Maximos Frountzas

The effect of bipolar electrocoagulation during ovarian cystectomy on ovarian reserve: a systematic review

The aim of the present systematic review was to study the effect of bipolar electrocoagulation during ovarian cystectomy on ovarian reserve. We searched Medline (1966-2015), Scopus (2004-2015), ClinicalTrials.gov (2008-2015), and Cochrane Central Register (CENTRAL) databases along with reference lists of electronically retrieved studies. The levels of antimullerian hormone (AMH) and antral follicle count (AFC) at 1, 3, 6, and 12 months following the excision of the benign ovarian cyst were defined as primary outcomes. Eight studies were finally included in our systematic review, which recruited 545 women. A metaanalysis was precluded because of significant heterogeneity in the methodological characteristics of the included studies. Data from the included studies suggest that the use of bipolar coagulation compared with ovarian sutures seems to result in significantly lower AMH and AFC during the first 3 months following the excision of the ovarian cyst. Two studies reported that this effect seems to persist at 6 and 12 months postoperatively. Bipolar electrodiathermy seems to be accompanied by increased damage to ovarian reserve, which is indicated by the lower levels of AMH and AFC. However, definitive results are precluded because of the significant heterogeneity of included studies and the potential bias.

Diabetes mellitus and functional sperm characteristics: A meta-analysis of observational studies.

OBJECTIVE Insulin resistance and diabetes mellitus (DM) are well defined causes of female infertility. Animal studies present evidence for decreased sperm quality, but conflicting results have been presented in clinically-orientated studies. We sought to evaluate whether DM affects functional sperm characteristics. STUDY DESIGN We searched the Medline, Scopus, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials databases. RESULTS DM seems to decrease the seminal volume (MD -0.66ml, 95% CI -1.10, -0.22) and the percentage of motile cells (MD -14.29%, 95% CI -22.76, -5.82) and increase the FSH values (MD 0.47mIU/ml, 95% CI 0.01, 0.93) of men who were screened for infertility. It does not, however, influence the total sperm count (MD 13.16 106 cells, 95% CI -22.75, 49.07), the percentage of normal sperm morphology (-3.06%, 95% CI -6.25, 0.14), or LH (MD 0.65mIU/ml, 95% CI -0.84, 2.13 Supp. Fig. 2) and testosterone values (MD -0.18ng/ml, 95% CI -0.60, 0.24). CONCLUSION Current evidence suggests that the presence of DM seems to influence functional sperm characteristics. Firm results are, however, precluded due to the significant heterogeneity of the included studies. Future prospective studies will clarify whether the DM affects semen quality and IVF outcome.

Cesarean wound scar characteristics for the prediction of pelvic adhesions: a meta-analysis of observational studies

Abstract Objective: The pathophysiologic processes that result in wound healing are the same regardless of the tissue involved. The purpose of the present meta-analysis is to evaluate whether cesarean scar characteristics may predict the presence of pelvic adhesions. Materials and methods: We conducted a systematic review searching the Medline (1966–2016), Scopus (2004–2016), ClinicalTrials.gov (2008–2016), Cochrane Central Register of Controlled Trials CENTRAL (1999–2016) and Google Scholar (2004–2016) databases together with reference lists from included studies. All prospective and retrospective observational cohort studies were included. Statistical meta-analysis was performed using the RevMan 5.1 software. Results: Current evidence suggests that depressed scars are positively associated with intra-abdominal adhesions (ΟR 2.79, 95%CI 1.74–4.46). Elevated scars might also correlate with the presence of adhesions, however, this association did not reach statistical significance (OR 1.61, 95%CI 0.91–2.85, p = 0.10). The same was reported in the case of scar pigmentation (REM, OR 1.68, 95%CI 0.86–3.26, p = 0.13). Flat scars were predictive of the absence of adhesions (899 patients, REM, OR 0.33, 95%CI 0.23-0.54, p < 0.00001). Conclusion: According to our meta-analysis, abdominal wound characteristics following cesarean section can predict the presence of adhesions. However, given the small number of published studies, further research is needed to corroborate our findings.

A Novel Experimental Model of Colorectal Endometriosis

ABSTRACT Purpose: Endometriosis is a disease that affects 6–10% of the female population, mainly women of reproductive age, and causes a variety of cyclic symptoms. Deep infiltrating endometriosis and in particular bowel involvement presents a challenge for modern surgery. To date, there are no experimental animal models in this field, demonstrating experimental induction of endometriosis directly attached to surface of the colon imitating human colorectal endometriosis; hence, the implementation of novel pharmaceutical and surgical strategies for the management of colorectal endometriosis is mainly limited to clinical studies. Aim of the study: To investigate whether induction of colorectal endometriotic lesions in is feasible in rats. Materials and Methods: Twenty, female, adult, non-pregnant Sprague Dawley rats sustained uterine horn resection, which was then placed around the rectum of the rat with the endometrial surface in direct contact with the bowel serosa and approximated in the serosal surface of the colon with two sutures. Results: Two weeks following, surgery rats were euthanized and the bowel was surgically explored. The presence of a cystic lump at the site of the surgical intervention was evaluated macroscopically and microscopically. Histopathology documented the presence of cystic endometriosis. The endometriotic focus was adherent to the bowel wall by large fibrous nodules with concomitant replacement of part of the outer longitudinal muscle layer. Conclusions: The findings of our study support that the proposed experimental model of colorectal endometriosis is feasible, easily reproducible and may be implemented in future research in this field.

Familiarization of undergraduate medical students with the two-dimensional vision of laparoscopic surgery: Preliminary results of a prospective follow-up study

BACKGROUND To date, the feasibility of pre-graduate training in 2D vision has not been studied thoroughly. The purpose of this pilot study is to present the preliminary results of a pre-graduate laparoscopic training program. MATERIALS AND METHODS We invited pre-graduate medical students to participate in an experimental training program which strengthened their essential skills in 2D-vision. An easy-to-use, cost-effective, hand-made laparoscopic training box was constructed and used. RESULTS Twenty-four pre-graduate students participated in our study. The ability of medical students to co-ordinate their movements on the 2D-space was strengthened from the first to the fourth time of performing the easiest tasks (bead transfer and rope cutting) (P<.001). This was not observed in the case of the two harder tasks (necklace formation and intracorporeal knot), despite the fact that time to fulfillment differed (P=.058 & P=.082) respectively. The overall assessment of the simulator in terms of portability, imaging, light, camera convenience to use and significance ranked from high to very high. CONCLUSION Familiarization with the 2D environment of laparoscopic surgery is extremely important for medical students. The results of our study seem to be promising, as they show that basic tasks are easy to learn with the use of relatively inexpensive equipment.

Healing after Resection of Colonic Endometriosis and Growth Factor–enriched Agents: An Experimental Rat Model

STUDY OBJECTIVE To examine the potential beneficial effect of platelet-rich plasma (PRP) and fibrin sealant (TISSEEL; Baxter Healthcare Corporation, Deerfield, IL) on bowel wound healing after shaving of an experimentally induced endometriotic lesion. DESIGN A single-blind, randomized study (Canadian Task Force classification I). SETTING A certified animal research facility. ANIMALS Thirty female Sprague-Dawley rats. INTERVENTIONS Experimental colonic endometriosis was induced by transplanting endometrial tissue to all animals (first surgery). Thirty rats were then randomized to 1 of 3 groups according to treatment; PRP (group 1, n = 10), fibrin sealant (group 2, n = 10), or no agent (group 3, n = 10) was applied after shaving of the endometriotic nodule (second surgery). MEASUREMENTS AND MAIN RESULTS Colonic endometriosis was successfully induced in all subjects. Four days after the second surgery, the animals were euthanized, and microscopic evaluation was performed. The pathologist was blinded to the treatment method. Histopathologic analysis revealed that compared with the control group, collagen disposition was found in a significantly higher expression in both the PRP and fibrin sealant groups (p = .011 and p = .011, respectively). Distortion of the integrity of the colon layers was statistically more pronounced in the control group compared with the fibrin sealant group (p = .033), whereas greater new blood vessel formation was observed in the fibrin sealant group compared with the control (p = .023). No histologic evidence of residual or recurrent disease was detected. CONCLUSION Both PRP and fibrin sealant appear to be safe and associated with improved tissue healing during shaving for the excision of colonic endometriosis, attributed to the enhanced collagen disposition, neovascularization, and protection of the integrity of colon layers. Clinical trials are warranted to confirm the feasibility of PRP and fibrin sealant in the clinical setting.

Alvarado or RIPASA score for diagnosis of acute appendicitis? A meta-analysis of randomized trials

BACKROUND The electronic diagnostic tools of acute appendicitis present serious disadvantages, thus some clinical scores have been formed in order to reach the diagnosis easily and safely. Alvarado and RIPASA scores are the most commonly used and the purpose of this meta-analysis is to compare the diagnostic accuracy of these two scoring systems. METHOD We searched MEDLINE (1966-2017), Scopus (2004-2017), ClinicalTrials.gov (2008-2017), Google Scholar (2004-2017) and Cochrane Central Register of Controlled Trials CENTRAL (1999-2017) databases. We selected all observational cohort studies that reported diagnostic parameters of Alvarado and RIPASA diagnostic scores on patients with clinical status of acute appendicitis. Statistical meta-analysis was performed with Meta Disc 1.4 software. RESULTS Twelve studies were included in our meta-analysis which enrolled 2161 patients. The sensitivity of RIPASA score was 94% (95% CI, 92%-95%) and the specificity was 55% (95% CI, 51%-55%). In addition, the area under the Roc Curve (AUC) was 0.9431 and the diagnostic Odds Ratio was 24.66 (95% CI, 8.06 to 75.43). The sensitivity of Alvarado score was 69% (95% CI, 67%-71%) and the specificity was 77% (95% CI, 74%-80%). Moreover, the AUC was 0.7944 and the diagnostic Odds Ratio was 7.99 (95% CI, 4.75 to 13.43). CONCLUSION RIPASA scoring system is more sensitive than Alvarado one, but the low specificity forms the need of a supplementary mean to provide the accurate diagnosis. Nevertheless, the wide and safe use of both tests is recommended in health systems that lack electronic diagnostic tests, such us developing countries or rural hospitals.