Interstitial Laser Coagulation Research Articles

Exploring the Legal Implications of Benign Prostatic Hyperplasia Surgeries in the United States: A Comprehensive Analysis of Two Decades of Lawsuits.

The United States (US) currently faces a medical malpractice crisis, and a survey done in 2006 informed that 63% of urologists faced an average of 2.1 medical malpractice lawsuits. Surgery for benign prostatic hyperplasia (BPH) is performed by 95% of US urologists. Hence, we postulated that these procedures might be responsible for a substantial number of medical malpractice lawsuits. We examined claims related to BPH surgery in various US courts. Data were collected from Westlaw and LexisNexis databasesusing the keywords "benign prostatic hyperplasia," "enlarged prostate," "surgery," and "malpractice" to search for cases from the entire US from January 2000 to December 2021. We extracted details such as the type of procedure, the plaintiff and defendant, the nature of the allegation, the alleged complications, the verdict, and the compensation amount. We found 30 casesin which the most common procedure was transurethral resection of the prostate (37%), with inadequate postoperative care as the most frequent reason for claims (33%). Urologists were the most frequently processed professionals (57%). The postsurgical outcomes that resulted in lawsuits were urinary incontinence (23%), erectile dysfunction (13%), and urinary retention (13%). Interestingly, 43% of the patients were inmates. Plaintiffs won only two (7%) cases: colon perforation after interstitial laser coagulation with Indigo laser and recto-urethral fistula after transurethral microwave therapy. Most lawsuits were related to postoperative incontinence and erectile dysfunction, with the verdict favoring the defendant in most cases. Inmates were the plaintiffs in a relatively high percentage of cases. Only two cases resulted in a plaintiff victory, wherein both cases presented unexpected and serious postsurgical complications.

Perinatal outcome after selective fetal reduction in monochorionic twin pregnancies: A comparison of techniques over a 20-year period.

To assess the perinatal outcome after fetal reduction in complicated monochorionic (MC) twin pregnancies by comparing different techniques. A retrospective cohort study at a national referral center comparing data between four techniques: interstitial laser coagulation, radiofrequency ablation (RFA), fetoscopic laser coagulation (FLC) and bipolar cord coagulation (BCC). The primary outcome was the mortality of the co-twins. Secondary outcomes were preterm pre-labor rupture of membranes (PPROM), gestational age at delivery and neonatal morbidity. 259MC twin pregnancies underwent selective fetal reduction: 29 IL, 64 RFA, 85 FLC and 81 BCC. The perinatal mortality rate was 29% and fetal demise of the co-twins occurred in 19%. The lowest mortality rate was seen after BCC (17%, p=0.012). PPROM occurred in 18% patients without significant differences between techniques. The mean gestational age at delivery in liveborn children was 35weeks and did not differ between techniques. Severe cerebral injury and neonatal morbidity were reported in 4% and 14%, respectively, without significant differences between techniques. Selective fetal reductions in MC twins are precarious procedures with an increased risk of perinatal mortality of the co-twins. Our results show the lowest mortality rates after BCC. However, high PPROM rates were seen irrespective of the technique.

Perinatal outcomes after selective feticide via umbilical cord occlusion in complicated monochorionic pregnancies: A systematic review and meta‐analysis

We aimed to compare perinatal outcomes between umbilical cord occlusion techniques in monochorionic pregnancies, including umbilical cord ligation, fetoscopic laser coagulation, interstitial laser coagulation, bipolar cord occlusion, radiofrequency ablation, and microwave ablation. This study was registered with PROSPERO (CRD42020158861). PubMed, Web of Science, Cochrane Library, and Embase were searched for studies published up to May 2020. The DerSimonian-Laird random-effects model was used for the meta-analysis. Subgroup analyses were performed to compare the outcomes among the six techniques. Meta-regression was used to adjust for confounders. Thirty-four studies with 1646 participants were included. The overall survival was 76.5% after umbilical cord ligation, 78.8% after fetoscopic laser coagulation, 60.3% after interstitial laser coagulation, 79.2% after bipolar cord occlusion, 77.5% after radiofrequency ablation, and 75.0% after microwave ablation. Subgroup comparison showed the rates of overall survival and preterm premature rupture of membranes were not significant different among six techniques. However, rates of fetal loss, premature birth, live birth, and neonatal death differed significantly among the six groups. The choice of umbilical cord occlusion techniques will affect perinatal outcomes. We suggested that the choice of umbilical cord occlusion techniques should fully consider these differences among techniques.

Complex treatment of children with vascular head and neck malformations

The article analyzes the results of treatment of children affected with lesions of blood vessels of the head and neck. The research is aimed at developing and implementing minimally invasive techniques to treat such children. The study group comprised 4416 patients with hyperplasia of blood vessels (the so-called infantile and congenital hemangiomas) and 397 patients with blood vessel malformations, examined and treated from 1991 to 2020. The paper summarizes developed indications and the results of implementation of effective minimally invasive methods for the treatment of children with vascular lesions: radiofrequency thermal ablation and pulsed dye laser treatment of children with severe forms of arterio-venous malformation in their maxillofacial area and. The treatment is currently the golden standard that provides stable aesthetic results. The most optimal and preferred methods of vascular lesions treatment proved to be minimally invasive techniques that include: radiofrequency thermal ablation, interstitial laser coagulation, pulse phototherapy, sclerotherapy and systemic treatment of beta-blockers.

Interstitial Laser Occlusion of the Systemic Feeding Vessel in a Hybrid Lung Lesion: Technique, Clinical Course, Perinatal Outcome and a Review of Literature

AbstractThe two most common fetal lung lesions include Bronchopulmonary sequestration (BPS) and Congenital pulmonary airway malformation (CPAM).Their co-existence is known as a hybrid lesion. Fetal hydrops in such cases is associated with very high morbidity and mortality. Several fetal interventions have been recommended over the past years to treat the same, with varying success rates. We describe a case of a hybrid CPAM complicated by hydrops which was successfully treated by interstitial laser coagulation of the systemic feeder artery. We also review current literature on the available interventions and conclude that interstitial laser has emerged as the preferred modality of treatment over the years.

Selective fetal termination in monochorionic twin pregnancies - pregnancy outcome after bipolar cord coagulation and interstitial laser coagulation

Introduction/Objective. In this paper we present the perinatal outcome after selective fetal termination (SFT) in monochorionic (MH) twins done by bipolar cord coagulation (BCC) and interstitial laser coagulation (ILC). Methods. During a five-year period, SFT was done in 22 MH twins. BCC was done in 15 and ILC in seven cases. We registered the indication for SFT, gestational age at SFT, immediate postoperative death and late death of the co-twin, PPROM (preterm pre-labor rupture of membranes), gestational age at delivery/abortion, procedure-to-delivery interval, mode of delivery, neonatal body weight and 5-minute Apgar score. Results. Live birth was significantly higher after BCC than after ILC (86.7:57.1%). Gestational age at intervention was higher in BCC (20.2 ? 1.8 : 16.5 ? 1.7 weeks). Gestational age at delivery/abortion was lower for ILC (32.5 ? 4.8 : 27.5 ? 9.5 weeks); however, there was no difference when comparing live births only (33.8 ? 3.7 : 34.7 ? 4.5 weeks). There was no difference between procedure-to-delivery/abortion interval (86.7 ? 33.7 : 77.1 ? 73 days); however, the interval was significantly higher after ILC when comparing live births only (93.3 ? 33 : 133 ? 30.9 days). There was no difference in PPROM (26.7:14.3%); preterm delivery (69.2:50%); Cesarean section rate (84.6:75%); neonatal body weight (2174 ? 82.4 : 2475 ? 823 g); or Apgar score (7.7 ? 1.9 : 9.2 ? 1). Conclusion. There is no ideal method of SFT in MH twins. Success of each SFT method depends upon the correctly set indication, gestational age at the procedure, and the SFT technique. The risk of co-twin death is lower after BCC than after ILC. As in Narodni Front University Clinic for Gynecology and Obstetrics better results were achieved after BCC, this method became a standard for SFT in MH twins, except in cases of twin reversed arterial perfusion sequence before 16 weeks.

Фокальная лазерная коагуляция в лечении пациента, страдающего раком почки и раком предстательной железы

The article describes the clinical observation of the patient 84 years old with prostate cancer T2bNxM0, left kidney cancer T1N0M0 and severe comorbidity. Stepwise interstitial laser coagulation was performed using the Russian microsecond Nd: YAG laser surgical complex.

H.-Peter Berlien

Laser are used today more and more  in therapy and diagnostics. In diagnostics they are used additional to other procedures like metabolic monitoring (fluorescence diagnostic) resp. for optical imaging (Infrared-diaphanoscopy). Main topic of medical applications therapy, in which Laser is sometime a surgical instrument sometime a central, alone standing therapeutic procedure. But it is forgotten that Laser is light, a special light, but the biological reactions are in general not different from normal light. This is important to prevent disappointments on the other to use the experience of photobiology and light therapy. In medicine Laser is used since his invention 40 years ago mostly destructive but nature uses light since billion of years mainly constructive! So Lasers are used not only for cutting and removal on surfaces the application is more complex. This is caused by a continuous technical development of Laser-systems and accessories, like endoscops, but more important is the better knowledge about Laser-tissue-interaction. The field of application is broad, there are daily new indications but other are replaced by the development of other techniques like Radiofrequency. The indications are from plastic surgery over the congenital and vascular diseases to open surgical organ and tumor resections. Very important is Laser in endoscopic surgery and in interstitial Lasercoagulation. But in contrast to thermal procedures the indication for Photo dynamic Therapy are dysplasias and virus-induced tumors. The experiences by the Photodynamic Therapy and the better understanding of biochemical metabolic processes open the field of indications for this therapeutic principle also for benign chronical diseases.

EP20.12: The heartless triplet: acardius anceps complicating monochorionic pregnancy

Twin Reversed Arterial Perfusion (TRAP) sequence affects 1% of monochorionic twins and 3% of monochorionic triplets. Acardius acephalus, acardius amorphous, acardius acormus and acardius anceps have been described. In the acardius anceps (9% of cases) the fetal head and body are differentiated. A 28 y.o. woman, G1P0 was referred at 14 weeks gestation with a monochorionic triamniotic triplet pregnancy complicated by demise of triplet 3; the fetus appeared fully formed with a marked cystic hygroma and no heartbeat. At 18 weeks there was a significant increase in size, hydrops and Doppler perfusion into triplet 3; TRAP sequence was diagnosed. End-diastolic flow (EDF) in the umbilical artery and a-wave in the ductus venosus of triplet 2 were absent, therefore interstitial laser coagulation of pelvic vessels was performed in triplet 3. Subsequent positive EDF in umbilical artery of triplet 2 deteriorated at 33+2 weeks, the babies were therefore delivered by emergency Caesarean section. Triplet 1 weight was 2030g with Apgars 10,10 and Triplet 2: 1650g with Apgars 7,9,10. Acardius anceps variant of TRAP was diagnosed on autopsy of triplet 3. Unlike other cases described, the upper body was better developed with normal occipital, parietal and frontal bones. Aortic type vessel was extending rostrally with two apparent brachial arteries and two apparent common carotid-like arteries. The upper limbs had 5 digits on each hand and were held in partially reducible flexion at shoulders and elbows; there was a bilateral cleft palate. In the lower body, the vasculature was difficult to assess, fracture dislocations were seen at knees and ankles, with fusion of the fourth and fifth digits of the feet. QFPCR confirmed a monozygotic pregnancy. The above case highlights the difficulties posed by well differentiated variants of TRAP at early gestations and the importance of a thorough examination, including Doppler studies to aid the diagnosis of these rare and challenging cases.

P18.11: Twin reversed arterial perfusion sequence: a 14‐year experience in a tertiary referral centre

The aim of this study is to review all cases of Twin reversed arterial perfusion (TRAP) sequence managed in a tertiary referral center and to compare the outcome in conservatively managed cases with that of those managed with interventions. This is a retrospective study analyzing all TRAP cases that were managed in a tertiary center from Jan 2000 to October 2013. Details assessed included (1) Gestation at diagnosis (2) Ultrasound features at Diagnosis (3)Treatment options offered (4) Outcome of these pregnancies and (5) Prognostic factors. Wherever possible, the outcomes and prognostic factors were compared between the groups with different management strategies. 59 cases of TRAP were identified during the study period. Follow up was available in 46(77%), among a total of 59 pregnancies complicated by TRAP sequence. Among, these 17 (37.8%) opted for elective termination of pregnancy and 29 (62.2%) continued their pregnancies. Among these 29 women who continued their pregnancies 10 were managed expectantly and 19 had an intervention for the twin with TRAP sequence. The intervention techniques used were alcohol ablation, coil embolization and interstitial laser coagulation. The overall survival rate in the group that had an expectant management was 80% and the mortality rate of the pump twin was 20%. The overall survival rate in the intervention group was 57.8% and the mortality rate was 36.8%. When intra fetal laser was used as the treatment of choice for TRAP sequence the survival rate was 82%.

Long-Term Results of Interstitial Laser Coagulation for the Treatment of Benign Prostatic Obstruction

Objectives: Long term data on the outcome of interstitial laser coagulation for the treatment of sub vesical obstruction due to benign prostatic enlargement have been rarely published. Our long-term outcome data are presented and the technique of interstitial laser coagulation is critically evaluated. Methods: We carried out an evaluation of the outcome of consecutive interstitial laser coagulation procedures between 1999 and 2004. Follow-up was done by questionnaires sent to the outpatient urologists and by telephone interviews of patients. Results: 68 patients were treated with ILC. Follow up was available for 66 patients (97%). Mean follow up was 41 months, 40 of 66 patients have been voiding spontaneously after ILC treatment (61%). Mean residual urine volume of these patients at the time of follow up was 25 ml (0-120 ml). Mean Qmax at the time of follow-up was 11.1 ± 4.5 ml/sec. 16 patients have needed a secondary procedure for bladder outlet obstruction (TURP in most of these) and have been catheter-free since that. 10 patients remained on catheter drainage. A history of high residual urine volume or urinary retention was identified as predictor for treatment failure. Conclusion: Interstitial laser coagulation can be used in selected patients

Replacing the scalpel with the laser reduces expenses in surgery – Taking the history of prostate therapy as an example

AbstractAgeing populations worldwide requires more affordable minimally invasive therapy procedures. German data show an increase in both benign prostate enlargement (BPE) and carcinoma of the prostate. In 1901 the introduction of anesthesia made the Freyer operation possible, and using electricity enabled transurethral resection of prostate (TURP) in the 1920s. In 1991 Hofstetter was the first physician to laser prostate tissue by means of interstitial laser coagulation. Twenty years later 80% of the BPE operations in the USA were carried out by mostly outpatient photoselective vaporization of the prostate (PVP). In France, this method was declared a standard in December 2012. Our experience with Medilas100 and re-sterilized quartz fibers dates back to 1988 and includes the laser treatment of 4000 urothelial tumors and 2000 BPEs (as presented at nearly 60 congresses). In 1996 the 50 W, 980 nm diode laser replaced the scalpel and reduced costs to 45% of the pre-laser era. Today portable laser devices with over 100 W and using an extremely wide variety of wavelengths operate for 100,000 maintenance-free hours and facilitate cutting, sawing and drilling in tissue, teeth and bones with bare fibers. Currently a method using beam reflection indicates when the beam is entering or leaving the tumor and Raman spectroscopy is being introduced as new diagnostic method for tissue differentiation. The proton laser DRACO has been tested at the Dresden Center OncoRay. It destroys only tumor tissue without damaging the surrounding healthy tissue. It is possible to use a laser anywhere where there is an electric source – in high-tech mega-clinics as well as in Red-Cross/Half Moon disaster relief tents. All laser physicians should publish their results, so that others can follow and prove the method.

Usage of GreenLight HPS 180-W laser vaporisation for treatment of benign prostatic hyperplasia

Laser therapy has gained increasing acceptance as a relatively less invasive treatment for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). From the early procedure of interstitial laser coagulation through to the use of holmium laser enucleation of the prostate, there has been an expanding body of evidence on the efficacy of such procedures. One of the newer lasers is the Green Light HPS 180 W laser. Studies with this GreenLight laser (GLL) (American Medical Systems, Inc, Minnetonka, MN, USA) showing results as good as those of transurethral resection of the prostate (TURP). In this paper, the efficacy of the new GLL 180-W versus the gold standard TURP in patients with LUTS due to BPH was tested in a prospective clinical trial. To compare results of Green light laser (GLL) evaporisation of the prostatae and transurethral resection of the prostate (TURP) for treatment of BPH. MATERIJALS AND METHODS: A total of 62 patients with BPH were randomly assigned to two equal groups: TURP or GLL. Both groups were compared regarding all relevant preoperative, operative, and postoperative parameters. Functional results in terms of improvement of International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), and postvoid residual (PVR) urine were assessed at 1, 3, 6 and 12 mo. A total of 62 patients completed 12 mo of follow-up in the TURP and GLL groups, respectively. Baseline characteristics were comparable. Mean operative time was significantly shorter for TURP. Compared to preoperative values, there was significant reduction in hemoglobin levels at the end of TURP only. A significant difference in favor of GLL was achieved regarding the duration of catheterization and hospital stay. In the GLL, no major intraoperative complications were recorded and none of the patients required blood transfusion. Among TURP patients, 6 required transfusion, 1 developed TUR syndrome, and capsule perforation was observed in 5 patients. There was dramatic improvement in Qmax, IPSS, and GLL compared with preoperative values and the degree of improvement was comparable in both groups at all time points of follow-up. Four TURP patients and one GLL patients developed bladder neck contracture treated by bladder neck incision; none in either group experienced urethral stricture or urinary incontinence. Compared to transurethral resection of the prostate, GreenLight HPS 180-W laser photoselective vaporization of the prostate is safe and effective in the treatment of patients suffering from lower urinary tract symptoms due to benign prostatic hyperplasia.

Combination of Channel-TURP and ILC versus Standard TURP or ILC for Elderly with Benign Prostatic Hyperplasia: A Randomized Prospective Trial

Purpose: A prospective randomized controlled trial was performed in elderly patients with benign prostatic hyperplasia (BPH) to evaluate the clinical effectiveness of channel transurethral resection of the prostate (C-TURP) combined with an interstitial laser coagulation (ILC) technique during a 4-year follow-up period. Methods: A total of 150 consecutive BPH patients were randomized to an ILC+C-TURP group (n = 50), an ILC group (n = 50) and a TURP group (n = 50). Urinary tract infection, acute urinary retention and retrograde ejaculation were monitored, and the retreatment rate, international prostate symptom score (IPSS) and maximum flow rate (Q_max) were measured. Results: A total of 142 patients completed the follow-up and were recruited for further analysis. At 1 month, the proportion of patients with urinary tract infection was similar between the C-TURP+ILC group and the TURP group (8.5 and 6.5%, p > 0.05), but significantly higher than that in the ILC group (51%, p < 0.001). Acute urinary retention was found in 30.6% of patients in the ILC group, but was not observed in the C-TURP+ILC and TURP groups. In the TURP group, the rate of retrograde ejaculation was significantly higher than that in the other 2 groups (p < 0.001). The retreatment rate was 8.5, 36.7 and 2.2% in the C-TURP+ILC, ILC and TURP groups, respectively (p < 0.001). When compared with baseline, the IPSS in the C-TURP+ILC, ILC and TURP groups was decreased by 70.6, 45.4, and 81.0%, respectively (ILC vs. C-TURP+ILC or TURP, p < 0.01) at the 48-month follow-up. One month after surgery, the Q_max was significantly increased in the C-TURP+ILC group and the TURP group when compared with that at baseline (p < 0.01). The TURP group had the highest and the ILC group had the lowest increase in the Q_max at the 12-, 24-, and 48-month follow-ups (p < 0.05). Conclusions: C-TURP+ILC is a safe and effective modality for the treatment of BPH, and exhibits favorable short-term clinical response and long-term durability. It is relatively reasonable and acceptable for treatment of high-risk elderly patients or those with a limited life expectancy.

Laser ablation of the prostate: a safe effective treatment of obstructive benign prostatic disease

Laser ablation of the prostate: a safe effective treatment of obstructive benign prostatic disease

CHORANGIOMA AND RELATED VASCULAR LESIONS OF THE PLACENTA — A REVIEW

Chorangioma has been referred to as a hamartoma-like, or a hyperplastic capillary lesion, rather than a true neoplasm. Its incidence is 1 in 100 placentas. In chorangiomas larger than 4 cm, there can be significant effects on the hemodynamic and circulatory processes of the fetus, leading to grave clinical consequences, such as polyhydramnios and fetal heart failure. Chorangiomas can show various histopathologic pictures, ranging from vascular to cellular, and can undergo degenerative changes. They can be diagnosed prenatally by ultrasound, color Doppler imaging, and magnetic resonance imaging (MRI). Chorangioma must be differentiated from other villous capillary lesions, namely, chorangiomatosis and chorangiosis. They have overlapping similarities with chorangioma, and have clinical implications. Chorangiomatosis has been associated with negative fetal outcomes such as intrauterine growth retardation (IUGR) and preeclampsia. Chorangiosis is associated with maternal diabetes mellitus. Another rarer differential is chorangioma with trophoblast proliferation (“chorangiocarcinoma,” a probable misnomer), a rare proliferation of trophoblastic tissue seen in the vicinity of otherwise benign chorangioma. Treatment modalities of chorangioma include endoscopic devascularization, alcoholic ablation, and interstitial laser coagulation. In this article, we will review the clinical and pathologic picture of chorangioma as well as treatment, and discuss its main differentials.

Construction and Evaluation of an Anatomically Correct Multi-Image Modality Compatible Phantom for Prostate Cancer Focal Ablation

Focal therapy using lasers is emerging as an alternative strategy for prostate cancer treatment. However, to our knowledge no anatomically correct models are available to test imaging and ablation techniques. Animal models present ethical, anatomical and cost challenges. We designed and validated an inexpensive but anatomically correct prostate phantom incorporating tumor, rectum and urethra that can be used for simulated and experimental magnetic resonance guided focal intervention. Our secondary aim was to asses the phantom using other imaging modalities. The phantom, which was constructed of ballistic gel, includes an 80 gm prostate with urethra, tumor, perineum and rectum. Gadolinium was added to make the gel visible to magnetic resonance imaging. To recreate a tumor an irregularly shaped 5 cc volume of coagulable gel was inserted into the prostate phantom. The phantom was evaluated using magnetic resonance, computerized tomography and transrectal ultrasound. Thermal ablation was delivered via interstitial placement of laser fibers. Magnetic resonance thermometry was done to record real-time tissue temperatures during thermal ablation. With all modalities tested the phantom emulated human prostate anatomy. The coagulable gel tumor allowed us to generate focal thermal lesions. The phantom had magnetic resonance imaging properties comparable to in vivo properties, allowing ablative zones to be accurately assessed and magnetic resonance thermometry to be done. The phantom is a useful tool to test different aspects of thermal focal ablation for prostate cancer using multiple imaging modalities, particularly magnetic resonance. It is inexpensive and easily constructed, and may be considered a valuable model to train on and teach focal therapy.

The impact of minimally invasive surgeries for the treatment of symptomatic benign prostatic hyperplasia on male sexual function: a systematic review

A systematic review of randomized controlled trials and cohort studies was conducted to evaluate data for the effects of minimally invasive procedures for treatment of symptomatic benign prostatic hyperplasia (BPH) on male sexual function. The studies searched were trials that enrolled men with symptomatic BPH who were treated with laser surgeries, transurethral microwave therapy (TUMT), transurethral needle ablation of the prostate (TUNA), transurethral ethanol ablation of the prostate (TEAP) and high-intensity frequency ultrasound (HIFU), in comparison with traditional transurethral resection of the prostate (TURP) or sham operations. A total of 72 studies were identified, of which 33 met the inclusion criteria. Of the 33 studies, 21 were concerned with laser surgeries, six with TUMT, four with TUNA and two with TEAP containing information regarding male sexual function. No study is available regarding the effect of HIFU for BPH on male sexual function. Our analysis shows that minimally invasive surgeries for BPH have comparable effects to those of TURP on male erectile function. Collectively, less than 15.4% or 15.2% of patients will have either decrease or increase, respectively, of erectile function after laser procedures, TUMT and TUNA. As observed with TURP, a high incidence of ejaculatory dysfunction (EjD) is common after treatment of BPH with holmium, potassium-titanyl-phosphate and thulium laser therapies (> 33.6%). TUMT, TUNA and neodymium:yttrium aluminum garnet visual laser ablation or interstitial laser coagulation for BPH has less incidence of EjD, but these procedures are considered less effective for BPH treatment when compared with TURP.

Early diagnosis, follow-up, and prenatal treatment of a case of TRAP sequence occurring in a dichorionic triamniotic triplet pregnancy

We are reporting a case of twin reversed arterial perfusion (TRAP) sequence occurring in a dichorionic triamniotic triplet pregnancy with successful percutaneous prenatal treatment and excellent neonatal outcome. TRAP sequence was diagnosed at 11 weeks in a spontaneous dichorionic-triamniotic triplet. Sonographic assessment showed persistent arterial flow and development of hydrops in the acardiac twin. Percutaneous cord interstitial laser coagulation was performed, and the co-twin subsequently developed growth restriction. The 9-month-old twins have a normal developmental course. This report confirms that fetal intervention is indicated in cases of TRAP sequence in which the acardiac twin presents a significant enlargement on follow-up sonographic examinations.

Transvaginal ultrasound-guided ovarian interstitial laser treatment in anovulatory women with polycystic ovary syndrome: a randomized clinical trial on the effect of laser dose used on the outcome

To explore an optimal laser dose of transvaginal ultrasound-guided ovarian interstitial laser coagulation in management of anovulation in patients with polycystic ovary syndrome (PCOS). Randomized, controlled trial. A reproductive medical center. Eighty women with PCOS and clomiphene citrate-resistant infertility underwent ultrasound-guided transvaginal ovarian interstitial yttrium aluminum garnet laser treatment. All subjects were divided randomly into four groups of A, B, C, and D. Group A, one coagulation point per ovary; group B, two points; group C, three points; group D, four to five points. Postoperative ovulation rate, pregnancy rate, and some biochemical parameters. The rates of ovulation in groups C (75.00%, 95% confidence interval [CI]: 51%-91%) and D (80.00%, 95% CI: 56%-94%) within 6 postoperative months were significantly higher than in groups A (5.00%, 95% CI: 0%-25%) and B (15.00%, 95% CI: 3%-38%). The pregnancy rates in groups C (45.00%, 95% CI: 23%-69%) and D (40.00%, 95% CI: 19%-64%) also were significantly higher than in groups A (5.00%, 95% CI: 0-25%) and B (10.00%, 95% CI: 1%-32%). The mean serum T levels were significantly lower in groups C (2.08 +/- 0.62 nmol/L) and D (2.07 +/- 0.42 nmol/L) compared with groups A (3.10 +/- 0.63 nmol/L) and B (2.95 +/- 0.63 nmol/L). One and two intraovarian laser coagulation points per ovary are associated with poor outcomes. Three points per ovary seem to represent the plateau of effective dose for the ovarian interstitial laser treatment in PCOS.