zanelli ◽

...

Keyword(s):

Peptic Ulcer ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Laparoscopic Approach ◽

Perforated Peptic Ulcer

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Robotic Versus Laparoscopic Approach for Rectal Cancer Surgery

Case Medical Research ◽

10.31525/ct1-nct03931980 ◽

2019 ◽

Author(s):

Keyword(s):

Rectal Cancer ◽

Laparoscopic Approach ◽

Cancer Surgery ◽

Rectal Cancer Surgery

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Endometrial Regeneration in Asherman's Syndrome: Clinical and Translational evidence of Stem Cell Therapies

Current Stem Cell Research & Therapy ◽

10.2174/1574888x14666190213100528 ◽

2019 ◽

Vol 14 (6) ◽

pp. 454-459

Author(s):

Xuejing Hou ◽

Ying Liu ◽

Isabelle Streuli ◽

Patrick Dällenbach ◽

Jean Dubuisson ◽

...

Keyword(s):

Stem Cell ◽

Molecular Mechanisms ◽

Uterine Cavity ◽

Stem Cell Therapies ◽

Intrauterine Adhesions ◽

Asherman’S Syndrome ◽

Cell Therapies ◽

Fibrotic Process ◽

Physical Barriers

Asherman’s Syndrome or Intrauterine adhesions is an acquired uterine condition where fibrous scarring forms within the uterine cavity, resulting in reduced menstrual flow, pelvic pain and infertility. Until recently, the molecular mechanisms leading to the formation of fibrosis were poorly understood, and the treatment of Asherman’s syndrome has largely focused on hysteroscopic resection of adhesions, hormonal therapy, and physical barriers. Numerous studies have begun exploring the molecular mechanisms behind the fibrotic process underlying Asherman’s Syndrome as well as the role of stem cells in the regeneration of the endometrium as a treatment modality. The present review offers a summary of available stem cell-based regeneration studies, as well as highlighting current gaps in research.

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Laparoscopic versus open distal pancreatectomy: a single centre propensity score matching analysis

Updates in Surgery ◽

10.1007/s13304-021-01039-x ◽

2021 ◽

Author(s):

Riccardo Casadei ◽

Carlo Ingaldi ◽

Claudio Ricci ◽

Laura Alberici ◽

Emilio De Raffele ◽

...

Keyword(s):

Propensity Score ◽

Hospital Stay ◽

Distal Pancreatectomy ◽

Pancreatic Neoplasms ◽

Postoperative Morbidity ◽

Laparoscopic Approach ◽

Length Of Hospital Stay ◽

Single Centre ◽

Oncological Outcomes ◽

Open Distal Pancreatectomy

AbstractThe laparoscopic approach is considered as standard practice in patients with body-tail pancreatic neoplasms. However, only a few randomized controlled trials (RCTs) and propensity score matching (PSM) studies have been performed. Thus, additional studies are needed to obtain more robust evidence. This is a single-centre propensity score-matched study including patients who underwent laparoscopic (LDP) and open distal pancreatectomy (ODP) with splenectomy for pancreatic neoplasms. Demographic, intra, postoperative and oncological data were collected. The primary endpoint was the length of hospital stay. The secondary endpoints included the assessment of the operative findings, postoperative outcomes, oncological outcomes (only in the subset of patients with pancreatic ductal adenocarcinoma-PDAC) and total costs. In total, 205 patients were analysed: 105 (51.2%) undergoing an open approach and 100 (48.8%) a laparoscopic approach. After PSM, two well-balanced groups of 75 patients were analysed and showed a shorter length of hospital stay (P = 0.001), a lower blood loss (P = 0.032), a reduced rate of postoperative morbidity (P < 0.001) and decreased total costs (P = 0.050) after LDP with respect to ODP. Regarding the subset of patients with PDAC, 22 patients were analysed: they showed a significant shorter length of hospital stay (P = 0.050) and a reduction in postoperative morbidity (P < 0.001) after LDP with respect to ODP. Oncological outcomes were similar. LDP showed lower hospital stay and postoperative morbidity rate than ODP both in the entire population and in patients affected by PDAC. Total costs were reduced only in the entire population. Oncological outcomes were comparable in PDAC patients.

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Endometrial Perivascular Progenitor Cells and Uterus Regeneration

Journal of Personalized Medicine ◽

10.3390/jpm11060477 ◽

2021 ◽

Vol 11 (6) ◽

pp. 477

Author(s):

Shiyuan Li ◽

Lijun Ding

Keyword(s):

Stem Cells ◽

Mesenchymal Stem Cells ◽

Embryo Implantation ◽

Endometrial Receptivity ◽

Perivascular Cells ◽

Asherman’S Syndrome ◽

Outermost Layer ◽

Adventitial Cells ◽

Structure And Functions ◽

Large Vessels

Ovarian steroid-regulated cyclical regeneration of the endometrium is crucial for endometrial receptivity and embryo implantation, and it is dependent on the dynamic remodeling of the endometrial vasculature. Perivascular cells, including pericytes surrounding capillaries and microvessels and adventitial cells located in the outermost layer of large vessels, show properties of mesenchymal stem cells, and they are thus promising candidates for uterine regeneration. In this review, we discuss the structure and functions of the endometrial blood vasculature and their roles in endometrial regeneration, the main biomarkers and characteristics of perivascular cells in the endometrium, and stem cell-based angiogenetic therapy for Asherman’s syndrome.

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THREE CASES OF BOWEL OBSTRUCTION BY BROAD LIGAMENT HERNIA

British Journal of Surgery ◽

10.1093/bjs/znab160.017 ◽

2021 ◽

Vol 108 (Supplement_3) ◽

Author(s):

M Soto Dopazo ◽

E Pérez Prudencio ◽

A Arango Bravo ◽

C Nuño Iglesias ◽

C Mateos Palacios ◽

...

Keyword(s):

Small Bowel ◽

Bowel Obstruction ◽

Broad Ligament ◽

Intestinal Resection ◽

Laparoscopic Approach ◽

Exploratory Laparotomy ◽

X Rays ◽

Intestinal Necrosis ◽

Urgent Surgery ◽

Internal Hernias

Abstract INTRODUCTION Internal hernias caused by broad ligament defects are an infrequent cause of bowel obstruction. These defects may be congenital or acquired mainly by gynecological antecedents. Small bowel is the most common affected and the diagnosis is difficult due to nonspecific symptoms and absences of characteristic radiological signs. MATERIAL AND METHODS We report the cases of three women aged from 43 to 56 years old, who came to the emergency with abdominal pain, vomiting and bloating of hours duration. One patient has a history of laparoscopic appendectomy, the rest of them with no surgical history. In all of the cases, x-rays showed dilatation of small bowel loops and air-fluid levels and the abdominal TC revealed a generalized distention of bowel loops with transition point in the terminal ileum with no identifiable cause compatible with small bowel obstruction. RESULTS We decided to perform an urgent surgery with an exploratory laparotomy in one case and the rest by laparoscopic approach, finding an internal hernia occasioned by incarceration of small bowel through a broad ligament defect. In all cases, the hernia content was liberated without evidence of ischemia with no need for intestinal resection, and the defect was closed. All patients had a favourable postoperative course without complications. DISCUSSION Broad ligament defects are a rare cause of internal hernias. These are difficult to diagnose clinically as well as radiologically for an absence of characteristic signs. A high level of clinical suspicion allows early diagnosis and the treatment should be performed as soon as possible to reduce the chances of intestinal necrosis.

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