Treatment of adenomyomectomy in women with severe uterine adenomyosis using a novel technique.

The advised treatment for severe adenomyosis is hysterectomy, but for patients wishing to preserve their uterus, novel conservative surgery, adenomyomectomy, can be performed. The technique needs to be developed to reduce spontaneous uterine rupture, adhesion and recurrence rates. This study aimed to investigate the safety and therapeutic outcomes of adenomyomectomy. Prospectively, 103 Iranian patients with documented severe adenomyosis were candidates for adenomyomectomy over a period of 7 years (from April 2004 to March 2011). The surgical procedure involved resection of adenomatosis lesions with a thin (⩽ 0.5 cm) margin (wedge-shaped removal) after sagittal incision in the uterine body. Reconstruction of the layers was performed and inverted sutures were used for the serosal layer ends. Of 103 patients, 55.34% presented with infertility, 16.50% with IVF failure, 8.74% with recurrent abortion and 19.42% with abnormal uterine bleeding. Of 70 patients who attempted pregnancy, naturally (n=21) or by assisted reproduction treatment (n=49), 30% achieved a clinical pregnancy, and 16 resulted in a full-term live birth. Dysmenorrhoea and hypermenorrhoea were reduced post surgery. Only one patient had relapsed adenomyosis. Adenomyomectomy is a conservative and effective treatment for adenomyosis. This study describes an efficient procedure to treat severe adenomyosis. Adenomyosis is uterine thickening that occurs when endometrial tissue, which normally lines the uterus, moves into the outer muscular walls of the uterus. The advised treatment for the severe forms of adenomyosis is hysterectomy (removal of the patient's uterus), but for the patient who wishes to preserve her uterus, a novel conservative surgery referred to as 'adenomyomectomy' (removal of the abnormal tissues) can be performed. This technique must be developed for reduction of spontaneous uterine rupture, adhesions and recurrence rate. This study aims to investigate the safety and therapeutic outcomes of adenomyomectomy. Prospectively, 103 Iranian patients with documented severe adenomyosis were candidates for adenomyomectomy over a period of 7 years (from April 2004 to March 2011). The surgical procedure was resection of adenomatosis lesions with a thin margin. Of 103 patients, 55.34% presented with infertility, 16.50% with IVF failure, 8.74% with recurrent abortion and 19.42% with abnormal uterus bleeding. Of 70 patients who attempted pregnancy either naturally (n=21) or using assisted reproduction technology (n=49), 30% became pregnant, and 16 pregnancies reached full term. There was a significant reduction in dysmenorrhoea and hypermenorrhoea. Only one patient had relapsed adenomyosis. Based on these results, we conclude that adenomyomectomy is the conservative and effective option to treat adenomyosis with preservation of the uterus. The procedure described in this study can be an efficient procedure to treat severe adenomyosis.

Low-Level Laser and Light Therapy After Total Knee Arthroplasty Improves Postoperative Pain and Functional Outcomes: A Three-Arm Randomized Clinical Trial.

Background: We examined the effect of low-level laser therapy (LLLT) and Bioptron light therapy on pain and function following primary total knee arthroplasty. Methods: A single-center, single-surgeon, prospective randomized clinical trial was performed with 3 groups of 15 patients: LLLT (804 nm), light (Bioptron; Bioptron AG, Wollerau, Switzerland), and controls. Range of motion (ROM), visual analog scale pain, opiate consumption (oxycodone in milligrams), knee swelling, and the Knee Society Score (KSS) were assessed before the surgery and on postoperative day 2, postoperative day 3, month 3, and month 12 after the operation. Results: The preoperative scores were similar between groups. A higher ROM was observed with the LLLT group at all follow-ups except at the 12-month follow-up (3-month ROM: 116.8° vs 104.0° vs 92.3°; P < .001). The knee swelling at 3 months was similar between the LLLT and light groups (2.1 cm), which was lower than that in controls (2.1 cm, P < .001). Furthermore, visual analog scale pain decreased more in the LLLT group than in other groups (8.5 vs 7.2 vs 6.0 points) at 3 months (P = .04) but was similar at 12 months (P > .05). Also, the LLLT group consumed fewer opiate painkillers during the first month (48.3 vs 60.3 mg of oxycodone, P = .02). In the LLLT group, the KSS at 3 and 12 months and the KSS function score at 3 months exceeded minimally clinically important differences (P < .05). Conclusions: In the early stages of recovery after total knee arthroplasty, LLLT and Bioptron light therapy could be helpful to control immediate and acute knee pain and swelling, reduce the need for opioids, improve ROM and functional scores, and improve recovery. Level of Evidence: Therapeutic level I.

Yoga Effects on Anthropometric Indices and Polycystic Ovary Syndrome Symptoms in Women Undergoing Infertility Treatment: A Randomized Controlled Clinical Trial.

The aim of this study was to investigate the effects of yoga exercises on anthropometric parameter and clinical sign of PCOS among women undergoing infertility treatment. This clinical trial study was performed on 61 women with PCOS who have undergone infertility treatment at Sarem Hospital in Tehran, Iran. The patients were first selecting based on purposeful and then randomly assigning to the intervention and control groups. In the intervention group, yoga exercises were performed for 6 weeks and the patients in the control group only received routine care. Anthropometric parameters and clinical signs were performed and recorded. After the intervention, here was a significant reduction in hirsutism, abdominal circumference, and hip circumference scores in the intervention group compared to the control group (P < 0.05). Given the effects of yoga exercises on the improvement of hirsutism, abdominal circumference, and hip circumference, it is suggested to use yoga as a treatment strategy in women with PCOS.

Super-Flexibility in Practice: Insights from a Crisis.

Flexibility is intuitively valued as a means of dynamically adapting to uncertainty. Historically, it has been especially prized during times of crisis. This is clearly demonstrated today as the current Coronavirus crisis is unfolding; there are many different dimensions of flexibility, ranging from versatility, agility, and resilience, to hedging, robustness and liquidity. For convenience, we fuse these terms together under the conceptual umbrella of "super-flexibility". We define super-flexibility as a dynamic capability to simultaneously withstand turbulence AND adapt to fluid reality. Our field research has focused on how companies in Silicon Valley embrace uncertainty and drive adaptation. In this paper, we draw on the experience of a manufacturing firm facing the floods that hit Thailand in October 2011. The crisis enabled us to observe a situation in which the different nuances of flexibility collectively came into play within a compressed time-frame. In this paper, we showcase the practical application of super-flexibility in a crisis. First, we describe the conceptual foundations of flexibility and its different nuances. We then examine the chronology of the crisis as events unfolded. We conclude by distilling a number of "super-flexibility" lessons for business leaders.

Metadata Correction: Uterine Fundectomy in Patients with Benign Etiology Undergoing Hysterectomy: New Surgical Technique.

[This corrects the article DOI: 10.2196/resprot.7536.].

Uterine Fundectomy in Patients With Benign Etiology Undergoing Hysterectomy: New Surgical Technique.

BACKGROUND: Hysterectomy is the most common surgical procedure in gynecology, not only in cases of malignancies but also in many benign cases. Many uterine preservation techniques have been introduced as alternatives to hysterectomy. OBJECTIVE: We aimed to propose a new uterine surgical procedure. In this paper, we compare the utility of this new technique to the limitations of current procedures. METHODS: Uterine fundectomy may be considered as a subtotal hysterectomy. In this new technique, the uterine fundus including all pathologic tissue is cut as a reverse trapezoid by monopolar cautery. The upper side of the trapezoid, which includes the whole uterine fundus, is removed, but the fallopian tubes and cornual segment are preserved. A small uterine cavity remains, as well as the endometrial tissue lining it. RESULTS: Patient recruitment for this study began in April 2017 and is expected to end approximately 12 months later. Assessment of the primary outcomes is expected to take place in April 2018. CONCLUSIONS: Uterine preservation is particularly critical in developing new surgical approaches that can lead to a positive impact on patient satisfaction. This protocol outlines the first attempt to prospectively test surgical fundectomy in candidates for hysterectomy for benign indications.