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Background The World Health Organization does not recommend dilatation and sharp curettage (D&C) for the surgical treatment of miscarriage during the first trimester because this may cause Asherman’s syndrome due to endometrial damage; therefore, suction remains the primary treatment option. While manual vacuum aspiration (MVA) has been widely used since the 1990s outside Japan, the use of an MVA device (Women’s MVA system) was approved in Japan in October 2015. Here, we examined the efficacy of the MVA kit in women surgically treated for miscarriage. Methods This retrospective cohort study was conducted between 2014 and 2018 at the International University of Health and Welfare Hospital in Japan. Women who underwent surgical treatment for miscarriage within 12 weeks of pregnancy were identified and enrolled in the study. A total of 404 women were included who underwent the following procedures: 121 D&C, 123 electric vacuum aspiration (EVA), and 160 MVA. For each participant, the duration of surgery, amount of bleeding, amount of anesthetic used, incomplete abortion requiring repeat procedures, and intraoperative/postoperative complications were evaluated. Results The duration of surgery was 13.7 ± 7.2, 11.2 ± 4.2, and 6.9 ± 4.3 min in the D&C, EVA, and MVA groups, respectively ( p  = 1.00). The amount of anesthetic used was not significantly different among all groups. Bleeding of ≥ 100 mL was confirmed in three (2.4%), one (0.8%), and one (0.6%) patient(s) in the D&C, EVA, and MVA groups, respectively ( p  = 0.50). Incomplete abortion was identified in three (2.4%), two (1.6%), and one (0.6%) patient(s) in the D&C, EVA, and MVA groups, respectively ( p  = 0.61). However, severe intraoperative/postoperative complications were not observed in any group. Conclusions Surgical treatment for miscarriage performed using the MVA kit has safety and efficacy similar to those of conventional methods, such as D&C and EVA.

Background The incidence of caesarean scar pregnancy (CSP) has significantly increased due to the increasing prevalence of caesarean deliveries and advances in diagnostic imaging. However, no consensus has yet been reached on the optimal therapeutic approach. Type II CSP leads to disease heterogeneity, characterized by multiple treatment options and the absence of a unified therapeutic approach. Hysteroscopic treatment for CSP has demonstrated a notable success rate, particularly in cases of type I CSP. High-intensity focused ultrasound (HIFU) ablation has emerged as a novel, non-invasive treatment option that minimizes intraoperative blood loss. However, its use may be excessive in low-risk cases. Here, we report a protocol for a randomized clinical trial designed to evaluate the necessity of performing HIFU in CSP treatment when combined with suction curettage under hysteroscopic guidance. Methods We aim to propose a randomized clinical trial that will enroll 140 participants. All participants will undergo surgical suction curettage guided by hysteroscopy, randomized into groups with or without HIFU pretreatment. Data on demographic characteristics, disease characteristics, ultrasound findings, and laboratory test results will be collected before the intervention. The primary outcome will be the intraoperative blood loss. Secondary outcomes will include the incidence of near haemorrhage, therapeutic success rates, and subsequent pregnancy outcomes within a 2-year follow-up period. Discussion Hysteroscopy has exhibited favourable therapeutic outcomes in the management of CSP, though it remains associated with a risk of intraoperative haemorrhage. HIFU has shown promise as a preoperative adjuvant modality. However, the comparative clinical advantages of standalone hysteroscopic intervention versus HIFU-assisted protocols are insufficiently explored in prospective clinical studies. This investigation seeks to assess both the standalone efficacy of hysteroscopic resection and the efficacy of combined therapy incorporating HIFU pretreatment for type II CSP. Trial registration Registration number: ChiCTR2000034332. Registration date: 2nd July 2020.

Background Intrauterine adhesions (IUA) are a challenging clinical problem in reproductive infertility. The most common causes are intrauterine surgery and abortions. We aimed to investigate whether early second-look office hysteroscopy can prevent IUA. Methods A single-center, prospective, two-armed, randomized controlled trial was designed to explore the efficacy of early office hysteroscopy after first-trimester induced abortion (suction dilatation and curettage [D&C]) and to further analyze fertility outcomes. Women aged 20–45 years undergoing suction D&C and desiring to conceive were recruited. Between October 2019 and September 2022, 66 women were enrolled, of whom 33 were allocated to group A (early hysteroscopy intervention). The women in intervention group A were planned to receive 2 times of hysteroscopies (early and late). In group B, women only underwent late (6 months post suction D&C) hysteroscopy. Results The primary outcome was the IUA rate assessed using office hysteroscopy 6 months after artificial abortion. Secondary outcomes included menstrual amount/durations and fertility outcomes. In intervention group A, 31 women underwent the first hysteroscopy examination, and 15 completed the second. In group B (late hysteroscopy intervention, 33 patients), 16 completed the hysteroscopic exam 6 months after an artificial abortion. Twenty-one women did not receive late hysteroscopy due to pregnancy. The IUA rate was 16.1% (5/31) at the first hysteroscopy in group A, and no IUA was detected during late hysteroscopy. Neither group showed statistically significant differences in the follow-up pregnancy and live birth rates. Conclusions Early hysteroscopy following suction D&C can detect intrauterine lesions. IUA detected early by hysteroscopy can disappear on late examination and become insignificant for future pregnancies. Notably, the pregnancy outcomes showed a favorable trend in the early hysteroscopy group, but there were no statistically significant differences. Trial registration ClinicalTrials.gov , ID: NCT04166500. Registered on 2019-11-10. https://clinicaltrials.gov/ct2/show/NCT04166500 .

This study compared the efficacy of apicoectomy and apical curettage with and without leukocyte- and platelet-rich fibrin (L-PRF) in treating large periapical lesions. Sixty-four adults (30 male, 34 female) with a previously endodontically treated tooth and a large periapical lesion were randomized into four groups (n = 16): retrograde obturation (RG), orthograde obturation (OG), RG + L-PRF, and OG + L-PRF. All participants underwent root canal retreatment in two sessions. The RG group underwent root-end resection and retrograde MTA obturation, the RG + L-PRF group underwent L-PRF application to the bone defect following the RG protocol, the OG group underwent orthograde MTA obturation and periapical curettage without root-end resection, and the OG + L-PRF group underwent L-PRF application following the OG protocol. Clinical and radiographic assessments were performed preoperatively, and at 1 week and 1, 3, 6, 9, and 12 months postoperatively. At follow-up visits, pain scores, swelling, tooth mobility, tenderness to percussion (T-PER), tenderness to palpation (T-PAL), and the presence of fistula were clinically assessed. Periapical radiography determined the periapical index (PAI) score and measured the periapical lesion area (PALA). The Kruskal–Wallis test was performed to test the effect of a single independent variable (factor) on a dependent variable. No statistically significant differences were identified between the groups for preoperative PAI scores, pain scores, swelling, tooth mobility, fistula, T-PER, or T-PAL (p > 0.05). At postoperative week 1, the RG + L-PRF group showed a significantly lower T-PER. The RG + L-PRF group showed significantly lower PALA values and significantly higher PALA healing rates at postoperative 1, 6, and 9 months. Both L-PRF groups achieved PALA healing rates of over 90% at 9 months. It was concluded that a combination of apicoectomy and L-PRF effectively treats periapical lesions and promotes both short- and long-term healing and that a combination of periapical curettage and L-PRF offers a less invasive alternative, especially when the crown-to-root ratio is a concern. Trial registration: The protocol was registered at ClinicalTrials.gov (NCT05847647).

Background Intrauterine adhesion (IUA) can arise as a potential complication following uterine surgery, as the surgical procedure may damage the endometrial stratum basalis. The objective of this study was to assess and compare the occurrence of IUA in women who underwent ultrasound-guided manual vacuum aspiration (USG-MVA) versus electric vacuum aspiration (EVA) for managing first-trimester miscarriage. Methods This was a prospective, single-centre, randomised controlled trial conducted at a university-affiliated tertiary hospital. Chinese women aged 18 years and above who had a delayed or incomplete miscarriage of ≤ 12 weeks of gestation were recruited in the Department of Obstetrics and Gynaecology at the Prince of Wales. Recruited participants received either USG-MVA or EVA for the management of their miscarriage and were invited for a hysteroscopic assessment to evaluate the incidence of IUA between 6 and 20 weeks after the surgery. Patients were contacted by phone at 6 months to assess their menstrual and reproductive outcomes. Results 303 patients underwent USG-MVA or EVA, of whom 152 were randomised to ‘USG-MVA’ and 151 patients to the ‘EVA’ group. Out of the USG-MVA group, 126 patients returned and completed the hysteroscopic assessment, while in the EVA group, 125 patients did the same. The incidence of intrauterine adhesion (IUA) was 19.0% (24/126) in the USG-MVA group and 32.0% (40/125) in the EVA group, showing a significant difference ( p  < 0.02) between the two groups. No significant difference in the menstrual outcomes at 6 months postoperatively between the two groups but more patients had miscarriages in the EVA group with IUA. Conclusions IUAs are a possible complication of USG-MVA. However, USG-MVA is associated with a lower incidence of IUA postoperatively at 6–20 weeks. USG-MVA is a feasible, effective, and safe alternative surgical treatment with less IUA for the management of first-trimester miscarriage. Trial registration The study was registered with the Centre for Clinical Research and Biostatics- Clinical Trials Registry (CCRBCTR), which is a partner registry of the WHO Primary Registry-Chinese Clinical Trials Registry (ChiCTR) (Unique Trial Number: ChiCTR1900023198 with the first trial registration date on 16/05/2019)

The orthopedic implant removal procedure is one of the most commonly performed orthopedic surgeries. This study aimed to compare and report the clinical outcomes between patients who underwent only curettage and those who received pure [beta]-TCP (Neobone.sup.®) following curettage. Between January 1, 2018, and December 31, 2023, patients at our hospital who underwent implant removal and could be followed for over a year were included in the study. The study encompassed 77 cases. The cohort comprised 40 males (51.9%) and 37 females (48.1%) with an average age of 32.5 ± 21.2 years (range 8-69). There were no significant differences between the groups in terms of sex, age, the interval between the first operation and the orthopedic implant removal procedure, locations of operations, or the orthopedic fixation techniques used initially. However, the group undergoing implant removal with [beta]-TCP (Neobone.sup.®) bone graft showed statistically significant improvements in performing scar revision procedures simultaneously and in not requiring drain insertion (p = .000). Compared to the group that only underwent curettage, the group treated with pure [beta]-TCP (Neobone.sup.®) bone graft required fewer drain placements and more often performed scar revisions simultaneously, facilitating faster healing. While there was no difference in the period for ROM exercises or weight bearing, no refractures occurred in the [beta]-TCP bone substitute group. Hence, the application of pure [beta]-TCP (Neobone.sup.®) is clinically advantageous.

Purpose The orthopedic implant removal procedure is one of the most commonly performed orthopedic surgeries. This study aimed to compare and report the clinical outcomes between patients who underwent only curettage and those who received pure [beta]-TCP (Neobone.sup.®) following curettage. Methods Between January 1, 2018, and December 31, 2023, patients at our hospital who underwent implant removal and could be followed for over a year were included in the study. The study encompassed 77 cases. Results The cohort comprised 40 males (51.9%) and 37 females (48.1%) with an average age of 32.5 ± 21.2 years (range 8-69). There were no significant differences between the groups in terms of sex, age, the interval between the first operation and the orthopedic implant removal procedure, locations of operations, or the orthopedic fixation techniques used initially. However, the group undergoing implant removal with [beta]-TCP (Neobone.sup.®) bone graft showed statistically significant improvements in performing scar revision procedures simultaneously and in not requiring drain insertion (p = .000). Conclusions Compared to the group that only underwent curettage, the group treated with pure [beta]-TCP (Neobone.sup.®) bone graft required fewer drain placements and more often performed scar revisions simultaneously, facilitating faster healing. While there was no difference in the period for ROM exercises or weight bearing, no refractures occurred in the [beta]-TCP bone substitute group. Hence, the application of pure [beta]-TCP (Neobone.sup.®) is clinically advantageous.

Patients undergo dilatation and evacuation for abortion or miscarriage. However, bleeding is sometimes problematic. Despite reports on the association between volatile anesthetics and increased bleeding during the procedure, firm evidence is lacking. Therefore, we conducted a systematic review and meta-analysis to compare the effects of volatile anesthetics and propofol on the amount of bleeding in patients undergoing dilatation and evacuation. We conducted a systematic search of four databases, namely PubMed, Embase, Cochrane Central Register of Controlled Trials databases, and Web of Science (Clarivate Analytics), from their respective inception to April 2021. Moreover, we searched two trial registration sites. The inclusion criterion was randomized controlled trials of patients who underwent dilatation and evacuation under general anesthesia using volatile anesthetics or propofol. The primary outcome was the amount of perioperative bleeding. The mean difference of the bleeding was combined using a random-effects model. The I2 statistic was used to assess heterogeneity. We assessed risk of bias with Cochrane domains. We controlled type I and II errors due to sparse data and repetitive testing with Trial Sequential Analysis. We assessed the quality of evidence with GRADE. Five studies were included in the systematic review. The amount of bleeding was compared in four studies and was higher in the volatile anesthetic group, with a mean difference of 164.7 ml (95% confidence interval, 43.6 to 285.7; p = 0.04). Heterogeneity was considerable, with an I2 value of 97%. Two studies evaluated the incidence of significant bleeding, which was significantly higher in the volatile anesthetic group (RR, 2.42; 95% confidence interval, 1.04-5.63; p = 0.04). Choosing propofol over volatile anesthetics during dilatation and evacuation might reduce bleeding and the incidence of excessive bleeding. However, the quality of the evidence was very low. This necessitates further trials with a low risk of bias. PROSPERO (CRD42019120873).

Background Primary aneurysmal bone cysts (ABCs) are benign, expansile bone lesions commonly treated with aggressive curettage with or without adjuvants such as cryotherapy, methacrylate cement, or phenol. It has been reported that occasionally these lesions heal spontaneously or after a pathologic fracture, and we observed that some ABCs treated at our center healed after biopsy alone. Because of this, we introduced a novel biopsy technique we call “curopsy,” which is a percutaneous limited curettage at the time of biopsy, obtaining the lining membrane from various quadrants of the cyst leading to consolidation (curopsy = biopsy with intention to cure). Questions/purposes We asked whether (1) a curopsy results in comparable likelihood of healing of the ABC compared with more aggressive approaches involving curettage, (2) the two approaches differ in terms of the likelihood of recurrence after treatment, and (3) the two approaches differ in terms of complications after surgery. Methods Between January 1, 1999 and June 30, 2012, 221 patients with a diagnosis of primary ABC were registered in our oncology database. Patients presenting with a pathologic fracture and those seeking a second opinion were excluded. One hundred ninety patients were included in the study. One hundred two (54%) were treated with curopsy and 88 (46%) were treated with curettage after a core needle biopsy. Complete followups were available for 88% (90 of 102) and 93% (80 of 88) of patients in those groups, respectively. During that period, a curopsy was performed for all patients with benign bone lesions with imaging suggestive of classic primary ABCs and for whom the core needle biopsy simply showed blood with no solid component. Curettage after a core needle biopsy was reserved for histologically confirmed primary ABCs, lesions with impending fractures, large lesions, if the ABC was thought to be a secondary disorder, and patients for whom the curopsy failed. All patients were followed up until consolidation of the lesion (mean, 9.6 weeks, range, 3–25 weeks, 95% CI, 8.32–10.9 for curopsy; mean, 11.4 weeks, range, 8–32 weeks, 95% CI, 10.6–12.3 for curettage). The median followup for all patients was 14 months (range, 6–36 months). Results Of the 102 patients who had curopsy and observation, 83 (81%) required no additional treatment and the lesion resolved. Of the 88 patients who underwent curettage (with or without adjuvant therapy) after core needle biopsy, the success rate was 90% (79 of 88). Local recurrences in both groups (curopsy or curettage) were treated successfully with additional curettage in all but one case. Curopsy in comparison to curettage provided a mean shorter healing time (9.6 versus 11.4, p = 0.01) but there was a higher local recurrence and need for additional intervention rate (18.6% versus 10.2%, p = 0.04). There were no differences in the complications between the treatment groups. Conclusions A curopsy is a novel biopsy technique that was successful in resolving ABCs in 81% of the patients in our study. Curopsy, as a biopsy technique, for ABCs needs consideration as it potentially minimizes the number of patients needing a second procedure (a core needle biopsy being the first) as is the current practice. Furthermore, it does not disadvantage the patient or surgeon should additional intervention be needed in the form of curettage with or without adjuvants. Level of Evidence Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Propofol-induced injection pain (PIP) is a well-known problem in general anesthesia. We hypothesized that pre-treatment with remimazolam prevents PIP in patients undergoing abortion or curettage. In this prospective, single-center, double-blinded, randomized, placebo-controlled clinical trial, adult patients aged 18 to 60 undergoing abortion or curettage were randomly assigned to three groups. Group Lido received system lidocaine (a bolus of 0.5 mg kg , iv). Group Remi received remimazolam (a bolus of 0.1 mg kg , iv). Group NS received identical volumes of 0.9% normal saline. Sixty seconds after the injection of lidocaine, remimazolam or saline, patients were injected with propofol at a rate of 12 mL/min until the loss of consciousness. The primary outcome was the incidence of PIP at the time of induction using 4-point scale. Secondary outcomes included propofol-induced injection pain, vital signs, the characteristics of anesthesia and surgery, and adverse events. The incidence of patients with PIP was higher in group NS than that in group Lido and group Remi (75.7, 44.3, and 42.9%, respectively, < 0.001). The percentages of patients with moderate PIP were higher in group NS than that in group Lido and group Remi (20.0, 2.9, and 1.4%, respectively, < 0.001). Moreover, the consumption of propofol and the incidence of adverse event (hypoxemia and chin lifting) in group Remi were lower than that in group NS and Lido, and less patients got physical movement and cough in group Remi. The recovery time in group NS was longer than that in group Lido and Remi. Our findings indicate that pre-treatment with remimazolam reduced the incidence and intensity of PIP in abortion or curettage patients, equivalent to that of lidocaine without severe adverse effects. Chinese Clinical Trial Registry (identifier: ChiCTR2100041805).