This document summarizes several systematic reviews on the topic of hysteroscopy. It discusses findings related to hysteroscopy preparation, diagnostic hysteroscopy, operative hysteroscopy, and prevention of complications. For diagnostic hysteroscopy, vaginoscopy was found to be less painful than traditional techniques. Hysteroscopy also has high accuracy for detecting endometrial cancer, polyps, and submucous myomas. For operative procedures, hysteroscopic polypectomy and myomectomy were associated with improved pregnancy rates. Hysteroscopic techniques were generally found to have lower complication rates compared to laparoscopic or abdominal approaches. Prevention of intrauterine adhesions after hysteroscopy remains uncertain
NEW USES OF LASER IN GYNECOLOGY
International Society for the Study of Vulvovaginal Disease (ISSVD)
International Continence Society (ICS)
2019 Guidelines
NEW USES OF LASER IN GYNECOLOGY
International Society for the Study of Vulvovaginal Disease (ISSVD)
International Continence Society (ICS)
2019 Guidelines
The Diagnostic Value of Saline Infusion Sonohysterography Versus Hysteroscopy...Ahmed Mowafy
The Diagnostic Value of Saline Infusion Sonohysterography Versus Hysteroscopy in Evaluation of Uterine Cavity in Patients with Infertility and Recurrent Pregnancy Loss
DOI: 10.21276/ijlssr.2016.2.3.15
ABSTRACT- Abnormal cervical cytology includes lesions of the cervix caused due to various infections, hormonal
disturbances, premalignant and malignant conditions. Screening of all the symptomatic women complaining of vaginal
discharge, irregular menstrual bleeding, dyspareunia, post-coital bleeding or post-menopausal bleeding is necessary for
detection and also to pick up any aberration in cervix epithelium i.e. dysplasia or early cervical cancer.
Key-words- Negative for Intraepithelial Lesion or Malignancy, Atypical Squamous Cell of Undetermined Significance,
Low grade Squamous Intraepithelial Lesion, High grade Squamous Intraepithelial Lesion, Squamous Cell Carcinoma
Original StudyType of Breast Cancer Diagnosis, Screening,a.docxvannagoforth
Original Study
Type of Breast Cancer Diagnosis, Screening,
and Survival
Carla Cedolini,1 Serena Bertozzi,1 Ambrogio P. Londero,2 Sergio Bernardi,3,4
Luca Seriau,1 Serena Concina,1 Federico Cattin,1 Andrea Risaliti1
Abstract
Organized, invitational breast cancer screening in our population succeeded in detecting early-stage tumors,
which have been consequently treated more frequently with breast and axillary conservative surgery, com-
plementary breast irradiation, and eventual hormonal therapy. The diagnosis of invasive cancer with screening
in our population resulted in a survival gain at 5 years from the diagnosis.
Introduction: Breast cancer screening is known to reduce mortality. In the present study, we analyzed the prevalence
of breast cancers detected through screening, before and after introduction of an organized screening, and we
evaluated the overall survival of these patients in comparison with women with an extrascreening imaging-detected
breast cancer or those with palpable breast cancers. Materials and Methods: We collected data about all women
who underwent a breast operation for cancer in our department between 2001 and 2008, focusing on type of tumor
diagnosis, tumor characteristics, therapies administered, and patient outcome in terms of overall survival, and re-
currences. Data was analyzed by R (version 2.15.2), and P < .05 was considered significant. Results: Among the 2070
cases of invasive breast cancer we considered, 157 were detected by regional mammographic screening (group A),
843 by extrascreening breast imaging (group B: 507 by mammography and 336 by ultrasound), and 1070 by extra-
screening breast objective examination (group C). The 5-year overall survival in groups A, B, and C were, respectively,
99% (95% CI, 98%-100%), 98% (95% CI, 97%-99%), and 91% (95% CI, 90%-93%), with a significant difference
between the first 2 groups and the third (P < .05) and a trend between groups A and B (P ¼ .081). Conclusion: The
diagnosis of invasive breast cancer with screening in our population resulted in a survival gain at 5 years from the
diagnosis, but a longer follow-up is necessary to confirm this data.
Clinical Breast Cancer, Vol. 14, No. 4, 235-40 ª 2014 Elsevier Inc. All rights reserved.
Keywords: Breast cancer, Breast cancer screening, Invasive breast cancer, Mammographic screening, Overall survival
Introduction
Because of the detection of early-stage tumors, breast cancer
screening reduced breast cancer mortality in Europe by 25%-31%
in patients who were invited for screening and by 38%-48% in
those who were actually screened during the last decade of the
twentieth century and the first decade of the twenty-first.1 In our
region of Italy, an organized breast cancer screening was firstly intro-
duced in 2005, but despite the high compliance of invited women
1Clinic of Surgery
2Clinic of Obstetrics and Gynecology
University of Udine, Udine, Italy
3Department of Surgery, Ospedale Civile di Latisana, Udine, Italy
4 ...
All the guidelines recommend co testing as the modality of choice for cervical cancer screening.
However, Cobas test was approved by FDA as primary screening modality in 2014.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
3. What is a systematic review?
A review of a clearly formulated question that
uses systematic and explicit methods to
1. identify, select and critically appraise relevant research
2. collect and analyse data from the studies that are
included in the review
(Cochrane Reviewers’ Handbook 4.1.5)
ABOUBAKR ELNASHAR
6. 3. METHODS
Pub med:
From 2006 till October 2016
Key words
•Hysteroscopy
•Systematic review
•Meta analysis
ABOUBAKR ELNASHAR
7. 4. RESULTS
122 SR:
oRandomized controlled trials
oCase control studies
oSelf controlled studies
Classified into:
I. Preparation
II. Diagnostic hysteroscopy
III. Operative hysteroscopy
IV. Prevention of complications
ABOUBAKR ELNASHAR
8. I. PREPARATION
Antibiotic prophylaxis
No advantage was found for, hysteroscopy.
(Morrill et al, 2013)
Routine antibiotic prophylaxis is generally not
recommended, patients at risk for pelvic
infections should be screened and treated prior to
the procedure
(Pereira et al, 2016)
ABOUBAKR ELNASHAR
9. II. DIAGNOSTIC HYSTEROSCOPY
1. Vaginoscopy:
Should be the standard technique for diagnostic
hysteroscopy (Grade A)
Using
(≤3.5mm sheath)(Grade A)
Rigid hysteroscope (Grade C)
N S distension medium (Grade C)
Without
Any anaesthesia(conscious sedation should not be routinely
used)
Cervical preparation (Grade B)
Vaginal disinfection
Antibiotic prophylaxy(Grade B).
(Cooper et al, 2010; French College of Gyn and Obst, 2014)ABOUBAKR ELNASHAR
10. Successful and significantly reduces pain, compared
with traditional techniques using a vaginal speculum
(Cooper et al, 2010)
No significant complications
An easy way to gain access to the cervical canal
An important tool to diagnose and treat vaginal
lesions.
(Sardo et al, 2016)
ABOUBAKR ELNASHAR
11. 2. Diagnostic accuracy of hysteroscopy
Accurate in the diagnosis of IU abnormalities
(van Dongen et al, 2007)
High for:
Endometrial cancer
Polyps
Submucous myomas
Moderate for:
Endometrial hyperplasia
(Clark et al, 2002; Gkrozou et al, 2015)
ABOUBAKR ELNASHAR
12. (Gkrozou et al, 2015)
SensitivityLesion
75.2%Endometrial hyperplasia
82.6%Endometrial cancer
95.4%Endometrial polyps
97.0%Submucous myomas
ABOUBAKR ELNASHAR
13. 3. Comparison between histology of endometrial
hyperplasia obtained by:
uterine curettage
hysteroscopically guided biopsy, or
hysteroscopic endometrial resection and
subsequent results of hysterectomy
Uterine curettage or hysteroscopically guided biopsy
Underestimation of endometrial cancer:
inappropriate surgical procedures
(31.7% of tubal conservation and no abdominal exploration in 24.6% of the cases)
Hysteroscopic resection:
Reduced the risk of underdiagnosed endometrial
cancer
(Bourdel et al, 2016)
ABOUBAKR ELNASHAR
14. 4. Hysteroscopy before IVF
Before the 1st trial of IVF?
(inSIGHT): multicentre, RCT
(Smit et al, 2016, Lancet)
750: normal TVS
Hysteroscopy (with treatment of any detected abnormalities)
before starting IVF, or
Immediate IVF
LBR did not differ significantly (55%)
Routine hysteroscopy does not improve LBR in
infertile women with a normal TVS before first IVF
treatment.
Women with a normal TVS should not be
offered routine hysteroscopy.
ABOUBAKR ELNASHAR
15. Before IVF in women with RIF (2-4):
(TROPHY): multicentre, RCT (8 hospitals in the UK,
Belgium, Italy, and the Czech Republic)
350: hysteroscopy
352: control.
LBR: 29% in each group, no significant
difference between either group
(relative risk 1.0; 95% CI 0・79–1.25; p=0.96).
Outpatient hysteroscopy before IVF with a
normal TVS and a history of unsuccessful IVF
does not improve LBR.
(El-Toukhy , 2016, Lancet)
Trial of outpatient hysteroscopy
ABOUBAKR ELNASHAR
16. III. OPERATIVE HYSTEROSCOPY
1. Removal of LNG-IUS with retracted strings due to
pregnancy
Combining hysteroscopy with US facilitates
removal.
(McCarthy et al, 2012)
ABOUBAKR ELNASHAR
17. 2. Hysteroscopic morcellation Vs resection (traditional
electrocautery) for treatment of uterine cavitary lesions:
Lower incidence of:
Life-threatening complications:
fluid overload
uterine perforation
bleeding
(Haber et al, 2015)
Incomplete lesion removal.
Shorter operative time
Limitation:
Heterogeneity
Small sample size
(Shazly et al, 2016)
ABOUBAKR ELNASHAR
18. 3. Hysteroscopic septoplasty
Uterine sptum ±: detrimental effect on:
pregnancy achievement
spontaneous abortion
obstetric outcome
Septoplasty
Reduced spontaneous abortion
(RR 0.37, 95% CI 0.25 to 0.55)
(Venetis et al, 2014)
Safe and effective: PR: 60%
LBR: 45%.
(Nouri et al, 2010)
ABOUBAKR ELNASHAR
19. 4. Myomectomy
Fibroid ≤4 cm
marginally significant benefit compared with
expectant management
(RR = 1.9; 95% CI: 1.0-3.7).
(Bosteels et al, 2010)
CPR:
Fibroid:
21%
After myomectomy:
39%
(95% CI 21% to 58%): (odds ratio (OR) 2.44, 95% confidence interval
(CI) 0.97 to 6.17, P = 0.06, 94 women
very low quality evidence
(Cochrane SR, 2015)
ABOUBAKR ELNASHAR
20. 5. Polypectomy:
For 16 mm :
Prior to IUI:
doubles PR
starting 3 months after polypectomy
[relative risk (RR) = 2.3; 95% confidence interval (CI): 1.6-3.2].
(Bosteels et al, 2010)
CPR:
simple diagnostic hysteroscopy:
28%
Polynectomy:
63%
(95% CI 50% to 76%)(OR 4.41, 95% CI 2.45 to 7.96, P <
0.00001, 204 women, moderate quality evidence).
(Cochrane sr, 2015)
ABOUBAKR ELNASHAR
21. 6. Endometrial scratching in RIF
In the cycle prior to starting COS
improve pregnancy outcomes.
70% more likely to result in CP as opposed to
no treatment
2-times more likely to result in CP compared
with diagnostic hysterscopy.
(Potadar et al, 2012)
ABOUBAKR ELNASHAR
22. 7. Niche resection
Rate of complications:
low.
AUB
improved in 87 to 100%.
Pregnancies
were reported after therapy
sample sizes and follow-up: insufficient to
study fertility or pregnancy outcome
More evidence is needed before (surgical)
niche interventions are implemented in daily
practice.
(Voet et al, 2014)
ABOUBAKR ELNASHAR
23. 8. Treating CSP
5 approaches depending on:
availability
severity of symptoms
surgical skills:
1. Resection through
1. TV approach
2. Laparoscopy
3. Hysteroscopy.
2. UAE + D& C and hysteroscopy
3. UAE + D &C
(Petersen et al, 2016)
ABOUBAKR ELNASHAR
24. Hysteroscopy:
most frequently adopted 1st line approach.
Hysteroscopy and laparoscopic hysterotomy:
safe and efficient
Systemic methotrexate and D&C:
not recommended as 1st line approach
{high complication and hysterectomy rates}.
Hysterectomy
(%)
Success
rate (%)
Resolution
time(D)
Bleeding
(%)
0.039207Hysteroscopy
1185933UAE
2922028Lap Hysterotomy
496014Systemic MTX
7624651D&C
Pektas et al, 2016: 1674
ABOUBAKR ELNASHAR
25. 9. Sterilization Essure(®):
After 3 months
Pregnancy: rare
{1. no imaging follow-up
2. inadequate confirmation of placement or
occlusion}.
(Cleary et al, 2013)
ABOUBAKR ELNASHAR
26. Hysteroscopic Vs Laparoscopic sterilization:
Lower:
PR (GRADE very low)
Complication rates (GRADE very low)
No significant improvement in patient satisfaction
(GRADE very low).
(McMartin; 2013)
Safe, permanent, irreversible
less invasive.
(Hurskainen et al, 2010)
more expensive {cost of the microinserts}
less costly {shorter recovery time required}.
(Toronto Health Economic, 2013)
ABOUBAKR ELNASHAR
27. 10. For management of hydrosalpinx
Before IVF:
effective
(Arora et al, 2014)
ABOUBAKR ELNASHAR
28. 11. Endometrial ablation
Newer techniques
technically easier
Success rates and complication profiles:
compare favourably with TCRE
(Lethaby et al, Cochrane, SR, 2005)
ABOUBAKR ELNASHAR
29. 12. RPOC:
Hysteroscopic resection Vs D&C:
Less:
IUAs: 13 vs 30%
Incomplete evacuation:1 vs 29%
Similar
Conception,OPR, LBR and miscarriage rates
Tendency toward earlier conception
HR may be a preferable surgical treatment of
RPOC
(Hooker et al, 2016)
ABOUBAKR ELNASHAR
30. IV. PREVENTION OF COMPLICATIONS
1. Adhesions
IUAs at any 2nd -look hysteroscopy
Anti-adhesion therapy:
fewer when compared with no treatment or
placebo
(OR 0.36, 95% CI 0.20 to 0.64, P value = 0.0005,no statistical
heterogeneity (Chi(2) = 2.65, df = 5 (P value = 0.75), I(2) = 0%).
Number needed to treat for an additional benefit:
9 (95% CI 6 to 20).
LBR
No evidence of differences between anti-
adhesion therapy and no treatment or placebo
(Cochrane SR, 2015)
ABOUBAKR ELNASHAR
31. IUD Vs IU balloon:
No evidence of differences with respect to IUAs
at 2nd -look hysteroscopy
(OR 1.23, 95% CI 0.64 to 2.37, P value = 0.54, one study, 162 women;
very low-quality evidence).
The quality of evidence:
low or very low for all outcomes.
Clinical effectiveness of anti-adhesion treatment
for improving reproductive outcomes or for
decreasing IUAs: uncertain.
(Cochrane SR, 2015)
ABOUBAKR ELNASHAR
32. Surgical techniques which reduce the use of
electrosurgery:
should be preferred whenever possible
(Level of evidence: 4)
Early 2nd -look hysteroscopy:
effective as preventive & therapeutic
Gel barriers:
significant effect on IUA prevention
{higher adhesiveness and prolonged residence
time on the injured surface}
(Level of evidence: 1b)
(Sardo et al, 2016)
ABOUBAKR ELNASHAR
33. Hormonal and antibiotic therapy
difficult to evaluate
{it has been used in association with other
prevention strategies in most studies}.
(Sardo et al, 2016)
ABOUBAKR ELNASHAR
34. Gel:
Hyaluronic acid, polyethylene oxide-sodium carboxymethyl cellulose
significant reduction of IU adhesion
Estrogen
no decrease in IU adhesion
lack of definitive evidence
that any treatment is effective in preventing post
hysteroscopy IU adhesion.
{significant heterogeneity
high risk of bias}
(Healy et al, 2016)
ABOUBAKR ELNASHAR
35. 2. Cancer cell dissemination
Hysteroscopy in patients with endometrial cancer
hints a risk for cancer cell dissemination within the
peritoneal cavity.
(Polyzos et al, 2010)
The risk:
statistically significantly associated with the use of a liquid
medium for uterine cavity distention
not associated with early-stage disease.
No evidence
to support an association between preoperative
hysteroscopic examination and worse prognosis.
(Chang et al, 2011)
Diagnostic or operative hysteroscopy
is allowed when an endometrial cancer is
suspected
(Grade B).(French College of Gynand Obs, 2014)ABOUBAKR ELNASHAR
36. ABOUBAKR ELNASHAR
You can get this lecture from:
1.My scientific page on Face book:
Aboubakr Elnashar Lectures.
https://www.facebook.com/groups/2277
44884091351/
2.Slide share web site
3.elnashar53@hotmail.com
4.My clinic: Elthwara St. Mansura