No abstract

We conducted this prospective cohort study to standardize our laparoscopic technique of excision of posterior deep infiltrating endometriosis (DIE) nodules, according to their size, location, and geometry, including 36 patients who were grouped, according to principal pelvic expansion of the nodule, into groups with central (group 1) and lateral (group 2) lesions, and according to nodule size, into ≤2 cm (group A) and >2 cm (group B) lesions, respectively. In cases of group 1 the following operative steps were more frequently performed compared to those of group 2: suspension of the rectosigmoid, colpectomy, and placement of bowel wall reinforcement sutures. The opposite was true regarding suspension of the adnexa, systematic ureteric dissection, and removal of the diseased pelvic peritoneum. When grouping patients according to nodule size, almost all of the examined parameters were more frequently applied to patients of group B: adnexal suspension, suspension of the rectosigmoid, systematic ureteric dissection, division of uterine vein, colpectomy, and placement of bowel wall reinforcement sutures. Nodule size was the single most important determinant of duration of surgery. In conclusion, during the building-up of one's learning curve of laparoscopic excision of posterior DIE nodules, technique standardization is very important to avoid complications.

Pulmonary actinomycosis is a rare infectious disease, which is characterized by a wide range of symptoms and no specific imaging findings and may be confused with neoplasia, tuberculosis or pneumonia. Endobronchial involvement of actinomycosis may be caused by aspiration of foreign bodies or broncholithiasis and may bronchoscopically masquerade as malignancy. A case of 68-year-old man is reported, who presented with productive cough and fever and had no response to antibiotic therapy with moxifloxacin. Patchy air-space consolidation on left lower lobe was demonstrated on CT and flexible bronchoscopy revealed an endobronchial white necrotized mass, causing partial occlusion of bronchus and masquerading as lung cancer. Endobronchial actinomycosis was confirmed by biopsies of lesion, which revealed radiating filamentous colonies of Actinomyces and no evidence of malignancy. The patient was successfully treated with intravenous penicillin G for two weeks, followed by doxycycline per oral for six months, achieving full resolution of lesion on follow-up CT and bronchoscopy and no recurrence of symptoms.

This 1-step approach is both safe and effective and could be offered as a valid operative choice for those women who wish or should avoid a repeat surgical procedure for postoperative SUI.