8605 Gynecologic Laparoscopy in the Bariatric Patient: A Retrospective Review of Abdominal Access and Associated Complications

Study Objective: To provide clinical direction on laparoscopic abdominal entry techniques in women with known history of laparoscopic Roux-en-Y Gastric Bypass (RYGB) undergoing gynecologic surgery and to identify any associated complications. Design: Retrospective Chart Review and Case Series. Setting: Community-based tertiary care medical center. Patients or Participants: All patients who underwent RYGB between 2013 and 2020 and had a subsequent gynecologic procedure. Interventions: Abdominal access. Measurements and Main Results: Thirty-one patients were identified, of which 18 had an adnexal surgery and 13 a hysterectomy. At time of surgery, the mean age was 44 years and body mass index was 32 kg/m2. The average interval time from RYGB to gynecologic surgery was 29 months. The majority of women (71%) had additional abdominal surgeries, among them 82% had prior laparotomies. Three entry sites were identified at the initial attempt to access the abdominal cavity; umbilical (71%), left upper quadrant (LUQ, 26%) and left lower quadrant (LLQ, 3%). Closed entry technique using the Veress needle was the most commonly used entry technique (68% versus 29% for optical trocar entry and 3% for open entry). There were no injuries resulting from abdominal access irrespective of the entry site or technique chosen. However, access was unsuccessful in 25% (2 out of 8) of the cases when attempted in the LUQ, resulting in conversion to alternative entry sites. Conclusion: Successful and safe abdominal access in the bariatric patient can sometimes be challenging and preoperative surgical planning is essential. While no injuries during entry were reported regardless of site chosen, closed entry at the umbilicus using the Veress needle was the technique the most practiced and was associated with fewer attempts and conversions to alternative sites as compared to LUQ entry

Design , Synthesis and Biological Evaluation Comparison Study of the Effect of Fig Fruit And Allopurinol Drug on Gout

The aim of study is to investigate the effect of dried and fresh Fig fruit on the level of serum uric acid (SUA), and to find abase for future study to clear ability of giving of this fruit or extractive effective substance for patients with hyperuricemia (increasing of serum uric acid) or patients of gout specially those suffering drug sensitivity that are lowering level of serum uric acid . This study is experimented on 50 patients with known level of serum uric acid . From these fifty patients, twenty live person (l5 male , l0 female ) were gave fresh Fig fruit with weight of I50 - 160 g ,and other 25 patients were gave them dried Fig fruit with weight of 4550- g within I0 days in both cases . Then we measured the level of serum uric acid of these 50 patients. The results showed, there is a significant depression that in the level of serum uric acid in most of patients with different percent from person to another in both case of fresh and dried Fig, Statistical analysis with use of paired t-test showed a significant difference ( 0.940) with high degree (p\u3e 0.01) for effect of dried and fresh Fig fruit on the level of serum uric acid (SUA)

Uterine Sparing Laparoscopic Ablation of Uterine Fibroids: A Survey of Patient\u27s Satisfaction and Treatment Outcomes

Study Objective: The primary purpose of this study was to assess the patient\u27s satisfaction with laparoscopic radiofrequency fibroid ablation (Lap-RFA) for the treatment of symptomatic uterine fibroids. We inquired about their quality of life, health state, and overall treatment effects. Design: Survey study. Setting: Community-based tertiary care medical center. Patients or Participants: All patients who underwent a Lap-RFA by a single surgeon between the years of 2012 and 2020. Interventions: laparoscopic radiofrequency fibroid ablation (Lap-RFA). Measurements and Main Results: 48 patients underwent Lap-RFA procedure by the same provider and were mailed surveys for postoperative evaluation. Twenty patients responded, yeilding a 42% response rate. The mean age of the patients was 46 (34-60) years. The average time interval from surgery to survey response was 23 months (1-50). The Uterine fibroid Symptom and Health-Related Quality of Life (UFS-QOL) and the Health State Questionnaire scores are inversely related to outcomes. The UFS-QOL score can range from 37 to 185 with 37 being the optimal outcome. The average UFS-QOL score was found to be 72 (range 37-146). In addition, the Health state questionnaire can range from 5 to 15, and the average score was 6 (range 5-9). On a scale of 1 to 10, 10 representing optimal outcome, the average health rating was 8 (range 5-10). Using the Menorrhagia Impact Questionnaire, seven patients reported improved menses, ten had no change in symptoms, one had worsening symptoms, and two were postmenopausal. Sixteen patients reported some degree of satisfaction with the procedure, while three were dissatisfied with their overall treatment outcomes. Ninety percent of patients would recommend Lap-RFA to a friend. Conclusion: Lap-RFA procedure is an effective uterine-sparing treatment for symptomatic fibroids with good patient satisfaction. The Lap-RFA procedure should be considered when counseling patients about fibroid management options

Iris Image Watermarking Technique for Security and Manipulation Reveal

Providing security while storing or sharing iris images has been considered as an interesting research topic and accordingly different iris image watermarking techniques have been presented. Most of the available techniques have been presented to ensure the attachment of the secret data to their related iris images or to hide a logo which can be used for copyright purposes. The previous security techniques can successfully meet their aims; however, they cannot reveal the manipulations in the iris region. This paper presents an iris image watermarking technique that can provide security and reveal manipulations in the iris region. At the sender side, the proposed technique divides the image into two regions (i.e., iris region and non-iris region) and generates the manipulation reveal data from the iris region then embeds it in the non-iris region. At the receiver side, the secret data is extracted from the non-iris region and compared with calculated data from the iris region to reveal manipulations if exist. Different experiments have been conducted to evaluate the performance of the proposed technique which proved its efficiency not only in providing security but also in revealing any manipulations in the iris region

Laparoscopy in the Chronic Pelvic Pain Patient: Incidence and Outcomes of Subsequent Laparoscopies

Study Objective: Our aim is to determine the incidence of multiple laparoscopies for chronic pelvic pain over 10 years and to compare outcomes between patients who underwent single vs multiple laparoscopies. Design: Retrospective case-control study. Setting: Urban based tertiary care medical center. Patients or Participants: Women with diagnosis of chronic pelvic pain that underwent one laparoscopy in comparison with those who underwent multiple laparoscopies in a 10-year period. Interventions: Multiple Laparoscopies. Measurements and Main Results: Parametric, nonparametric and descriptive statistics were employed. 792 patients were managed with laparoscopy for a diagnosis of chronic pelvic pain (CPP), 14% of which had multiple laparoscopies. 678 controls with single laparoscopy and 114 cases with multiple laparoscopies were identified. 400 (59%) had medical management prior to first laparoscopy in the control group and 82 (72%) in the cases. 559 had diagnostic and 119 had extirpative laparoscopies in the single laparoscopy group vs 91 diagnostic and 23 extirpative laparoscopies in the multiple laparoscopy group. Of the patients with persistent pain after first laparoscopy in the control group, 52 underwent hysterectomy. Of the 37 who followed up, 26 reported pain response and 5 no response. The average number of laparoscopies in the multiple laparoscopy group was 2.27. In the multiple laparoscopy group, 38 patients underwent hysterectomy. Of the 26 that followed up, 22 reported pain response and 4 no response. Of the total patients who underwent hysterectomy and had follow-up, 80% (54 of 67) reported pain response. Of the 792 patients who underwent laparoscopy, 25 had pathologic evidence of endometriosis in the single laparoscopy group vs 32 in the multiple laparoscopy group. Conclusion: Approximately 1 in 7 patients are subject to multiple laparoscopies for CPP. Despite clinical symptoms, endometriosis is a minor contributor to CPP. Management of CPP with laparoscopy poorly correlates with response to hysterectomy

2629 IV Iron in the Setting of Value-Based Care: Quality-of-Life Improvement and Perioperative Optimization of Anemia in The Gynecologic Population

Study Objective: To study the improvement of quality-of-life measures and hematologic response to intravenous iron in patients with chronic blood anemia undergoing gynecologic surgery Design: Prospective observational study was performed with 31 patients with hemoglobin level less than 11 g/dL and/or ferritin less than 200ug/L. Our primary outcome was to assess hematologic response (hemoglobin and iron studies) and quality of life (Health-Related Quality of Life (HRQOL) and 36-Item Short Form Survey (SF-30) questionnaires) at 30 days and 90 days. Exclusion criteria included severe hepatic impairment, malignancy or hypersensitivity to parental iron. Setting: Iron deficiency anemia is a common occurrence in women of reproductive age, especially due to blood loss from menstrual bleeding. These women frequently require gynecological surgery. However, their anemia is not frequently optimized preoperatively at the time of presentation due to poor tolerance of oral iron supplementation. Anemia increases risk of perioperative morbidity such need for blood transfusion and poor wound healing. Intravenous iron is an underutilized entity that can be used to prevent such complications with excellent patient compliance. Patients or Participants: Women with chronic blood loss anemia undergoing gynecologic surgery Interventions: Intravenous iron dextran at a fixed dose of 1000 mg following a test dose Measurements and Main Results: For hematologic response, we noted a significant improvement in hemoglobin and ferritin at 30 and 90 days. The quality-of-life scores correlated with an upward trend in T-score for physical health and mental health. An adverse reaction was noted in one patient. Conclusion: Intravenous iron is an effective low cost treatment of chronic blood loss anemia in patients who do not tolerate oral iron. In today\u27s world of value-based care, it is imperative to use safe, cost effective and convenient interventions to optimize patients’ quality of life