[Pelvic inflammatory disease and an abscessed endometriosis cyst: a diagnostic problem and a therapeutic dilemma],'Pelvic inflammatory disease' en een geabcedeerde endometriosecyste: een diagnostisch probleem en een therapeutisch dilemma.

Item does not contain fulltextA 52-year-old woman with known endometriosis was treated with a levonorgestrel-containing IUD for irregular vaginal blood loss. Two weeks later she was admitted with signs ofpelvic inflammatory disease (PID) and was treated with antibiotics. As no clinical improvement ensued, laparoscopy was performed which demonstrated an infected endometriosis cyst in her right ovary. Ovariectomy was performed. In a 29-year-old woman with a symptomatic endometriosis cyst in the right ovary, PID was also suspected. After an initially good response to antibiotic therapy her condition deteriorated. Laparotomy revealed an infected endometriosis cyst. It was drained with subsequent cystectomy. A third, 43-year-old, woman with known endometriosis was admitted with signs of PID. Although she had a good clinical response to antibiotic therapy, her C-reactive protein (CRP) level remained elevated. Diagnostic laparoscopy demonstrated a large abscess in the right ovary. Ovariectomy was performed. Histology showed signs of an infected endometriosis cyst. All these women presented with PID and, in addition, a cystic adnexal mass on ultrasonography. The incidence oftubo-ovarian and ovarian abscesses is higher in the presence of an endometriosis cyst. Irrespective of the presence of an endometriosis cyst, antibiotics should be the first line of treatment. Reduction in the size of the abscess is not a useful parameter for monitoring conservative treatment when an infected endometriosis cyst is present. If it is decided to perform surgery on the infected endometriosis cyst, drainage of the abscess is usually not sufficient: excision of the endometriosis cyst is the only adequate therapy

Systematic review on recovery specific quality-of-life instruments.

Contains fulltext : 70895.pdf (publisher's version ) (Closed access)BACKGROUND: Postoperative recovery is a considerable issue in studies comparing operative techniques of similar effectiveness. In recent years, a shift has occurred toward patient-centered study outcomes such as quality-of-life questionnaires. The objective of this article is to provide a systematic review of the literature on general postoperative, recovery-specific quality-of-life instruments and their measurement properties. METHODS: We searched the databases EMBASE.com, Cinahl, PsycINFO, and PubMed for articles reporting on postoperative, recovery-specific quality-of-life instruments. A checklist was used to assess the revealed studies and instruments. Existing quality criteria were applied to the measurement properties to compare the instruments. RESULTS: The search strategy identified 620 studies, of which 18 studies reported on 12 different postoperative, recovery-specific quality-of-life instruments. None of the instruments had been validated completely in line with the 8 quality criteria, which were used to assess the measurement properties. Two instruments were clearly superior, which were the Postdischarge surgical recovery scale and the Quality of recovery-40. CONCLUSIONS: No fully validated instrument is available for the assessment of general postoperative recovery. We advise to use the Postdischarge surgical recovery scale and the Quality of recovery-40 in future validation and application studies on short-term postoperative recovery

Pelvic organ function in randomized patients undergoing laparoscopic or abdominal hysterectomy.

STUDY OBJECTIVE: To assess the incidence of urinary incontinence, bowel dysfunction, and sexual problems after laparoscopic hysterectomy as compared with abdominal hysterectomy. DESIGN: Randomized controlled trial (Canadian Task Force classification I). SETTING: Single-center teaching hospital in the Netherlands, experienced in gynecologic minimal access surgery. PATIENTS: Women with a benign or malignant condition scheduled for hysterectomy where vaginal hysterectomy was not feasible and laparoscopic hysterectomy was possible. INTERVENTIONS: Laparoscopic (n = 38) and abdominal hysterectomy (n = 38). MEASUREMENTS AND MAIN RESULTS: Patients were asked before and 3 months after surgery whether they experienced urinary incontinence and completed the validated questionnaires Urogenital Distress Inventory, Incontinence Impact Questionnaire, Defecatory Distress Inventory, and the Questionnaire for screening Sexual Dysfunctions 1 year after surgery. The incidence of urinary incontinence at 3 months after surgery decreased equally in both groups as compared with baseline. De novo urinary incontinence and sexual problems were rare. One year after surgery, a significant treatment effect favoring laparoscopic hysterectomy was found in the Urogenital Distress Inventory and Incontinence Impact Questionnaire, whereas no differences were found in the Defecatory Distress Inventory and Questionnaire for screening Sexual Dysfunctions. CONCLUSION: Laparoscopic hysterectomy is superior to abdominal hysterectomy with respect to postoperative symptoms of urinary dysfunction

Clinimetric properties of 3 instruments measuring postoperative recovery in a gynecologic surgical population.

Contains fulltext : 69131.pdf (publisher's version ) (Closed access)BACKGROUND: General, health-related quality-of-life questionnaires and recovery-specific questionnaires have been used to measure recovery in surgical patients. The aim of this study was to evaluate the clinimetric properties of 3 recovery instruments and to examine whether recovery-specific instruments are useful. METHODS: The Quality of Recovery-40 (QoR-40), Recovery Index-10 (RI-10), and RAND-36 health survey were used to measure recovery in women undergoing different types of hysterectomy in the first 12 weeks after operation. Construct validity was assessed by testing predefined hypotheses. The changes observed during the postoperative period were used as indicators for responsiveness. RESULTS: One hundred and sixty-one women were included. Response rate and internal consistency were found satisfactory. The highest number of hypotheses used for assessment of construct validity was confirmed in the RI-10. The RI-10 was more responsive compared with the QoR-40 and the RAND-36. CONCLUSIONS: Because construct validity and responsiveness were greatest in the RI-10, we conclude that this short recovery-specific instrument is useful in studies evaluating postoperative recovery. We recommend the use of the RI-10, unless the immediate postoperative days are of interest in which the QoR-40 was valid

Quality of life and surgical outcome after total laparoscopic hysterectomy versus total abdominal hysterectomy for benign disease: a randomized, controlled trial.

Contains fulltext : 52884.pdf (publisher's version ) (Closed access)STUDY OBJECTIVE: Minimally invasive surgery aims to achieve at least a similar clinical effectiveness with a quicker recovery than traditional open techniques. Although there have been numerous randomized clinical trials comparing laparoscopic hysterectomy with hysterectomy by laparotomy, only a few studies have compared quality of life after different types of hysterectomy. None of these studies evaluated total laparoscopic hysterectomy. In this paper, we report on a randomized comparison of quality of life after total laparoscopic versus total abdominal hysterectomy. DESIGN: Randomized, controlled trial (Canadian Task Force classification I). SETTING: Single-center teaching hospital in The Netherlands. PATIENTS: Patients scheduled for hysterectomy for a benign condition, in whom a vaginal hysterectomy was not possible and laparoscopic hysterectomy was feasible (mobile uterus not exceeding the size of 18 weeks' gestation). INTERVENTIONS: Abdominal versus laparoscopic hysterectomy. MEASUREMENTS AND MAIN RESULTS: Patients completed the Dutch version RAND-36 health survey preoperatively as well as at 5 time points in the first 12 weeks after surgery. The primary outcome of the study was quality of life as measured by the RAND-36. A linear mixed model was used for statistical analysis while accounting for baseline values. Secondary outcomes were hospital stay and complications. There were 88 patients eligible, of whom 59 gave consent for randomization. Twenty-seven women were allocated to the laparoscopic arm and 32 to the abdominal arm. We found a significant treatment effect favoring laparoscopic hysterectomy in the RAND-36 scale for vitality. Laparoscopic hysterectomy performed better on all other scales of the RAND-36, but these differences were not statistically significant. CONCLUSIONS: Laparoscopic hysterectomy results in more postoperative vitality when compared with abdominal hysterectomy. For this reason, all women with a benign condition requiring abdominal hysterectomy, in whom the laparoscopic approach is feasible, should have the chance to choose laparoscopic hysterectomy