Henri Temianka Correspondence; (cutner)

https://digitalcommons.chapman.edu/temianka_correspondence/2862/thumbnail.jp

The UK National Prolapse Survey: 10 years on

INTRODUCTION AND HYPOTHESIS: To assess trends in the surgical management of pelvic organ prolapse (POP) amongst UK practitioners and changes in practice since a previous similar survey. METHODS: An online questionnaire survey (Typeform Pro) was emailed to British Society of Urogynaecology (BSUG) members. They included urogynaecologists working in tertiary centres, gynaecologists with a designated special interest in urogynaecology and general gynaecologists. The questionnaire included case scenarios encompassing contentious issues in the surgical management of POP and was a revised version of the questionnaire used in the previous surveys. The revised questionnaire included additional questions relating to the use of vaginal mesh and laparoscopic urogynaecology procedures. RESULTS: Of 516 BSUG members emailed, 212 provided completed responses.. For anterior vaginal wall prolapse the procedure of choice was anterior colporrhaphy (92% of respondents). For uterovaginal prolapse the procedure of choice was still vaginal hysterectomy and repair (75%). For posterior vaginal wall prolapse the procedure of choice was posterior colporrhaphy with midline fascial plication (97%). For vault prolapse the procedure of choice was sacrocolpopexy (54%) followed by vaginal wall repair and sacrospinous fixation (41%). The laparoscopic route was preferred for sacrocolpopexy (62% versus 38% for the open procedure). For primary prolapse, vaginal mesh was used by only 1% of respondents in the anterior compartment and by 3% in the posterior compartment. CONCLUSION: Basic trends in the use of native tissue prolapse surgery remain unchanged. There has been a significant decrease in the use of vaginal mesh for both primary and recurrent prolapse, with increasing use of laparoscopic procedures for prolapse

Deadlock-free asynchronous message reordering in rust with multiparty session types

Rust is a modern systems language focused on performance and reliability. Complementing Rust's promise to provide "fearless concurrency", developers frequently exploit asynchronous message passing. Unfortunately, sending and receiving messages in an arbitrary order to maximise computation-communication overlap (a popular optimisation in message-passing applications) opens up a Pandora's box of subtle concurrency bugs. To guarantee deadlock-freedom by construction, we present Rumpsteak: a new Rust framework based on multiparty session types. Previous session type implementations in Rust are either built upon synchronous and blocking communication and/or are limited to two-party interactions. Crucially, none support the arbitrary ordering of messages for efficiency. Rumpsteak instead targets asynchronous async/await code. Its unique ability is allowing developers to arbitrarily order send/receive messages while preserving deadlock-freedom. For this, Rumpsteak incorporates two recent advanced session type theories: (1) k-multiparty compatibility (k-MC), which globally verifies the safety of a set of participants, and (2) asynchronous multiparty session subtyping, which locally verifies optimisations in the context of a single participant. Specifically, we propose a novel algorithm for asynchronous subtyping that is both sound and decidable. We first evaluate the performance and expressiveness of Rumpsteak against three previous Rust implementations. We discover that Rumpsteak is around 1.7 - 8.6x more efficient and can safely express many more examples by virtue of offering arbitrary ordering of messages. Secondly, we analyse the complexity of our new algorithm and benchmark it against k-MC and a binary session subtyping algorithm. We find they are exponentially slower than Rumpsteak's

Designing a Replication Study in Kinesiology: Lessons from the Field

The submitted presentation material summarizes a project presented at the 2021 Cal Poly Virtual BEACoN Symposium. The title of the project which the presentation is based is, “Towards Equitable Communication: Explorations to Guide Knowledge Translation in Kinesiology.” The uploaded file document presents the presentation abstract, student testimony, as well as suggested citations for individual aspects of the presentation material. Please follow the social media profiles of the faculty mentor to the project, Dr. Thomas, for timely project updates. You may find related work from this lab group published to Cal Poly Digital Commons under the Kinesiology and Public Health section (see URL): https://digitalcommons.calpoly.edu/kinesp/ . Finally, a copy of the video presentation itself has been attached. Patrons are encouraged to use the file itself in their work. The video has English subtitles

Ultrasound mapping of pelvic endometriosis: does the location and number of lesions affect the diagnostic accuracy? a multicentre diagnostic accuracy study

BACKGROUND: Endometriosis is a common condition which causes pain and reduced fertility. Treatment can be difficult, especially for severe disease, and an accurate preoperative assessment would greatly help in the managment of these patients. The objective of this study is to assess the accuracy of pre-operative transvaginal ultrasound scanning (TVS) in identifying the specific features of pelvic endometriosis and pelvic adhesions in comparison with laparoscopy. METHODS: Consecutive women with clinically suspected or proven pelvic endometriosis, who were booked for laparoscopy, were invited to join the study. They all underwent a systematic transvaginal ultrasound examination in order to identify discrete endometriotic lesions and pelvic adhesions. The accuracy of ultrasound diagnosis was determined by comparing pre-operative ultrasound to laparoscopy findings. RESULTS: 198 women who underwent preoperative TVS and laparoscopy were included in the final analysis. At laparoscopy 126/198 (63.6%) women had evidence of pelvic endometriosis. 28/126 (22.8%) of them had endometriosis in a single location whilst the remaining 98/126 (77.2%) had endometriosis in two or more locations. Positive likelihood ratios (LR+) for the ultrasound diagnosis of ovarian endometriomas, moderate or severe ovarian adhesions, pouch of Douglas adhesions, and bladder deeply infiltrating endometriosis (DIE), recto-sigmoid colon DIE, rectovaginal DIE, uterovesical fold DIE and uterosacral ligament DIE were >10, whilst for pelvic side wall DIE and any ovarian adhesions the + LH was 8.421 and 9.81 respectively. The negative likelihood ratio (LR-) was: <0.1 for bladder DIE; 0.1-0.2 for ovarian endometriomas, moderate or severe ovarian adhesions, and pouch of Douglas adhesions; 0.5-1 for rectovaginal, uterovesical fold, pelvic side wall and uterosacral ligament DIE. The accuracy of TVS for the diagnosis of both total number of endometriotic lesions and DIE lesions significantly improved with increasing total number of lesions. CONCLUSIONS: Our study has shown that the TVS diagnosis of endometriotic lesion is very specific and false positive results are rare. Negative findings are less reliable and women with significant symptoms may still benefit from further investigation even if TVS findings are normal. The accuracy of ultrasound diagnosis is significantly affected by the location and number of endometriotic lesions

Laparoscopic sacrohysteropexy and myomectomy for uterine prolapse: a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>A large number of hysterectomies are carried out for uterine prolapse, menorrhagia and other symptomatic but benign gynaecological conditions, which has increased interest in new approaches to treat these disorders. These new procedures are less invasive and offer reduced risk and faster recovery.</p> <p>Case presentation</p> <p>Sacrohysteropexy can be carried out instead of vaginal hysterectomy in the treatment of uterine prolapse. It involves using a synthetic mesh to suspend the uterus to the sacrum; this maintains durable anatomic restoration, normal vaginal axis and sexual function. A laparoscopic approach has major advantages over the abdominal route including shorter recovery time and less adhesion formation. We describe a laparoscopic sacrohysteropexy in a 55-year-old Caucasian British woman that was technically difficult. An intramural uterine fibroid was encroaching just above the uterosacral ligament making mesh positioning impossible. This was removed and the procedure completed successfully.</p> <p>Conclusion</p> <p>Posterior wall fibroid is not a contraindication for laparoscopic sacrohysteropexy. This procedure has increasingly become an effective treatment of uterine prolapse in women who have no indication for hysterectomy.</p

Effectiveness of ovarian suspension in preventing post-operative ovarian adhesions in women with pelvic endometriosis: A randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>Endometriosis is a common benign condition, which is characterized by the growth of endometrial-like tissue in ectopic sites outside the uterus. Laparoscopic excision of the disease is frequently carried out for the treatment of severe endometriosis. Pelvic adhesions often develop following surgery and they can compromise the success of treatment. Ovarian suspension (elevating both ovaries to the anterior abdominal wall using a Prolene suture) is a simple procedure which has been used to facilitate ovarian retraction during surgery for severe pelvic endometriosis. The study aims to assess the effect of temporary ovarian suspension following laparoscopic surgery for severe pelvic endometriosis on the prevalence of post-operative ovarian adhesions.</p> <p>Methods</p> <p>A prospective double blind randomised controlled trial for patients with severe pelvic endometriosis requiring extensive laparoscopic dissection with preservation of the uterus and ovaries. Severity of the disease and eligibility for inclusion will be confirmed at surgery. Patients unable to provide written consent, inability to tolerate a transvaginal ultrasound scan, unsuccessful surgeries or suffer complications leading to oophorectomies, bowel injuries or open surgery will be excluded.</p> <p>Both ovaries are routinely suspended to the anterior abdominal wall during surgery. At the end of the operation, each participant will be randomised to having only one ovary suspended post-operatively. A new transabdominal suture will be reinserted to act as a placebo. Both sutures will be cut 36 to 48 hours after surgery before the woman is discharged home. Three months after surgery, all randomised patients will have a transvaginal ultrasound scan to assess for ovarian mobility. Both the patients and the person performing the scan will be blinded to the randomisation process.</p> <p>The primary outcome is the prevalence of ovarian adhesions on ultrasound examination. Secondary outcomes are the presence, intensity and site of post-operative pain.</p> <p>Discussion</p> <p>This controlled trial will provide evidence as to whether temporary ovarian suspension should be included into the routine surgical treatment of women with severe pelvic endometriosis.</p> <p>Trial registration</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN24242218">ISRCTN24242218</a></p

Trocar-guided total tension-free vaginal mesh repair of post-hysterectomy vaginal vault prolapse

Contains fulltext : 81076.pdf (publisher's version ) (Closed access)INTRODUCTION AND HYPOTHESIS: The objective of this study was to report 1 year anatomical and functional outcomes of trocar-guided total tension-free vaginal mesh (Prolift) repair for post-hysterectomy vaginal vault prolapse with one continuous piece of polypropylene mesh. METHODS: We conducted a prospective observational cohort study of 46 patients. A minimum sample size of 35 patients was needed to detect a recurrence rate of less than 20% at 12 months. Instruments of measurement used were pelvic organ prolapse quantification and validated questionnaires. RESULTS: Overall anatomical success was 91% (95% confidence interval 83-99), with significant improvement in experienced bother and quality of life. Mesh exposure occurred in seven patients (15%). No adverse effects on sexual function could be detected. CONCLUSIONS: Trocar-guided total tension-free vaginal mesh (Prolift) repair with one continuous piece of mesh for post-hysterectomy vaginal vault prolapse is well tolerated and anatomically and functionally highly effective. Results of controlled trials will determine its position in the operative armamentarium