Introduction ERAS pathway has been proposed as the standard of care in elective abdominal surgery. Guidelines on ERAS in emergency surgery have been recently published; however, few evidences are still available in the literature. The aim of this study was to evaluate the feasibility of an enhanced recovery protocol in a large cohort of patients undergoing emergency surgery and to identify possible factors impacting postoperative protocol compliance. Methods This is a prospective multicenter observational study including patients who underwent major emergency general surgery for either intra-abdominal infection or intestinal obstruction. The primary endpoint of the study is the adherence to ERAS postoperative protocol. Secondary endpoints are 30-day mortality and morbidity rates, and length of hospital stay. Results A total of 589 patients were enrolled in the study, 256 (43.5%) of them underwent intestinal resection with anastomosis. Major complications occurred in 92 (15.6%) patients and 30-day mortality was 6.3%. Median adherence occurred on postoperative day (POD) 1 for naso-gastric tube removal, on POD 2 for mobilization and urinary catheter removal, and on POD 3 for oral intake and i.v. fluid suspension. Laparoscopy was significantly associated with adherence to postoperative protocol, whereas operative fluid infusion > 12 mL/Kg/h, preoperative hyperglycemia, presence of a drain, duration of surgery and major complications showed a negative association. Conclusions The present study supports that an enhanced recovery protocol in emergency surgery is feasible and safe. Laparoscopy was associated with an earlier recovery, whereas preoperative hyperglycemia, fluid overload, and abdominal drain were associated with a delayed recovery.
Ospemifene is efficacious for improving vaginal dryness or dyspareunia as the patient-identified most bothersome symptom, and Phase III clinical trials (4648 patients) have shown good efficacy in terms of improvement of objective and subjective signs and measures of GSM in postmenopausal women. Future studies with a long-term follow-up are required to better elucidate its safety profile. In particular, on the basis of preclinical and early clinical findings of antagonistic to neutral effect on breast tissue, more research is needed to assess the treatment with ospemifene in breast cancer survivors.
Objectives: To correlate the ultrasound appearance of highly vascularised uterine myomas to the histopathological diagnosis. Methods: This retrospective study included patients presenting with an ultrasound diagnosis of uterine myoma characterised by a circumferential and intralesional vascular pattern with a colour score assessment of 3 or 4, according to the Morphological Uterus Sonographic Assessment (MUSA). All the patients underwent myomectomy or hysterectomy after the ultrasound examination. The ultrasound appearance of the myomas was analysed and described using the terms and definitions of the MUSA paper. The echogenicity of each myoma, the presence of cystic areas and the total myoma volume were recorded. The ultrasound characteristics were compared with the histological diagnosis. Results: 52 patients were included in this study. Mean patient age was 42.5 years, 45 (86%) were in premenopause, 26 (50%) showed symptoms (pelvic pain, menorrhagia). At histological examination 25 (48%) myomas were compatible with a diagnosis of atypical leiomyoma (76% (19) hypercellular leiomyoma, 16% (4) myxoid leiomyoma, 8% (2) apoplectic leiomyoma). 25 (48%) were typical leiomyomas and 2 (4%) were adenomyomas. Cystic areas within the lesion were found in 32% (8/25) of atypical leiomyomas and in 16% (4/25) of typical leiomyomas. Conclusions: Ultrasound features such as circumferential and intralesional vascularity with a colour score of 3 or 4 and the presence of cystic areas may be predictive of atypical leiomyomas. Such features may be used to differentiate typical uterine myomas from the atypical variants in a pre-operative setting and to identify patients that may benefit from a conservative medical treatment rather than a radiological treatment. OP24.06Comparison of 2D and 3D transvaginal sonography to assess endometrial thickness
Methods: Thirty fetuses were included in the study and ultrasound with cephalic volume acquisition 3D was performed twice and prospectively. Measurements of the biparietal diameter (BPD) and head circumference (HC) were performed from volumes by two experienced sonographers and by SmartPlane ® software. These measurements were compared one hand to measurements obtained with automated calipers positioning and the other to conventional 2D measurements. Means and standard deviations of the differences between the series of measurements were calculated. Intra and interobserver reproducibility was assessed using intraclass correlation coefficient (ICC). Bland-Altmann plots were used to evaluate the agreement between the series of measurements. Results: Intra and interobserver reproducibility was high regardless of the measurement technique (ICC> 0.99 for both). The maximum average difference between two series of measurements was 1.12 mm +/-0.86 and 4.02 mm +/-2.8 for the biparietal diameter and the head circumference, respectively. For these two parameters, the agreement between software and operators was clever (95% of the observed differences were <2.5 mm and <4 mm for the BPD and the HC respectively). Conclusions: Agreement between measurements performed from 3D volumes by software and conventional 2D measurements is clever and comparable to agreement observed between semi-automatic and conventional 2D measurements. Reproducibility of these measurements is similar to those observed in experienced sonographers. OP30.11The first trimester fetal central nervous system: a novel ultrasonographic perspective The fetal central nervous system (CNS) and in particular ventricular system, is difficult to examine in any great detail in the first trimester as it is rapidly changing. Furthermore, visualisation of the anatomical complexity of the CNS is limited by image resolution and operator expertise as a thorough knowledge of both sonoembryology and three-dimensional (3D) multiplanar reconstruction is required to obtain diagnostic images.We present a case of 32 year-old nulliparous woman who presented for a routine first trimester ultrasound scan, demonstrating a viable pregnancy with a Crown-rump length of 67mm (13 weeks and 1 day gestation). On two-dimensional imaging, all fetal structures appeared normal. A 3D volume of the fetus was obtained by coronal acquisition and examined using Crystal Vue and Realistic Vue™ rendering software, revealing a novel 3D impression of the fetal ventricular system comparable to digitally reconstructed embryological models.Crystal Vue and Realistic Vue™ enables a perception of depth whilst preserving contextual information. As demonstrated in this case, it allows visualisation of the third, fourth and developing lateral ventricles in a completely novel way not seen using standard imaging methods. The relatively simple use of this software may help to improve our understanding of neurodevelopmental changes in the first trimester and provide insight into pathognomonic markers of ventricular ...
Methods: From a group of consecutive patients suspected for ovarian cancer (OC) (symptoms, ascites, elevated cancer antigen (CA) 125) and who underwent laparotomy, 14 had PPC (tumour disseminated on the peritoneum without or with only minimal ovaries involvement). Before surgery all patient underwent standardised transvaginal and abdominal ultrasound examination with predefined definitions (images and videos stored) so to calculate RMI, LR2, ADNEX, SR. A subjective assessment was to discriminate between malignant and benign disease in a 6 point score. Results: High RMI was assessed in all cases. Tumours were classified as malignant (n=3) or inconclusive (n=11) with IOTA-SR. Median value of LR2 was 75.1% (range: 34.7-94.9). Median values of ADNEX model calculations were as follows: risk of malignancy-98.6% (range: 85.6-99.9), risk of stage II-IV OC-89.9%, risk of stage I OC -1.1%, risk of borderline tumour-0.45%, risk of metastatic cancer-7.4%. Once ADNEX model was calculated without CA125, in all cases with ascites the risk of malignancy was still over 91%, while in patients without ascites (n=3) this value was 58-63%. In subjective assessment all patients were suspected for malignancy. There were no pelvic tumours with locules, nor with papillations. Ascites and metastatic tumours in abdominal cavity were detected in 11 and 12 patients respectively. Median ultrasound diameter of ovaries or ovarian involvement was 34mm. Median concentration of CA125 was 928 U/ml (98-7000). Conclusions:In cases with PPC, the RMI, ADNEX model and subjective ultrasound assessment can predict malignancy with a very high accuracy. Evaluation of CA125 should be considered, both as a single diagnostic measure and a part of ADNEX model. IOTA-SR has limited value in diagnosing PPC. P30.03Imaging in gynecological disease: clinical and ultrasound features of ovarian endometrioid carcinoma
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