Analysis of the gestational period and perinatal outcomes in women after surgical treatment of the cervix

Background. The purpose was to conduct a comparative analysis of the course of pregnancy and perinatal outcomes in women who underwent treatment of the cervix using various organ preserving surgical methods. Material and methods. We examined 250 women of reproductive age who underwent excision or ablative treatment of the cervix before pregnancy. The subjects were divided into five groups depending on the cervix treatment method. The study used general clinical examination protocols outlined in the regulations № 417 and № 676 issued by the Ministry of Health of Ukraine. The results. The most frequent complications of pregnancy in the patients with cervical surgery were: threatened abortion, threatened of preterm birth, anemia, low placentation, placental dysfunction, and low levels of amniotic fluid. Childbirth complications in women who underwent excision or ablation treatment of the cervix before pregnancy predominantly consisted of labor abnormalities, premature amniotic sac rupture, fetal distress, tears of the cervix and perineum. Among the complications of the postpartum period, there were isolated cases of subinvolution of the uterus, lochiometers, metroendometritis, and lactostasis. There were no cases of intrapartum and early neonatal mortality among the newborns. Conclusions. Given the high frequency of gestational and postpartum complications in women after organ-sparing surgical treatment of the cervix, it is necessary to choose the least harmful approach. The lowest incidence of complications during pregnancy, intra and postnatal periods was observed in the women who underwent laser vaporization and radio-wave ablation.

Spectroscopic properties of CrOx/Al2O3 nanopowders synthesized by cw CO2 laser vaporization

Nanosized 5.0 wt% Cr/nano-Al2O3 powders with the particle size of ca. 15 nm were synthesized via laser vaporization using irradiation by a cw CO2 laser in different gas atmospheres – Ar, Ar+O2, Ar+H2. All the investigated nanopowders were studied by XRF, XRD, TEM, UV-vis DRS and PL spectroscopy methods. The nanopowders were found to contain the Cr6+ ions located on the surface of Al2O3 nanoparticles and two types of Cr3+ sites. One type is Cr3+ ions located in the bulk (Cr3+ b-sites) of Al2O3 matrix in a strong crystal field. The second type is represented by Cr3+ sites residing near the surface (Cr3+ s-sites) of CrOx/Al2O3 nanoparticles in a weak crystal field. It was shown that varying the composition of the buffer gas (Ar, Ar+O2, Ar+H2) during laser vaporization makes it possible to control the properties of the obtained 5.0 wt% Cr/nano-Al2O3 nanopowders with a change in Cr6+/Cr3+ ratio in the bulk and on the surface of alumina support.

Luminescence performance of laser synthesized Al2O3:Eu3+ nanophosphors depending on synthesis conditions

Al2O3:Eu3+ nanophosphors were prepared by laser vaporization method in a flowing mixture of Ar/He and O2. Luminescence properties of Al2O3:Eu3+ nanophosphors are predominantly determined by Eu3+ ions red emission with inhomogeneously broadened bands in the region of 550-750 nm corresponding to 5D0 →7FJ transitions of Eu3+ (J = 0 - 4). Hypersensitive electric dipole transition 5D0 →7F2 dominates in the spectrum and is responsible for the red emission. The effect of crystallite size on luminescence properties of Al2O3:Eu3+ nanocrystals was observed. It was shown that the introduction of oxygen during the synthesis improves the luminescence performance. The obtained chromaticity coordinates and high absolute QY (~ 14%) indicate the possibility of using red nanophosphors based on Al2O3:Eu3+.

Comparison on the Efficacy and Safety of Different Surgical Treatments for Benign Prostatic Hyperplasia With Volume >60 mL: A Systematic Review and Bayesian Network Meta-Analysis of Randomized Controlled Trials

The objective of this study was to compare the efficacy and safety of 10 different surgical treatments for benign prostatic hyperplasia (BPH) with volume >60 mL. A systematic literature review and network meta-analysis of randomized controlled trials (RCTs) within a Bayesian framework was performed. A total of 52 parallel-group RCTs included, reporting on 6,947 participants, comparing open prostatectomy (OP), monopolar/bipolar transurethral resection of prostate (monopolar/ bipolar TURP), thulium, holmium and diode laser enucleation of prostate (LEP), bipolar enucleation of prostate, potassium titanyl phosphate laser vaporization of prostate (KTP LVP), bipolar vaporization of prostate (bipolar VP), and laparoscopic simple prostatectomy (laparoscope SP). Compared with OP, laparoscope SP identified better maximal flow rate (Qmax; mean differences [MDs] = 2.89 mL/s) at the 24th month, but bipolar VP demonstrated worse Qmax (MD = −3.20 mL/s) and International Prostate Symptom Score (IPSS; MD = 2.60) at the 12th month. Holmium LEP (MD = 1.37) demonstrated better International Index of Erectile Function–5 at the 12th month compared with OP. However, compared with OP, KTP LVP demonstrated worse postvoid residual volume (PVR) at the sixth (MD = 10.42 mL) and 12th month (MD = 5.89 mL) and monopolar TURP (MD = 6.9 mL) demonstrated worse PVR at the 12th month. Eight new surgical methods for BPH with volume >60 mL appeared to be superior in safety compared with OP and monopolar TURP due to fewer complications. Bipolar VP and KTP LVP maybe not suitable for prostates more than 60 mL due to short- and middle-term worse Qmax, IPSS, and PVR than OP.

The first experience of tracheal recanalization by tumor resection with Nd-YAG-laser

Actuality. Tracheal cancer is a rare disease which amounts up to 0.2% of the total number of cancers. Currently, there is an increase in the number of patients with impaired tracheal patency. Endoscopic procedures are most commonly used to restore and maintain the tracheal lumen. The key treatment for primary cancer is a surgical one; however, due to late diagnostics, the tumor is often inoperable. Chemotherapy for tracheal cancer is ineffective, and practically is not used. At present, endoscopic tracheal recanalization with laser vaporization is a method of choice in patients with inoperable tracheal tumors.Objective: to improve outcomes in patients with inoperable primary tracheal cancer using Nd-YAG laser either as the fi rst component of staged treatment strategy, or as the fi nal volume treatment.Methods. Patient K., 75 years old, was admitted to the hospital with complaints of dyspnea at rest, weakness and hemoptysis. As anamnesis showed, the patient had noticed a deterioration in her breathing during the last 6 months. CT scan revealed a volumetric formation (tumor) of the cervicothoracic trachea (8.0 cm above the bifurcation) with 90% stenosing in the lumen. When performing tracheobronchoscopy in the cervicothoracic trachea, a broad-based lumpy tumor, 5 cm long, stenosing the tracheal lumen by 2/3 was found on the posterior wall. Morphological examination of biopsy material revealed adenocystic carcinoma.Results. The performed endoscopic examination with neodymium YAG laser recanalization demonstrated the advantage of this technique in patients with inoperable tracheal tumors.Conclusion. Endoscopic recanalization of the trachea with neodymium YAG laser has been proven to be effective in patients with inoperable tracheal cancer. It improves their quality of life as well.

Prevention of progression of cervical carcinogenesis at the stage of postoperative rehabilitation

The objective: a study the effect of a complex of hyaluronic acid with plant extracts and a polyphenolic component on cell proliferation and the progression of cervical carcinogenesis.Materials and methods. 74 patients with cervical pathology (average age is 29.8 years) formed the basic group and were examined in the clinic “Doctor Alex” (Kharkiv), 62 women of them had diathermoconization, 12 – laser vaporization of the cervix. Histologically, high-grade squamous intraepithelial lesions (HSIL) was detected in 20 patients, low-grade squamous intraepithelial lesions (LSIL) was found in 46 women, and epidermal endocervicosis – in 8 persons.The patients in the basic group during the postoperative period at the stage of healing additionally used vaginal suppositories of hyaluronic acid with plant extracts and polyphenolic component (aloe vera leaf juice, chamomile flower extract, Centella asiatica extract, sea buckthorn oil, tea tree oil, calendula flower extract, epigallocatechin gallate).The comparison group included 112 women (average age is 32.4 years), 31 of them were diagnosed HSIL, 67 – LSIL, 14 – epidermal endocervicosis; laser vaporization was performed in 21 women, diathermoconization – 91. These patients received antiviral therapy. Markers of proliferation p16 and Ki-67 and the presence of human papilloma virus (HPV) were determined in all women of both groups.Results. 6 months after the treatment, there was a decrease in the frequency of HPV in the basic group (from 55.4% to 5.4%) and in the comparison group (from 51.8% to 6.3%), proliferation markers – from 23.0% to 2.7% and from 20.5% to 6.3%, respectively. In the basic group, a more rapid epithelialization of the cervix was established, which after laser vaporization lasted 28.7 days, after diathermoconization – 36.9 days, and in the comparison group these indicators were, respectively, 30.2 and 44.6 days.Conclusions. The use of laser vaporization or diathermoconization of the cervix in the patients with background cervical pathology, LSIL and HSIL in combination with courses of vaginal suppositories containing hyaluronic acid with plant extracts and a polyphenolic component, can significantly reduce the incidence of HPV, leads to a faster recovery of its epithelium and can be comparable in the effectiveness to the combination of laser vaporization / diathermoconization with antiviral therapy.

Laser Vaporization of Intracoronary Thrombus and Identifying Plaque Morphology in ST-Segment Elevation Myocardial Infarction as Assessed by Optical Coherence Tomography

Objectives. We evaluated the thrombus-vaporizing effect of excimer laser coronary angioplasty (ELCA) in patients with ST-segment elevation myocardial infarction (STEMI) by optical coherence tomography (OCT). Background. Larger intracoronary thrombus elevates the risk of interventional treatment and mortality in patients with STEMI. Methods. A total of 92 patients with STEMI who presented within 24 hours from the onset and underwent ELCA following manual aspiration thrombectomy (MT) were analyzed. Results. The mean baseline thrombolysis in myocardial infarction flow grade was 0.4 ± 0.6, which subsequently improved to 2.3 ± 0.7 after MT ( p < 0.0001 ) and 2.7 ± 0.5 after ELCA ( p = 0.0001 ). The median residual thrombus volume after MT was 65.7 mm3, which significantly reduced to 47.5 mm3 after ELCA ( p < 0.0001 ). Plaque rupture was identified by OCT in only 22 cases (23.9%) after MT, but was distinguishable in 36 additional cases after ELCA (total: 58 cases; 63.0%). Ruptured lesions contained a higher proportion of red thrombus than nonruptured lesions (75.9% vs. 43.3%, p = 0.001 ). Significantly larger thrombus burden after MT (69.6 mm3 vs. 56.3 mm3, p < 0.05 ) and greater thrombus reduction by ELCA (21.2 mm3 vs. 11.8 mm3, p < 0.01 ) were observed in ruptured lesions than nonruptured lesions. Conclusions. ELCA effectively vaporized intracoronary thrombus in patients with STEMI even after MT. Lesions with plaque rupture contained larger thrombus burden that was frequently characterized by red thrombus and more effectively reduced by ELCA.

P–303 Similar long term recurrence rates with cystectomy and CO2-laser vaporization for endometrioma: a retrospective study

Study question Is there a difference in recurrence rate of endometrioma(s) after cystectomy versus CO2-laser vaporization of the cyst wall? Summary answer Similar rates of imaging based recurrence or need for reintervention for endometrioma were observed after cystectomy versus CO2-laser vaporization. What is known already Surgical treatment of endometrioma(s) is mainly performed by 2 types of procedures: cystectomy and ablation. When performing surgery for endometrioma(s), a balance should be made between minimal destruction of normal ovarian cortex and maximal completeness to avoid (early) recurrence. Previous studies have shown that cyst recurrence rates were higher with ablation using bipolar current than after cystectomy. However, only 2 groups have evaluated recurrence rates after cystectomy versus CO2 laser vaporization and found no difference with extended follow-up. Furthermore, ablation with CO2 laser may be less invasive than conventional cystectomy with increased preservation of antral follicles in favor of ablation. Study design, size, duration Single-center retrospective study on data of 271 patients operated between January 2010 and December 2014. Participants/materials, setting, methods Women of reproductive age (18–45 years), undergoing CO2 laser laparoscopic excision of any rAFS-stage endometriosis with at least one endometrioma, were eligible for the study. All 271 included patients were treated in a tertiary referral center for endometriosis of a University Hospital, and underwent complete CO2-laser laparoscopic surgery for endometrioma(s). 155 underwent cystectomy, 77 CO2 laser vaporization, and 46 a mixed technique. Main results and the role of chance The mean duration of follow-up was 58 months. Primary outcome studied was the comparison of recurrence rates between cystectomy and vaporization; secondary outcomes included pregnancy rate and ovarian reserve testing. Recurrence was defined as either imaging based (i.e. cyst recurrence identified at ultrasound and/or MRI) or need for reintervention for suspected cyst recurrence. Imaging based recurrence was reported in 9.92% of patients (n = 12/121) treated with cystectomy and in 11.76% of patients (n = 6/51) who underwent a CO2 laser vaporization (p = .62). The need for reintervention for endometrioma(s) was also similar in both groups, with a rate of 3.23% (n = 5/155) after cystectomy and 4.29% (n = 3/70) after CO2 laser vaporization (p = .567). No difference was seen regarding AMH drop pre- versus postoperatively (p=.233). The 2 study groups were similar, except for the mean cyst diameter, which was higher in the cystectomy group (42.36 ± 25.49 mm) compared to the CO2 laser vaporization group (31.7 ± 26.98 mm) (p = &lt;.001). This suggests that smaller endometriomas might be more likely to undergo CO2 laser vaporization. Limitations, reasons for caution The retrospective character of the study may induce information bias concerning the registration of recurrence. Moreover, regarding the evaluation of imaging-based recurrence, a selection bias cannot be excluded, because most likely only patients complaining about pain would be referred for an ultrasound or planned for a reintervention. Wider implications of the findings: In this study, similar rates of recurrence for endometrioma(s) were observed after cystectomy versus CO2-laser vaporization. Since previous studies suggested that CO2-laser vaporization may cause less damage to the adjacent ovarian tissue, we consider this a valuable alternative technique, especially for women with a future child wish. Trial registration number S59032