We compared the feasibility, blood loss, duration of surgery, and complications between patients in whom both uterine arteries were sutured at the beginning of total laparoscopic hysterectomy (TLH) ...and patients in whom suturing was done after cornual pedicles. Using a prospective study (Canadian Task Force classification II-2) at a dedicated high-volume gynecologic laparoscopy center, a total of 350 women who underwent TLH from January 2005 through January 2007 were assigned into 2 groups. The indications for TLH were predominantly myomas and menorrhagia. In group A, TLH was done by suturing both uterine arteries at the beginning of the procedure. In group B, the uterine arteries were sutured after the cornual pedicles as done conventionally. All the other pedicles were desiccated and cut either with harmonic ultracision or bipolar diathermy. The uterus with cervix was removed either vaginally or by morcellation. The median age of patients in group A was 46 years and in group B was 44 years. Mean uterine size, weight, estimated blood loss, total operating time, need for blood transfusion, and complications were analyzed. In group A the total duration of surgery was 60 minutes (range 20-210). In group B, the total duration of surgery was 70 minutes (range 30-190). In group A, the median total blood loss was 50 mL (range 10-2000). In group B the total blood loss was 60 mL (range 10-2500). The comparison between the 2 groups revealed a statistically significant difference (p <.05, Mann-Whitney test). Need for blood transfusion was less in group A. One patient in group A had secondary hemorrhage 3 weeks later and the vaginal vault was resutured. In group B, 2 patients had blood loss more than 1500 mL (uterus weight > 1000 g) and required 4 units of packed cell transfusion in each. One patient in group B with previous cesarean section had a bladder wall rent and this was sutured laparoscopically using 3-0 delayed absorbable sutures. Uterine artery ligation at the beginning of TLH as done in group A is a technically feasible procedure. It reduces the total blood loss and decreases the time taken for the procedure.
Introduction and hypothesis
To correlate dynamic assessment of sling function using 2D and 3D transperineal ultrasound with outcomes following transobturator sling surgery.
Methods
This is an ...unmatched case–control study of 100 patients who underwent transobturator sling surgery at our center between 2009 and 2012. Group A (
n
= 50) patients had successful outcomes and group B (
n
= 50) patients had suboptimal outcomes 1 year following surgery. The patients underwent 2D dynamic and 3D transperineal ultrasound. The two groups were compared with regard to the deformability of the sling on Valsalva, the concordance of urethral movement with the sling, and location of the sling.
Results
When compared with group B, group A had a significantly greater number of patients in whom the sling deformed at Valsalva (flat at rest, curving into a c-shape at Valsalva), the urethral movement was concordant with the sling and the sling had a midurethral location (
p
< 0.0001). In all 17 patients in group B in whom the urethra moved in a concordant manner with the sling (34%), the sling did not deform on Valsalva maneuver and was located proximally. In all 15 patients in group A in whom the sling remained either flat or curved (30%), the urethra moved concordant with the sling and the sling was in midurethral location.
Conclusions
On 2D and 3D transperineal ultrasound, the best outcomes following transobturator sling surgery are associated with concordance of urethral movement with the sling, midurethral location, and deformability of the sling on dynamic assessment.
Information provision for social welfare via cheap technological media is now a widely available tool used by policymakers. Often, however, an ample supply of information does not translate into high ...consumption of information due to various frictions in demand, possibly stemming from the pecuniary and non‐pecuniary cost of engagement, along with institutional factors. We test this hypothesis in the Indian context using a unique data set comprising 2 million call records of enrolled users of ARMMAN, a Mumbai‐based nongovernmental organization that sends timely informational calls to mobile phones of less‐privileged pregnant women. The strict lockdown induced by COVID‐19 in India was an unexpected shock on engagement with m‐Health technology, in terms of both reductions in market wages and increased time availability at home. Using a difference‐in‐differences design on unique calls tracked at the user‐time level with fine‐grained time‐stamps on calls, we find that during the lockdown period, the call durations increased by 1.53 percentage points. However, technology engagement behavior exhibited demographic heterogeneity increasing relatively after the lockdown for women who had to borrow the phones vis‐à‐vis phone owners, for those enrolled in direct outreach programs vis‐à‐vis self‐registered women, and for those who belonged to the low‐income group vis‐à‐vis high‐income group. These findings are robust with coarsened exact matching and with a placebo test for a 2017–2018 sample. Our results have policy implications around demand‐side frictions for technology engagement in developing economies and maternal health.
To estimate whether levator ani deficiency severity is a predictor of clinically significant pelvic organ prolapse (POP) and to determine whether there is a levator ani deficiency threshold above ...which POP occurs.
Two-hundred twenty three-dimensional ultrasound scans performed on urogynecologic clinic patients were reviewed, and each levator ani muscle subdivision was individually scored (0=no defect, 1=50% or less defect, 2=more than 50% defect, 3=total absence of the muscle) on each side. A levator ani deficiency score was calculated and categorized as mild (score 0-6), moderate (score 7-12), and severe (score more than 13). Clinically significant prolapse was defined as stage 2 or higher.
The mean age was 56.50 (standard deviation ±15.58) and median parity was 2 (range 0-6). A mild positive correlation was demonstrated between levator ani deficiency category and prolapse stage (rs=0.44; P<.001). Score distribution significantly differed by prolapse stage (P<.001). No patients with stage 3 prolapse had a levator ani score less than 6, and no patients with stage 4 prolapse had a levator ani score less than 9. In patients with prolapse, those with moderate levator ani deficiency had 3.2 times the odds of POP compared with patients with a minimal defect; those with severe levator ani deficiency had 6.4 times the odds of prolapse than those with minimal deficiency.
Levator ani deficiency severity is associated with clinically significant prolapse.
II.
Background
The aim of the study was to assess the long-term outcome in terms of weight loss and remission of comorbidities among the patients who had undergone LSG in an Indian setting.
Methods
This ...is a retrospective observational study of patients (BMI > 30 kg/m
2
) who underwent LSG having a minimum 6 months of follow-up data. Based on preoperative BMI, patients were grouped as class 1, 30 < BMI < 35 kg/m
2
; class 2, 35 < BMI < 40 kg/m
2
; and class 3, BMI > 40 kg/m
2
. Data on BMI and %EWL between three classes and among genders at different follow-up points for 7 years were compared.
Result
Study included 95 patients (mean age of 33.7 ± 11 years), and the preoperative mean BMI was 40.2 ± 5.1 kg/m
2
. At one year of surgery, 85.5% patients achieved > 50%EWL. The highest mean %EWL was found in class 1 (66.19%), followed by class 2 (56.73%) and class 3 (46.59%) at the sixth month follow-up. At the seventh year, %EWLs were 85.11% (class 1), 76.69% (class 2), and 62.98% (class 3) and the mean BMIs were 25.13 ± 3.09 kg/m
2
(class 1), 26.86 ± 2.12 kg/m
2
(class 2), and 31.07 ± 3.39 kg/m
2
(class 3) and were significantly different (
p
< 0.05). At the last follow-up, though, the males showed slight weight regain; however, there were no statistical differences between the genders (
p
= 0.065).
Conclusion
Outcome from LSG was better in patients with BMI < 40 kg/m
2
compared to the patients with BMI > 40 kg/m
2
. Remission of obesity-related comorbidities was observed with LSG in all groups and gender did not influence the outcome significantly.
As hypoxia can mediate resistance to immunotherapy, we investigated the safety, tolerability, and efficacy of combining evofosfamide, a prodrug that alleviates hypoxia, with ipilimumab, an immune ...checkpoint inhibitor, in immunologically "cold" cancers, which are intrinsically insensitive to immunotherapy, as well as in "hot/warm" metastatic cancers that are, atypical of such cancers, resistant to immunotherapy.
In a phase I, 3+3 dose-escalation trial (NCT03098160), evofosfamide (400-640 mg/m
) and ipilimumab (3 mg/kg) were administered in four 3-week cycles. The former was administered on days 1 and 8 of cycles 1-2, while the latter was administered on day 8 of cycles 1-4. Response was assessed using immune-related RECIST and retreatment was allowed, if deemed beneficial, after completion of cycle 4 or at progression.
Twenty-two patients were enrolled, of whom 21 were evaluable, encompassing castration-resistant prostate cancer (
= 11), pancreatic cancer (
= 7), immunotherapy-resistant melanoma (
= 2), and human papillomavirus-negative head and neck cancer (
= 1). Drug-related hematologic toxicities, rash, fever, nausea, vomiting, and elevation of liver enzymes were observed in > 10% of patients. The most common drug-related grade 3 adverse event was alanine aminotransferase elevation (33.3%). Two patients discontinued ipilimumab and 4 required evofosfamide deescalation due to toxicity. Of 18 patients with measurable disease at baseline, 3 (16.7%) achieved partial response and 12 (66.7%) achieved stable disease. The best responses were observed at 560 mg/m
evofosfamide. Preexisting immune gene signatures predicted response to therapy, while hypermetabolic tumors predicted progression. Responders also showed improved peripheral T-cell proliferation and increased intratumoral T-cell infiltration into hypoxia.
No new or unexpected safety signals were observed from combining evofosfamide and ipilimumab, and evidence of therapeutic activity was noted.
The NCCN Guidelines for Non-Small Cell Lung Cancer (NSCLC) provide recommendations for management of disease in patients with NSCLC. These NCCN Guidelines Insights focus on neoadjuvant and adjuvant ...(also known as perioperative) systemic therapy options for eligible patients with resectable NSCLC.
Two cases of pelvic schwannoma appeared as broad ligament myoma. Laparoscopic myomectomy was planned for both patients in view of suspected broad ligament myoma. Intraoperative findings appeared to ...be degenerated myomas with suggestion of malignancy. Both patients underwent complete tumor excision laparoscopically and had uneventful postoperative recovery. Histopathologic examination confirmed them to be schwannomas. Solitary nerve sheath tumors such as benign schwannomas arising in pelvic retroperitoneum are infrequently reported and difficult to diagnose preoperatively. Complete surgical excision is the treatment of choice. Benign retroperitoneal schwannomas in 2 patients primarily given the diagnosis of myoma were treated by laparoscopic excision. A MEDLINE search did not reveal reports of removing these tumors laparoscopically.
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