BEDSIDE LAPAROSCOPY AS DIAGNOSTIC TOOL REVIEW OF ABDOMINAL PATHOLOGIES IN CRITICALLY ILL PATIENTS: REVIEW

Introduction: The diagnosis of abdominal pathologies in critically ill patients is often difficult because of inconclusive laboratory tests or imaging results, or the inability to safely transfer a patient to the radiology room. These causes give a delayed diagnosis of abdominal pathology in the intensive care unit (ICU) and increase rate of morbidity and mortality. The aim of this retrospective study is to evaluate the safety and diagnostic accuracy of bedside diagnostic laparoscopy in the identification of intra-abdominal pathology in critically ill patients. Aim: The aim of this retrospective study is to evaluate the safety and diagnostic accuracy of bedside diagnostic laparoscopy in the identification of intra-abdominal pathology in critically ill patients. Materials and Methods: A literature research was carried out including PubMed, Medline, Embase, Cochrane and Google Scholar databases to identify articles reporting on importance of diagnostic accuracy of bedside diagnostic laparoscopy in the identification of intra-abdominal pathology in critically ill patients. Conclusions: Bedside diagnostic laparoscopy represents a safe and accurate technique for diagnosing intraabdominal pathology in an ICU setting and should be taken into consideration when patient transfer to radiology or the operating room is considered unsafe or when routine radiological examinations are not conclusive enough to reach a definite diagnosis. Keywords: Bedside laparoscopy, critically ill patients, ultrasonography (US), computed tomography (CT) , emergency surgery

Machine learning algorithms as new screening approach for patients with endometriosis

Endometriosis—a systemic and chronic condition occurring in women of childbearing age—is a highly enigmatic disease with unresolved questions. While multiple biomarkers, genomic analysis, questionnaires, and imaging techniques have been advocated as screening and triage tests for endometriosis to replace diagnostic laparoscopy, none have been implemented routinely in clinical practice. We investigated the use of machine learning algorithms (MLA) in the diagnosis and screening of endometriosis based on 16 key clinical and patient-based symptom features. The sensitivity, specificity, F1-score and AUCs of the MLA to diagnose endometriosis in the training and validation sets varied from 0.82 to 1, 0–0.8, 0–0.88, 0.5–0.89, and from 0.91 to 0.95, 0.66–0.92, 0.77–0.92, respectively. Our data suggest that MLA could be a promising screening test for general practitioners, gynecologists, and other front-line health care providers. Introducing MLA in this setting represents a paradigm change in clinical practice as it could replace diagnostic laparoscopy. Furthermore, this patient-based screening tool empowers patients with endometriosis to self-identify potential symptoms and initiate dialogue with physicians about diagnosis and treatment, and hence contribute to shared decision making.

Frequency of Genital Tuberculosis in Patients Undergoing Diagnostic Laparoscopy for Infertility

OBJECTIVES: To determine the frequency of genital tuberculosis in patients undergoing diagnostic laparoscopy for infertility. METHODOLOGY: It is a descriptive (cross-sectional) prospective study. The study was performed within the duration of six months i.e., February 12th, 2020 to August 12th, 2020 at the Department of Obstetrics and Gynecology, Khyber Teaching Hospital, Peshawar. A total of 196 patients were observed by using 47.1% proportion of genital tuberculosis in infertility, 95% confidence interval with margin of error 7%, using software of WHO for sample size calculation. Further, sample collection was performed using non-probability (consecutive) sampling techniques. RESULTS: The mean age of the patients in our study was 30 years (SD+3.92). Fifty seven percent of cases were having primary infertility and 43% of patients were having secondary infertility. The incidence of genital tuberculosis undergoing infertility was 45%. CONCLUSION: Our study concludes that the incidence of genital TB in infertility in our setup was 45%.

Urgent gynecology: a new look

To improve the diagnostics and treatment of urgent gynecological diseases 1000 patients with the pathology were examined. 700 women were subjected to laparoscopy. The following structure of acute gynecological diseases was defined: 47% ectopic pregnancy, 24% acute inflammatory diseases of adnexa uteri, 17% ovarian apoplexy, 7% torsion of ovarian cyst pedicle, 4% uterine myoma associated with the disturbances of alimentation of the ganglion, 1% perforation of the uterus. On the basis of the analysis of complains, anamnesis, clinical symptoms and results of supplementary examinations the algorithm of management of patients with suspected acute gynecological diseases including diagnostic laparoscopy was elaborated

The role of diagnostic laparoscopy in the treatment of patients with ovarian tumors

The aim of the investigation was to study the role of diagnostic laparoscopy in treatment of patients with ovarian cancer. The analysis of 480 laparoscopic operations, which was carried out on 42 patients with benign tumors, 29 cases of suspected tumor malignization, 67 patients with non gynecological pathology with suspected ovarian neoplasia and 174 women with established ovarian cancer, made it possible to define indications to laparoscopic operations. Using this method the authors managed to solve differential-diagnostic difficulties in 81,7% cases. The results of the investigation revealed the advantages of the method as to patients with benign tumors. This method is recommended for ovarian tumor and early recurrence diagnostics and also for morphological verification of tumor development. But the role of laparoscopy in treatment of malignant ovarian cancer, especially its early forms, still has to be further investigated.

THE ROLE OF THE INSTUMENTAL EXAMINATIONS IN DIAGNOSTICS AND STAGING OF LOCALY DISTRIBUTED STOMACH CANCER

Objective. Improvement of algorithm of diagnostics of patients with complicated stomach cancer. Materials and methods. It was shown the analysis of results of surgical treatment of 418 patients with complicated stomach cancer, which got the hospital treatment at GI “V.T. Zaycev Institute of General and Urgent Surgery of NAMS of Ukraine “ from 2010 till 2019, aged 29 till 76. Results. Patiens were examinated with using of combination of instrumental methods. Goal is total detal examination of pathologic process. SCT has precission of 95-97 % at detecting of cancer, definition of stage – 77-80 %. Endoscopy allows to define the location, spreading of process, to find a pathologic process at starting and precancer stages. There no any ideal oncomarker. Diagnostic precission of CA 72-4 is 28-80 % (40-46 % on the average). According to international guides [7], all patients were performed the diagnostic laparoscopy with researching of washout liquids of abdomen in uncertain cases. Conclusion. Only complex examination of patients with stomach cancer with using combination of SCT of abdomen, FEGDS with biopsy, laparoscopy can provide total volum of examination, staging and surgical aid.