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Rationale: Skin breakdown, as in wounds, leads to an electric potential, defined as current of injury with the intent of wound closure. Burn wounds are defined by different zones of perfusion having a direct influence on further therapy (e.g. conservative management or skin grafting). We studied immediate, quantifiable effects of electric stimulation on skin perfusion in burn wounds.Method: Wireless Microcurrent Stimulation (WMCS) was utilised as an adjunct therapeutic modality in 10 patients with partial thickness burn wounds. Microcirculation in the skin was quantified with a Laser Doppler (LDI) before and after WMCS treatment. We included a control group of 10 healthy individuals.Results: A single application of WMCS significantly increased mean flow, velocity and subsequently, haemoglobin and oxygen saturation in partial thickness burn wounds. In healthy skin these parameters increased, but were far less pronounced than in thermally injured skin.Conclusion: This study revealed, for the first time that non-contact WMCS improves blood flow in critically perfused partial thickness burn wounds without disturbing the wound or systemically affecting the patient and may represent a promising adjunct tool in burn treatment, with the potential of faster healing by enhanced perfusion of burn wounds and reduction of the zone of stasis.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

Objective To present the reproductive and obstetric outcome after laparoscopic excision of functional, non-communicating broadly attached rudimentary horn. Study design As a part of a retrospective study performed over the past 21 years to determine the reproductive and obstetric outcome after laparoscopic treatment for symptomatic non-communicating rudimentary horn, we identified seven women who became pregnant after laparoscopic removal of the broadly attached rudimentary horn. The main outcome measures were reproductive outcome, preterm birth, mode of delivery, birth weight, pregnancy-induced hypertension, antenatal bleeding and presence of other congenital anomalies. Results Infertility was present in 3 out of 8 cases (37.5%), although in 2 of them other confounding infertility factors existed. Seven out of 8 patients conceived, 2 of them by assisted reproduction techniques. All patients had a preterm delivery at 33 weeks of gestation (32.5 ± 2.4) by cesarean section due to pregnancy-induced hypertension (3 cases), IUGR (one case), contractions and hemorrhage (one case), while two were elective. The mean weight of infants was 1897 ± 607.8 g. Pregnancy-induced hypertension was observed in 3 and antenatal vaginal bleeding occurred in 5 patients. All infants are alive with no apparent congenital anomaly. Conclusions This case series confirms that pregnancies in women after laparoscopic excision of broadly attached rudimentary horns should be considered as high-risk ones and should be managed accordingly to ensure a satisfactory obstetric outcome. [ABSTRACT FROM AUTHOR]

Aims of the study and methods: Survival, complications and recurrences after diaphragmatic surgery at primary or interval debulking surgery were compared. One hundred and sixty three consecutive patients with stage III/IV ovarian cancer underwent diaphragmatic surgery between September 1993 and December 2007. Primary debulking was performed in group 1 (89) patients and interval debulking was performed in group 2 (74) patients. Cytoreductive outcome, overall survival (OS), disease-free survival (DFS) and post-operative complications were analysed. Results: Despite differences in baseline mean age (p =0.015), in FIGO stage III/IV (p =0.036) and in mean largest diameter of metastatic disease at the beginning of debulking surgery (p =0.037), the optimal debulking rates (residual tumour less than 1cm) were similar (p =0.065). Excision of diaphragmatic metastases was most frequently performed in group 1 (77.53%) and coagulation was most frequently performed in group 2 (58.10%). Similar overall survival and disease-free survival rates were found. After the propensity matching procedure, the largest diameter of metastatic disease at the time of debulking and no residual tumour (complete debulking) were demonstrated as independent prognostic factors for OS. Plaque-like lesions on the diaphragm metastases were significantly (p =0.015) more associated with diaphragm recurrence than papillary lesions. Minor and major complications related to diaphragmatic surgery as well as mean operating time, post-operative care in intensive care unit and length of hospitalisation were significantly higher in group 1 rather than in group 2 (p =0.043). Conclusions: Diaphragmatic dissemination resulted in similar survival and cytoreductive rates after primary and interval debulking. However, the morbidity was less after interval debulking as fewer surgical procedures were performed. [Copyright &y& Elsevier]

Objective: To compare the diagnostic performance of saline infusion sonohysterography (SIS), transvaginal ultrasound (TVS), and diagnostic hysteroscopy (DH) in the detection of endometrial lesions in symptomatic women. Design: Prospective, comparative study. Setting: Obstetrics and Gynecology Department of a tertiary academic hospital. Patient(s): A total of 105 consecutive women presenting in an outpatient clinic with symptoms of menorrhagia, postmenopausal bleeding, and infertility. Intervention(s): Each patient had TVS, SIS, and DH. Main Outcome Measure(s): The sensitivity, specificity, and positive and negative likelihood ratios (LR+ and LR-) for TVS, SIS, and DH were determined for the diagnosis of endometrial pathology. More specifically, the diagnostic performance of each of these three methods was compared after receiver operating characteristic analysis. Result(s): By comparative analysis of the area under the curve, DH was found to have a significantly better diagnostic performance compared to SIS and TVS. In addition, after comparing the receiver operating characteristic curves, DH was found to be significantly more precise in the diagnosis of intracavitary masses than TVS and SIS. However, SIS was more accurate compared to TVS. Conclusion(s): Saline infusion sonohysterography appears to be more valuable than TVS in the diagnosis of intracavitary masses (both polyps and myomas). [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of two different laparoscopic methods on ovarian reserve in patients with ovarian endometriomas. Design: Prospective, randomized clinical trial. Setting: Endoscopy unit of a university hospital. Patient(s): Twenty women with endometriomas. Intervention(s): Patients were randomly selected to undergo either laparoscopic cystectomy for endometrioma (group 1) or the “three-step procedure” (group 2). Before and 6 months after laparoscopy all patients were evaluated, and 12 months postoperatively they underwent ultrasound scan examination. Main Outcome Measure(s): The primary end point was ovarian reserve damage based on the alterations of anti-Müllerian hormone (AMH). Secondary end points were the changes of antral follicle count and serum concentration of FSH, LH, E2, and inhibin B. Result(s): Mean serum AMH was reduced significantly from 3.9–2.9 ng/mL in group 1 compared with the reduction from 4.5–3.99 ng/mL in group 2. Conclusion(s): Ovarian reserve determined by AMH is less diminished after the three-step procedure compared with cystectomy of endometriomas. [Copyright &y& Elsevier]

Abstract: INTRODUCTION: Free tissue transfer (FTT) is now a common procedure in many surgical centres around the world and it has shown well established results especially in the field of reconstructive surgery. The choice of FTT depends on the size of defect, nature of tissue, length of pedicle and donor site morbidity. Notwithstanding, FTT is complex and always depending on a sufficient recipient vessel. PRESENTATION OF CASE: Herein, we report a case in which the abdominal aorta was used as arterial recipient vessel for microvascular transfer of a free latissimus dorsi myocutaneous flap. It was utilized to reconstruct an extensive pelvic and hip defect following a massive gas gangrene with a prior debridement of other potential recipient vessels. DISCUSSION: In this case, the patient had a large defect that demanded a choice of a large flap such as the free latissimus dorsi myocutaneous flap. The iliac system has been sacrificed during the debridement procedure together with other potential recipient vessels. In the presented case, arterial anastomosis of the free latissimus dorsi myocutaneous flap was performed to the distal part of the aorta without complications. CONCLUSION: Using the abdominal aorta as a recipient arterial vessel seems to be a reliable alternative that should be considered in difficult reconstructive scenarios such as the “vessel-depleted” pelvis. [Copyright &y& Elsevier]

This study evaluated the osmoregulatory system changes in 39 patients with severe ovarian hyperstimulation syndrome. Plasma osmolality (Posm) less or more than 280 mOsm/kg body weight were associated with inappropriate antidiuretic hormone secretion syndrome and hypovolemia, respectively. [Copyright &y& Elsevier]

B Presenter: b Chrysanthos Christou | Aristotle University of Thessaloniki B Background: b Hepatectomy or hepatic resection is indicated in a plethora of liver and biliary track conditions. B Methods: b We created a highly standardized open hepatic resection protocol, which was implemented on every patient admitted in our department for a hepatectomy since 2010. [Extracted from the article]