Laparoscopic Examination Research Articles

The significance of clinical and instrumental methods for the diagnosis of multiple injuries in road accidents at an early hospital stage

BACKGROUND: By reason of the high urbanization of the population the mortality rate in combined injury cases remains stably high, despite the CT-scans have appeared in the arsenal of many hospitals. There are a lot of questions: how to reduce the time of diagnosis in favor of therapeutic measures, determine the sequence of actions in different situations?
 AIM: To determine the degree of informativeness of clinical and instrumental methods for diagnosing combined injuries in an accident.
 MATERIALS AND METHODS: Were done a retrospective analysis of the results of treatment of 517 patients with combined trauma delivered to the emergency department of the Omsk City Clinical Hospital and the V.P. Demikhovs City Clinical Hospital of the Moscow for 20172019. All patients were examined by a multidisciplinary team using modern diagnostic methods including laparoscopic examination, CT according to the whole body program.
 RESULTS: The results of the data analysis showed that clinical examination, radiography and ultrasound do not allow the diagnosis to be carried out in full, revealing up to 80% of all injuries.
 CONCLUSION: FAST protocol has a high degree of informativeness at the early hospital stage (efficiency 83%, reliability 81%). When using modern computed tomographs with subsequent digital analysis of reconstructions, the value of performing radiographs in an urgent situation decreases. MSCT is the gold standard in the diagnosis of combined trauma, has a high diagnostic efficiency compared to other methods of radiation diagnostics.

Simultaneous bilateral fallopian tubal pregnancy of a laparoscopic definite spontaneous unilateral ovulation: a case report

BackgroundBilateral simultaneous fallopian tubal pregnancy is one of the rarest forms of ectopic pregnancy. Due to the lack of unique features and clinical presentation to distinguish bilateral from unilateral ectopic pregnancy, challenges the diagnosis.Case reportA 27-year-old Asian woman presented with pelvic pain and vaginal bleeding. Pelvic transvaginal ultrasound showed fluid in Douglas Pouch and posterior fornix puncture revealed unclotted blood. Laparoscopic examination unveiled bilateral ectopic pregnancy with two corpus luteum visible in the right ovary, suggesting a double spontaneous unilateral ovulation. Bilateral fallopian tube fenestration and embryo extraction were performed to preserve fertility.ConclusionDiagnosis of bilateral tubal pregnancy is difficult during preoperative ultrasound examination and careful examination during laparoscopic inspection of the whole pelvic cavity to avoid missed diagnosis.

Frequency of endometriosis found on laparoscopic examination among females with subfertility.

Objective: To determine frequency of endometriosis and its staging found on diagnostic laparoscopy for subfertility among females. Study Design: Cross Sectional study. Setting: Department of Gynecology and Obstetrics, Jinnah Medical and Dental College and Hospital Karachi. Period: August 2020 to January 2021. Material & Methods: Total 120 female cases were enrolled into the study who were admitted in the ward for diagnostic laparoscopy to determine cause of subfertility. All female patients in reproductive age having undiagnosed primary or secondary subfertility were selected using consecutive sampling technique. Those who had previously any abdominal surgery were excluded from the study. Data was analyzed using SPSS-20 software. Results were presented in the form of frequency, percentage, and mean ± standard deviation. Results: Endometriosis was diagnosed on laparoscopy in 29.1% cases as a cause of infertility. Age range of the patients in study group was 16-45 years with mean age of 27.42 ± 2.16 years. Infertility duration was ≤3 years in majority of cases (65%). Primary infertility was present in 65.7% and secondary infertility was found in 34.3% cases in study group. Most of the patients diagnosed for endometriosis were having age > 30 years. Stage-4 endometriosis was found commonly in 42.8% cases. Conclusion: Laparoscopy is a best modality for diagnosing endometriosis and its effect on fertility in future. This facility should be available in all gynecological departments for timely diagnosing endometriosis and to treat it promptly.

Uterine artery chemoembolization for management of unruptured interstitial pregnancy diagnosed in the early first trimester

Background: With the increased frequency of diagnosis of interstitial pregnancy in the early first trimester, non-surgical management of unruptured interstitial pregnancy has become an important issue. However, management of unruptured interstitial pregnancy by uterine artery chemoembolization (UACE) with dactinomycin has never been evaluated via a case series. Methods: With this aim, a retrospective review of electronic chart records over a five-year period was performed, and a series of cases of unruptured interstitial pregnancy during the first trimester was extracted. Diagnostic procedures included ultrasonography, magnetic resonance imaging (MRI), and laparoscopic examination, if necessary. Conservative treatment regimen included UACE. Additional administration of methotrexate (MTX) was considered when an insufficient decline of serum β-hCG was noted. Clinical characteristics and treatment outcomes are described. Results: Among four women diagnosed with unruptured interstitial pregnancy at six weeks of gestation, one case was managed by laparoscopic cornuostomy due to concerns of rupture after the identification of thinning of the myometrium, whereas the other three cases were initially managed by UACE. One case of proximal interstitial pregnancy was diagnosed solely by MRI, whereas two cases of distal interstitial pregnancy was diagnosed by exploratory laparoscopy. Two cases were successfully managed by UACE alone, whereas one case required additional systemic administration of MTX to achieve resolution of gestational products after UACE. Thereafter, one patient conceived spontaneously and experienced a successful vaginal birth. Conclusions: This small case series emphasizes that UACE is a feasible minimally invasive option for the management of unruptured interstitial pregnancy identified in the early first trimester.

Clinical impact of gastrectomy for gastric cancer patients with positive lavage cytology without gross peritoneal dissemination.

The prognosis of gastric cancer patients with positive lavage cytology without gross peritoneal dissemination (P0CY1) is poor. The survival benefit of gastrectomy for these patients has not been established. In this population-based cohort study, we investigated the impact of radical gastrectomy with lymph node dissection for P0CY1 patients. Patients who were diagnosed with Stage IV gastric cancer from 2008 to 2015 in all nine cancer-designated hospitals in a tertiary medical area were listed. Patients who were diagnosed with histologically proven adenocarcinoma in both the primary lesion and lavage cytology during the operation or a diagnostic laparoscopic examination were enrolled. Patients with a gross peritoneal lesion or other metastatic lesions were excluded. The primary outcome was the adjusted hazard ratio (aHR) of gastrectomy for overall survival. We also evaluated the survival time in patients who underwent gastrectomy or chemotherapy in comparison to patients managed without primary surgery or with best supportive care. One hundred patients were enrolled. The aHR (95% confidence interval) of gastrectomy was 0.677 (0.411-1.114, p = 0.125). The median survival time in patients who received gastrectomy (n = 74) was 21.7, while that in patients managed without primary surgery (n = 30) was 20.5 months (p = 0.155). The median survival time in patients who received chemotherapy (n = 76) was 23.0 months, while that in patients managed without chemotherapy was 8.6 months (p < 0.001). Gastrectomy was not effective for improving the survival time in patients with P0CY1 gastric cancer. Surgeons should prioritize the performance of chemotherapy over surgery as the initial treatment.

Diagnostic laparoscopy findings in pelvic pain among the women attending Gynecology OPD at Dhulikhel Hospital

Aims: To evaluate the laparoscopic findings in women with pelvic pain.&#x0D; Methods: A prospective study conducted in Department of Obstetrics and Gynecology at Dhulikhel Hospital from March 2017 to December 2018. All women with pelvic pain, ultrasound evaluation and laparoscopic procedure at the hospital were taken. Data entered in SPSS 23 and analyzed using descriptive parameters.&#x0D; Results: Maximum number of cases of pelvic pain belonged to 21-30 years, most of them were parous with mean duration of pain of 16.48±4 months. The mean age and parity of the patients was 34±5 years and 1.74 respectively. The most common complaint was dysmenorrhea (33.3%) followed by abnormal vaginal discharge (31.7%). On clinical examination, pelvic tenderness was observed in majority (21.7%) of cases.&#x0D; On laparoscopic examination, normal finding were seen in 41.7% cases followed by pelvic inflammatory disease (19.2%), endometriosis (17.5%), pelvic adhesion (12.5%), retroverted uterus (2.5%). PCOS, pelvic congestion and fimbrial cyst were seen in 1.7% each. Pyosalphinx and twisted ovary were seen in 0.8% each.&#x0D; Conclusions: Laparoscopy serves as diagnostic as well as a therapeutic modality of management in chronic pelvic pain.

Tuberculose péritonéale pseudo tumorale: à propos d’une série de 14 cas

Pseudotumoral peritoneal tuberculosis is uncommon, but its incidence is high in endemic areas. Given the great radioclinical similarity between pseudotumoral peritoneal tuberculosis and ovarian cancer, we conducted a retrospective study in the Department of Obstetrics and Gynaecology of the Military Hospital of Instruction Mohammed V in Rabat, involving 14 cases (n= 14) of pseudotumoral peritoneal tuberculosis in order to illustrate the problem of differential diagnosis. All other extra-pelvic locations were excluded, the average age of our patients was 33.4 years with a maximum of cases in the 16-40 years group: 71% (n=10/14). Common clinical symptoms of this particular form of peritoneal tuberculosis were abdominal pain: 100% (n=14/14) associated with abdominopelvic mass: 71% (n=10/14) and ascites: 64% (n=09/14) mimicking peritoneal carcinosis of ovarian origin, especially since both pathologies progressed in a context of impaired general condition. Diagnosis was based on invasive laparoscopic examinations: 35% (n=05/14) or laparotomy: 57% (n=08/14) with biopsies. Indeed, only histological examination can help to establish definitive Corriger diagnosis, in the majority of cases. Therapeutic management of our patients was based on medical treatment, according to the national tuberculosis control program, and surgical treatment. The use of invasive explorations is often unavoidable before initiating any anti-bacillary treatment. Patients´ outcome under specific treatment is favorable, the prognosis of fertility is engaged in young women.

Comparison of diagnostic values of transvaginal sonography with laparoscopic and histological results in the evaluation of uterosacral ligaments' involvement in endometriosis patients.

Endometriosis is one of the most common gynecological disorders, which causes pain and reduces fertility. An accurate diagnostic technique would be helpful in the management of these patients preoperatively. The objective of this study was to do a comparative evaluation of uterosacral involvement in deep infiltrative endometriosis by transvaginal sonography (TVS) and laparoscopic biopsy. TVS and laparoscopy were done in all patients suspected to have endometriosis. TVS examination was carried out to identify endometriotic lesions, and in suspicious laparoscopic views, biopsy was done and laparoscopic findings were confirmed by pathologic report. Then, TVS and pathological findings in laparoscopy were compared and data analyzed by SPSS Version 23. In our study on 80 patients, the mean age was 34.47 ± 5.94 (mean ± SD) years. Comparison of ultrasound with laparoscopic examinations showed that ultrasound as the gold standard method, has sensitivity, specificity, and positive and negative predictive values of 93%, 65%, and 87%, and 78.9%, respectively, while in the diagnosis of increased uterosacral ligament thickness showed 82%, 100%, and 100% and 6.66%, respectively. While in the diagnosis of nodules in the uterosacral ligament, 100% for all four parameters in the diagnosis of endometrioma in the ovaries, and 71%, 96.4%, and 97.3% and 64.2%, respectively, in the diagnosis of rectal, bladder, and ureteral involvement. TVS can be used in the diagnosis of endometriosis by examining the increase in the thickness of the uterosacral ligament and the presence of hypoechoic nodules in it; also, this method demonstrates acceptable sensitivity and specificity in ovarian endometrioma.

The Role of Selected Chemokines in the Peritoneal Fluid of Women with Endometriosis—Participation in the Pathogenesis of the Disease

Endometriosis is a disorder characterized by the presence of endometrial tissue outside the uterine cavity, primarily into the peritoneal cavity. It is known as a complex, chronic inflammatory disease and it is strongly associated with immune dysregulation. Various soluble mediators of the immune and inflammatory responses, including chemokines, play an important role in these processes. The aim of the study was to understand the role of the chemokines MCP-1, MCP-2, MCP-3, MCP-4, MIP-1 α, MIP-1β, eotaxin 2, eotaxin 3, ENA-78, and fractalkine in the development of endometriosis through their assessment in the peritoneal fluid of women with endometriosis. The study group included 58 women with endometriosis who were diagnosed during laparoscopy and then confirmed by histopathology. In 15 women from the reference group, laparoscopic examination demonstrated a normal status of the pelvic organs without any evidence of endometriosis nor inflammation in the peritoneal cavity. The peritoneal fluid of women with endometriosis and of women from the reference group were examined. To determine the concentration of the studied chemokines, enzyme immunoassays for Luminex® platforms were used. In the peritoneal fluid of women with endometriosis, a statistically significant increase in the concentration of MIP-1β, eotaxin 2, eotaxin 3, ENA-78, and fractalkine and a decrease in the concentration of MCP-1, MCP-2, MCP-3, MCP-4, and MIP-1α were observed compared to the reference group. The concentration of these cytokines depended on the severity of the disease. Changes in the concentration of the studied chemokines in the peritoneal fluid of women with endometriosis suggest their participation in the pathogenesis of the disease. The differences in chemokines concentration observed in different stages of endometriosis may be associated with the presence of inflammation in the peritoneal cavity at each step of disease development.

Laparoscopic morphological aspects and tentative explanation of the aetiopathogenesis of isolated endometriosis of the sciatic nerve: a review based on 267 patients.

Endometriosis of the sciatic nerve (ESN) is considered a rare disease. How can endometriosis develop within the sciatic nerve; a structure which has nothing in common with the uterus either anatomically or functionally, and why it occurs in the absence of any retroperitoneal/parametric endometriosis, is unknown. A better understanding of the pathophysiology of this enigmatic disease may improve its diagnosis and therapy. From a pool of 452 patients operated for ESN, only patients with "isolated" endometriosis of the sciatic nerve" confirmed at laparoscopy were included in this study. Patients with suspicion of ESN by extension from a parametric, ovarian or other intraperitoneal deeply infiltrating endometriosis were excluded from this study. All information acquired during the preoperative patient's medical history and clinical examination were collected and compared with the morphological aspects of the disease observed by the laparoscopic treatment. Patients were classified into three groups according to the time interval between the onset of sciatic pain and the time of surgery: less than 1 year (Group 1), between 1 and 3 years (Group 2), and more than 3 years (Group 3). Two hundred sixty-seven consecutive patients were included in this study. In Group 1 (n=67), 76% of the patients presented with cyclical sciatica, without sensory or motor disorders of the lower limbs. Laparoscopic exploration found in the great majority of these patients only the presence of an isolated endometrioma in the nerve itself, the size of which was proportional to the time elapsed since the onset of pain. In Group 2 (n=83), pain had become constant in 91% of the patients with neurological disorders of the lower limb (foot drop, Trendelenburg gait, atrophied muscles) in about 30% of patients. Laparoscopic examination revealed, in addition to intraneural cystic lesions, a retroperitoneal fibrosis in more than 80% of the patients. In the third group (N=117), more than 80% of the patients presented with neurological disorders of the lower limb, with, on laparoscopic examination, massive retroperitoneal fibrosis with endometriomas in the nerve and adjacent pelvic wall muscles in all patients and an infiltration of the obturator nerve in 41% of patients. The different morphologic aspects of ESN do not correspond to different forms of the disease, but obviously to one single disease at different stages of its evolution. ENS starts first with the development of an endometrioma within the sciatic nerve, then develops in a second step a perineural fibrosis that expands into the whole retroperitoneal space and finally involves surrounding anatomical structures. The ESN is a very particular pathology because it induces a completely new aspect on the pathogenesis of endometriosis: all hypothesis of implanted endometrial cells following retrograde menstruation, angiogenic spread, lymphogenic spread or the metaplasia theory cannot explain the pathogenesis of this disease. ESN obviously does not develop from "genital metastatic cells". A possible hypothesis for explanation the pathogenesis of ESN, could consist in the development of endometriosis of the nerve from progenitor stem cells present within the nerve, pluripotent cells which, for an as yet unknown reason (possibly in connection with iterative inflammations and micro-damages of the nerve itself), mutate and proliferate to form endometriosis.

Laparoscopic Examination and Transabdominal Preperitoneal (TAPP) Approach with Biologic Mesh for Strangulated Direct Inguinal Hernia: a Case Series

Laparoscopic Examination and Transabdominal Preperitoneal (TAPP) Approach with Biologic Mesh for Strangulated Direct Inguinal Hernia: a Case Series

Comparison of Hysterosalpingography With Laparoscopy in the Diagnosis of Tubal Factor of Female Infertility.

Background: Laparoscopy is considered to be the gold standard in the evaluation of causes leading to infertility. Hysterosalpingography (HSG) permits indirect visualization of the cervical canal, uterine cavity, and tube patency, which is helpful for evaluating the causes of infertility.Objective: This study aimed to detect tubal abnormalities in infertile women by HSG or laparoscopy and determine the value of HSG in diagnosing fallopian tube status.Methods: The study group consisted of 1,276 patients. HSG was performed as a preliminary test for the evaluation of fallopian tube status. Women were subjected to laparoscopic examination on evidence of HSG abnormalities.Results: The negative predictive value of HSG for detecting patency or occlusion for the right/left tube was 92.08 and 95.44%, respectively. The kappa values for the consistent diagnosis in the right/left tube were 0.470 and 0.574, respectively. In cases of low patency of the right/left tube, there was a greater than a 40% chance for the tube to be patent, and the remaining high probability was pelvic adhesion. The positive predictive value of HSG for detecting patency or occlusion for both tubes was 87.2%. The kappa value was 0.898 [95% CI (0.838, 0.937), p < 0.001], which meant that the diagnostic accuracy of HSG for both tube patency/occlusion was explicit. The kappa value for the diagnosis of hydrosalpinx (especially for bilateral tube hydrosalpinx) was 0.838 [95% CI (0.754, 0.922), p < 0.001], and the diagnostic accuracy for HSG was 79.8, 67.9, and 72.4%, respectively.Conclusion: The current study concluded that HSG is a good diagnostic modality to detect tube abnormalities in infertile patients. HSG and laparoscopy are complementary to each other and whenever the patient is undertaken for diagnosis of infertility. Cost-effective HSG had good predictive value in identifying tubal factor infertility.

S-1 Combined With Apatinib and Trans-arterial Chemotherapy and Embolization for Conversion Therapy of Unresectable Locally Advanced Gastric Cancer

Conversion therapy is a promising option for unresectable locally advanced gastric cancer (GC) patients.This study aimed to investigate the feasibility and efficacy of conversion therapy based on S-1, apatinib combined with transarterial chemotherapy and embolization (TACE). Twenty eligible unresectable locally advanced GC patients were enrolled in this single-arm, single-center, prospective clinical trial. Apatinib was administered orally at 0.5 g once daily and continuously for 58 d, whileS-1 twice daily on d 1-14 was given at a dose calculated according to the body surface area and repeated every 3 wk for three cycles. TACE (oxaliplatin 80 mg/m2 and etoposide 80 mg/m2) was performed on d 1 and was repeated on d 31. Nineteen patients completed conversion therapy and no treatment-related deaths occurred. The objective response rate (ORR) was 94.7% (18/19) and noncurative factors had resolved in 13 patients (68.4%) based on imaging estimation. 18 patients received laparoscopic examination and 12 cases underwent definitive surgery. Based on the intraoperative and postoperative pathological examination, 10 patients received radical resection (R0+D2/D2+). The patients who underwent the conversion surgery had a superior median overall survival (OS) compared with those who did not (P=0.010). S-1 combined with apatinib and TACE regimen is feasible for preoperative treating initial unresectable locally advanced GC patients with high rates of objective response and radical resection which may provide a survival benefit.

Intussuscepção cecocólica e torção de ceco em bovinos

This work aims to describe the clinical, laboratory, and anatomopathological findings of two bovines, one affected by cecocolic intussusception, and the other by dilation with cecal torsion. The clinical examination demonstrated metallic resonance from the right flank, ruminal and intestinal hypomotility, and abdominal distension, in addition to alterations in feces characteristics. Was observed in the two animals leukocytosis by neutrophilia with regenerative shift to the left, and hyperfibrinogenemia. The analysis of ruminal fluid revealed impairment of the microbiota and an increase in chloride levels. The laparoscopic examination performed on one of the animals showed dilation of the colon, the cecum with hyperemia and serous edema, with a dividing halo between affected and unaffected portions, in addition to reddish peritoneal fluid. In the laparotomy, an enlarged cecum was found, with gaseous and liquid contents, swollen and turgid colon, and peritonitis. In addition to the findings observed during surgery, the anatomopathological examination demonstrated, in bovine 01, intestinal intussusception in the region of the cecocolic valve, and, in bovine 02, twisting of the loop at the ileocecocolic junction. Despite the low occurrence of digestive system disorders in cattle, cecal torsion and intussusception represent serious intestinal clinical conditions. These reports take the attention to the importance of a multidisciplinary approach to provide a correct diagnosis of intestinal diseases.

Еволюція діагностики та хірургічного лікування хворих на інтраабдомінальні інфільтрати й абсцеси первинного та післяопераційного походження

Purpose – to improve the results of surgical treatment of patients with intra-abdominal infiltrates and abscesses through the introduction of the latest imaging methods and surgical technologies. Materials and methods. In the clinic of the Department of Surgical Diseases No 1, on the basis of the Surgery Center of the Kyiv City Clinical Hospital No. 1 from 2006 to 2019 218 patients with primary and secondary intra-abdominal infiltrates, abscesses and fluid formations were treated. The patients’ age ranged from 16 to 85 years. There were 107 (49.08%) male patients, 111 (50.92%) female patients. Depending on the time of hospitalization (by years), the patients were divided into two groups: the control group (CG) (2006–2012) 117 (53.67%) patients and the study group (SG) (2013–2019) 101 (46.33%) patients. The SG used the latest imaging technologies and improved methods of surgical treatment. Results. The patients were divided into two groups: primary in 191 (87.61%) and secondary postoperative infiltrates and abscesses in 27 (12.39%). The causes of primary infiltrates and abscesses were: complicated forms of appendicitis in 74 (33.94%), perforated stomach and duodenal ulcer in 48 (22.02%), complicated forms of cholecystitis in 69 (31.65%). Postoperative infiltrates and abscesses were observed in 27 (12.39%) patients who underwent urgent surgery: adgeolysis of adhesive ileus in 14 (6.42%) and complicated hernias of various localization in 13 (5.97%). Postoperative complications were diagnosed in 43 (19.72%) patients, of whom 34 (15.59%) from the surgical wound and 29 (15.18%) of the abdominal cavity, who required relaparotomy or laparoscopy, with destructive appendicitis in 10 (13.51%), perforated gastric ulcer and 12 duodenal ulcer in 6 (12.5%), destructive cholecystitis in 9 (13.04%), adhesive intestinal obstruction in 13 (19.12%) and with strangulated and complicated hernias in 14 (17.28%) of the examined patients. During relaparotomy, incompetence of the intestinal wall and intestinal sutures was established in 11 out of 32 patients, an ileostomy was imposed in 7, and cecostomy in 1 patient. Actually, in the control group, 8 (6.84%) patients died on the background of ongoing peritonitis, thrombosis of mesenteric vessels and multiple organ failure and concomitant ailments and in the study group 4 (3.96%) patients died. Conclusions. Surgical treatment is individualized depending on the disease, so with destructive appendicitis from 74 (38.74%) laparotomic in 42 (21.99%), laparoscopic in 32 (16.75%), and in 12 (6.28%) with conversion; perforated gastric ulcer and duodenal ulcer in 48 (25.13%) open laparotomy; with cholecystitis of 69 (36.13%) patients, 48 (25.13%) had laparotomy and 21 (11.00%) had laparoscopic examination. The use of the latest imaging and treatment technologies: Doppler ultrasonography, hydrojet scalpel and laparoscopy in 64 (33.51%), allowed to have better near and long-term results and to reduce postoperative mortality from 6.84% to 3.96%, with an average of 5.5%. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. The authors declare no conflicts of interests. Key words: destructive appendicitis, cholecystitis, perforated gastric ulcer and 12-duodenal ulcer, adhesive leakage, strangulated hernias, diagnosis and treatment.

Diagnostic Laparoscopic Procedure In Cats With Abdominal Disorders

The use of diagnostic and therapeutic laparoscopy has increased tremendously in human medicine in the last 10 years. The widespread acceptance of laparoscopy is due to technological advances in equipment and the impressive results of this noninvasive modality compared to invasive surgery. Many procedures performed in humans are accepted for veterinary medicine due to the convenience, efficiency, and low morbidity of many procedures. Techniques have been developed in veterinary medicine for noninvasive evaluation of various organs including the liver, extrahepatic biliary system, pancreas, kidneys, spleen, intestine, and genitourinary system. Biopsy procedures of these organs can be performed in most patients with minimal risk. Twenty cats of different breeds, ages, genders, and weights with abdominal complications and a history of trauma were used as study material. After the clinical examination of the patients, laparoscopic surgery was performed. Clinical examination revealed that the cases were stable. Liver, gall bladder, stomach, kidney, intestines, urinary bladder, ovary, and spleen were clearly observed during the laparoscopic examination. While almost all of the cases are not encountered with any pathology in the organs; It was observed comfortably that in one case the spleen color changed regardless of age. Laparoscopy enabled controlled cytosynthesis in some cases. This article reviews that the equipment and techniques should be required for performing laparoscopy in cats. As a result, it was concluded that laparoscopic examination yielded more successful results in the examination of abdominal organs or the application of surgical techniques on the biopsy of pathological masses compared to other diagnostic methods. Further studies with a larger group of cats should be considered to compare the efficacy of laparoscopic procedures.

Intermittent intestinal intussusception in patients with mesenteric lymphadenitis in the ileocecal angle

Introduction. At present, lymphadenopathy – as a cause of idiopathic intestinal intussusception in little children - comes to the fore. However, intestinal intussusception in case of destructive mesenteric lymphadenitis in combination with lymphoid hyperplasia of the ileocecal angle ( what does not exclude lymphoma intraoperatively) is extremely rare in clinical practice.Purpose. To present a therapeutic and diagnostic algorithm in intestinal intussusception which was caused by the “volumetric“ abdominal lymphadenopathy.Case Report. A 3-year-old boy was admitted by the ambulance with recurrent abdominal pain, single episode of vomiting and no stool for 4 days. The ultrasound examination revealed intermittent ileocecal intussusception. The risk factor which had triggered the disease was an acute respiratory viral infection complicated with purulent mesenteric lymphadenitis and lymphoid hyperplasia with ulcerative lesions of the mucous membrane in the ileocecal junction. Laparoscopic desinvagination with lymph node removal and colonoscopy with ladder biopsy were performed. A differential diagnostics of nonspecific lymphadenopathy, Burkitt’s lymphoma and Crohn’s disease was made. Immunohistological examination intraoperatively was made; examination of the biopsy material excluded tumor and inflammatory bowel disease (IBD). The inflammatory process regressed under conservative therapy (antibacterial, anti-inflammatory and antispasmolytic) ; there were no any recurrent intussusception episodes within one-year follow-up.Conclusion. Successive ultrasound, laparoscopic and colonoscopic examinations followed by the immunohistological analysis of intraoperative and biopsy material allowed to put a correct diagnosis and, thereby, to minimize surgical aggression in ileocecal intussusception which was accompanied by volumetric lymphadenopathy.

Unilateral absence of ovary and fallopian tube

A 19-year-old young woman was admitted to our Unit for irregular menstrual cycles within 40- to 60-day intervals for 7 months. She had no history of abdomino-pelvic surgery or acute pelvic pain. Pelvic magnetic resonance imaging revealed a right ovarian mass (Figure1A &amp; B), measuring 6.0 cm X 5.1 cm X 5.0 cm. The patient underwent laparoscopy. At the laparoscopic examination, we evidenced a right ovarian teratoma about 6.0 cm X 6.0 cm and a small mesosalpinx cyst about 2.5 cm X 2.0 cm on the right fallopian tube (Figure 2A). On the left, neither fallopian tube nor ovary was detected (Figure 2B). We performed laparoscopic cystectomy and sutured residual ovarian tissues for hemostasis. Subsequent urinary ultrasonography demonstrated a normal urinary tract without any congenital anomaly. The pathological examination confirmed the diagnosis of mature teratoma and right mesosalpinx serous cyst. The patient was successfully discharged at the third day with no complications.

Rectal metastasis from bladder urothelial carcinoma: a case report

BackgroundUrothelial carcinoma arises from transitional cells in the urothelial tract. In advanced cases, it can metastasize locally to surrounding organs or distally to organs such as the lungs, bones, or liver. Here we describe a case of rectal metastasis from urothelial carcinoma treated with multiple sessions of transurethral resection of bladder tumor (TURBT).Case presentationA 72-year-old woman presented to our department with abdominal bloating andobstructed defecation. She had undergone two sessions of TURBT for early urothelial carcinoma in another hospital at 64 and 65 months ago, respectively. Cystoscopy at 3 months after the second TURBT session had indicated disease recurrence, and thus, she had been referred to our hospital for further examination, followed by TURBT for the third time at 59 months ago and for the fourth time at 48 months ago; thereafter, she had been followed up with cystoscopy every 6 months without any recurrence. However, she returned to our hospital, complaining of difficult defecation. Subsequent colonoscopy demonstrated an obstructive tumor in the rectum, which was pathologically diagnosed as metastatic urothelial carcinoma of the bladder. Laparoscopic examination revealed two small areas of peritoneal dissemination in the pelvis. A sigmoid colostomy was performed without rectal tumor resection. She has been receiving chemotherapy and is still alive 10 months after surgery.ConclusionsRectal metastasis is a rare site of metastasis for urothelial carcinomas. It is important to consider the possibility of annular rectal constriction caused by infiltrating or metastasizing urothelial carcinoma when managing patients with urothelial carcinoma and with difficult defecation.

The association between vitamin D level and Endometriosis

ABSTRACTBackground: Vitamin D is a family of fat-soluble secosteroids. In humans, the crucial compound in this group are vitamin D3 (named as cholecalciferol) and vitamin D2 (i.e. ergocalciferol). Cholecalciferol and ergocalciferol could be ingested from the diet and from supplements. Only a few foods have vitamin D. The chief natural source of the vitamin is the synthetic pathway of cholecalciferol in the skin from cholesterol via a chemical reaction that is dependent on sun exposure (particularly uv radiation).Aim of Study: The aim of this study is to assess the association between 25-Hydroxyvitamin D Serum Levels and endometriosis.Methods: The current research study was a case control research study performed at the department of Obstetrics and Gynecology at Ain Shams University Maternity Hospital, Outpatient Clinics (Gynecology & Infertility Clinics). On women with a surgical diagnosis of endometriosis confirmed by biopsy, and control research group women came for laparoscopic examination for unexplained infertility. Results: In the current research study the findings were that proportion of women who had deficient/insufficient serum 25-OH-vitamin D have been statistically significantly higher among women of research group I [Endometriosis research group] in comparison to women of research group II [Control research group] [OR = 5.67, 95% CI (1.95 to 16.46), p value =0.004]. Conclusion: Vitamin D in serum could be implemented after more future research efforts as a biomarker to determine developmental course and progress of endometriosis. Vitamin D deficiency appears to be crucial finding correlated to endometriosis disease development.Keywords: vitamin D; Endometriosis