This document discusses uterine-sparing surgery for adenomyosis to improve fertility. It describes how adenomyosis can negatively impact fertility and IVF success rates. There are two types of uterine-sparing surgery discussed - complete excision (adenomyomectomy) for localized adenomyosis and partial excision (cytoreductive surgery) for diffuse adenomyosis. The techniques, indications, complications, and outcomes of these surgeries are examined, including improved fertility and pregnancy rates compared to hormonal therapies. However, risks like uterine rupture during subsequent pregnancy must be considered. Overall, the document concludes uterine-sparing surgery is a feasible option for improving fertility in qualified patients with adenomyosis, but it requires
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
Advance in diagnosis & treatment of cancers has led to high cure rate & longer survival.
Nearly 1 in 12 cases detected before 40 years age.
Survivors have to face infertility or early menopause.
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
Advance in diagnosis & treatment of cancers has led to high cure rate & longer survival.
Nearly 1 in 12 cases detected before 40 years age.
Survivors have to face infertility or early menopause.
Role of Stem Cells in Obstetrics and Gynecology PracticeAsha Jain
Role of Stem Cells in Obstetrics and Gynecology Practice
Talk delivered at 4th Biennial International ISCSGCON 2021
on Febuary 13,2021 by Dr. Asha Jain
Invited Lecture delivered by Dr Sujoy Dasgupta in a CME, sponsored by Serum Institute of India Pvt Ltd in the Convocation Ceremony of Interns at Sagor Dutta Medical College
this presentation highlights the principles of uterine and ovarian transplantation. It explores the past and examines the current status for uterine and ovarian factor infertility.
Endometriosis and Subfertility - What to do?Sujoy Dasgupta
Lecture delivered by Dr Sujoy Dasgupta in IPCON 2823, the Mid term conference of ISOPARB (Indian Society of Perinatology and Reproductive Biology) held at Kolkata on 10 September
Role of Stem Cells in Obstetrics and Gynecology PracticeAsha Jain
Role of Stem Cells in Obstetrics and Gynecology Practice
Talk delivered at 4th Biennial International ISCSGCON 2021
on Febuary 13,2021 by Dr. Asha Jain
Invited Lecture delivered by Dr Sujoy Dasgupta in a CME, sponsored by Serum Institute of India Pvt Ltd in the Convocation Ceremony of Interns at Sagor Dutta Medical College
this presentation highlights the principles of uterine and ovarian transplantation. It explores the past and examines the current status for uterine and ovarian factor infertility.
Endometriosis and Subfertility - What to do?Sujoy Dasgupta
Lecture delivered by Dr Sujoy Dasgupta in IPCON 2823, the Mid term conference of ISOPARB (Indian Society of Perinatology and Reproductive Biology) held at Kolkata on 10 September
Endometriosis and Subfertility, Primium non nocereSujoy Dasgupta
Dr Sujoy dasgupta and Dr Arun Madhab Barua were invited to moderate a panel discussion on "Endometriosis and Subfertility, Primium non nocere" in the International Congress on Endometriosis (ICE) on 10 December 2023 at Dhana Dhanya Auditorium, Kolkata
Fairmonte 2014 treatment of niche asogicMohamad Saad
Transvaginal repair of symptomatic caesarian section scar defects (CSSD)
A novel vaginal approach
by Prof.Reffat Alsheemy
faculty of medicine - Al Azhar university
Egypt
In this manuscript we show the successful laparoscopical treatment of a ruptured cornual ectopic pregnancy. In many settings this condition is treated by open approach due to the advanced skills required to control bleeding. This is a case report with the aim of showing images of the procedure, how to easily prevent bleeding and the management of it.
Fertility Management: Synergy between Endoscopists and Fertility SpecialistsSujoy Dasgupta
Dr Sujoy Dasgupta was invited to moderate a panel discussion on "Fertility Management: Synergy between Endoscopists and Fertility Specialists " in a CME by Torrent held on 27 May 2023.
AGAINST the Motion- “Surgery is the ONLY treatment of Endometriosis with Infe...Sujoy Dasgupta
Dr Sujoy Dasgupta participated in the invited debate on “Surgery is the ONLY treatment of Endometriosis with Infertility” in the Webinar organized by the AICC RCOG (All India Coordinating Committee) East Zone held in February, 2022
AGAINST the Motion- “Surgery is the ONLY treatment of Endometriosis with Infe...Sujoy Dasgupta
Dr Sujoy Dasgupta participated in an invited debate through a webinar organized by Dr B. N. Chakraborty School of Fertility Management and research, held in July, 2020
Fetal anterior neck teratomas are tumors which arise from the
three blastomericl ayers - ectoderm, endoderm and mesoderm. It occurs when the totipotent germ cells are out of control of primary organizers [1,2]. Th e histologic features may include cystic and solid areas with organoid patterns and it may include mature or immature cells [1]. Even though the most common area of occurrence is at sacrococcgeal area it can also occur in other body parts [1,3]. In this case report we presented one of the rare place of teratoma - anterior fetal neck teratoma.
Management of Endometrioma- Current UpdateSujoy Dasgupta
Invited Lecture by Dr Sujoy Dasgupta in the Webinar on "Update on Endometriosis" organized by AICC RCOG (All India Coordinating Committee of Royal College of Obstetricians and Gynaecologists) East Zone, held in December, 2021
Endometriosis is a disease restricted usually to the female genital tract. Involvement of the bowel by this disease can lead to a diagnostic dilemma due to the great variation in the symptomatology. Awareness of the pathophysiology, clinical features and diagnostic modalities is of utmost importance to decide the modality of treatment. Hormonal manipulation and surgical resection are the two modalities of treatment. The choice depends upon critical analysis of clinical and radiological findings and the desire to have pregnancy in cases associated with infertility.
Similar to Uterine-Sparing Surgery for Adenomyosis Prof. Aboubakr Elnashar (20)
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/
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
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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.
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
2. Is there a role for
uterine sparing surgery in
diffuse adenomyosis
to improve fertility
? 5/7/2017ABOUBAKR ELNASHAR
3. Contents
I. Adenomyosis associated infertility
II. Uterine spraining surgery for adenomyosis
1.Types
2.Route
3.Steps; Video
4.Techniques
5.Indications
6.Complications
7.Outcome
1.Symptoms
2.Fertility
3.Pregnancy
8.Comparison with other tt
Conclusion 5/7/2017ABOUBAKR ELNASHAR
4. Adenomyosis and infertility
Strong association between adenomyosis and
fertility.
Infertile women should be evaluated for the
possibility of adenomyosis
[Vercellini et al, 2014 ].
Decreased CPR
Increased abortion rate
5/7/2017ABOUBAKR ELNASHAR
5. Adenomyosis and ICSI
(Vercellini et al, 2014; Benagianoet al, MA, 2015]
lower
implantation rate/ET
CPR
(RR 0.72, 95% CI 0.55e0.95)
LBR
(RR 0.70, 95% CI 0.56e0.87).
higher
spontaneous abortion rate.
(RR 2.12, 95% CI 1.20e3.75)
{adenomyotic uterine environment}
5/7/2017ABOUBAKR ELNASHAR
6. Treatment of adenomyosis associated infertility
Highly controversial
No consensus
Extremely challenging
Multiple treatment modalities
1. Hormonal therapy with GnRha
(Lin et al, 2000)
Effect is often transient:
Rapid regrowth of adenomyosis
Relapse of S and S.
5/7/2017ABOUBAKR ELNASHAR
7. 2. ART:
Two studies:
positive effect of prolonged down-regulation
on IVF outcomes
(Wang et 2009, Koo t al, 2011 )
Another study:
negative effect
(Fujishita et al, 2004).
5/7/2017ABOUBAKR ELNASHAR
8. 3. Conservative surgical procedures:
(Nishida et al, 2010).
Increasingly used
More women delay their 1st pregnancy until 30
or 40 y
Feasible
Satisfactory
Fertility preservation
Quality-of-life improvement
5/7/2017ABOUBAKR ELNASHAR
11. 2. Route of surgery
For localized adenomyosis=Type I
The first series:
through laparotomy
[Fedele et al,1993; Tadjerouni et al, 1995 ]
Nowadays:
safely and effectively performed
laparoscopically.
(Huang et al, 2015)
5/7/2017ABOUBAKR ELNASHAR
12. For Diffuse adenomyosis= Type II
Best performed via laparotomy
{digital palpation of the uterus to:
identify affected areas
selective and piecemeal removal of lesions]
5/7/2017ABOUBAKR ELNASHAR
13. 4. Techniques
Complete excision= Adenomyomectomy=Type I
1. Classic technique
(Hyams 1952; Grimbizis et al., 2008; Wang et al. 2009)/
plus intraoperative ultrasound guidance
(Nabeshima et al. 2003; Nabeshima et al. 2008)
2. U-shaped suturing
(Sun et al. 2011)
3. Overlapping flaps
(Tacheshi et al. 2006)
4. Triple flap method
(Osada et al. 2011)
5/7/2017ABOUBAKR ELNASHAR
14. Classic technique:
(a)Longitudinal incision along the adenomyoma. (b) Sharp and blunt dissection
with scissors, graspers and/or diathermy. (c) Suturing of the endometrial
cavity. (d) Suturing of the uterine wall.
5/7/2017ABOUBAKR ELNASHAR
15. overlapping flaps:
(a) Transverse incision. (b) The lesion is excised with monopolar needle. (c, d)
The remaining seromuscular layers are overlapped and sutured to counteract
the lost muscle layer of the uterus
5/7/2017ABOUBAKR ELNASHAR
16. Triple flap technique:
(a)Bisection of the uterus in
the midline and in the
sagittal plane
(b) Opening of the endometrial
cavity and excision of
adenomyotic tissues leaving a
myometrial thickness of 1 cm.
(c) Closure of the
endometrium.
(d) Closure of the flaps
approximating the
myometrium and serosa of the one
side of the bisected uterus in the
anteroposterior plane
(e) The contralateral side of
the uterine wall is brought over
the reconstructed first side in
such a way as to cover it.
5/7/2017ABOUBAKR ELNASHAR
18. II. Partial excision (cytoreductive surgery) Partial
adenomyomectomy = Type II
1. Classic technique
(Fujishita et al. 2004)
2. Transverse H incision
(Fujishita et al. 2004)
3. Wedge resection of the uterus
(Sun et al. 2011)
4. Asymmetric dissection of the uterus
(Nishida et al. 2010)
5/7/2017ABOUBAKR ELNASHAR
19. 5. Indications
Desire for pregnancy.
IVF failures
Age ≤39 years.
{No benefit on fertility ≥40 y
(Kishi et al, 2014)
CPR:
41.3% in those aged ≤ 39 y
3.7% in those aged 40 y}
[odds ratio (OR) 0.77, 95% CI 0.67e0.88, p ¼ 0.002]
5/7/2017ABOUBAKR ELNASHAR
20. Decision should be taken carefully after
1. Extensive counseling
2. Consideration of alternatives
3. Low index of suspicion with uterine rupture in
women who conceive after uterine sparing
surgery
[Pepas et al, 2012 ].
5/7/2017ABOUBAKR ELNASHAR
21. Management of women with adenomyosis-
associated infertility
Tsui et al, 2015.
1.Routine infertility investigation plus ORT
Normal: long agonist protocol and natural
conception
Abnormal: IVF
2. Failed natural conception or IVF:
repeat IVF
3. Failed IVF:
conservative surgery
IVF after 3 m
5/7/2017ABOUBAKR ELNASHAR
22. 6. Complications
I. Before pregnancy
1. Asherman syndrome
2. Uterine deformities
3. Reduced uterine capacity.
[Liu et al, 2014]
The incidence of these complications: unknown.
5/7/2017ABOUBAKR ELNASHAR
23. II. During pregnancy
1. Rapid growth of adenomyosis or adenomyoma in
pregnancy,
2. Spontaneous miscarriage
3. Preterm birth
4. IUGR
5. Preeclampsia
6. Obstetric hemorrhages
{defective remodeling of the spiral arteries during the
decidualization process: vascular resistance and
an increased risk of defective deep placentation}
[Vercellini et al, 2014].
7. Spontaneous rupture of an unscarred uterus during
pregnancy or labor
[Wang et al, 2000; Benagiano et al, 2015].
5/7/2017ABOUBAKR ELNASHAR
24. 103 women: excision of diffuse adenomyosis
through laparotomy
residual myometrial thickness was at least 0.5 cm
70 of whom wished to conceive
21 pregnancies: 16 reached term.
2 (9.5 %) cases of uterine rupture which
occurred at 32 and 37 w
Postoperative Asherman syndrome:
4 out of 103 (3.9 %) patients.
(Saremi et al.2014)
5/7/2017ABOUBAKR ELNASHAR
25. Causes of Uterine rupture
1. Poor healing of the uterine defect
2. Weakness of the uterine scar.
[Wang et al, 2009]
The defect contains adenomyotic foci.
Decidualization of residual adenomyotic
fragments: weakens the scar
[Ukita et al, 2011 ].
Inadequate repair
Decreased tensile strength of the uterus
[Takeuchi et al, 2006; Horng et al, 2013; Grimbizis et al 2014]
5/7/2017ABOUBAKR ELNASHAR
26. How to decrease uterine rupture
(Osada et al., 2011)
1. No intramural dead spaces
2. Preserve at least 1 cm of myometrial
thickness:
no uterine rupture among 14 women who
subsequently had a term delivery
Video
5/7/2017ABOUBAKR ELNASHAR
29. Pregnancy outcome
Type I:
Four-fifths had a successful delivery
Type II:
Two-thirds had a successful delivery
(Grimbizis et al 2014]
5/7/2017ABOUBAKR ELNASHAR
30. Mode of delivery:
Elective CS after Type I or Type II
(Grimbizis et al 2014].
Although a few case reports showed the possibility
of successful vaginal deliveries in women with
adenomyosis after conservative surgery, the majority
of cases were completed by cesarean section.
5/7/2017ABOUBAKR ELNASHAR
31. 8. Comparison with GNRHa in management of
symptomatic women
Higher CPR in the surgical group
[Wang et al, 2009].
Conservative surgery or combination therapy provides more
effective and longer durable symptom control in the
management of symptomatic women with extensive
uterine adenomyosis, compared with GnRHa alone.
Reproductive performance was also better in patients treated
with conservative surgery with/without GnRHa
5/7/2017ABOUBAKR ELNASHAR
32. CONCLUSION
Uterine-sparing surgery of adenomyosis:
Feasible and effective.
Technically demanding, especially in cases of
diffuse disease
Women have to be extensively counseled about
the risk of uterine rupture in a future pregnancy.
Myometrial reconstruction has to be performed
meticulously
leaving at least 1 cm of myometrial thickness
no intramural dead spaces
5/7/2017ABOUBAKR ELNASHAR
33. Control of symptoms is achieved in
80% (dysmenorrhea control)
50% (menorrhagia control)
45% CPR
Results are difficult to compare between surgical
series but it seems that LBR after excision of
adenomyosis around 30 %.
5/7/2017ABOUBAKR ELNASHAR
34. 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
5/7/2017