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Machlab Mashlab S, Martínez-Bauer E, López P, Pujals MDM, Fernández-Bañares F, Selva A, Calvet X, Campo R. Unrestricted vs 3-day low-residue diet for colonoscopy preparation. Results of a feasibility randomized trial. Rev Esp Enferm Dig 2024. [PMID: 38591600 DOI: 10.17235/reed.2024.10417/2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
AIM To compare the impact of an unrestricted diet with a 3-day low-residue diet before colonoscopy on bowel preparation quality. METHODS A randomized, multicenter, researcher-blinded, parallel-group feasibility trial was conducted to assess the efficacy of an unrestricted diet versus a 3-day low-residue diet for colonoscopy preparation. Participants, aged 50 to 69, were enrolled in a colorectal cancer screening program with no factors linked to poor bowel cleansing. The Boston Bowel Preparation Scale was used to evaluate colon preparation during intubation and withdrawal. Secondary outcomes included bowel exploration time, adenoma and polyp detection rates, and preparation and diet tolerability. The trial is registered under Clinical Trials (NCT04664543). RESULTS One hundred and two individuals (mean age 59.3 ± 5.5 years, 40.1% female) were randomly assigned to each diet. All participants in both groups achieved adequate preparation (Boston scores ≥ 2 in each segment). Complete adherence to preparation was observed in the majority of participants in both groups. No significant differences were noted between groups in withdrawal or cecal intubation times, or in adenoma detection rates. The unrestricted diet was better tolerated than the 3-day low-residue diet (82.5% vs. 32.3%). Preparation assessed during intubation was adequate in 82.5% of the unrestricted diet group and in 90.3% of the 3-day low-residue diet group. CONCLUSIONS It is feasible to test the impact of an unrestricted diet for adequate bowel preparation. Comparable cleansing results were achieved, but the unrestricted diet showed better tolerability.
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Affiliation(s)
- Salvador Machlab Mashlab
- Endoscopy Unit. Gastroenterology, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, España
| | - Eva Martínez-Bauer
- Endoscopy Unit. Gastroenterology , Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, España
| | - Pilar López
- Clinical Epidemiology and Cancer Screening, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Spain
| | | | | | - Anna Selva
- Clinical Epidemiology and Cancer Screening, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Spain
| | - Xavier Calvet
- Endoscopy Unit. Gastroenterology, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Spain
| | - Rafel Campo
- Endoscopy Unit. Gastroenterology, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Spain
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Machlab S, Martínez-Bauer E, López P, Ruiz-Ramirez P, Gómez B, Gimeno-Garcia AZ, Pujals MDM, Tanco S, Sargatal L, Pérez B, Justicia R, Enguita M, Piqué N, Valero O, Calvet X, Campo R. Restrictive diets are unnecessary for colonoscopy: Non-inferiority randomized trial. Endosc Int Open 2024; 12:E352-E360. [PMID: 38464979 PMCID: PMC10919995 DOI: 10.1055/a-2256-5356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/06/2024] [Indexed: 03/12/2024] Open
Abstract
Background and study aims In colonoscopy, preparation is often regarded as the most burdensome part of the intervention. Traditionally, specific diets have been recommended, but the evidence to support this policy is insufficient. The aim of this study was to evaluate the impact of the decision not to follow a restrictive diet on bowel preparation and colonoscopy outcomes. Patients and methods This was a multicenter, controlled, non-inferiority randomized trial with FIT-positive screening colonoscopy. The subjects were assigned to follow the current standard (1-day low residue diet [LRD]) or a liberal diet. The allocation was balanced for the risk of inadequate cleansing using the Dik et al. score. All participants received the same instructions for morning colonoscopy preparation. The primary outcome was the rate of adequate preparations as defined by the Boston Bowel Preparation Scale. Secondary outcomes included tolerability and measures of colonoscopy performance and quality. Results A total of 582 subjects were randomized. Of these, 278 who received the liberal diet and 275 who received the 1-day LRD were included in the intent-to-treat analysis. Non-inferiority was demonstrated with adequate preparation rates of 97.8% in the 1-day LRD and 96.4% in the liberal diet group. Tolerability was higher with the liberal diet (94.7% vs. 83.2%). No differences were found with respect to cecal intubation time, aspirated volume, or length of the examination. Global and right colon average adenoma detection rates per colonoscopy were similar. Conclusions The liberal diet was non-inferior to the 1-day LRD, and increased tolerability. Colonoscopy performance and quality were not affected. (NCT05032794).
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Affiliation(s)
- Salvador Machlab
- Digestive Endoscopy Unit, Gastroenterology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Sabadell, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Eva Martínez-Bauer
- Digestive Endoscopy Unit, Gastroenterology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Sabadell, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Pilar López
- Clinical Epidemiology and Cancer Screening, Parc Taulí Hospital Universitari. Institut d’Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain
| | - Pablo Ruiz-Ramirez
- Gastroenterology Department, Hospital Universitari Mùtua de Terrassa, Terrassa, Spain
| | - Bárbara Gómez
- Gastroenterology Department, Hospital de Mataró, Mataró, Spain
| | | | - María del Mar Pujals
- Gastroenterology Department, Hospital Universitari Mùtua de Terrassa, Terrassa, Spain
| | - Sara Tanco
- Gastroenterology Department, Hospital de Mataró, Mataró, Spain
| | - Lluïsa Sargatal
- Gastroenterology Department, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Betty Pérez
- Gastroenterología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Reyes Justicia
- Colorectal Cancer Screening Office, Consorci Sanitari de Terrassa, Terrassa, Spain
| | | | - Nùria Piqué
- Institut de Recerca en Nutrició i Seguretat Alimentària de la UB (INSA-UB), Universitat de Barcelona Facultat de Farmàcia i Ciències de l'Alimentació, Barcelona, Spain
| | - Oliver Valero
- Mathematics Department and Applied Statistics, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Xavier Calvet
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Gastroenterology Department, Parc Taulí Hospital Universitari. Institut d’Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain
| | - Rafel Campo
- Digestive Endoscopy Unit, Gastroenterology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Sabadell, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
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Garcia-Iglesias P, Machlab S, Martinez-Bauer E, Lira A, Campo R, Marín S, Raurich-Seguí M, Calvet X, Brullet E. Diagnostic accuracy of the Oakland score versus haemoglobin for predicting outcomes in lower gastrointestinal bleeding. Gastroenterol Hepatol 2024:S0210-5705(24)00036-0. [PMID: 38341089 DOI: 10.1016/j.gastrohep.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Acute lower gastrointestinal bleeding (ALGIB) is a common cause of hospitalization. Recent guidelines recommend the use of prognostic scales for risk stratification. However, it remains unclear whether risk scores are more accurate than some simpler prognostic variables. OBJECTIVE To compare the predictive values of haemoglobin alone and the Oakland score for predicting outcomes in ALGIB patients. DESIGN Single-centre, retrospective study at a University Hospital. Data were extracted from the hospital's clinical records. The Oakland score was calculated at admission. Study outcomes were defined according to the original article describing the Oakland score: safe discharge (the primary Oakland score outcome), transfusion, rebleeding, readmission, therapeutic intervention and death. Area under the receiver operating characteristics (AUROC) curve and accuracy using haemoglobin and the Oakland score were calculated for each outcome. RESULTS Two hundred and fifty-eight patients were included. Eighty-four (32.6%) needed transfusion, 50 (19.4%) presented rebleeding, 31 (12.1%) required therapeutic intervention, 20 (7.8%) were readmitted and six (2.3%) died. There were no differences in the AUROC curve values for haemoglobin versus the Oakland score with regard to safe discharge (0.82 (0.77-0.88) vs 0.80 (0.74-0.86), respectively) or to therapeutic intervention and death. Haemoglobin was significantly better for predicting transfusion and rebleeding, and the Oakland score was significantly better for predicting readmission. CONCLUSION In our study, the Oakland score did not perform better than haemoglobin alone for predicting the outcome of patients with ALGIB. The usefulness of risk scores for predicting outcomes in clinical practice remains uncertain.
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Affiliation(s)
- Pilar Garcia-Iglesias
- Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Spain; Grup de Recerca Consolidat, Spain
| | - Salvador Machlab
- Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - Eva Martinez-Bauer
- Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Spain; Grup de Recerca Consolidat, Spain; CIBEREHD - Instituto de Salud Carlos III.(SGR01500), Spain
| | - Alba Lira
- Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Spain
| | - Rafel Campo
- Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Spain; Grup de Recerca Consolidat, Spain; CIBEREHD - Instituto de Salud Carlos III.(SGR01500), Spain
| | - Susana Marín
- Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Spain; Documentació Clínica i Arxiu, Unitat de l'Organització de la Informació Assistencial, Spain
| | - Maria Raurich-Seguí
- Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Spain; Documentació Clínica i Arxiu, Unitat de l'Organització de la Informació Assistencial, Spain
| | - Xavier Calvet
- Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Spain; Grup de Recerca Consolidat, Spain; CIBEREHD - Instituto de Salud Carlos III.(SGR01500), Spain.
| | - Enric Brullet
- Hospital de Sabadell, Corporació Sanitària Universitària Parc Taulí, Sabadell, Spain
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Gordts S, Grimbizis G, Tanos V, Koninckx P, Campo R. Junctional zone thickening: an endo-myometrial unit disorder. Facts Views Vis Obgyn 2023; 15:309-316. [PMID: 38128089 PMCID: PMC10832651 DOI: 10.52054/fvvo.15.4.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Adenomyosis is a disease defined by histopathology, mostly of hysterectomy specimens, and classification is challenged by the disagreement of the histologic definition. With the introduction of Magnetic Resonance Imaging (MRI) and two- and three-dimensional ultrasound, the diagnosis of adenomyosis became a clinical entity. In MRI and US, adenomyosis ranges from thickening of the inner myometrium or junctional zone to nodular, cystic, or diffuse lesions involving the entire uterine wall, up to a well-circumscribed adenomyoma or a polypoid adenomyoma. The absence of an accepted classification and the vague and inconsistent terminology hamper basic and clinical research. The sub-endometrial halo seen at US and MRI is a distinct entity, differing from the outer myometrium by its increased nuclear density and vascular structure. The endometrium and the sub-endometrial muscularis or archimetra are of Müllarian origin, while the outer myometrium is non-Mullerian mesenchymal. The junctional zone (JZ) is important for uterine contractions, conception, implantation, and placentation. Thickening of the JZ can be considered inner myometrium adenomyosis, with or without endometrial invasion. Changes in the JZ should be considered a different entity than myometrial clinically associated with impaired conception, implantation, abnormal uterine bleeding, pelvic pain and obstetrical outcome. Pathology of the basal endometrium and JZ is a separate entity and should be identified as an endo-myometrial unit disorder (EMUD).
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Wattiez A, Schindler L, Ussia A, Campo R, Keckstein J, Grimbizis G, Exacoustos C, Kondo W, Nezhat C, Canis M, De Wilde RL, Miller C, Fazel A, Rabischong B, Graziottin A, Koninckx PR. A proof of concept that experience-based management of endometriosis can complement evidence-based guidelines. Facts Views Vis Obgyn 2023; 15:197-214. [PMID: 37742197 PMCID: PMC10643008 DOI: 10.52054/fvvo.15.3.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Background Management of endometriosis should be based on the best available evidence. The pyramid of evidence reflects unbiased observations analysed with traditional statistics. Evidence-based medicine (EBM) is the clinical interpretation of these data by experts. Unfortunately, traditional statistical inference can refute but cannot confirm a hypothesis and clinical experience is considered a personal opinion. Objectives A proof of concept to document clinical experience by considering each diagnosis and treatment as an experiment with an outcome, which is used to update subsequent management. Materials and Methods Experience and knowledge-based questions were answered on a 0 to 10 visual analogue scale (VAS) by surgery-oriented clinicians with experience of > 50 surgeries for endometriosis. Results The answers reflect the collective clinical experience of managing >10.000 women with endometriosis. Experience-based management was overall comparable as approved by >75% of answers rated ≥ 8/10 VAS. Knowledge-based management was more variable, reflecting debated issues and differences between experts and non-experts. Conclusions The collective experience-based management of those with endometriosis is similar for surgery-oriented clinicians. Results do not conflict with EBM and are a Bayesian prior, to be confirmed, refuted or updated by further observations. What is new? Collective experience-based management can be measured and is more than a personal opinion. This might extend EBM trial results to the entire population and add data difficult to obtain in RCTs, such as many aspects of surgery.
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Gordts S, Puttemans P, Segaert I, Valkenburg M, Schutyser V, Campo R, Gordts S. Diagnosis and treatment of early-stage endometriosis by
Transvaginal Hydro laparoscopy. Facts Views Vis Obgyn 2023; 15:45-52. [PMID: 37010334 PMCID: PMC10392117 DOI: 10.52054/fvvo.15.1.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Background: Transvaginal Hydro Laparoscopy (THL) is known as a minimal invasive procedure allowing endoscopic exploration of the female pelvis.
Objective: To evaluate the possibilities of the THL as a tool for early diagnosis and treatment of minimal endometriosis.
Materials and methods: A retrospective study of a consecutive series of 2288 patients referred for fertility problems to a tertiary centre for reproductive medicine was undertaken. Mean duration of infertility was 23.6 months (SD ±11-48), mean age of patients was 31.25 (SD± 3.8y). With normal findings at clinical and ultrasound examination patients underwent, as part of their fertility exploration, a THL.
Main outcome measures: Evaluation of feasibility, identified pathology and pregnancy rate.
Results: Endometriosis was diagnosed in 365 patients (16%); the localisation was higher on the left side (n=237) than on the right side (n=169). Small endometriomas, with diameters between 0.5 and 2 cm, were present in 24.3% (right side in 31, left side 48 and bilateral 10). These early lesions were characterised by the presence of active endometrial like cells and a pronounced neo-angiogenesis. Destruction of the endometriotic lesions with bipolar energy resulted in an in vivo pregnancy rate (spontaneous/IUI) of 43.8% (CPR after 8 months: spontaneous 57.7%; IUI/AID 29.7%).
Conclusion: THL allowed in a minimally invasive way an accurate diagnosis of the early stages of peritoneal and ovarian endometriosis with the possibility of offering treatment with minimal damage.
What is new? This is the largest series reporting the usefulness of THL for the diagnosis and treatment of peritoneal and ovarian endometriosis in patients without obviously visible preoperative pelvic pathology.
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Zhang S, Di W, Wang Y, Shi J, Yin X, Zhang Y, Zhao A, Campo R, Bigatti G. Hysteroscopic myomectomy with the IBS® Intrauterine Bigatti Shaver: A Retrospective Comparative Analysis of the impact of rotational speed and aspiration flow rate. Facts Views Vis Obgyn 2023; 15:53-59. [PMID: 37010335 PMCID: PMC10392109 DOI: 10.52054/fvvo.15.1.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Background: Myoma removal remains a challenge hysteroscopically including for the “IBS®” Intrauterine Bigatti Shaver technique.
Objective: To evaluate whether the Intrauterine IBS® instrument settings and the myoma size and type are prognostic factors for the complete removal of submucous myomas using this technology.
Materials and methods: This study was conducted at the San Giuseppe University Teaching Hospital Milan, Italy; Ospedale Centrale di Bolzano - Azienda Ospedaliera del Sud Tirolo Bolzano, Italy (Group A) and the Sino European Life Expert Centre-Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China (Group B). In Group A: surgeries were performed between June 2009 and January 2018 on 107 women using an IBS device set to a rotational speed of 2,500 rpm and an aspiration flow rate of 250ml/min. In Group B: surgeries were performed between July 2019 and March 2021 on 84 women with the instrument setting to a rotational speed of 1,500 rpm and aspiration flow rate of 500 ml/min. Further subgroup analysis was performed based on fibroid size:<3 cm and 3-5 cm. Both Groups A and B were similar in terms of patient age, parity, symptoms, myoma type and size. Submucous myomas were classified according to the European Society for Gynaecological Endoscopy classification. All patients underwent a myomectomy with the IBS® under general anaesthesia. The conventional 22 Fr. Bipolar Resectoscope was used in cases requiring conversion to the resection technique. All surgeries were planned, performed and followed by the same surgeon in both institutions.
Main outcome measures: Complete resection rates, total operation time, resection time and used fluid volume.
Results: Complete resection with the IBS® Shaver was seen in 93/107 (86.91%) in Group A versus 83/84 (98.8 %) in Group B (P=0.0021). Five patients (5.8%) in Subgroup A1 (<3 cm) and nine patients (42.9%) in Subgroup A2 (3cm~5cm) could not be finished with the IBS (P<0.001, RR=2.439), while in Group B only one case (8.3%) in Subgroup B2 (3cm~5cm) underwent a conversion to bipolar resectoscope (Group A: 14/107=13.08% vs. Group B: 1/84=1.19%, P=0.0024). For <3cm myomas (subgroup A1 versus B1) there was a statistically significant difference in terms of resection time (7.75±6.363 vs. 17.28±12.19, P<0.001), operation time (17.81 ± 8.18 vs. 28.19 ±17.614, P<0.001) and total amount of fluid used (3365.63 ± 2212.319 ml vs. 5800.00 ± 8422.878 ml, P<0.05) in favour of Subgroup B1. For larger myomas, a statistical difference was only observed for the total operative time (51.00±14.298 min vs. 30.50±12.122 min, P=0.003).
Conclusion: For hysteroscopic myomectomy using the IBS®, 1,500rpm rotational speed and 500ml/min aspiration flow rate are recommended as these settings result in more complete resections compared to the conventional settings. In addition, these settings are associated with a reduction in total operating time.
What is new? Reducing the rotational speed rate from 2500 rpm to 1500 rpm and increasing the aspiration flow rate from 250 ml/min to 500 ml/min improve complete resection rates and reduce operating times.
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Vives M, Hernández A, Carmona P, Villen T, Borrat X, Sánchez E, Nagore D, González AD, Cuesta P, Serna M, Campo R, Bengoetxea U, Mercadal J. Diploma on Basic Echocardiography training and competencies for Intensive Care and Emergency medicine: Consensus document of the Spanish Society of Anesthesiology and Critical Care (SEDAR) and the Spanish Society of Emergency Medicine (SEMES). Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:402-410. [PMID: 35871144 DOI: 10.1016/j.redare.2021.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 05/09/2021] [Indexed: 06/15/2023]
Abstract
Cardiac ultrasound has become an essential tool for diagnosis and hemodynamic monitoring in critically ill patients. Scientific societies need to work toward developing a training program that will allow clinicians to acquire competence in performing cardiac ultrasound and understanding its indications. The Clinical Ultrasound for Intensive Care task force of the Spanish Society of Anesthesiology and Critical Care (SEDAR) and the Spanish Society of Emergency Medicine (SEMES) have drawn up this position statement defining the learning objectives and training required to acquire the competencies recommended for basic ultrasound management in the intensive care and emergency setting in order to obtain a diploma in Basic Ultrasound in Intensive Care and Emergency Medicine. This document defines the training program and the competencies needed for basic skills in ultrasound in Intensive Care and Emergency Medicine-part of the Diploma in Ultrasound for Intensive Care and Emergency Medicine awarded by SEDAR/SEMES. The Spanish Society of Anesthesia (SEDAR), Spanish Society of Internal Medicine (SEMI) and Spanish Society of Emergency Medicine (SEMES) have drawn up a position statement determining the competencies and training program for a diploma in ultrasound (lung, abdominal and vascular) in Intensive Care and Emergency Medicine. To obtain the SEDAR/SEMES Diploma in Ultrasound in Intensive Care and Emergency Medicine, clinicians must have completed the SEDAR, SEMI and SEMES Diploma in basic ultrasound and the Diploma in lung, abdominal, and vascular ultrasound.
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Affiliation(s)
- M Vives
- Co-directores del Grupo de trabajo de Ecografía Clínica en Cuidados Intensivos de la SEDAR; Unidad de Reanimación Posquirúrgica, Servicio de Anestesiología y Reanimación. Hospital Universitario de Girona Dr. J Trueta. Institut d'Investigació Biomèdica de Girona (IDIBGI), Universitat de Girona, Girona, Spain. Representante en España de la «European Association of Cardiothoracic Anesthesia and Intensive Care» (EACTAIC).
| | - A Hernández
- Unidad de Reanimación Posquirúrgica, Servicio de Anestesiología y Reanimación, Grupo Policlínica, Ibiza, Spain. Board member del Subcomité de Cuidados Intensivos de la EACTAIC
| | - P Carmona
- Unidad de Reanimación Posquirúrgica, Servicio de Anestesiología y Reanimación, Hospital Universitario La Fe, Valencia, Spain
| | - T Villen
- Director del Grupo de trabajo de Ecografía Clínica en Urgencias y Emergencias de la SEMES; Servicio de Urgencias, Hospital Universitario La Paz, Madrid, Spain
| | - X Borrat
- Unidad de Cuidados Intensivos Postquirúrgica, Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, Spain
| | - E Sánchez
- Unidad de Reanimación Postquirúrgica, Servicio de Anestesiología y Reanimación, Hospital Gregorio Marañón, Madrid, Spain
| | - D Nagore
- Intensive Care Unit, Department of Anaesthesia & Intensive Care, Barts Heart Center, Barts Health NHS Trust, London, UK
| | - A D González
- Unidad de Cuidados Intensivos, Servicio de Anestesiología y Reanimación, Clínica Universidad de Navarra, Pamplona, Spain
| | - P Cuesta
- Unidad de Reanimación Postquirúrgica, Servicio de Anestesiología y Reanimación, Hospital Universitario de Albacete, Spain
| | - M Serna
- Unidad de Reanimación Postquirúrgica, Servicio de Anestesiología y Reanimación, Hospital Universitario de Denia, Spain
| | - R Campo
- Servicio de Urgencias, Hospital Santa Bárbara de Puertollano, Ciudad Real, Spain
| | - U Bengoetxea
- Unidad de Reanimación Postquirúrgica, Servicio de Anestesiología y Reanimación, Hospital de Urduliz, Bilbao, Spain
| | - J Mercadal
- Co-directores del Grupo de trabajo de Ecografía Clínica en Cuidados Intensivos de la SEDAR; Unidad de Cuidados Intensivos Postquirúrgica, Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, Spain; Coordinador de la Sección de Críticos de la Sociedad Catalana de Anestesiología y Reanimación (SCARDT)
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Ombelet W, Van der Auwera I, Bijnens H, Kremer C, Bruckers L, Mestdagh G, Dhont N, Campo R. Factors influencing pregnancy outcome with special attention to modified slow-release insemination and a patient-centred approach in a donor insemination programme: a prospective cohort study. Facts Views Vis Obgyn 2022; 14:163-170. [DOI: 10.52054/fvvo.14.2.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: A higher pregnancy rate after slow-release insemination instead of bolus injection was described in previous studies. Besides an effective medical treatment most patients wish to receive a patient-centred approach with sufficient emotional support.
Study question: Does a patient-friendly approach with slow-release insemination (SRI) increase the clinical pregnancy rate (CPR) after intrauterine insemination (IUI) with donor semen?
Study design, size, duration: The data of an ongoing prospective cohort study were analysed investigating the results of 1995 donor inseminations in 606 women from July 2011 until December 2018. As from January 2016 the insemination procedure was performed by midwives instead of medical doctors. Instead of bolus injection of sperm a slow-release IUI was done together with a more patient-centred approach.
Materials and Methods: The data of 1995 donor inseminations were analysed to study the importance of different covariates influencing IUI success. Generalized estimating equations (GEEs) were used for statistical analysis. Results of two periods (2011-2015 and 2016-2018) were examined and compared.
Results: Clinical pregnancy rates (with foetal heartbeat) following donor inseminations increased from 16.6 % to 20.8 % per cycle, a non-significant increase (p=0.061).
Conclusion: A more patient-friendly approach with slow-release of processed semen resulted in a non-significant higher clinical pregnancy rate of 4.2 % per cycle after donor insemination.
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Shi J, Zhang Y, Zhang S, Yin X, An D, Zhang J, Cheng J, Wang Y, Zhao A, Di W, Campo R, Bigatti G. Intrauterine Bigatti Shaver (IBS ® ) successful placental remnants removal, after caesarean section for a cervical pregnancy with placenta accreta. Facts Views Vis Obgyn 2022; 14:95-98. [PMID: 35373555 PMCID: PMC9612859 DOI: 10.52054/fvvo.14.1.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Placenta accreta located in a caesarean section scar is difficult to remove. The Intrauterine Bigatti Shaver (IBS®) has already been proven to be effective in placental remnant removal. Our case report highlights that the IBS® is also a safe method to remove placental remnants attached to a previous caesarean section scar performed for a cervical pregnancy and associated with placenta accreta.
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11
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Ombelet W, Bijnens H, Kremer C, Onofre J, Campo R, Bruckers L, Dhont N. 371 Improving iui success after modified slow-release insemination: a prospective cohort study. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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12
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Ombelet W, Van der Auwera I, Bijnens H, Onofre J, Kremer C, Bruckers L, Mestdagh G, Campo R, Dhont N. Improving IUI success by performing modified slow-release insemination and a patient-centred approach in an insemination programme with partner semen: a prospective cohort study. Facts Views Vis Obgyn 2021; 13:359-367. [PMID: 35026097 PMCID: PMC9148711 DOI: 10.52054/fvvo.13.4.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Pregnancy rates after in vitro fertilisation (IVF) treatment continue to improve, while intrauterine insemination (IUI) programmes show no such trend. There is a need to improve success rates with IUI to retain it as a viable option for couples who prefer avoiding IVF as a first line treatment. Objective To investigate if a modified slow-release insemination (SRI) increases the clinical pregnancy rate (CPR) after intrauterine insemination (IUI) with partner semen. Materials and Methods This was a prospective cohort study in a Belgian tertiary fertility centre. Between July 2011 and December 2018, we studied data from an ongoing prospective cohort study including 989 women undergoing 2565 IUI procedures for unexplained or mild/moderate male infertility. These data were analysed in order to study the importance of different covariates influencing IUI success. Generalised estimating equations (GEEs) were used for statistical analysis. Results of two periods (2011-2015, period 1 and 2016-2018, period 2) were examined and compared. From January 2016 (period 2) onwards, a standardised SRI procedure instead of bolus injection of sperm was applied. The primary outcome parameter was the difference in clinical pregnancy rate (CPR) per cycle between period 1 (bolus IUI) and period 2 (modified SRI). Secondary outcome results included all other parameters significantly influencing CPR after IUI. Results Following the application of modified SRI the CPR increased significantly, from 9.03% (period 1) to 13.52% (period 2) (p = 0.0016). Other covariates significantly influencing CPR were partner’s age, smoking/ non-smoking partner, BMI patient, ovarian stimulation protocol and Inseminating Motile Count (after semen processing). Conclusion The intentional application of modified slow-release of processed semen appears to significantly increase CPRs after IUI with homologous semen. Future studies should investigate whether SRI, patient-centred measures, or a combination of both, are responsible for this improvement.
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13
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Carugno J, Grimbizis G, Franchini M, Alonso L, Bradley L, Campo R, Catena U, De Angelis C, Di Spiezio Sardo A, Farrugia M, Haimovich S, Isaacson K, Moawad N, Saridogan E, Clark TJ. International Consensus Statement for recommended terminology describing hysteroscopic procedures. Facts Views Vis Obgyn 2021; 13:287-294. [PMID: 34647447 PMCID: PMC9148713 DOI: 10.52054/fvvo.13.4.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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14
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Machlab S, Martínez-Bauer E, López P, Piqué N, Puig-Diví V, Junquera F, Lira A, Brullet E, Selva A, García-Iglesias P, Calvet X, Campo R. Comparable quality of bowel preparation with single-day versus three-day low-residue diet: Randomized controlled trial. Dig Endosc 2021; 33:797-806. [PMID: 33015912 DOI: 10.1111/den.13860] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/23/2020] [Accepted: 09/28/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND AIMS There is controversy about the length of low-residue diet (LRD) for colonoscopy preparation. The aim of the study was to compare one-day vs. three-day LRD associated to standard laxative treatment for achieving an adequate colonoscopy preparation in average risk subjects with positive fecal immunochemical test undergoing screening colonoscopy. METHODS A non-inferiority, randomized, controlled, parallel-group clinical trial was performed in the setting of average risk colorectal cancer screening program. Participants were randomized to receive 1-day vs. 3-day LRD in addition to standard polyethilenglicol treatment. Adequacy of preparation was evaluated using the Boston Bowel Preparation Scale (BBPS). Primary outcome was achieving a BBPS ≥ 2 in all colon segments. Analysis was performed for a non-inferiority margin of 5%, a 95% statistical power and one-sided 0.05 significance level. RESULTS A total of 855 patients were randomized. Adequate bowel preparation was similar between groups: 97.9% of patients in the 1-day LRD group vs 96.9% in the 3-day LRD group achieved the primary outcome (P-value for non-inferiority < 0.001). The percentage of patients with BBPS scores ≥ 8 was superior in the 1-day LRD group (254 vs 221 in the 3-day LRD group, P = 0.032). The 1-day regimen was better tolerated than the 3-day diet. 47.7% (vs 28.7%, P < 0.05) of patients rated the 1-day LRD as very easy to follow. CONCLUSION The 1-day LRD is non-inferior to 3-day LRD for achieving an adequate colon cleansing before average risk screening colonoscopy and it is better tolerated.
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Affiliation(s)
- Salvador Machlab
- Gastroenterology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eva Martínez-Bauer
- Gastroenterology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Pilar López
- Clinical Epidemiology and Cancer Screening, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Barcelona, Spain
| | - Núria Piqué
- Microbiology Section, Department of Biology, Healthcare and Environment, Faculty of Pharmacy and Food Sciences, Universitat de Barcelona (UB), Barcelona, Spain.,Institut de Recerca en Nutrició i Seguretat Alimentària de la UB (INSA-UB), Universitat de Barcelona (UB), Barcelona, Spain
| | - Valentí Puig-Diví
- Gastroenterology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Barcelona, Spain
| | - Félix Junquera
- Gastroenterology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Alba Lira
- Gastroenterology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Barcelona, Spain
| | - Enric Brullet
- Gastroenterology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Barcelona, Spain
| | - Anna Selva
- Clinical Epidemiology and Cancer Screening, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Barcelona, Spain
| | - Pilar García-Iglesias
- Gastroenterology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Barcelona, Spain
| | - Xavier Calvet
- Gastroenterology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Rafel Campo
- Gastroenterology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Parc Taulí Hospital Universitari, Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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15
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Gordts S, Gordts S, Puttemans P, Segaert I, Valkenburg M, Campo R. Systematic use of transvaginal hydrolaparoscopy as a minimally invasive procedure in the exploration of the infertile patient: results and reflections. Facts Views Vis Obgyn 2021; 13:131-140. [PMID: 34184842 PMCID: PMC8291988 DOI: 10.52054/fvvo.13.2.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background The aim of this study was to evaluate the added value of transvaginal hydrolaparoscopy (THL) in the investigation of the infertile patient. Methods A retrospective cohort study, based on records from 01/09/2006 to 30/12/2019 was undertaken in a tertiary care infertility centre. THL was performed in 2288 patients. These were patients who were referred for endoscopic exploration of the female pelvis as part of their infertility investigation. In 374 patients with clomiphene- resistant polycystic ovary syndrome (PCOS), ovarian capsule drilling was also performed. The outcome objectives of this study included the evaluation of the added diagnostic value of THL as well as the feasibility and safety of the visual inspection of the female pelvis using this technique. Results Of the 2288 procedures failed access to the pouch of Douglas occurred in in 23 patients (1%). The complication rate was 0.74%, due to bowel perforations (n= 13) and bleeding (n= 4) requiring laparoscopy. All bowel perforations were treated conservatively, with 6 days of antibiotics, and no further complications occurred. Findings were normal in 49.8% of patients. Endometriosis was diagnosed in 366 patients (15.9%); adhesions were present in 144 patients. Conclusions THL is a minimally invasive procedure, with a low complication and failure rate, providing an accurate visual exploration of the female pelvis in a one-day hospital setting. When indicated, minimally invasive surgery is possible in the early stages of endometriosis and for ovarian capsule drilling in patients with clomiphene- resistant PCOS.
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16
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Catena U, Campo R, Bolomini G, Moruzzi M, Verdecchia V, Nardelli F, Romito I, Camolo F, La Manna V, Ianieri M, Scambia G, Testa A. New approach for T-shaped uterus: Metroplasty with resection of lateral fibromuscular tissue using a 15 Fr miniresectoscope. A step-by-step technique. Facts Views Vis Obgyn 2021. [DOI: 10.52054/fvvo.13.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
T-shaped uterus is a congenital uterine malformation (CUM), only recently defined by the ESGE ESHRE classification as Class U1a. The uterus is characterised by a narrow uterine cavity due to thickened lateral walls with a correlation 2/3 uterine corpus and 1/3 cervix (Grimbizis et al, 2013). Although the significance of this dysmorphic malformation on reproductive performance has been questioned, recent studies reported significant improvement of life birth rates after surgical correction in patients with failed in-vitro fertilisation (IVF) or recurrent miscarriage (Ferro et al, 2018; Di Spiezio Sardo et al, 2020; Alonso Pacheco et al. 2019). The classical surgical technique to treat a T-shaped uterus is by performing a sidewall incision with the micro scissor or bipolar needle, resulting in a triangular cavity.
In this video article, we describe a new surgical technique with a step-by-step method combining three-dimensional ultrasound (3D-US) and hysteroscopic metroplasty in an office setting, using a 15 Fr office resectoscope (Karl Storz, Tuttlingen, Germany), to treat a T-shaped uterus by resecting the lateral fibromuscular tissue of the uterine walls. No complications occurred and the postoperative hysteroscopy showed a triangular and symmetrical uterine cavity without any adhesions.
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Affiliation(s)
- U. Catena
- Department of Women’s and Children’s Health, Fondazione Policlinico Universitario “A. Gemelli”- IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - R. Campo
- Department of Obstetrics and Gynecology, ZOL Hospitals, Genk, Belgium
| | - G. Bolomini
- Department of Women’s and Children’s Health, Fondazione Policlinico Universitario “A. Gemelli”- IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - M.C. Moruzzi
- Department of Women’s and Children’s Health, Fondazione Policlinico Universitario “A. Gemelli”- IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - V. Verdecchia
- Department of Women’s and Children’s Health, Fondazione Policlinico Universitario “A. Gemelli”- IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - F. Nardelli
- Department of Women’s and Children’s Health, Fondazione Policlinico Universitario “A. Gemelli”- IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - I. Romito
- Department of Women’s and Children’s Health, Fondazione Policlinico Universitario “A. Gemelli”- IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - F. Camolo
- Department of Women’s and Children’s Health, Fondazione Policlinico Universitario “A. Gemelli”- IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - V. La Manna
- Department of Women’s and Children’s Health, Fondazione Policlinico Universitario “A. Gemelli”- IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - M.M. Ianieri
- Department of Women’s and Children’s Health, Fondazione Policlinico Universitario “A. Gemelli”- IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - G. Scambia
- Department of Women’s and Children’s Health, Fondazione Policlinico Universitario “A. Gemelli”- IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy; Istituto di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A.C. Testa
- Department of Women’s and Children’s Health, Fondazione Policlinico Universitario “A. Gemelli”- IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy; 3Istituto di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
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17
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Catena U, Campo R, Bolomini G, Moruzzi MC, Verdecchia V, Nardelli F, Romito I, Camolo F, La Manna V, Ianieri MM, Scambia G, Testa AC. New approach for T-shaped uterus: Metroplasty with resection of lateral fibromuscular tissue using a 15 Fr miniresectoscope. A step-by-step technique. Facts Views Vis Obgyn 2021; 13:67-71. [PMID: 33889862 PMCID: PMC8051189 DOI: 10.52054/fvvo.13.1.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
T-shaped uterus is a congenital uterine malformation (CUM), only recently defined by the ESGE ESHRE classification as Class U1a. The uterus is characterised by a narrow uterine cavity due to thickened lateral walls with a correlation 2/3 uterine corpus and 1/3 cervix. Although the significance of this dysmorphic malformation on reproductive performance has been questioned, recent studies reported significant improvement of life birth rates after surgical correction in patients with failed in-vitro fertilisation (IVF) or recurrent miscarriage. The classical surgical technique to treat a T-shaped uterus is by performing a sidewall incision with the micro scissor or bipolar needle, resulting in a triangular cavity. In this video article, we describe a new surgical technique with a step-by-step method combining three- dimensional ultrasound (3D-US) and hysteroscopic metroplasty in an office setting, using a 15 Fr office resectoscope (Karl Storz, Tuttlingen, Germany), to treat a T-shaped uterus by resecting the lateral fibromuscular tissue of the uterine walls. No complications occurred and the postoperative hysteroscopy showed a triangular and symmetrical uterine cavity without any adhesions.
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Affiliation(s)
- U Catena
- Department of Women's and Children's Health, Fondazione Policlinico Universitario "A. Gemelli"- IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - R Campo
- Department of Obstetrics and Gynecology, ZOL Hospitals, Genk, Belgium
| | - G Bolomini
- Department of Women's and Children's Health, Fondazione Policlinico Universitario "A. Gemelli"- IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - M C Moruzzi
- Department of Women's and Children's Health, Fondazione Policlinico Universitario "A. Gemelli"- IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - V Verdecchia
- Department of Women's and Children's Health, Fondazione Policlinico Universitario "A. Gemelli"- IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - F Nardelli
- Department of Women's and Children's Health, Fondazione Policlinico Universitario "A. Gemelli"- IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - I Romito
- Department of Women's and Children's Health, Fondazione Policlinico Universitario "A. Gemelli"- IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - F Camolo
- Department of Women's and Children's Health, Fondazione Policlinico Universitario "A. Gemelli"- IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - V La Manna
- Department of Women's and Children's Health, Fondazione Policlinico Universitario "A. Gemelli"- IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - M M Ianieri
- Department of Women's and Children's Health, Fondazione Policlinico Universitario "A. Gemelli"- IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - G Scambia
- Department of Women's and Children's Health, Fondazione Policlinico Universitario "A. Gemelli"- IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy.,Istituto di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A C Testa
- Department of Women's and Children's Health, Fondazione Policlinico Universitario "A. Gemelli"- IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy.,Istituto di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
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18
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Onofre J, Geenen L, Cox A, Van Der Auwera I, Willendrup F, Andersen E, Campo R, Dhont N, Ombelet W. Simplified sperm testing devices: a possible tool to overcome lack of accessibility and inconsistency in male factor infertility diagnosis. An opportunity for low- and middle- income countries. Facts Views Vis Obgyn 2021; 13:79-93. [PMID: 33889864 PMCID: PMC8051200 DOI: 10.52054/fvvo.13.1.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background Manual semen assessment (MSA) is a key component in a male’s fertility assessment. Clinicians rely on it to make diagnostic and treatment decisions. When performed manually, this routine laboratory test is prone to variability due to human intervention which can lead to misdiagnosis and consequently over- or under- treatment. For standardisation, continuous training, quality control (QC) programs and pricy Computer-Assisted Sperm Analysis (CASA) systems have been proposed, yet, without resolving intra- and inter-laboratory variability. In response, promising simplified sperm testing devices, able to provide cost-effective point-of-care male infertility diagnosis are prospected as a plausible solution to resolve variability and increase access to sperm testing. Materials and methods A throughout literature research for semen testing, sperm analysis, smart-phone assisted semen analysis, ‘at-home’ semen testing, male infertility, infertility in developing countries, infertility in low- and middle-income countries (LMIC) and quantitative sperm analysis was performed. A total of 14 articles, specific to ‘at-home’ simplified sperm assessment, were included to treat the core subject. Results Continuous training and consistent QC, are sine qua none conditions to achieve accurate and comparable MSA. Compliance does not rule-out variability, nevertheless. Emerging simplified sperm assessment devices are an actual alternative to resolve the lack of standardisation and accessibility to sperm analysis. YO ® , SEEM ® , and ExSeed ® are commercially available, user-friendly smartphone-based devices which can accurately measure volume, sperm concentration (millions/ml) and total motile sperm count. More broadly, by cost-effectiveness, availability, accuracy and convenient application, these devices could effectively select patients for first-line artificial reproduction treatments such as intrauterine insemination. Conclusions Accuracy and cost-effectiveness make smart-phone based sperm testing devices a practical and realistic solution to overcome variability in MSA. Importantly, these tools represent an actual opportunity to standardise and improve male subfertility diagnosis and treatment, especially in LMIC. However, before clinical application is possible, guidelines, further testing with special attention on accuracy in washed sperm, availability, cost-benefit and reliability are required.
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Affiliation(s)
- J Onofre
- Genk Institute for Fertility Technology, Genk, Belgium.,Department of Obstetrics, Gynaecology and Infertility, Ziekenhuis Oost Limburg, Genk, Belgium
| | - L Geenen
- University of Hasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - A Cox
- Department of Obstetrics, Gynaecology and Infertility, Ziekenhuis Oost Limburg, Genk, Belgium
| | - I Van Der Auwera
- Department of Obstetrics, Gynaecology and Infertility, Ziekenhuis Oost Limburg, Genk, Belgium
| | | | | | - R Campo
- Genk Institute for Fertility Technology, Genk, Belgium.,Department of Obstetrics, Gynaecology and Infertility, Ziekenhuis Oost Limburg, Genk, Belgium
| | - N Dhont
- Genk Institute for Fertility Technology, Genk, Belgium.,Department of Obstetrics, Gynaecology and Infertility, Ziekenhuis Oost Limburg, Genk, Belgium
| | - W Ombelet
- Genk Institute for Fertility Technology, Genk, Belgium.,Department of Obstetrics, Gynaecology and Infertility, Ziekenhuis Oost Limburg, Genk, Belgium
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Vives M, Hernández A, González AD, Torres J, Cuesta P, Villen T, Carmona P, Nagore D, Serna M, Bengoetxea U, Borrat X, García de Casasola G, Sánchez E, Campo R, Mercadal J. Diploma on Ultrasound training and competency for Intensive Care and Emergency Medicine: Consensus document of the Spanish Society of Anesthesia (SEDAR), Spanish Society of Internal Medicine (SEMI) and Spanish Society of Emergency Medicine (SEMES). Rev Esp Anestesiol Reanim (Engl Ed) 2021; 68:143-148. [PMID: 33172655 DOI: 10.1016/j.redar.2020.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 06/11/2023]
Abstract
The use of ultrasound as a clinical diagnostic tool and guide of bedside procedures has become an indispensable examination in the acute critically ill patient. The training of professionals in minimum skills of knowledge, management and indications of use of ultrasound required to be defined by the Scientific Societies. The Intensive Care Ultrasound Working Group of the Spanish Society of Anesthesiology and Resuscitation (SEDAR), of the Spanish Society of Internal Medicine (SEMI) and the Spanish Society of Emergency Medicine (SEMES) has developed this consensus document in which the recommended training program and the minimum competencies to be achieved with regard to the use of Ultrasound in Intensive Care, Anesthesia and Emergency medicine are defined. This document defines the training program and the skills to acquire in order to achieve the diploma in lung, abdominal and vascular ultrasound. This document can serve as a guide to define the skills to be acquired in the training programs of residents (MIRs) of specialists working in intensive care, anesthesia, and emergency medicine.
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Affiliation(s)
- M Vives
- Co-director del grupo de trabajo de Ecografía Clínica en Cuidados Intensivos de la SEDAR; Servicio de Anestesia y Reanimación, Hospital Universitario de Girona Dr. J. Trueta. Universidad de Girona, Girona, España.
| | - A Hernández
- Servicio de Anestesia y Reanimación, Grupo Policlínica, Ibiza, España
| | - A D González
- Servicio de Anestesia y Reanimación, Clínica Universidad de Navarra, Pamplona, España
| | - J Torres
- Servicio de Medicina Interna, Hospital Universitario Infanta Cristina Parla, Madrid, España; Co-director del grupo de trabajo de Ecografía Clínica de la SEMI
| | - P Cuesta
- Servicio de Anestesia y Reanimación, Hospital Universitario de Albacete, Albacete, España
| | - T Villen
- Servicio de Urgencias, Hospital Universitario La Paz, Madrid, España; Director del grupo de trabajo de Ecografía Clínica de la SEMES
| | - P Carmona
- Servicio de Anestesia y Reanimación, Hospital Universitario La Fe, Valencia, España
| | - D Nagore
- Department of Anaesthesia & Intensive Care, Barts Heart Center. Barts Health NHS Trust, London, Reino Unido
| | - M Serna
- Servicio de Anestesia y Reanimación, Hospital Universitario de Denia, Denia, Alicante, España
| | - U Bengoetxea
- Servicio de Anestesia y Reanimación, Hospital de Urduliz, Bilbao, España
| | - X Borrat
- Servicio de Anestesia y Reanimación, Hospital Clínic de Barcelona, Barcelona, España
| | - G García de Casasola
- Servicio de Medicina Interna, Hospital Universitario Infanta Cristina. Parla, Madrid, España; Co-director del grupo de trabajo de Ecografía Clínica de la SEMI
| | - E Sánchez
- Servicio de Anestesia y Reanimación, Hospital Gregorio Marañón, Madrid, España
| | - R Campo
- Servicio de Urgencias, Hospital Santa Bárbara de Puertollano, Ciudad Real, España
| | - J Mercadal
- Co-director del grupo de trabajo de Ecografía Clínica en Cuidados Intensivos de la SEDAR; Servicio de Anestesia y Reanimación, Hospital Clinic de Barcelona, Barcelona, España
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Argay IM, Lawrence T, Afors K, Centini G, Lazzeri L, Habib N, Amoruso N, Zupi E, Campo R, Wattiez A. 1 vs 3 days laparoscopic suturing courses: is it feasible to design a valid training curriculum? Facts Views Vis Obgyn 2020; 12:163-168. [PMID: 33123691 PMCID: PMC7580269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Laparoscopic skills are unlikely to be achieved exclusively in the operating theatre, so simulation training has become mandatory to acquire specific psychomotor skills to be merged in a more complex procedure. OBJECTIVE To compare 3-day vs. 1-day laparoscopic suturing courses and to better address participants' needs according to their level of experience. METHODS Observational cohort study conducted between January 2017 and December 2018 including 107 participants amongst which 61 attended a 3-day and 46 the 1-day suturing course. RESULTS Data analysis showed no significant difference in the pre-test suturing scores between the two groups. On each course, when comparing the pre- and post-tests results, the participants reached a statistically significant improvement in both precision and knotting score (p< 0.01). However, when comparing the two types of courses, the data showed a better performance in the post-session test for those attending the 3-day course (p<0.05), as well as a higher mean score improvement (4.7 vs. 2.8; p<0.05) and time needed to complete exercises (-270s vs. -150s; p<0.05). Furthermore, grouping the participants according to their experience, the experts achieved a significantly better improvement attending the 3-day course, when compared to the beginners. CONCLUSIONS Both 3 and 1-day course are successful in improving laparoscopic suturing skills regardless of the participant's experience. However experienced participants benefit more from a longer course while the 1-day one should be dedicated to pre-surgical competences acquisition.
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Affiliation(s)
- IM Argay
- University of Debrecen Clinical Center, Department of Obstetrics and Gynaecology, H-4032 Debrecen, Nagyerdei Krt. 98, Hungary
| | - T Lawrence
- Department of Obstetrics and Gynaecology, Whittington Hospital, London, United Kingdom
| | - K Afors
- Department of Obstetrics and Gynaecology, Whittington Hospital, London, United Kingdom
| | - G Centini
- Department of Molecular and Developmental medicine, University of Siena, Siena, Italy
| | - L Lazzeri
- Department of Molecular and Developmental medicine, University of Siena, Siena, Italy
| | - N Habib
- Obstetrics and Gynaecology Service, Beaujon Teaching Hospital, Clichy and Paris Diderot University, Clichy, France
| | - N Amoruso
- Department of Molecular and Developmental medicine, University of Siena, Siena, Italy
| | - E Zupi
- Department of Molecular and Developmental medicine, University of Siena, Siena, Italy
| | - R Campo
- Life Expert Centre, Tiensevest 168, 3000 Leuven, Belgium
| | - A Wattiez
- Latifa Hospital, Dubai, United Arab Emirates
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21
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Argiz L, Reyes C, Belmonte M, Franchi O, Campo R, Fra-Vázquez A, Val Del Río A, Mosquera-Corral A, Campos JL. Assessment of a fast method to predict the biochemical methane potential based on biodegradable COD obtained by fractionation respirometric tests. J Environ Manage 2020; 269:110695. [PMID: 32425161 DOI: 10.1016/j.jenvman.2020.110695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/29/2020] [Accepted: 05/03/2020] [Indexed: 06/11/2023]
Abstract
The biochemical methane potential test (BMP) is the most common analytical technique to predict the performance of anaerobic digesters. However, this assay is time-consuming (from 20 to over than 100 days) and consequently impractical when it is necessary to obtain a quick result. Several methods are available for faster BMP prediction but, unfortunately, there is still a lack of a clear alternative. Current aerobic tests underestimate the BMP of substrates since they only detect the easily biodegradable COD. In this context, the potential of COD fractionation respirometric assays, which allow the determination of the particulate slowly biodegradable fraction, was evaluated here as an alternative to early predict the BMP of substrates. Seven different origin waste streams were tested and the anaerobically biodegraded organic matter (CODmet) was compared with the different COD fractions. When considering adapted microorganisms, the appropriate operational conditions and the required biodegradation time, the differences between the CODmet, determined through BMP tests, and the biodegradable COD (CODb) obtained by respirometry, were not significant (CODmet (57.8026 ± 21.2875) and CODb (55.6491 ± 21.3417), t (5) = 0.189, p = 0.853). Therefore, results suggest that the BMP of a substrate might be early predicted from its CODb in only few hours. This methodology was validated by the performance of an inter-laboratory studyconsidering four additional substrates.
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Affiliation(s)
- L Argiz
- CRETUS Institute, Universidade de Santiago de Compostela, 15782, Santiago de Compostela, Galicia, Spain.
| | - C Reyes
- Laboratorio de Biotecnología, Medio Ambiente e Ingeniería (LABMAI), Facultad de Ingeniería, Universidad de Playa Ancha, Avda. Leopoldo Carvallo 270, 2340000, Valparaíso, Chile
| | - M Belmonte
- Laboratorio de Biotecnología, Medio Ambiente e Ingeniería (LABMAI), Facultad de Ingeniería, Universidad de Playa Ancha, Avda. Leopoldo Carvallo 270, 2340000, Valparaíso, Chile
| | - O Franchi
- Facultad de Ingeniería y Ciencias, Universidad Adolfo Ibáñez, Avda. Padre Hurtado 750, Viña del Mar, Chile
| | - R Campo
- Dipartimento di Ingegneria Civile e Ambientale (DICEA), Università degli Studi Firenze, Via di Santa Marta, 3, 50139, Firenze, Italy
| | - A Fra-Vázquez
- CRETUS Institute, Universidade de Santiago de Compostela, 15782, Santiago de Compostela, Galicia, Spain
| | - A Val Del Río
- CRETUS Institute, Universidade de Santiago de Compostela, 15782, Santiago de Compostela, Galicia, Spain
| | - A Mosquera-Corral
- CRETUS Institute, Universidade de Santiago de Compostela, 15782, Santiago de Compostela, Galicia, Spain
| | - J L Campos
- Facultad de Ingeniería y Ciencias, Universidad Adolfo Ibáñez, Avda. Padre Hurtado 750, Viña del Mar, Chile
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22
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Inan OT, Tenaerts P, Prindiville SA, Reynolds HR, Dizon DS, Cooper-Arnold K, Turakhia M, Pletcher MJ, Preston KL, Krumholz HM, Marlin BM, Mandl KD, Klasnja P, Spring B, Iturriaga E, Campo R, Desvigne-Nickens P, Rosenberg Y, Steinhubl SR, Califf RM. Digitizing clinical trials. NPJ Digit Med 2020; 3:101. [PMID: 32821856 PMCID: PMC7395804 DOI: 10.1038/s41746-020-0302-y] [Citation(s) in RCA: 140] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/19/2020] [Indexed: 01/31/2023] Open
Abstract
Clinical trials are a fundamental tool used to evaluate the efficacy and safety of new drugs and medical devices and other health system interventions. The traditional clinical trials system acts as a quality funnel for the development and implementation of new drugs, devices and health system interventions. The concept of a "digital clinical trial" involves leveraging digital technology to improve participant access, engagement, trial-related measurements, and/or interventions, enable concealed randomized intervention allocation, and has the potential to transform clinical trials and to lower their cost. In April 2019, the US National Institutes of Health (NIH) and the National Science Foundation (NSF) held a workshop bringing together experts in clinical trials, digital technology, and digital analytics to discuss strategies to implement the use of digital technologies in clinical trials while considering potential challenges. This position paper builds on this workshop to describe the current state of the art for digital clinical trials including (1) defining and outlining the composition and elements of digital trials; (2) describing recruitment and retention using digital technology; (3) outlining data collection elements including mobile health, wearable technologies, application programming interfaces (APIs), digital transmission of data, and consideration of regulatory oversight and guidance for data security, privacy, and remotely provided informed consent; (4) elucidating digital analytics and data science approaches leveraging artificial intelligence and machine learning algorithms; and (5) setting future priorities and strategies that should be addressed to successfully harness digital methods and the myriad benefits of such technologies for clinical research.
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Affiliation(s)
- O. T. Inan
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332 USA
| | - P. Tenaerts
- Clinical Trials Transformation Initiative, Duke University, Durham, NC 27708 USA
| | - S. A. Prindiville
- Coordinating Center for Clinical Trials, Office of the Director, National Cancer Institute at the National Institutes of Health, Bethesda, MD 20892 USA
| | - H. R. Reynolds
- School of Medicine, New York University, New York, NY 10003 USA
| | - D. S. Dizon
- The Lifespan Cancer Institute, Brown University, Providence, RI 02912 USA
| | - K. Cooper-Arnold
- National, Heart, Lung and Blood Institute at the National Institutes of Health, Bethesda, MD 20892 USA
- Present Address: Fortira at AstraZeneca, Gaithersburg, MD 20877 USA
| | - M. Turakhia
- VA Palo Alto Health Care System and the Center for Digital Health, Stanford University, Stanford, CA 94305 USA
| | - M. J. Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA 94143 USA
| | - K. L. Preston
- Intramural Research Program of the National Institute on Drug Abuse at the National Institutes of Health, Baltimore, MD 21224 USA
| | - H. M. Krumholz
- The Center for Outcomes Research, Yale New Haven Hospital, Yale University, New Haven, CT 06510 USA
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510 USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut 06510 USA
| | - B. M. Marlin
- College of Information and Computer Sciences, University of Massachusetts at Amherst, Amherst, MA 01003 USA
| | - K. D. Mandl
- Computational Health Informatics Program at Boston Children’s Hospital, Departments of Biomedical Informatics and Pediatrics, Harvard Medical School, Boston, MA 02115 USA
| | - P. Klasnja
- School of Information, University of Michigan, Ann Arbor, MI 48109 USA
| | - B. Spring
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611 USA
| | - E. Iturriaga
- National Heart, Lung, and Blood Institute at the National Institutes of Health, Bethesda, MD 20892 USA
| | - R. Campo
- National Heart, Lung, and Blood Institute at the National Institutes of Health, Bethesda, MD 20892 USA
| | - P. Desvigne-Nickens
- National Heart, Lung, and Blood Institute at the National Institutes of Health, Bethesda, MD 20892 USA
| | - Y. Rosenberg
- National Heart, Lung, and Blood Institute at the National Institutes of Health, Bethesda, MD 20892 USA
| | - S. R. Steinhubl
- Scripps Research Translational Institute, La Jolla, CA 92037 USA
| | - R. M. Califf
- School of Medicine, Duke University, Durham, NC 27710 USA
- Verily Life Sciences and Google Health, South San Francisco, CA 94080 USA
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23
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Watrelot AA, Tanos V, Grimbizis G, Saridogan E, Campo R, Wattiez A. From complication to litigation: The importance of non-technical skills in the management of complications. Facts Views Vis Obgyn 2020; 12:133-139. [PMID: 32832928 PMCID: PMC7431200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Complications do occur in daily clinical life and can sometimes lead to litigation, which adversely affect the entire health care system, leading to a loss of confidence in medical providers, an increase in defensive medical practice and high professional indemnity insurance costs. Some complications are inevitable but can be minimised by completing a structured training programme. The likelihood of litigation can be reduced when adequate and clear information is given to the patient preoperatively. Non-technical skills are essential in complication management and crucial if confronted with litigation. Checklists and documentation of medication and surgical steps should be routine in all surgeries. Awareness of the complexity of the planned operation, theatre set-up and equipment are important in preventing complications. Mental preparation of surgeons is of the utmost importance in order to be able to confront any problem. When complications occur, remaining calm, calling for assistance, effective team leadership and harmony in the team are important in managing the situation. Good and effective communication with the patient and relatives, offering explanations, apologies and timely intervention without delays reduce the risk of litigation and strengthen any defence in court.
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Affiliation(s)
| | | | - V Tanos
- Nicosia University Medical School and Aretaeio Hospital, Nicosia, Cyprus
| | | | - E Saridogan
- University College London Hospital, London, United Kingdom
| | - R Campo
- Life Center, Leuven, Belgium
| | - A Wattiez
- Latifa Hospital, Dubai, United Arab Emirates
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Alves A, Alonso R, Cuevas A, Margarida AM, Pereira C A, Jannes E C, J. Krieger E, Arroyo R, Schreier L, Corral P, Bañares G V, Araujo M, Asenjo S, Stoll M, Dell'Oca N, Reyes X, Ressia A, Campo R, Merchan A, Magaña-Torres Teresa M, Vasques-Cardenas N A, Mata P, Santos R, Bourbon M. Molecular Aspects Of Homozygous Familial Hypercholesterolemia In Ibero-American Countries. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Fernández-Bañares F, Clèries R, Boadas J, Ribes J, Oliva JC, Alsius A, Sanz X, Martínez-Bauer E, Galter S, Pujals M, Pujol M, Del Pozo P, Campo R. Prediction of advanced colonic neoplasm in symptomatic patients: a scoring system to prioritize colonoscopy (COLONOFIT study). BMC Cancer 2019; 19:734. [PMID: 31345180 PMCID: PMC6659265 DOI: 10.1186/s12885-019-5926-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/11/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Fast-track colonoscopy to detect patients with colorectal cancer based on high-risk symptoms is associated with low sensitivity and specificity. The aim was to derive a predictive score of advanced colonic neoplasia in symptomatic patients in fast-track programs. METHODS All patients referred for fast-track colonoscopy were evaluated. Faecal immunological haemoglobin test (3 samples; positive> 4 μg Hb/g), and a survey to register clinical variables of interest were performed. Colorectal cancer and advanced adenoma were considered as advanced colonic neoplasia. A sample size of 600 and 500 individuals were calculated for each phase 1 and phase 2 of the study, respectively (Phase 1, derivation and Phase 2, validation cohort). A Bayesian logistic regression analysis was used to derive a predictive score. RESULTS 1495 patients were included. Age (OR, 21), maximum faecal-Hb value (OR, 2.3), and number of positive samples (OR, 28) presented the highest ORs predictive of advanced colonic neoplasia. The additional significant predictive variables adjusted for age and faecal-Hb variables in Phase 1 were previous colonoscopy (last 5 years) and smoking (no, ex/active). With these variables a predictive score of advanced colonic neoplasia was derived. Applied to Phase 2, patients with a Score > 20 had an advanced colonic neoplasia probability of 66% (colorectal cancer, 32%), while those with a Score ≤ 10, a probability of 10% (colorectal cancer, 1%). Prioritizing patients with Score > 10, 49.4% of patients would be referred for fast-track colonoscopy, diagnosing 98.3% of colorectal cancers and 77% of advanced adenomas. CONCLUSIONS A scoring system was derived and validated to prioritize fast-track colonoscopies according to risk, which was efficient, simple, and robust.
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Affiliation(s)
- Fernando Fernández-Bañares
- Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Plaza Dr Robert 5, 08221, Terrassa, Barcelona, Spain. .,Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto Salud Carlos III, Madrid, Spain.
| | - Ramon Clèries
- Pla Director d'Oncologia, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jaume Boadas
- Department of Gastroenterology, Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain
| | - Josepa Ribes
- Pla Director d'Oncologia, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Joan Carles Oliva
- Pla Director d'Oncologia, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Xavier Sanz
- Pla Director d'Oncologia, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Eva Martínez-Bauer
- Department of Gastroenterology, Hospital Parc Taulí, Sabadell, Barcelona, Spain
| | - Sara Galter
- Department of Gastroenterology, Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain
| | - Mar Pujals
- Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Plaza Dr Robert 5, 08221, Terrassa, Barcelona, Spain
| | - Marta Pujol
- Department of Gastroenterology, Hospital Parc Taulí, Sabadell, Barcelona, Spain
| | - Patricia Del Pozo
- Department of Gastroenterology, Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain
| | - Rafel Campo
- Department of Gastroenterology, Hospital Parc Taulí, Sabadell, Barcelona, Spain
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26
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Carrera P, Campo R, Méndez R, Di Bella G, Campos JL, Mosquera-Corral A, Val Del Rio A. Does the feeding strategy enhance the aerobic granular sludge stability treating saline effluents? Chemosphere 2019; 226:865-873. [PMID: 30978598 DOI: 10.1016/j.chemosphere.2019.03.127] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 03/11/2019] [Accepted: 03/19/2019] [Indexed: 06/09/2023]
Abstract
The development and stability of aerobic granular sludge (AGS) was studied in two Sequencing Batch Reactors (SBRs) treating fish canning wastewater. R1 cycle comprised a fully aerobic reaction phase, while R2 cycle included a plug-flow anaerobic feeding/reaction followed by an aerobic reaction phase. The performance of the AGS reactors was compared treating the same effluents with variable salt concentrations (4.97-13.45 g NaCl/L) and organic loading rates (OLR, 1.80-6.65 kg CODs/(m3·d)). Granulation process was faster in R2 (day 34) than in R1 (day 90), however the granular biomass formed in the fully aerobic configuration was more stable to the variable feeding composition. Thus, in R1 solid retention times (SRT), up to 15.2 days, longer than in R2, up to 5.8 days, were achieved. These long SRTs values helped the retention of nitrifying organisms and provoked the increase of the nitrogen removal efficiency to 80% in R1 while it was approximately of 40% in R2. However, the presence of an anaerobic feeding/reaction phase increased the organic matter removal efficiency in R2 (80-90%) which was higher than in R1 with a fully aerobic phase (75-85%). Furthermore, in R2 glycogen-accumulating organisms (GAOs) dominated inside the granules instead of phosphorous-accumulating organisms (PAOs), suggesting that GAOs resist better the stressful conditions of a variable and high-saline influent. In terms of AGS properties an anaerobic feeding/reaction phase is not beneficial, however it enables the production of a better quality effluent.
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Affiliation(s)
- P Carrera
- Department of Chemical Engineering, School of Engineering, Universidade de Santiago de Compostela, E-15782, Santiago de Compostela, Galicia, Spain.
| | - R Campo
- Dipartimento di Ingegneria Civile e Ambientale - DICEA, Università degli Studi di Firenze, 50139 Firenze, Italy.
| | - R Méndez
- Department of Chemical Engineering, School of Engineering, Universidade de Santiago de Compostela, E-15782, Santiago de Compostela, Galicia, Spain.
| | - G Di Bella
- Facoltà di Ingegneria e Architettura, Università degli Studi di Enna "Kore'', Cittadella Universitaria, 94100 Enna, Italy.
| | - J L Campos
- Facultad de Ingeniería y Ciencias, Universidad Adolfo Ibáñez, Avda. Padre Hurtado 750, Viña del Mar, Chile.
| | - A Mosquera-Corral
- Department of Chemical Engineering, School of Engineering, Universidade de Santiago de Compostela, E-15782, Santiago de Compostela, Galicia, Spain.
| | - A Val Del Rio
- Department of Chemical Engineering, School of Engineering, Universidade de Santiago de Compostela, E-15782, Santiago de Compostela, Galicia, Spain.
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Torres-De La Roche LA, Campo R, Devassy R, Di Spiezio Sardo A, Hooker A, Koninckx P, Urman B, Wallwiener M, De Wilde RL. Adhesions and Anti-Adhesion Systems Highlights. Facts Views Vis Obgyn 2019; 11:137-149. [PMID: 31824635 PMCID: PMC6897521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The peritoneal and intrauterine cavities are lined by fragile membranes with a high-wound healing capacity, e.g. repairing the endometrium in its cyclical "injury and scar-free repair process" during menstruation. However, peritoneal and intrauterine fibrosis and adhesions can develop after surgical trauma through activation of molecular, immune and genetic mechanisms. During procedures with a high-risk of adhesions, the use of new peritoneal and intrauterine conditions in combination with anti-adhesion substances are promising measures to preserve peritoneal and endometrial function and avoid the most common complication of gynecological surgery. Highlights of adhesions and anti-adhesion prevention techniques in laparoscopic, laparotomic and hysteroscopic surgeries are discussed in this paper. Unfortunately, evidence is lacking to prove the superiority of one technique over its counterparts in terms of postoperative adhesions, such as instrumentation, type of energy, distending media, and intracavitary pressure. Additionally, there is limited evidence about the efficacy and outcomes of techniques and adjuvant measures used during adhesiolysis. The definition of a universal intrauterine adhesions classification scheme as well as a prognostic scoring system to identify women at high risk of postoperative adhesions are necessary for advising those who could benefit the most of the use of antiadhesion barriers.
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Affiliation(s)
- LA Torres-De La Roche
- University Hospital for Gynecology, Pius Hospital, University Medicine Oldenburg, Carl von Ossietzky University Oldenburg, 26121, Germany
| | - R Campo
- Leuven Institute for Fertility and Embryology, Tiensevest, 3000, Leuven
| | - R Devassy
- Dubai London Clinic and Speciality Hospital, Dubai, 3371500, UAE
| | | | - A Hooker
- Zaans Medical Centre, Zaandam, 1502, Netherlands
| | - P Koninckx
- UZ Leuven Campus Gasthuisberg, Leuven, 3000, Belgium
| | - B Urman
- Koç University Faculty of Medicine, Department of Obstetrics and Gynecology, Istanbul, Turkey, 34330, Turkey
| | - M Wallwiener
- Heidelberg University Women's Hospital, Heidelberg, 69115, Germany
| | - RL De Wilde
- University Hospital for Gynecology, Pius Hospital, University Medicine Oldenburg, Carl von Ossietzky University Oldenburg, 26121, Germany
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28
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Gordts S, Campo R. Modern approaches to surgical management of endometrioma. Best Pract Res Clin Obstet Gynaecol 2019; 59:48-55. [PMID: 30709745 DOI: 10.1016/j.bpobgyn.2018.12.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/29/2018] [Accepted: 12/31/2018] [Indexed: 11/17/2022]
Abstract
Formation of the ovarian endometrioma consists of implantation, invagination of the ovarian cortex, and adhesion formation. Progression is characterized by repeated injury and repair with degenerative changes. Already with a partially deprived ovarian reserve, resulting from the disease, surgical treatment carries a potential risk of further follicular deprivation. Surgery should therefore be performed with microsurgical precision by experienced hands. Early treatment can possibly prevent further progression. The adverse impact on ovarian reserve of the ablative approach has to be balanced against a lower recurrence rate of a cystectomy. Adapted surgical approaches like a two-step approach or a combination of excisional and ablative surgery has to be considered in case of a large endometrioma. Further studies on the possibility and advantages of sclerotherapy are warranted. Fertility preservation by cryopreservation of ovarian cortex should be part of the informed consent with the patient.
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Affiliation(s)
- S Gordts
- Leuven Institute for Fertility & Embryology, Schipvaartstraat 4, 3000 Leuven, Belgium.
| | - R Campo
- Leuven Institute for Fertility & Embryology, Schipvaartstraat 4, 3000 Leuven, Belgium
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29
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Yin X, Cheng J, Ansari SH, Campo R, Di W, Li W, Bigatti G. Hysteroscopic tissue removal systems for the treatment of intrauterine pathology: a systematic review and meta-analysis. Facts Views Vis Obgyn 2018; 10:207-213. [PMID: 31367293 PMCID: PMC6658200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The use of mechanical tissue removal systems is more frequently implemented as the first line approach for the treatment of intrauterine pathology. Scientific evidence is provided that their use is easier and faster than the conventional resectoscope. It is necessary to objectively evaluate the results on tissue removal systems for the treatment of endometrial pathology as the reports in the literature are still conflicting. OBJECTIVE To review and compare mechanical hysteroscopic tissue removal systems (Truclear®, Myosure® or IBS®) versus conventional bipolar and monopolar resectoscopy for the treatment of polyp and myoma removal. Operation time, completeness of tissue removal, complication rate, fluid deficit, tolerability and learning curve were evaluated. METHODS Electronic databases PubMed; Medline and Web of Science were searched for papers published from 1st January 2010 to 1st May 2019 using terms: ("hysteroscopic" or "hysteroscopy" or "hysteroscopic surgery") and ("myoma" or "polyps"). Studies were included if they were retrospective, observational and prospective randomized clinical controlled trials if they investigated the techniques between the tissue removal systems (Truclear®, Myosure® or IBS®) and conventional resectoscopy for the treatment of intrauterine pathology. Data were extracted from the included studies by two independent reviewers. Meta-analysis was performed by Rev Man 5 software (Cochrane Collaboration, London, UK). Results: Overall, 498 patients were analysed from five studies in which there was no difference in age and size of pathology treated either by the hysteroscopic tissue removal systems and the conventional resectoscope. Hysteroscopic tissue removal systems showed a significantly higher success rate of complete endometrial pathology removal (P=0.002) and a significantly shorter operation time for polyp removal (P<0.0001) compared to conventional resectoscopy. No significant differences, in terms of complications rate, were found (P=0.09). The fluid deficit was significantly higher in the tissue removal system group, compared to conventional resectoscopy (P=0.02). CONCLUSION Hysteroscopic tissue removal systems showed a major advantage in successful removal of the pathology and total operation time. It is likely that the tissue removal systems are more accessible and have a lower complication profile including perforation, via falsa and bleeding due to its specific action mechanism and shorter operation time but higher-quality trials will be required to confirm this hypothesis.
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Affiliation(s)
- X Yin
- Sino European Life Expert Centre-Department of Obstetrics and Gynaecology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Gynaecologic Oncology, China
| | - J Cheng
- Sino European Life Expert Centre-Department of Obstetrics and Gynaecology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Gynaecologic Oncology, China
| | - S H Ansari
- Department of Obstetrics and Gynaecology, Day General Hospital, Tehran, Iran
| | - R Campo
- Life Expert Centre, Leuven, Belgium
| | - W Di
- Sino European Life Expert Centre-Department of Obstetrics and Gynaecology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Gynaecologic Oncology, China
| | - W Li
- Sino European Life Expert Centre-Department of Obstetrics and Gynaecology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Gynaecologic Oncology, China
| | - G Bigatti
- Sino European Life Expert Centre-Department of Obstetrics and Gynaecology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Campo R, Santangelo F, Gordts S, Di Cesare C, Van Kerrebroeck H, De Angelis MC, Di Spiezio Sardo A. Outpatient hysteroscopy. Facts Views Vis Obgyn 2018; 10:115-122. [PMID: 31191845 PMCID: PMC6548410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Modern hysteroscopy represents a copernical revolution for the diagnosis and treatment of uterine pathology. Traditionally hysteroscopy was performed in a conventional operation room under general anaesthesia (in-patient hysteroscopy). Recent advances in technology and techniques made hysteroscopy less painful and invasive allowing it to be performed in an ambulatory setting (outpatient hysteroscopy). The so called "see & treat hysteroscopy", has reduced the distinction between diagnostic and operative procedure, thus, introducing the concept of a single procedure in which the operative part is perfectly integrated within the diagnostic work-up. The "digital hysteroscopic clinic" (DHC) on the other hand combines ultrasound with hysteroscopy, ideal for a one stop diagnostic procedure and surgical approach, outlasting laparoscopy with ultrasound, for increased surgical performance in outpatient settings. The aim of this paper is to describe the "state of the art" in an outpatient hysteroscopy setting.
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Affiliation(s)
- R Campo
- European Academy of Gynaecological Surgery, Diestsevest, 43, 3000 Leuven Belgium.,Department of Obstetrics and Gynecology, ZOL Hospitals, Schiepse Bos 6, 3600 Genk, Belgium,Life Expert Centre, Schipvaart straat 4, 3000 Leuven Belgium
| | - F Santangelo
- Unit of Obstetrics and Gynecology, University of Federico II, Naples, Italy, 80131
| | - S Gordts
- Life Expert Centre, Schipvaart straat 4, 3000 Leuven Belgium
| | - C Di Cesare
- Catholic University of Sacred Heart, Department of Obstetrics and Gynecology , Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - H Van Kerrebroeck
- Department of Obstetrics and Gynecology, ZOL Hospitals, Schiepse Bos 6, 3600 Genk, Belgium
| | - MC De Angelis
- Unit of Obstetrics and Gynecology, University of Federico II, Naples, Italy, 80131
| | - A Di Spiezio Sardo
- European Academy of Gynaecological Surgery, Diestsevest, 43, 3000 Leuven Belgium.,Unit of Obstetrics and Gynecology, University of Federico II, Naples, Italy, 80131
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31
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Ruiz A, Patino LF, Amaya KJ, Gomez JE, Ordonez F, Paternina S, Mercado M, Pachajoa H, Campo R, Coll M, Jimenez R, Matallana A, Zuluaga N, Toro JM, Rivera C. P6266Homozygous familial hypercholesterolemia: A study of 36 cases with phenotype of homozygous familiar hypercholesterolemia in Colombia. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Ruiz
- Pontifical Xaverian University, Epidemiology, Bogota, Colombia
| | - L F Patino
- Pontifical Xaverian University, Bogota, Colombia
| | - K J Amaya
- Valentech for Life, Bogotá, Colombia
| | - J E Gomez
- Fundaciόn Valle de Lili, Cali, Colombia
| | - F Ordonez
- Foundation Cardioinfantil, Bogota, Colombia
| | - S Paternina
- Rehabilitar De Sucre IPS, Sincelejo, Colombia
| | - M Mercado
- Rehabilitar De Sucre IPS, Sincelejo, Colombia
| | - H Pachajoa
- Centro De Investigaciones en Anomalías congénitas y enfermedades raras. Universidad Icesi, Cali, Colombia
| | - R Campo
- Fundaciόn Cardiovascular, Bucaramanga, Colombia
| | - M Coll
- Fundaciόn Hospital de la Misericordia. Universidad Nacional de Colombia, Bogota, Colombia
| | - R Jimenez
- Hospital Tomas Uribe, Tulua, Colombia
| | | | - N Zuluaga
- Hospital Universitario San Vicente Fundaciόn, Medellín, Colombia
| | - J M Toro
- Fundaciόn Clinica Noel, Medellin, Colombia
| | - C Rivera
- Foundation Cardioinfantil, Bogota, Colombia
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Tanos V, Berry KE, Frist M, Campo R, DeWilde RL. Prevention and Management of Complications in Laparoscopic Myomectomy. Biomed Res Int 2018; 2018:8250952. [PMID: 29693017 PMCID: PMC5859837 DOI: 10.1155/2018/8250952] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 02/04/2018] [Indexed: 11/18/2022]
Abstract
Myomectomy aims to preserve fertility, treat abnormal uterine bleeding, and alleviate pain. It should cause minimal damage to the endometrium, while being tolerable and durable, and reduce the incidence of myoma recurrence and complications including bleeding, hematoma, adhesions, and gravid uterus perforation. Training and experience are crucial to reduce complications. The surgical strategy depends on imaging information on the myomas. The position of the optical and secondary ports will determine the degree of ergonomic surgery performance, time and difficulty of myoma enucleation, and the suturing quality. Appropriate hysterotomy length relative to myoma size can decrease bleeding, coagulation, and suturing times. Bipolar coagulation of large vessels, while avoiding carbonization and myometrium gaps after suturing, may decrease the risk of myometrial hematoma. Quality surgery and the use of antiadhesive barriers may reduce the risk of postoperative adhesions. Slow rotation of the beveled morcellator and good control of the bag could reduce de novo myoma and endometriosis. Low intra-abdominal CO2 pressure may reduce the risk of benign and malignant cell dissemination. The benefits a patient gains from laparoscopic myomectomy are greater than the complication risks of laparoscopic morcellation. Recent publications on laparoscopic myomectomies demonstrate reduced hospitalization stays, postoperative pain, blood loss, and recovery compared to open surgery.
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Affiliation(s)
- V. Tanos
- University of Nicosia Medical School, Nicosia, Cyprus
- European Academy for Gynecological Surgery (Nicosia Branch), 55-57 Andrea Avraamidi St., Strovolos, 2024 Nicosia, Cyprus
- Aretaeio Hospital, Strovolos, Nicosia, Cyprus
| | - K. E. Berry
- St George's, University of London MBBS Programme at the University of Nicosia Medical School, Nicosia, Cyprus
| | - M. Frist
- St George's, University of London MBBS Programme at the University of Nicosia Medical School, Nicosia, Cyprus
| | - R. Campo
- European Society Gynaecological Endoscopy, Leuven, Belgium
- The European Academy for Gynecological Surgery, Leuven, Belgium
- Life Expert Centre, Schipvaartstraat 4, 3000 Leuven, Belgium
| | - R. L. DeWilde
- European Society Gynaecological Endoscopy, Leuven, Belgium
- Cahir Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius-Hospital Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany
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Bujanda L, Sarasqueta C, Vega P, Salve M, Quintero E, Alvarez-Sánchez V, Fernández-Bañares F, Boadas J, Campo R, Garayoa A, Ferrandez A, Torrealba L, Rodríguez-Alcaide D, D'Amato M, Hernández V, Cubiella J. Effect of aspirin on the diagnostic accuracy of the faecal immunochemical test for colorectal advanced neoplasia. United European Gastroenterol J 2017; 6:123-130. [PMID: 29435322 DOI: 10.1177/2050640617707094] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 04/03/2017] [Indexed: 12/18/2022] Open
Abstract
Background Aspirin (ASA) is a drug that can cause gastrointestinal lesions and symptoms. Colorectal cancer (CRC) is the most prevalent type of cancer in Western countries. We assessed the effect of aspirin on the diagnostic accuracy of the faecal immunochemical test (FIT) for CRC and/or advanced neoplasia (AN) in patients undergoing colonoscopy for gastrointestinal symptoms. Methods We conducted a prospective multicentre observational study of diagnostic tests that included patients with gastrointestinal symptoms undergoing colonoscopy between March 2012 and 2014 (the COLONPREDICT study). Symptoms were assessed and a FIT and blood tests assessing haemoglobin and carcinoembryonic antigen (CEA) levels were performed. Results The study included 3052 patients: A total of 2567 did not take aspirin (non-user group) and 485 (16%) took aspirin (user group). Continuous treatment with ASA did not change the AUC (0.88, 0.82; p = 0.06), sensitivity (92%, 88%; p = 0.5) or specificity (71%, 67%; p = 0.2) of the FIT for CRC detection. Similarly, we found no differences in the AUC (0.81, 0.79; p = 0.6), sensitivity (74%, 75.5%; p = 0.3) or specificity (76%, 73.6%; p = 0.3) for AN detection. Patients with an aspirin use of ≥ 300 mg/day had a lower prevalence of AN and the sensitivity, specificity and AUC for AN for these patients were 54%, 68% and 0.66, significantly lower than for the non-user group (p = 0.03). Conclusions Aspirin does not modify the diagnostic accuracy of FIT for CRC and/or AN in patients with gastrointestinal symptoms. Aspirin use of ≥ 300 mg/day decreases the accuracy of the test.
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Affiliation(s)
- Luis Bujanda
- Gastroenterology Department, Hospital Universitario Donostia/Biodonostia Institute, University of the Basque Country (UPV/EHU), San Sebastián, Spain; and Centro de Investigación en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Cristina Sarasqueta
- Hospital Universitario Donostia/ Biodonostia Institute, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), San Sebastián, Spain
| | - Pablo Vega
- Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | - María Salve
- Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Enrique Quintero
- Gastroenterology Department, Hospital Universitario de Canarias, Instituto Universitario de Tecnologías Biomédicas (ITB) & Centro de Investigación Biomédica de Canarias (CIBICAN). Departamento de Medicina Interna. Universidad de La Laguna, La Laguna, Spain
| | - Victoria Alvarez-Sánchez
- Gastroenterology Department, Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | | | - Jaume Boadas
- Gastroenterology Department, Consorci Sanitari Terrassa, Spain
| | - Rafel Campo
- Gastroenterology Department, Corporació Sanitària Parc Taulí and CIBERehd, Sabadell, Spain
| | - Ana Garayoa
- Gastroenterology Department, Hospital de Sagunto, Valencia, Spain
| | - Angel Ferrandez
- Gastroenterology Department, Hospital Universitario Clínico de Zaragoza y CIBERehd, Zaragoza, Spain
| | | | | | - Mauro D'Amato
- Biodonostia Institute, San Sebastian and IKERBASQUE, The Basque Science Foundation, Bilbao, Spain
| | - Vicent Hernández
- Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Spain.,Instituto de Investigación Biomédica Ourense, Pontevedra e Vigo, Spain
| | - Joaquin Cubiella
- Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Ourense, Spain.,Instituto de Investigación Biomédica Ourense, Pontevedra e Vigo, Spain
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Cubiella J, Digby J, Rodríguez-Alonso L, Vega P, Salve M, Díaz-Ondina M, Strachan JA, Mowat C, McDonald PJ, Carey FA, Godber IM, Younes HB, Rodriguez-Moranta F, Quintero E, Álvarez-Sánchez V, Fernández-Bañares F, Boadas J, Campo R, Bujanda L, Garayoa A, Ferrandez Á, Piñol V, Rodríguez-Alcalde D, Guardiola J, Steele RJC, Fraser CG. The fecal hemoglobin concentration, age and sex test score: Development and external validation of a simple prediction tool for colorectal cancer detection in symptomatic patients. Int J Cancer 2017; 140:2201-2211. [PMID: 28187494 DOI: 10.1002/ijc.30639] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 01/22/2017] [Accepted: 01/30/2017] [Indexed: 12/15/2022]
Abstract
Prediction models for colorectal cancer (CRC) detection in symptomatic patients, based on easily obtainable variables such as fecal haemoglobin concentration (f-Hb), age and sex, may simplify CRC diagnosis. We developed, and then externally validated, a multivariable prediction model, the FAST Score, with data from five diagnostic test accuracy studies that evaluated quantitative fecal immunochemical tests in symptomatic patients referred for colonoscopy. The diagnostic accuracy of the Score in derivation and validation cohorts was compared statistically with the area under the curve (AUC) and the Chi-square test. 1,572 and 3,976 patients were examined in these cohorts, respectively. For CRC, the odds ratio (OR) of the variables included in the Score were: age (years): 1.03 (95% confidence intervals (CI): 1.02-1.05), male sex: 1.6 (95% CI: 1.1-2.3) and f-Hb (0-<20 µg Hb/g feces): 2.0 (95% CI: 0.7-5.5), (20-<200 µg Hb/g): 16.8 (95% CI: 6.6-42.0), ≥200 µg Hb/g: 65.7 (95% CI: 26.3-164.1). The AUC for CRC detection was 0.88 (95% CI: 0.85-0.90) in the derivation and 0.91 (95% CI: 0.90-093; p = 0.005) in the validation cohort. At the two Score thresholds with 90% (4.50) and 99% (2.12) sensitivity for CRC, the Score had equivalent sensitivity, although the specificity was higher in the validation cohort (p < 0.001). Accordingly, the validation cohort was divided into three groups: high (21.4% of the cohort, positive predictive value-PPV: 21.7%), intermediate (59.8%, PPV: 0.9%) and low (18.8%, PPV: 0.0%) risk for CRC. The FAST Score is an easy to calculate prediction tool, highly accurate for CRC detection in symptomatic patients.
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Affiliation(s)
- Joaquín Cubiella
- Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Ourense, Spain.,Instituto de Investigación Biomedica (IBI) Ourense, Pontevedra y Vigo, Vigo, Spain
| | - Jayne Digby
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital & Medical School, Dundee, Scotland, United Kingdom
| | - Lorena Rodríguez-Alonso
- Department of Gastroenterology and Hepatology, University Hospital of Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Ciber de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Pablo Vega
- Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | - María Salve
- Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Marta Díaz-Ondina
- Clinical Analysis Department, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Judith A Strachan
- Blood Sciences, Ninewells Hospital & Medical School, Dundee, Scotland, United Kingdom
| | - Craig Mowat
- Department of Gastroenterology, Ninewells Hospital & Medical School, Dundee, Scotland, United Kingdom
| | - Paula J McDonald
- Kings Cross Hospital, Scottish Bowel Screening Centre, Dundee, Scotland, United Kingdom
| | - Francis A Carey
- Department of Pathology, Ninewells Hospital & Medical School, Dundee, Scotland, United Kingdom
| | - Ian M Godber
- Department of Biochemistry, Monklands Hospital, Airdrie, Lanarkshire, Scotland, United Kingdom
| | - Hakim Ben Younes
- Department of Surgery, Wishaw General Hospital, Wishaw, Lanarkshire, Scotland, United Kingdom
| | - Francisco Rodriguez-Moranta
- Department of Gastroenterology and Hepatology, University Hospital of Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Ciber de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Enrique Quintero
- Gastroenterology Department, Hospital Universitario de Canarias, Instituto Universitario de Tecnologías Biomédicas (ITB) & Centro de Investigación Biomédica de Canarias (CIBICAN), Universidad de La Laguna, Tenerife, Spain
| | | | - Fernando Fernández-Bañares
- Gastroenterology Department, Hospital Universitari Mútua de Terrassa, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Terrassa, Spain
| | - Jaume Boadas
- Gastroenterology Department, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Rafel Campo
- Gastroenterology Department, Hospital de Sabadell, Corporació Sanitària i Universitària Parc Taulí, Sabadell, Spain
| | - Luis Bujanda
- Donostia Hospital, Biodonostia Institute, University of the Basque Country UPV/EHU (CIBERehd), San Sebastian, Spain
| | - Ana Garayoa
- Gastroenterology Department, Hospital de Sagunto, Sagunto, Valencia, Spain
| | - Ángel Ferrandez
- Servicio de Aparato Digestivo, Hospital Clínico Universitario, IIS Aragón, University of Zaragoza, (CIBERehd), Zaragoza, Spain
| | - Virginia Piñol
- Gastroenterology Department, Hospital Dr. Josep Trueta, Girona, Spain
| | | | - Jordi Guardiola
- Department of Gastroenterology and Hepatology, University Hospital of Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Ciber de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Robert J C Steele
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital & Medical School, Dundee, Scotland, United Kingdom
| | - Callum G Fraser
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital & Medical School, Dundee, Scotland, United Kingdom
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Cubiella J, Vega P, Salve M, Díaz-Ondina M, Alves MT, Quintero E, Álvarez-Sánchez V, Fernández-Bañares F, Boadas J, Campo R, Bujanda L, Clofent J, Ferrandez Á, Torrealba L, Piñol V, Rodríguez-Alcalde D, Hernández V, Fernández-Seara J. Development and external validation of a faecal immunochemical test-based prediction model for colorectal cancer detection in symptomatic patients. BMC Med 2016; 14:128. [PMID: 27580745 PMCID: PMC5007726 DOI: 10.1186/s12916-016-0668-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 08/04/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Risk prediction models for colorectal cancer (CRC) detection in symptomatic patients based on available biomarkers may improve CRC diagnosis. Our aim was to develop, compare with the NICE referral criteria and externally validate a CRC prediction model, COLONPREDICT, based on clinical and laboratory variables. METHODS This prospective cross-sectional study included consecutive patients with gastrointestinal symptoms referred for colonoscopy between March 2012 and September 2013 in a derivation cohort and between March 2014 and March 2015 in a validation cohort. In the derivation cohort, we assessed symptoms and the NICE referral criteria, and determined levels of faecal haemoglobin and calprotectin, blood haemoglobin, and serum carcinoembryonic antigen before performing an anorectal examination and a colonoscopy. A multivariate logistic regression analysis was used to develop the model with diagnostic accuracy with CRC detection as the main outcome. RESULTS We included 1572 patients in the derivation cohort and 1481 in the validation cohorts, with a 13.6 % and 9.1 % CRC prevalence respectively. The final prediction model included 11 variables: age (years) (odds ratio [OR] 1.04, 95 % confidence interval [CI] 1.02-1.06), male gender (OR 2.2, 95 % CI 1.5-3.4), faecal haemoglobin ≥20 μg/g (OR 17.0, 95 % CI 10.0-28.6), blood haemoglobin <10 g/dL (OR 4.8, 95 % CI 2.2-10.3), blood haemoglobin 10-12 g/dL (OR 1.8, 95 % CI 1.1-3.0), carcinoembryonic antigen ≥3 ng/mL (OR 4.5, 95 % CI 3.0-6.8), acetylsalicylic acid treatment (OR 0.4, 95 % CI 0.2-0.7), previous colonoscopy (OR 0.1, 95 % CI 0.06-0.2), rectal mass (OR 14.8, 95 % CI 5.3-41.0), benign anorectal lesion (OR 0.3, 95 % CI 0.2-0.4), rectal bleeding (OR 2.2, 95 % CI 1.4-3.4) and change in bowel habit (OR 1.7, 95 % CI 1.1-2.5). The area under the curve (AUC) was 0.92 (95 % CI 0.91-0.94), higher than the NICE referral criteria (AUC 0.59, 95 % CI 0.55-0.63; p < 0.001). On the basis of the thresholds with 90 % (5.6) and 99 % (3.5) sensitivity, we divided the derivation cohort into three risk groups for CRC detection: high (30.9 % of the cohort, positive predictive value [PPV] 40.7 %, 95 % CI 36.7-45.9 %), intermediate (29.5 %, PPV 4.4 %, 95 % CI 2.8-6.8 %) and low (39.5 %, PPV 0.2 %, 95 % CI 0.0-1.1 %). The discriminatory ability was equivalent in the validation cohort (AUC 0.92, 95 % CI 0.90-0.94; p = 0.7). CONCLUSIONS COLONPREDICT is a highly accurate prediction model for CRC detection.
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Affiliation(s)
- Joaquín Cubiella
- Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Rua Ramón Puga 52-54, 32005, Ourense, Spain. .,Instituto de Investigación Biomedica (IBI) Ourense, Pontevedra y Vigo, Vigo, Rua Ramón Puga 52-54, 32003, Ourense, Spain.
| | - Pablo Vega
- Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Rua Ramón Puga 52-54, 32005, Ourense, Spain
| | - María Salve
- Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Rua Ramón Puga 52-54, 32005, Ourense, Spain
| | - Marta Díaz-Ondina
- Clinical Analysis Department, Complexo Hospitalario Universitario de Ourense, Rua Ramón Puga 52-54, 32003, Ourense, Spain
| | - Maria Teresa Alves
- NECOM Group, University of Vigo, Campus Universitario As Lagoas, Marcosende, 36310, Vigo, Spain
| | - Enrique Quintero
- Gastroenterology Department, Hospital Universitario de Canarias, Instituto Universitario de Tecnologías Biomédicas (ITB) & Centro de Investigación Biomédica de Canarias (CIBICAN), Universidad de La Laguna, Carretera de Ofra, s/n, 38320, San Cristóbal de La Laguna, Santa Cruz de Tenerife, Spain
| | - Victoria Álvarez-Sánchez
- Gastroenterology Department, Complejo Hospitalario de Pontevedra, Av. Montecelo, 36164 Casas Novas, Pontevedra, Spain
| | - Fernando Fernández-Bañares
- Gastroenterology Department, Hospital Universitari Mútua de Terrassa, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Plaça del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain
| | - Jaume Boadas
- Gastroenterology Department, Consorci Sanitari de Terrassa, Carr. Torrebonica, S/N, 08227, Terrassa, Barcelona, Spain
| | - Rafel Campo
- Gastroenterology Department, Hospital de Sabadell, Corporació Sanitària i Universitària Parc Taulí, Parc Taulí, 1, 08208, Sabadell, Barcelona, Spain
| | - Luis Bujanda
- Donostia Hospital, Biodonostia Institute, University of the Basque Country UPV/EHU, (CIBERehd), Paseo del Doctor Begiristain 117, 20080, San Sebastian, Guipuzcoa, Spain
| | - Joan Clofent
- Gastroenterology Department, Hospital de Sagunto, Avenida Ramón y Cajal, S/N, 46520, Sagunto, Valencia, Spain
| | - Ángel Ferrandez
- Servicio de Aparato Digestivo, Hospital Clínico Universitario, IIS Aragón, University of Zaragoza, (CIBERehd), Avda. San Juan Bosco, 15, 50009, Zaragoza, Spain
| | - Leyanira Torrealba
- Gastroenterology Department, Hospital Dr. Josep Trueta, Avenida de Francia, s/n, 17007, Girona, Spain
| | - Virginia Piñol
- Gastroenterology Department, Hospital Dr. Josep Trueta, Avenida de Francia, s/n, 17007, Girona, Spain
| | - Daniel Rodríguez-Alcalde
- Digestive Disease Section, Hospital Universitario de Móstoles Río Júcar, s/n, 28935, Mostoles, Madrid, Spain
| | - Vicent Hernández
- Instituto de Investigación Biomedica (IBI) Ourense, Pontevedra y Vigo, Vigo, Rua Ramón Puga 52-54, 32003, Ourense, Spain.,Gastroenterology Department, Vigo, Pontevedra, Spain
| | - Javier Fernández-Seara
- Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Rua Ramón Puga 52-54, 32005, Ourense, Spain.,Instituto de Investigación Biomedica (IBI) Ourense, Pontevedra y Vigo, Vigo, Rua Ramón Puga 52-54, 32003, Ourense, Spain
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Tanos V, Socolov R, Demetriou P, Kyprianou M, Watrelot A, Van Belle Y, Campo R. Implementation of minimal invasive gynaecological surgery certification will challenge gynaecologists with new legal and ethical issues. Facts Views Vis Obgyn 2016; 8:111-118. [PMID: 27909568 PMCID: PMC5130300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The introduction of a certification / diploma program in Minimal Invasive Surgery (MIS) is expected to improve surgical performance, patient's safety and outcome. The Gynaecological Endoscopic Surgical Education and Assessment programme (GESEA) and the ESHRE Certification for Reproductive Endoscopic Surgery (ECRES) provides a structured learning path, recognising different pillars of competence. In order to achieve a high level of competence a two steps validation is necessary: (a) the individual should be certified of having the appropriate theoretical knowledge and (b) the endoscopic psychomotor skills before entering in the diploma programme reflecting the surgical competence. The influence of such an educational and credentialing path could improve safety and offer financial benefits to the hospitals, physicians and healthcare authorities. Moreover the medicolegal consequences can be important when a significant amount of surgeons possess the different diplomas. As the programs are becoming universally accessible, recognised as the best scientific standard, included in the continuous medical education (CME) and continuous professional development (CPD), it is expected that a significant number of surgeons will soon accomplish the diploma path. The co-existence and practice of both non-certified and certified surgeons with different degrees of experience is unavoidable. However, it is expected that national health systems (NHS), hospitals and insurance companies will demand and hire doctors with high and specific proficiency to endoscopic surgery. When medico-legal cases are under investigation, the experts should be aware of the limitations that individual experience provides. The court first of all examines and then judges if there is negligence and decides accordingly. However, lack of certification may be considered as negligence by a surgeon operating a case that eventual faces litigation problems. Patients' safety and objective preoperative counselling are mandatory, directly connected to MIS certification while eliminating any dispute of surgeons' credibility.
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Affiliation(s)
- V Tanos
- Aretaeio Hospital and St Georges Medical School, Nicosia University, Nicosia, Cyprus
| | - R Socolov
- University of Medicine and Pharmacy Gr. T. Popa, Iasi, Romania
| | - P Demetriou
- 2, Agias Elenis Street, Stasinos Building, 7th Floor, 1060 Nicosia, Cyprus
| | - M Kyprianou
- 2, Agias Elenis Street, Stasinos Building, 7th Floor, 1060 Nicosia, Cyprus
| | - A Watrelot
- Hôpital NATECIA, 22 Avenue Rockefeller 69008-Lyon-France
| | - Y Van Belle
- European Academy of Gynaecological Surgery, Diestsevest 43, 3000 Leuven, Belgium
| | - R Campo
- LIFE, Tiensevest 168, 3000 Leuven, Belgium
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Jayaweera DT, Scerpella E, Robinson M, Rode R, Campo R, Rodriguez A, Asthana D, Tanner T, Kolber MA. The safety and efficacy of indinavir and ritonavir (400/400 mg BID) in HIV-1-infected individuals from an inner-city minority population: a pilot study. Int J STD AIDS 2016; 14:732-6. [PMID: 14624734 DOI: 10.1258/09564620360719750] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We evaluated the safety and efficacy of indinavir 400 mg and ritonavir 400 mg twice daily (RIT/IND 400/400) in HIV-1-infected individuals, using an open label, proof of concept study. All patients received indinavir 400 mg and ritonavir 400 mg twice daily. Patients were followed up to 48 weeks. Nineteen subjects were enrolled, 11 (58%) men and eight (42%) women. The majority were American Black (nine; 47%) or Haitian (eight; 42%). The median baseline plasma HIV-1 viral load (VL) was 5.13 log10 copies/mL and the median CD4 cell count was 112 cells/mm3. The proportion of compliant patients with VL <400 copies/mL at week 24 was 60% compared with 0% for non-compliant patients ( P=0.011 [intent-to-treat] or P=0.085 [on-treatment]). VL at week 4 predicted week 24 VL response. Compliant patients had a median average CD4 cell count increase of 83.2 cells/mm3 compared with 42.0 cells/mm3 for non-compliant patients (P=0.010). The median average changes in triglycerides and cholesterol were significantly higher in compliant patients. This is a potent, safe combination for the treatment of HIV-1. VL at week 4 is predictive of viral outcome at week 24. Fasting serum cholesterol and triglycerides were significantly elevated during the study.
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Affiliation(s)
- D T Jayaweera
- Division of Infectious Diseases, University of Miami School of Medicine, 1500 NW 12th Ave, 8th Floor West, Miami, FL 33136, USA.
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De Wilde RL, Alvarez J, Brölmann H, Campo R, Cheong Y, Lundorff P, Pawelczyk L, Roman H, di Spiezio Sardo A, Wallwiener M. Adhesions and endometriosis: challenges in subfertility management : (An expert opinion of the ANGEL-The ANti-Adhesions in Gynaecology Expert PaneL-group). Arch Gynecol Obstet 2016; 294:299-301. [PMID: 26894304 PMCID: PMC4937065 DOI: 10.1007/s00404-016-4049-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 02/11/2016] [Indexed: 12/16/2022]
Abstract
There is molecular evidence that endometriosis has a negative impact on the ovaries, although the exact pathophysiology concerning endometriosis-associated subfertility is not known. The negative impact on the tubo-ovarian unit can be directly by distorting the anatomy, indirectly by invoking inflammation or by oxidative damage with poorer-quality oocytes. Endometriosis even seems to have a negative effect on pregnancy outcome after in vitro fertilization.
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Affiliation(s)
- R L De Wilde
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius-Hospital Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany.
| | - J Alvarez
- Hospital Universitario Infanta Sofía, Paseo de Europa, 34, 28702, San Sebastián de Los Reyes, Spain
| | - H Brölmann
- Department of Obstetrics and Gynecology, VU University, 1081, Amsterdam, The Netherlands
| | - R Campo
- Leuven Institute for Fertility and Embryology (LIFE), Tiensevest 168, 3000, Louvain, Belgium
| | - Y Cheong
- Human Development and Health Unit, University of Southampton and Complete Fertility Centre, Southampton, UK
| | - P Lundorff
- Department of Obstetrics and Gynecology, Privathospitalet Mølholm, 7100, Vejle, Denmark
| | - L Pawelczyk
- Division of Infertility and Reproductive Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | - H Roman
- Hopitaux De Rouen, Clinique Gynecologique et Obstetricale, 1 Rue Germont, 76031, Rouen Cedex, France
| | | | - M Wallwiener
- Department of Obstetrics and Gynecology, University Clinic Heidelberg, 69120, Heidelberg, Germany
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Campo R, Di Prima N, Freni G, Giustra MG, Di Bella G. Start-up of two moving bed membrane bioreactors treating saline wastewater contaminated by hydrocarbons. Water Sci Technol 2016; 73:716-724. [PMID: 26901712 DOI: 10.2166/wst.2015.512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This work aims to assess the acclimation of microorganisms to a gradual increase of salinity and hydrocarbons, during the start-up of two moving bed membrane bioreactors (MB-MBRs) fed with saline oily wastewater. In both systems an ultrafiltration membrane was used and two types of carriers were employed: polyurethane sponge cubes (MB-MBRI) and polyethylene cylindrical carriers (MB-MBRII). A decreasing dilution factor of slops has been adopted in order to allow biomass acclimation. The simultaneous effect of salinity and hydrocarbons played an inhibitory role in biomass growth and this resulted in a decrease of the biological removal efficiencies. A reduction of bound extracellular polymeric substances and a simultaneous release of soluble microbial products (SMPs) were observed, particularly in the MB-MBRII system, probably due to the occurrence of a greater suspended biomass stress as response to the recalcitrance of substrate. On the one hand, a clear attachment of biomass occurred only in MB-MBRI and this affected the fouling deposition on the membrane surface. The processes of detachment and entrapment of biomass, from and into the carriers, significantly influenced the superficial cake deposition and its reversibility. On the other hand, in MB-MBRII, the higher production of SMPs implied a predominance of the pore blocking.
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Affiliation(s)
- R Campo
- Facoltà di Ingegneria e Architettura, Università degli studi di Enna ''Kore'', Cittadella Universitaria, 94100 Enna, Italy E-mail:
| | - N Di Prima
- Facoltà di Ingegneria e Architettura, Università degli studi di Enna ''Kore'', Cittadella Universitaria, 94100 Enna, Italy E-mail:
| | - G Freni
- Facoltà di Ingegneria e Architettura, Università degli studi di Enna ''Kore'', Cittadella Universitaria, 94100 Enna, Italy E-mail:
| | - M G Giustra
- Facoltà di Ingegneria e Architettura, Università degli studi di Enna ''Kore'', Cittadella Universitaria, 94100 Enna, Italy E-mail:
| | - G Di Bella
- Facoltà di Ingegneria e Architettura, Università degli studi di Enna ''Kore'', Cittadella Universitaria, 94100 Enna, Italy E-mail:
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Corsino SF, Campo R, Di Bella G, Torregrossa M, Viviani G. Study of aerobic granular sludge stability in a continuous-flow membrane bioreactor. Bioresour Technol 2016; 200:1055-1059. [PMID: 26526094 DOI: 10.1016/j.biortech.2015.10.065] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/16/2015] [Accepted: 10/17/2015] [Indexed: 06/05/2023]
Abstract
A granular continuous-flow membrane bioreactor with a novel hydrodynamic configuration was developed to evaluate the stability of aerobic granular sludge (AGS). Under continuous-flow operation (Period I), AGS rapidly lost their structural integrity resulting in loose and fluffy microbial aggregates in which filamentous bacteria were dominant. The intermittent feeding (Period II) allowed obtaining the succession of feast and famine conditions that favored the increase in AGS stability. Although no further breakage occurred, the formation of new granules was very limited, owing to the absence of the hydraulic selection pressure. These results noted the necessity to ensure, on the one hand the succession of feast/famine conditions, and on the other, the hydraulic selection pressure that allows flocculent sludge washout. This preliminary study shows that the proposed configuration could meet the first aspect; in contrast, biomass selection needs to be improved.
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Affiliation(s)
- S F Corsino
- Dipartimento di Ingegneria Civile, Ambientale, Aerospaziale, dei Materiali, Università di Palermo, Viale delle Scienze, 90128 Palermo, Italy
| | - R Campo
- Facoltà di Ingegneria e Architettura, Università degli Studi di Enna "Kore", Cittadella Universitaria, 94100 Enna, Italy
| | - G Di Bella
- Facoltà di Ingegneria e Architettura, Università degli Studi di Enna "Kore", Cittadella Universitaria, 94100 Enna, Italy.
| | - M Torregrossa
- Dipartimento di Ingegneria Civile, Ambientale, Aerospaziale, dei Materiali, Università di Palermo, Viale delle Scienze, 90128 Palermo, Italy
| | - G Viviani
- Dipartimento di Ingegneria Civile, Ambientale, Aerospaziale, dei Materiali, Università di Palermo, Viale delle Scienze, 90128 Palermo, Italy
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Ramírez-Lázaro MJ, Lario S, Calvet X, Sánchez-Delgado J, Montserrat A, Quílez EM, Casalots A, Suarez D, Campo R, Brullet E, Junquera F, Sanfeliu I, Segura F. Occult H. pylori infection partially explains 'false-positive' results of (13)C-urea breath test. United European Gastroenterol J 2015; 3:437-42. [PMID: 26535122 DOI: 10.1177/2050640615572723] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In a previous study, UBiT-100 mg, (Otsuka, Spain), a commercial (13)C-urea breath test omitting citric acid pre-treatment, had a high rate of false-positive results; however, it is possible that UBiT detected low-density 'occult' infection missed by other routine reference tests. We aimed to validate previous results in a new cohort and to rule out the possibility that false-positive UBiT were due to an 'occult' infection missed by reference tests. METHODS Dyspeptic patients (n = 272) were prospectively enrolled and UBiT was performed, according to the manufacturer's recommendations. Helicobacter pylori infection was determined by combining culture, histology and rapid urease test results. We calculated UBiT sensitivity, specificity, positive and negative predictive values (with 95% CI). In addition, we evaluated 'occult' H. pylori infection using two previously-validated polymerase chain reaction (PCR) methods for urease A (UreA) and 16 S sequences in gastric biopsies. We included 44 patients with a false-positive UBiT, and two control groups of 25 patients each, that were positive and negative for all H. pylori tests. RESULTS UBiT showed a false-positive rate of 17%, with a specificity of 83%. All the positive controls and 12 of 44 patients (27%) with false-positive UBiT were positive for all two PCR tests; by contrast, none of our negative controls had two positive PCR tests. CONCLUSIONS UBiT suffers from a high rate of false-positive results and sub-optimal specificity, and the protocol skipping citric acid pre-treatment should be revised; however, low-density 'occult' H. pylori infection that was undetectable by conventional tests accounted for around 25% of the 'false-positive' results.
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Affiliation(s)
- María J Ramírez-Lázaro
- Digestive Diseases Department, Corporació Sanitària i Universitària Parc Taulí, Sabadell, Spain ; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain ; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Barcelona, Spain
| | - Sergio Lario
- Digestive Diseases Department, Corporació Sanitària i Universitària Parc Taulí, Sabadell, Spain ; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain ; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Barcelona, Spain
| | - Xavier Calvet
- Digestive Diseases Department, Corporació Sanitària i Universitària Parc Taulí, Sabadell, Spain ; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain ; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Barcelona, Spain
| | - Jordi Sánchez-Delgado
- Digestive Diseases Department, Corporació Sanitària i Universitària Parc Taulí, Sabadell, Spain ; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain ; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Barcelona, Spain
| | - Antònia Montserrat
- Digestive Diseases Department, Corporació Sanitària i Universitària Parc Taulí, Sabadell, Spain ; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain ; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Barcelona, Spain
| | - Elisa M Quílez
- Digestive Diseases Department, Corporació Sanitària i Universitària Parc Taulí, Sabadell, Spain ; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alex Casalots
- Pathology Department, UDIAT-CD, Corporació Sanitària i Universitària Parc Taulí, Sabadell, Spain
| | - David Suarez
- Epidemiology and Evaluation Unit, Fundació Parc Taulí- UAB, Sabadell, Spain
| | - Rafel Campo
- Digestive Diseases Department, Corporació Sanitària i Universitària Parc Taulí, Sabadell, Spain ; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain ; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Barcelona, Spain
| | - Enric Brullet
- Digestive Diseases Department, Corporació Sanitària i Universitària Parc Taulí, Sabadell, Spain ; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain ; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Barcelona, Spain
| | - Félix Junquera
- Digestive Diseases Department, Corporació Sanitària i Universitària Parc Taulí, Sabadell, Spain ; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain ; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Barcelona, Spain
| | - Isabel Sanfeliu
- Microbiology Laboratory, UDIAT-CD, Corporació Sanitària i Universitaria Parc Taulí, Sabadell, Spain ; Spanish Network for the Research in Infectious Diseases (REIPI RD06/0018), Sevilla, Spain
| | - Ferran Segura
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain ; Spanish Network for the Research in Infectious Diseases (REIPI RD06/0018), Sevilla, Spain ; Infectious Diseases Department, Corporació Sanitària i Universitària Parc Taulí, Sabadell, Spain
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Di Spiezio Sardo A, Campo R, Gordts S, Spinelli M, Cosimato C, Tanos V, Brucker S, Li TC, Gergolet M, De Angelis C, Gianaroli L, Grimbizis G. The comprehensiveness of the ESHRE/ESGE classification of female genital tract congenital anomalies: a systematic review of cases not classified by the AFS system. Hum Reprod 2015; 30:1046-58. [PMID: 25788565 PMCID: PMC4400201 DOI: 10.1093/humrep/dev061] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 02/11/2015] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION How comprehensive is the recently published European Society of Human Reproduction and Embryology (ESHRE)/European Society for Gynaecological Endoscopy (ESGE) classification system of female genital anomalies? SUMMARY ANSWER The ESHRE/ESGE classification provides a comprehensive description and categorization of almost all of the currently known anomalies that could not be classified properly with the American Fertility Society (AFS) system. WHAT IS KNOWN ALREADY Until now, the more accepted classification system, namely that of the AFS, is associated with serious limitations in effective categorization of female genital anomalies. Many cases published in the literature could not be properly classified using the AFS system, yet a clear and accurate classification is a prerequisite for treatment. STUDY DESIGN, SIZE AND DURATION The CONUTA (CONgenital UTerine Anomalies) ESHRE/ESGE group conducted a systematic review of the literature to examine if those types of anomalies that could not be properly classified with the AFS system could be effectively classified with the use of the new ESHRE/ESGE system. An electronic literature search through Medline, Embase and Cochrane library was carried out from January 1988 to January 2014. Three participants independently screened, selected articles of potential interest and finally extracted data from all the included studies. Any disagreement was discussed and resolved after consultation with a fourth reviewer and the results were assessed independently and approved by all members of the CONUTA group. PARTICIPANTS/MATERIALS, SETTING, METHODS Among the 143 articles assessed in detail, 120 were finally selected reporting 140 cases that could not properly fit into a specific class of the AFS system. Those 140 cases were clustered in 39 different types of anomalies. MAIN RESULTS AND THE ROLE OF CHANCE The congenital anomaly involved a single organ in 12 (30.8%) out of the 39 types of anomalies, while multiple organs and/or segments of Müllerian ducts (complex anomaly) were involved in 27 (69.2%) types. Uterus was the organ most frequently involved (30/39: 76.9%), followed by cervix (26/39: 66.7%) and vagina (23/39: 59%). In all 39 types, the ESHRE/ESGE classification system provided a comprehensive description of each single or complex anomaly. A precise categorization was reached in 38 out of 39 types studied. Only one case of a bizarre uterine anomaly, with no clear embryological defect, could not be categorized and thus was placed in Class 6 (un-classified) of the ESHRE/ESGE system. LIMITATIONS, REASONS FOR CAUTION The review of the literature was thorough but we cannot rule out the possibility that other defects exist which will also require testing in the new ESHRE/ESGE system. These anomalies, however, must be rare. WIDER IMPLICATIONS OF THE FINDINGS The comprehensiveness of the ESHRE/ESGE classification adds objective scientific validity to its use. This may, therefore, promote its further dissemination and acceptance, which will have a positive outcome in clinical care and research. STUDY FUNDING/COMPETING INTERESTS None.
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Affiliation(s)
- A Di Spiezio Sardo
- Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - R Campo
- Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - S Gordts
- Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - M Spinelli
- Department of Obstetrics and Gynecology, University of Naples 'Federico II', Naples, Italy
| | - C Cosimato
- Department of Obstetrics and Gynecology, University of Salerno, Fisciano (SA), Italy
| | - V Tanos
- Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - S Brucker
- Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - T C Li
- Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - M Gergolet
- Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - C De Angelis
- Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - L Gianaroli
- Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - G Grimbizis
- Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
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Sleiman Z, Tanos V, Van Belle Y, Carvalho J, Campo R. The European Academy laparoscopic "Suturing Training and Testing'' (SUTT) significantly improves surgeons' performance. Facts Views Vis Obgyn 2015; 7:153-60. [PMID: 26977264 PMCID: PMC4788330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
UNLABELLED The efficiency of suturing training and testing (SUTT) model by laparoscopy was evaluated, measuring the suturingskill acquisition of trainee gynecologists at the beginning and at the end of a teaching course. During a workshop organized by the European Academy of Gynecological Surgery (EAGS), 25 participants with three different experience levels in laparoscopy (minor, intermediate and major) performed the 4 exercises of the SUTT model (Ex 1: both hands stitching and continuous suturing, Ex 2: right hand stitching and intracorporeal knotting, Ex 3: left hand stitching and intracorporeal knotting, Ex 4: dominant hand stitching, tissue approximation and intracorporeal knotting). The time needed to perform the exercises is recorded for each trainee and group and statistical analysis used to note the differences. Overall, all trainees achieved significant improvement in suturing time (p < 0.005) as measured before and after completion of the training. Similar significantly improved suturing time differences (p < 0.005) were noted among the groups of trainees with different laparoscopic experience. In conclusion a short well-guided training course, using the SUTT model, improves significantly surgeon's laparoscopic suturing ability, independently of the level of experience in laparoscopic surgery. KEY WORDS Endoscopy, laparoscopic suturing, psychomotor skills, surgery, teaching, training suturing model.
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Affiliation(s)
- Z. Sleiman
- Department of Obstetrics and Gynecology , Middle East Institute
of Health, Bsalim, Lebanon.
| | - V. Tanos
- Department of Obstetrics and Gynecology, Aretaeio hospital
Andrea Avraamidi 55-57, Strovolos 2024, Cyprus.
| | - Y. Van Belle
- European Academy for Gynecological Surgery, Diestsevest 43/0001,
3000 Leuven, Belgium.
| | - J.L. Carvalho
- Department of Obstetrics and Gynecology, CUF Porto Hospital
Estrada da Circunvalação 14341, 4100-180 Porto, Portugal.
| | - R. Campo
- European Academy for Gynecological Surgery, Diestsevest 43/0001,
3000 Leuven, Belgium.
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Abstract
In 1908, Cullen described the first cases of cystic adenomyosis in his textbook on adenomyomata. Although not very common, with the introduction of noninvasive imaging techniques such as magnetic resonance imaging (MRI) and 3-D transvaginal ultrasound, an increasing number of cases have been reported. Patients primarily complain of severe dysmenorrhea, chronic pelvic pain, and dysfunctional uterine bleeding. Currently, it is unclear whether adenomyosis and, more specifically, cystic adenomyosis can be an underlying reason for impaired fertility and reproductive outcome. With the postponement of childbearing, the number of patients with adenomyosis and cystic adenomyosis seeking fertility treatment is increasing. Therefore, in these patients, uterine exploration should include not only the evaluation of the endometrial cavity but also the exploration of the sub-endometrial zone. Indirect imaging techniques, combined with office mini-hysteroscopy, offer the possibility of complete uterine exploration. Two patients with cystic adenomyosis are described in this paper: one had the chief complaint of menorrhagia and the other was referred for evaluation of infertility and severe dysmenorrhea. The aim of these case reports is to present hysteroscopic dissection and ablation of adenomyotic cysts as an alternative procedure for the surgical management of this condition.
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Affiliation(s)
- S Gordts
- Leuven Institute for Fertility & Embryology, Tiensevest 168, 3000 Leuven, Belgium
| | - R Campo
- Leuven Institute for Fertility & Embryology, Tiensevest 168, 3000 Leuven, Belgium
| | - I Brosens
- Leuven Institute for Fertility & Embryology, Tiensevest 168, 3000 Leuven, Belgium
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Rothmund R, Taran FA, Boeer B, Wallwiener M, Abele H, Campo R, Wallwiener D, Brucker S, Rall K. Surgical and Conservative Management of Symptomatic Leiomyomas during Pregnancy: a Retrospective Pilot Study. Geburtshilfe Frauenheilkd 2014; 73:330-334. [PMID: 24771919 DOI: 10.1055/s-0032-1328437] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 03/11/2013] [Accepted: 03/12/2013] [Indexed: 10/26/2022] Open
Abstract
Purpose: Evidence regarding distinguishing characteristics of women with symptomatic leiomyomas during pregnancy who undergo myomectomy during pregnancy and those who respond to conservative treatment is sparse because it mostly derives from case reports and small patient series. As the first of its type, the present study analyzed the characteristics of women with symptomatic leiomyomas treated with myomectomy during pregnancy and those treated conservatively. Methods: We performed a computer search of medical records from 1 January 2001 to 31 March 2011 using the International Classification of Diseases Codes for pregnancy, myomectomy and leiomyomas during pregnancy. Results: 27 patients were admitted during pregnancy directly related to leiomyomas; 17 of the 27 patients received conservative treatment for symptomatic leiomyomas, and 10 patients had surgery during pregnancy: 3 had undergone diagnostic surgical procedures and 7 myomectomy. Perioperative and postoperative morbidity was low in all women in our sample. Conclusion: In our pilot study, myomectomy during pregnancy was safely performed in carefully selected patients, with subserosal or pedunculated leiomyomas that failed to respond to conservative treatment, with low perioperative and postoperative morbidity.
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Affiliation(s)
- R Rothmund
- Women's Clinic, University Tübingen, Tübingen
| | - F A Taran
- Women's Clinic, University Tübingen, Tübingen
| | - B Boeer
- Women's Clinic, University Tübingen, Tübingen
| | - M Wallwiener
- Women's Clinic, University Heidelberg, Heidelberg
| | - H Abele
- Women's Clinic, University Tübingen, Tübingen
| | - R Campo
- Leuven Institute for Fertility and Embryology, Leuven, Belgium
| | | | - S Brucker
- Women's Clinic, University Tübingen, Tübingen
| | - K Rall
- Women's Clinic, University Tübingen, Tübingen
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Grimbizis GF, Gordts S, Di Spiezio Sardo A, Brucker SY, De Angelis C, Gergolet M, Li TC, Tanos V, Brölmann HH, Gianaroli L, Campo R. Reply: are the ESHRE/ESGE criteria of female genital anomalies for diagnosis of septate uterus appropriate? Hum Reprod 2014; 29:868-9. [PMID: 24480715 DOI: 10.1093/humrep/deu002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- G F Grimbizis
- Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group, ESGE Central Office, Diestsgvest 43/0001, 3000 Leuven, Belgium
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Campo R, Meier R, Dhont N, Mestdagh G, Ombelet W. Implementation of hysteroscopy in an infertility clinic: The one-stop uterine diagnosis and treatment. Facts Views Vis Obgyn 2014; 6:235-9. [PMID: 25593699 PMCID: PMC4286863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Magnetic Resonant Imaging (MRI) has demonstrated that we can differentiate the uterus in 3 important functional areas. Exploration of the uterus in the infertile patient should implement the evaluation of the endometrium, the Junctional zone myometrium (JZ), the outer myometrium and the cervical canal. Especially the JZ myometrium should receive our close attention in the exploration and treatment of the infertile patient. MRI cannot be implemented as a screening examination but also limiting the imaging of the womb to a 2 or 3 D ultrasound exam only does not meet the scientific requirements of sensitivity and specificity. Modern ambulatory uterine diagnosis in a one-stop approach includes transvaginal ultrasound, fluid mini Hysteroscopy, contrast sonography and endomyometrial tissue sampling. Transvaginal Ultrasound being the gold standard for global uterine screening has a cardinal importance for diagnosis of myometrial disorders and uterine congenital malformations whereas hysteroscopy remains the gold standard for the evaluation of the endometrium and cervical canal. The major challenge remains to perform a tissue sampling of the endo-myometrium in an ambulatory, patient friendly and reliable way for which the newly designed Trophy hysteroscope provide a satisfactory answer. This one-stop approach opens a total new and advanced dimension to the screening, diagnosis and treatment of uterine pathology in the infertile patient.
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Affiliation(s)
- R. Campo
- Genk Institute for Fertility Technology, ZOL Hospitals, Genk, Belgium.
,European Academy for Gynaecological Surgery, Leuven, Belgium.
,European Society for Gynaecological Endoscopy, Leuven, Belgium
| | - R. Meier
- European Academy for Gynaecological Surgery, Leuven, Belgium.
| | - N. Dhont
- Genk Institute for Fertility Technology, ZOL Hospitals, Genk, Belgium.
| | - G. Mestdagh
- Genk Institute for Fertility Technology, ZOL Hospitals, Genk, Belgium.
| | - W. Ombelet
- Genk Institute for Fertility Technology, ZOL Hospitals, Genk, Belgium.
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Ombelet W, Van Blerkom J, Klerkx E, Janssen M, Dhont N, Mestdagh G, Nargund G, Campo R. The (t)WE lab Simplified IVF Procedure: First Births after freezing/thawing. Facts Views Vis Obgyn 2014; 6:45-9. [PMID: 25009725 PMCID: PMC4086002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Infertility care is one of the most neglected health care issues in developing countries (DC), affecting more than 50 million couples. The social stigma of childlessness still leads to isolation and abandonment. Bilateral tubal occlusion due to sexually transmitted diseases and pregnancy-related infections is the most common cause of infertility in DC. Consequently most cases of infertility are only treatable by using assisted reproductive technologies which are either unavailable or too costly. Lowering the laboratory costs associated with IVF is a crucial step to make IVF affordable for a larger part of the world population. We recently developed and described a new simplified method of IVF culturing, called the (t)WE lab method. Our initial results in fresh IVF cycles showed that IVF methodology can be significantly simplified and result in successful outcomes at levels that compare favourably to those obtained in high resource programs. CASE-REPORTS We report three pregnancies and four live births as a result of transferring five cryo/thawing embryos which were developed after using the simplified (t)WE lab system. The two singleton babies delivered vaginally, for the twin pregnancy a caesarean section was performed. All babies were healthy, the perinatal outcome was uneventful in all cases. CONCLUSION We provide proof-of-principle evidence that transferring cryopreserved/thawed embryos obtained with our (t)WE lab simplified culture system can lead to successful pregnancies and healthy live births.
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Affiliation(s)
- W. Ombelet
- Genk Institute for Fertility Technology, Department of Obstetrics and Gynaecology, ZOL, Campus St Jan, Genk, Belgium.
,Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, 3590 Diepenbeek, Belgium.
| | - J. Van Blerkom
- Colorado Reproductive Endocrinology, Rose Medical Center, Denver, Colorado.
| | - E. Klerkx
- Genk Institute for Fertility Technology, Department of Obstetrics and Gynaecology, ZOL, Campus St Jan, Genk, Belgium.
| | - M. Janssen
- Genk Institute for Fertility Technology, Department of Obstetrics and Gynaecology, ZOL, Campus St Jan, Genk, Belgium.
| | - N. Dhont
- Genk Institute for Fertility Technology, Department of Obstetrics and Gynaecology, ZOL, Campus St Jan, Genk, Belgium.
| | - G. Mestdagh
- Genk Institute for Fertility Technology, Department of Obstetrics and Gynaecology, ZOL, Campus St Jan, Genk, Belgium.
| | - G. Nargund
- Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, 3590 Diepenbeek, Belgium.
| | - R. Campo
- Genk Institute for Fertility Technology, Department of Obstetrics and Gynaecology, ZOL, Campus St Jan, Genk, Belgium.
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Campo R, Puga M, Meier Furst R, Wattiez A, De Wilde R. Excellence needs training "Certified programme in endoscopic surgery". Facts Views Vis Obgyn 2014; 6:240-4. [PMID: 25593700 PMCID: PMC4286864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The complexity of modern surgery has increased the demands and challenges to surgical education and quality control. Today the endoscopic approach is preferred because it increases the surgical possibilities and decreases patient discomfort. Implementing endoscopic surgery without specific training leads to decrease in surgical performance and increase in patient morbidity and mortality. Research of the European Academy for Gynaecological Surgery (+he Academy) has resulted in the establishment of a structured certification and diploma programme with three levels of expertise. One level should be passed to obtain access to the next level. Furthermore one should first pass +he Academy skill exam before entering the clinical surgical competence programme. The European Society for Gynaecological Endoscopy (ESGE) has defined the different diplomas, whereas the Bachelor diploma is seen as a prerequisite to start the in OR one to one clinical training aiming to provide endoscopic skilled individuals to the clinical one to one training. Further diplomas are the Minimal invasive Gynaecological Surgeon (MIGS), master in hysteroscopy and the laparoscopic pelvic surgeon. This programme is based on the best available scientific evidence. It counteracts the problem of the traditional surgical apprentice tutor model and increases patient safety and surgical performance. It is seen as a major step toward standardization of endoscopic surgical training in general.
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Affiliation(s)
- R. Campo
- Genk Institute for Fertility Technology, ZOL Hospitals, Genk, Belgium.
,European Academy for Gynaecological Surgery, Leuven, Belgium.
,European Society for Gynaecological Endoscopy, Leuven, Belgium.
| | - M. Puga
- European Academy for Gynaecological Surgery, Leuven, Belgium.
| | - R. Meier Furst
- European Academy for Gynaecological Surgery, Leuven, Belgium.
| | - A. Wattiez
- European Academy for Gynaecological Surgery, Leuven, Belgium.
,European Society for Gynaecological Endoscopy, Leuven, Belgium.
| | - R.L. De Wilde
- European Society for Gynaecological Endoscopy, Leuven, Belgium.
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Abstract
Acute lower gastrointestinal bleeding (LGIB) is diverse in origin and can be substantial, requiring urgent hemostasis. Hemospray is a promising novel hemostatic agent for upper gastrointestinal bleeding (UGIB). It has been claimed in a small series that the use of Hemospray is also feasible in LGIB. We aimed to expand our knowledge of the application of Hemospray for the treatment of LGIB in a wider range of conditions to further define the optimal patient population for this new therapeutic modality. We analyzed the outcomes of nine unselected consecutive patients with active LGIB treated with Hemospray in two major hospitals in Europe. Initial hemostasis was achieved after Hemospray application in all patients. Rebleeding occurred in two patients (22%) who were on acetyl salicylic acid and presented with spurting bleeds. These preliminary data show that Hemospray can be effective in the management of LGIB, but suggest cautious use for patients on antithrombotic therapy and spurting bleeds.
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Affiliation(s)
- I Lisanne Holster
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Enric Brullet
- Department of Digestive Diseases, Hospital of Sabadell, Corporació Sanitaria Universitaria Parc Taulí, Sabadell, Spain and Networked Biomedical Research Center for Hepatic and Digestive Diseases (CIBERehd), Spain
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Rafel Campo
- Department of Digestive Diseases, Hospital of Sabadell, Corporació Sanitaria Universitaria Parc Taulí, Sabadell, Spain and Networked Biomedical Research Center for Hepatic and Digestive Diseases (CIBERehd), Spain
| | - Alberto Fernández-Atutxa
- Department of Digestive Diseases, Hospital of Sabadell, Corporació Sanitaria Universitaria Parc Taulí, Sabadell, Spain and Networked Biomedical Research Center for Hepatic and Digestive Diseases (CIBERehd), Spain
| | - Eric T T L Tjwa
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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