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BACKGROUND: Glomerulations are not specific for interstitial cystitis/bladder pain syndrome (IC/BPS). Controversy exists about whether cystoscopic findings differ between patients with and without lower urinary tract symptoms. We sought to compare the prevalence of cystoscopic findings in women with “no or minimal” urinary symptoms to those with a “high” symptom burden. METHODS: This is a secondary analysis of a prospective cohort study performed at a University Educational Facility. Participants in this study were part of a larger prospective study, in which female patients scheduled to undergo routine gynecologic procedures were all consented for cystoscopy with hydrodistension (CWHD). We defined the “minimally symptomatic group” as those with ≤1 on each of the O’Leary/Sant Interstitial Cystitis Symptom Index (ICSI) subscores and without history of IC/BPS. The “highly symptomatic” cohort of women had composite ICSI score ≥12 and a Burning/Pain subscore of 4 or 5. All were non-smokers. RESULTS: A total of 84 women underwent CWHD, with 33 having minimal symptoms and 51 being highly symptomatic. The two groups were not statistically different when assessing for ‘any glomerulations’ compared to ‘no glomerulations.’ However, minimally symptomatic women had an eight-fold lower prevalence of significant glomerulations than highly symptomatic women (3.0% minimally symptomatic vs. 23.5% highly symptomatic, P

Introduction: Previous studies have linked chronic pelvic pain (CPP) to appendix pathologies. However, few studies have investigated appendix pathology specifically in the context of CPP that is right-side predominant (R-CPP). We hypothesized that women with R-CPP have higher rates of appendix pathology compared with women with CPP that is not right-side predominant (N-CPP). Methods: We conducted a retrospective case–control study of 220 women who underwent diagnostic laparoscopy and planned or incidental appendectomy for CPP and suspected endometriosis between January 2015 and December 2018 at a tertiary care center in Saint Louis, MO. Results: No significant difference in abnormal appendix pathology was found between women with R-CPP and women with N-CPP (30.9% vs 34.5%, p = 0.74, odds ratio = 0.85, 95% CI: (0.44, 1.62)). Gross abnormalities of the appendix were documented in 40 of 220 patients (18.2%), with the most common abnormal gross findings being adhesions (8.2%), followed by abnormal lesions (7.3%). Conclusion: In this study, the presence of abnormal pathology within the appendix did not correlate with R-CPP, indicating triage based on predominant pain location cannot help identify patients with underlying appendix pathology. However, consistent with previous studies, we identified a high rate of abnormal appendix pathology overall, supporting the practice of many surgeons to perform routine appendectomy in women with CPP.

The case presents the background of the Wharf Hotels (WH) and its two brands, namely, Niccolo Hotels and Marco Polo Hotels. This case discusses the various initiatives that Dr. Jennifer Cronin, Pre...

Sustainability has become a vital issue for the hotel industry. Hotel ICON, the world’s first fully-integrated teaching and research hotel was built with the aim of becoming a role-model hotel for ...

Objectives: This review sought to evaluate the evidence for embryo formation during intrauterine device (IUD) use, to articulate how often embryo loss occurs in well-designed studies, and to comment on other bodies of literature suggestive of postfertilization mechanisms of action of IUDs. Methods: The MEDLINE, EMBASE, and Ovid databases were searched for English-language studies of markers of pregnancy in IUD users in May 2018. Studies of human chorionic gonadotropin (hCG) were subjected to quality assessment based on the US Preventive Services Task Force quality tool. Bias of studies assessing pregnancy in other ways was assessed on a study-to-study basis. Results: In all, 1,073 studies were identified and 138 were read in detail. Twenty-three studies of β-hCG, 4 studies of direct observation of embryos in fallopian tubes, 2 studies of pregnancy-specific binding globulin (PSBG), and 1 study of heat-shock protein 10 (Hsp10) or chaperonin 10 were included. In all studies considered together, 7.3 percent of IUD users had evidence of fertilization and pregnancy failure. In good-quality studies, 4.5 percent had evidence of fertilization and pregnancy failure. Discussion: There are no randomized trials of embryo formation and loss in IUD users compared with noncontracepting controls. Studies of β-hCG span a large spectrum of quality, but several good-quality studies exist, which support embryo formation and loss in IUD users. Evidence of embryos found in tubes is moderate and evidence of PSBG and Hsp10 elaboration was limited, but these are also concerning for embryo formation and loss. Conclusion: There is good-quality evidence of embryo formation and loss in IUD users. Studies are inconsistent, and the stated conclusions of several papers inaccurately diminish postfertilization evidence of embryo formation. To better assess the rate of embryo loss in IUD users compared with non-users, future research should include well-designed prospective trials and less subjective assessments of embryos in fallopian tubes. Summary: A systematic review was carried out examining the English-language literature in the MEDLINE, EMBASE, and Ovid databases for evidence of embryo formation and loss during IUD use. In all, 1,073 studies were identified and 138 were read. There are no randomized trials and evidence ranges in quality, but evidence for the embryo formation and loss in 4.5 percent of IUD users exists in good-quality research. Further research is needed to compare embryo loss in IUD users to loss in controls.

The purpose of this review was to determine whether there is evidence that ovulation can occur in women using hormonal contraceptives and whether these drugs might inhibit implantation. We performed a systematic review of the published English-language literature from 1990 to the present which included studies on the hormonal milieu following egg release in women using any hormonal contraceptive method. High circulating estrogens and progestins in the follicular phase appear to induce dysfunctional ovulation, where follicular rupture occurs but is followed by low or absent corpus luteum production of progesterone. Hoogland scoring of ovulatory activity may inadvertently obscure the reality of ovum release by limiting the term “ovulation” to those instances where follicular rupture is followed by production of a threshold level of luteal progesterone, sufficient to sustain fertilization, implantation, and the end point of a positive β-human chorionic gonadotropin. However, follicular ruptures and egg release with subsequent low progesterone output have been documented in women using hormonal contraception. In the absence of specific ovulation and fertilization markers, follicular rupture should be considered the best marker for egg release and potential fertilization. Women using hormonal contraceptives may produce more eggs than previously described by established criteria; moreover, suboptimal luteal progesterone production may be more likely than previously acknowledged, which may contribute to embryo loss. This information should be included in informed consent for women who are considering the use of hormonal contraception. Summary: For this study, the authors looked at English-language research articles that focused on how hormonal birth control, such as the birth control pill, may affect very early human embryos. The authors found that abnormal ovulation, or release of an egg followed by abnormal hormone levels, may often occur in women using hormonal birth control. This may increase the number of very early human embryos who are lost before a pregnancy test becomes positive. For women who are thinking about using hormonal birth control, this is important information to consider.

Introduction The aim of this manuscript is to present a systematic review of characteristics and management of endometriosis in adolescents in order to gain some relevant insight into the most appropriate clinical management of the disease. Methods The literature review was done using electronic database PubMed focusing on the terms ‘adolescents’, ‘endometriosis’, ‘teenagers’, ‘pain’, ‘infertility’, ‘quality of life’, ‘medical’ and ‘surgical management’ from 1980 onward and was limited to articles in English. Articles were only included if they reported original relevant research. Results The 24 studies selected for review included 1148 adolescents with laparoscopic proven endometriosis. The diagnosis of endometriosis was histologically confirmed in 39.02% (448/1148) of cases. The results from trials have been tabulated and main results presented in a question and answer format. Conclusions The majority of adolescent girls with chronic pelvic pain not responding to conventional medical therapy have endometriosis (up to 80%). Laparoscopy with biopsy is the only way to diagnose endometriosis in the adolescent population, and depends on recognition of atypical manifestations of the disease. Surgical management (especially by an expert surgeon) has been shown to be beneficial in reducing pain, improving infertility, and preventing progression or recurrence of disease. Postoperative hormonal suppression helps reduce pain symptoms and recurrence of endometriomas, but it does not seem to prevent disease recurrence or progression of peritoneal endometriosis, and has not been shown to improve future fertility. Postoperative suppression until pregnancy is based on expert opinion only. There is a need for good quality properly randomized trials.

Study Objective The aim of our study is to test a combination of biological markers differentially expressed in samples from women with or without endometriosis. Methods Design ENDOSEARCH is a prospective multicentric international clinical trial registered with Clinical Trial.gov. Setting 20 renowned specialized centers in Europe, USA, Canada, and the Indian Ocean, granted by the European Union aiming to validate a cluster of biomarkers. Patients or Participants 1000 patients. The Patient Group includes women between 18 and 45 with suspected endometriosis undergoing laparoscopy. Patients with predominant adenomyosis and/or fibroids diagnosed by imaging, chronic, malignant, infectious, metabolic or endocrine diseases are excluded. The Control Group includes patients of same age group without any endometriosis-related clinical sign, with planned laparoscopic surgery for other indications. Samples of endometriosis lesions and endometrial biopsies for both groups are sent to a unique center (Endodiag, Paris, France) to be tested with the cluster of biomarkers. Interventions Laparoscopy for endometriosis or benign conditions (Control group). Measurements and Main Results 40% of the patients recruited in the Endometriosis group have already had at least one and up to 4 previous laparoscopies for endometriosis. Almost 50% of the patients had an AFS score of III or IV. 14% of the patients suspected of endometriosis had negative pathology while 2% of the patients in the control group had severe endometriosis at laparoscopy and were excluded. Conclusion We present the first large prospective multicentric international clinical trial aiming to test a cluster of biomarkers to diagnose endometriosis by recruiting over 1000 patients all around Europe, the US and Canada. Even in major referral centers almost 14% of the pre-op diagnosis were negative at pathology while 2% of the control group had severe endometriosis. Those preliminary results with others show the necessity of development of accurate biological tests to diagnose endometriosis and avoid unnecessary laparoscopies.

Objective The aim of this report is to highlight the value of excision when treating and diagnosing endometriosis, as well as present an unusual case of concomitant endometriosis and pelvic malignancy in a young female. Case Report In a university hospital referral center, a 24-year-old nulligravid woman with suspected endometriosis had been treated unsuccessfully with empiric therapy for several years. Interventions were preoperative cyclic and continuous combined oral contraceptive pills and a NuvaRing for 2 years. Diagnosis was completed by laparoscopy and histologic evaluation. Surgical debulking by gynecology oncologist was followed by chemotherapy. The main outcome measure was definitive diagnosis via histology. Results Histologic diagnosis of endometriosis and concomitant pelvic malignancy with successful surgical excision of both. Conclusions When evaluating a patient with chronic pelvic pain, it is necessary to have a high degree of suspicion for endometriosis. Early surgical and histologic evaluation is imperative for definitive diagnosis. An added benefit of histologic diagnosis is the opportunity to assess for malignancy.

A multicenter prospective study evaluating the management of endometriosis comparing excision versus ablation is needed using primary outcomes other than chronic pelvic pain., Objective: To serve as a pilot feasibility study for a randomized study of excision versus ablation in the treatment of endometriosis by (1) estimating the magnitude of change in symptoms after excision only at multiple referral centers and (2) determining the proportion of women willing to participate in a randomized trial. Methods: We performed a multicenter prospective study of women undergoing excision for endometriosis (Canadian Task Force class II-3) at Duke University Center for Endometriosis Research & Treatment (currently the Saint Louis University Center for Endometriosis), Center for Endometriosis Care, Northshore University Health System, Memorial University (Canada), and Florida Hospital. The study comprised 100 female patients, aged 18 to 55 years, with endometriosis-suspected pelvic pain. The intervention was laparoscopic excision only of the abnormal peritoneum suspicious for endometriosis. The main outcome measures were quality of life, pelvic pain, dysmenorrhea, dyspareunia, and bowel and bladder symptoms. Results: The mean follow-up period was 8.5 months. Excision of endometriosis showed a significant reduction in all pain scores except bowel symptoms, as well as significant improvement in quality of life. Of the patients, 84% were willing to participate in a randomized study. Conclusions: Quality of life is a needed primary outcome for any randomized study comparing excision versus ablation. A multicenter comparative trial is feasible, although quality assurance would have to be addressed. Patients were willing to be randomized even at surgical referral centers.

Study Objective To estimate patient preferences insofar as the cosmetic appeal of abdominal incisions used for hysterectomy. We hypothesized that the laparoendoscopic single-site surgery (LESS) incision would be preferred cosmetically to traditional multiport laparoscopic incisions and open abdominal incisions via Pfannenstiel, vertical midline, or horizontal mini-laparotomy. Design Prospective comparative study (Canadian Task Force classification II-2). Setting Two gynecology clinics at Duke University Medical Center in Durham, North Carolina. Patients Seventy-three women including 50 consecutive women from a private specialty clinic and 23 consecutive women from a resident indigent care clinic. Interventions A brief questionnaire was distributed that assessed preferences via ranking and by using a visual analog scale. Patients were also asked to rate the importance of 4 factors in their decision making: size, location, and number of incisions, and perceived recovery time. Descriptive statistics, t tests, Wilcoxon rank-sum tests, and χ2 tests were used to compare continuous or categorical values. Measurements and Main Results Overall, the LESS incision was the most preferred incision according to most common choice and visual analog scale scores. In the private clinic, the LESS incision was preferred most often, with 53% of women (39/73) ranking it as their first choice. In the resident clinic, the horizontal mini-laparotomy incision was preferred most often, with 27% of women (20/73) ranking it their first choice. Neither the demographic factors nor any of the factors in decision making explained the difference between the clinics. Conclusion The LESS incision was most preferred in this study. However, the horizontal mini-laparotomy incision and the traditional laparoscopic with low lateral incisions were also highly preferred. Patient perception of the “visibility” of abdominal incisions may be the distinguishing issue to explain the difference in the preferences between the clinics and the differences between the present study and previously published studies of cosmetic preferences.

Study Objective To report on the presence and rate of endometriosis in hydatid cysts of Morgagni found at the time of excision surgery for endometriosis and to describe any association of endometriosis in hydatid cysts of Morgagni with preoperative or operative factors. Design A retrospective cohort study (Canadian Task Force Classification II-2). Setting The Center for Endometriosis at Saint Louis University, a tertiary referral center for endometriosis. Patients Women who underwent optimal excision surgery for suspected endometriosis because of chronic pelvic pain and/or infertility and who also had hydatid cysts of Morgagni removed at the time of surgery when found. Interventions Preoperative and operative data were collected prospectively. Main Outcome Measures The rate of endometriosis in hydatid cysts of Morgagni. Secondary measures included are the rate of hydatid cysts of Morgagni in patients with pelvic pain or infertility with and without endometriosis in the cysts. Results The overall prevalence of endometriosis in hydatid cysts of Morgagni was 11.3%. Patients with pelvic pain had a higher rate (although not statistically significant) of hydatid cysts of Morgagni compared with those without pain (21.1% vs 12.5 %, p = .54). Patients with infertility had a higher rate of hydatid cysts of Morgagni compared with those without infertility (38.1% vs 16.7%, p

Objective The purpose of this study was to examine if deep retraction pockets (DRPs) in the posterior cul-de-sac and uterosacral ligaments could be a manifestation of endometriosis and if excision of these pockets improves pain symptoms and quality of life. Study design Prospective cohort study Canadian Task Force Classification, II-3. Materials and methods Preoperative data, operative data, and follow-up data were collected prospectively at the Center for Endometriosis at Saint Louis University, a referral center for the surgical management of endometriosis. Results The 107 consecutive patients who presented with preoperative deep dyspareunia were included in the study, and the median postoperative follow-up was 13 months. Endometriosis was confirmed histologically in any location excised in 88/107 (82.2%) of the women, and 31 DRPs were excised from 25 women with DRPs in the posterior cul-de-sac or uterosacral ligaments, of which 15/31 (48.4%) had endometriosis. Of the 10 DRPs without visible surface lesions, 3 (30.0%) had endometriosis on histology. Pain symptoms and quality of life significantly improved after excision surgery, whether or not DRPs were present. Women who had endometriosis in their DRP also had significant improvement in deep dyspareunia and chronic pelvic pain and quality of life. Results did not differ when patients who took postoperative hormonal suppression were removed from the analyses. Conclusion Patients had significantly improved pain symptoms and quality of life after excision surgery, whether or not DRPs were present. This study demonstrated that a DRP may be a manifestation of endometriosis (even with a clear surface of the pocket), so that DRPs should be excised to achieve optimal excision of endometriosis.

Study Objectives To compare the intraoperative direct costs of a single-use energy device with reusable energy devices during laparoscopic hysterectomy. Design A randomized controlled trial (Canadian Task Force Classification I). Setting An academic hospital. Patients Forty-six women who underwent laparoscopic hysterectomy from March 2013 to September 2013. Interventions Each patient served as her own control. One side of the uterine attachments was desiccated and transected with the single-use device (Ligasure 5-mm Blunt Tip LF1537 with the Force Triad generator). The other side was desiccated and transected with reusable bipolar forceps (RoBi 5 mm), and transected with monopolar scissors using the same Covidien Force Triad generator. The instrument approach used was randomized to the attending physician who was always on the patient's left side. Resident physicians always operated on the patient's right side and used the converse instruments of the attending physician. Measurements and Main Results Start time was recorded at the utero-ovarian pedicle and end time was recorded after transection of the uterine artery on the same side. Costs included the single-use device; amortized costs of the generator, reusable instruments, and cords; cleaning and packaging of reusable instruments; and disposal of the single-use device. Operating room time was $94.14/min. We estimated that our single use-device cost $630.14 and had a total time savings of 6.7 min per case, or 3.35 min per side, which could justify the expense of the device. The single-use energy device had significant median time savings (−4.7 min per side, p Conclusions A single-use energy device that both desiccates and cuts significantly reduced operating room time to justify its own cost, and it also reduced total intraoperative direct costs during laparoscopic hysterectomy in our institution. Operating room cost per minute varies between institutions and must be considered before generalizing our results.

The recent industry wide post-ILI pipeline ruptures due to external corrosion happened in a relatively short period of time after the ILI using high-resolution Magnetic Flux Leakage (MFL) technology. Failure investigations show that the critical defects that caused these pipeline ruptures are generally long and complex corrosion, which typically consist of a number of deep corrosion pits (i.e. localized metal-loss) within an overall shallower, but relatively large corrosion area (i.e. generalized metal-loss). This has led us to investigate the gaps and “blind spots” of the ILI-based corrosion management program particularly to find out why existing methods fail to effectively identify and remediate such critical defects before they fail. Learning from these post-ILI failures, TransCanada has developed many assessment methods and criteria for identifying challenging areas. The many types of criteria account for blind spots from different perspectives in a multi-faceted manner. The traditional ILI based corrosion management programs calculate a deterministic failure pressure ratio (FPR) and maximum anomaly depth and ensure these do not reach a limiting value. However, this strictly deterministic assessment does not acknowledge the uncertainties, particularly the significant uncertainties in the ILI measurements, assessment models, and material properties. When all uncertainties are accounted for and a probabilistic excavation criterion is used, the excavations reveal that certain anomalies are found to be near-critical in the field even though the deterministic FPR based criteria did not identify these. The probabilistic criteria identifies longer shallower anomalies, with non-critical ILI based FPR values, as anomalies that have a higher probability of exceeding the FPR criteria in-the-ditch (where the uncertainties are minimized). This is because the probabilistic criterion acknowledges that longer anomalies are more sensitive to the depth measurement error and have a higher probability of becoming critical in-the-ditch. This “blind spot” in the deterministic method was overcome by incorporating a probabilistic criterion into the corrosion management program. The effectiveness of these new measures is discussed by examining excavation results of this program and subsequent ILI results. This paper discusses the approach to corrosion management where new learning and knowledge as well as new-found uncertainties are readily accommodated. The approach is also transparent and documented; so that new information can be incorporated into the assessment and post-ILI failures can be prevented more effectively.

Endometriosis, an underdiagnosed and undertreated condition, affects 1 in 10 women and is associated with pain and infertility. Preoperative evaluation should include testing and management of other causes of pelvic pain. Ultrasonography can aid in surgical planning. Hormonal suppression improves symptoms, but should not be used to diagnose endometriosis, and is not shown to be effective in preventing disease recurrence nor in improving fertility. The goal of surgical management should be optimal removal or treatment of disease and should include measures for adhesion prevention. Rates of recurrence of endometriosis depend on the surgical completeness of removing the disease.

Dear Editor, I read with interest the recent issue of the Linacre dedicated to geriatrics and end-of-life care. This is such a timely topic! With the implementation of Obamacare – which is government-run health care funded at the rate of economic inflation, not the more rapidly increasing healthcare inflation – there will be ever-increasing healthcare rationing. This will lead to escalating pressure to withhold life-preserving treatment (including food and water) especially to vulnerable populations including the elderly, the disabled, and the poor. As a result, end-of-life documents are already incredibly important and will become ever moreso. The article by Dr. Morrow articulates several key principles that should be present in an end-of-life document that adheres to Catholic principles – one that recognizes and respects the inherent dignity for human life for its own sake, one that ensure ordinary care and comfort care, and one that is “personalized” by appointing a healthcare proxy who understands and can implement your wishes according to the situation at hand. While there are several end-of-life document templates available, most do not adhere to the principles outlined in Dr. Morrow's article. A practical, easy-to-use resource for developing an end-of-life document that adheres firmly to the principles outlined in Dr. Morrow's article is the Will To Life Project developed by the National Right To Life Committee. From this website, one can download a legally valid document for any of the fifty states. While creating a Catholic end-of-life document can be daunting, this resource provides a practical starting point and a template anyone can complete. For more information, check out: http://www.nrlc.org/medethics/willtolive/.

This is the first known case of extended somatic support beyond viability for a pregnant woman with brain death resulting from metastatic malignant melanoma, resulting in a live birth.

A 44-year-old female, 1 year status-post ObTape transobturator mid-urethral sling, was evaluated by orthopaedic oncology and urology for persistent thigh pain and a left thigh mass. Multiple muscle biopsies were inconclusive, raising concern for inflammatory sarcoma. After serial débridements of the thigh abscess, sling material was found in the obturator space, which gave the diagnosis. Health care providers, both gynecologic and nongynecologic, need to be aware of serious complications of transobturator slings that may present in atypical ways.

The current approach to infertility of assisted reproductive technology (ART) completely misses and then bypasses the evaluation and treatment of cervical factor infertility. In contrast, the Creighton Model Fertility Care System (CrMS), a method of fertility awareness that has the unique ability to quantify cervical mucus observations, and natural procreative technology (NaProTECHNOLOGY or NPT) directly evaluate and treat cervical factor infertility. The ART treatment of choice for cervical factor infertility–-intrauterine insemination (IUI)–-is also morally disparate from the NPT treatment protocol: while the latter genuinely assists the infertile couple's act of sexual union to achieve its natural end of pregnancy, IUI replaces the natural act, depriving human conception of the one context worthy of the dignity of human life and procreation, a reciprocal self-gifting act of love between husband and wife. A renewed interest and focus on the direct evaluation and treatment of cervical factor infertility is needed.

In 2009 a pipeline within the TransCanada pipeline system experienced a rupture. As this pipeline was already under a rigorous In Line Inspection (ILI) based corrosion management program this failure led to an extensive root cause analysis. Even though the hazard causing the failure was microbiologically induced corrosion (MIC) under tape coating, the more troubling question was “Why had the severity of this anomaly not been determined by the ILI based corrosion management program?” This led to an investigation of what key characteristics of the ILI signals resulting from areas of “complex corrosion” are more difficult to correctly interpret and size and furthermore where the line condition is such that manual verification is needed. By better understanding the limitations of the technology, processes used, and the critical defect signal characteristics, criteria were developed to ensure that “areas of concern” are consistently identified, manually verified and therefore the sizing is validated at these potentially higher risk locations. These new criteria were applied on ILI data and then validated against in-the-ditch measurements and a hydrotest. This process in conjunction with optimization of ILI sizing algorithms enabled the operator to overcome some of the known challenges in sizing areas of complex corrosion and update its corrosion management process to improve the detection and remediation of critical defects. This paper describes this investigation of the failure location, development of the complex corrosion criteria, and the validation of effectiveness of the criteria. The criteria are focused on external corrosion and have been currently validated on pipelines of concern. Application to other lines should be similarly validated.

Magnetic Flux Leakage inspection tools are generally calibrated on a series of manufactured defects. This has been shown to give good results on a wide range of defects in varying wall thicknesses, velocities and pipeline conditions. Significant improvements in sizing performance can be achieved if sizing algorithms can be optimized on high resolution field data with low uncertainty that more closely reflects the actual line specific corrosion dimensions and profiles. The effects of defect profile can be significant to the MFL signal response. In order to achieve this goal, very high resolution and accurate field measurement techniques are needed to map the combined profile of a significant number of corrosion defects. This paper discusses a process for developing high performance sizing algorithms that consistently better industry standards for MFL sizing performance in areas of high density or complex corrosion in both oil and gas pipelines through the incorporation of high resolution laser scan technology. Complex corrosion may be considered as an area wherein individual corrosions interact together such that they no longer behave as a single corrosion and the MFL response experiences a superposition of leakage signals. A review of the methodology will be discussed and the results demonstrated through case studies from both Enbridge Pipelines Inc. and TransCanada Pipelines Ltd. where high-resolution field data was used as the basis for sizing model optimization.Copyright © 2012 by ASME

Laparo-endoscopic single site (LESS) surgery has recently gained broader acceptance as a less-invasive approach to traditional multi-port laparoscopic procedures. LESS hysterectomy represents the gynecologic surgeon's progression toward this goal of performing minimally invasive hysterectomy procedures through increasingly fewer incisions. Although this procedure offers improved cosmesis and potentially decreased post-operative pain, there are also many challenges to adoption of this surgical procedure. LESS hysterectomy is associated with a steep learning curve and the need for the gynecologic surgeon to adopt new technologies and develop a new set of surgical skills. Following the basic principles of LESS surgery is essential for the gynecologic surgeon to safely and efficiently adopt this surgical procedure. Advances in surgical instrumentation will continue to allow surgeons to perform increasingly complex LESS surgical procedures in the future.

Objective To report the novel technique of periumbilical ultrasound-guided saline infusion (PUGSI). Design Prospective study of two noninvasive diagnostic tests to detect obliterating subumbilical adhesions. Setting Tertiary care center. Patient(s) One hundred fifty patients were included in the study. Patients without risk factors for adhesions were used as a control group (n = 38), whereas the study group had risk factors for intra-abdominal adhesions (n = 112). Intervention(s) Preoperative examination with the visceral slide and the PUGSI. Main Outcome Measure(s) The presence of obliterating subumbilical adhesions in the high-risk patient and the ability of the PUGSI to detect them preoperatively. Result(s) There were no obliterating umbilical adhesions in the control group. The prevalence of obliterating umbilical adhesions in the risk group was 3.6%. The visceral slide test had an accuracy of 96.4%, a sensitivity of 50%, and a specificity of 98.1%, with a negative predictive value of 98.1% and a positive predictive value of 50%. The PUGSI test was able to detect all cases of obliterating subumbilical adhesions, demonstrating sensitivity and specificity of 100%. Conclusion(s) The PUGSI test has excellent negative and positive predictive values and is useful in determining patients who have obliterating subumbilical adhesions. Use of both tests preoperatively appears to be helpful in identifying patients at risk for visceral injury during laparoscopic surgery.

Objective: To assess the intratubal pressure (ITP) and patency status of the fallopian tubes before and after transcervical catheterization of the fallopian tubes (TCFT). Design: Prospective procedural assessment. Setting: Pope Paul VI Institute for the Study of Human Reproduction. Patient(s): Two hundred thirty-four women with either primary or secondary infertility. Intervention(s): Patients underwent selective hysterosalpingography and, in some cases, TCFT with measurement of the ITP before and after the procedure. Main Outcome Measure(s): The ITP before and after TCFT. Result(s): The mean (±SD) ITP in freely patent tubes was 0.53 ± 0.06 atm, that in partially obstructed tubes was 1.23 ± 0.52 atm, and that in completely obstructed tubes was 2.79 ± 1.40 atm. After TCFT, the mean (±SD) ITP in partially obstructed tubes decreased to 0.64 ± 0.31 atm and that in completely obstructed tubes decreased to 1.86 ± 1.35 atm. The ITP was normalized in 76% of partially obstructed tubes and in 29.5% of completely obstructed tubes. In all cases of complete obstruction in which surgical correction was attempted, organic pathology was identified. Conclusion(s): The procedure described is a safe and easy means of obtaining reliable and significant information on the status of the proximal fallopian tube.

A Feasibility Multi-Center Study of Patients after Excision of Endometriosis: A Randomized Comparative Trial of Excision Versus Ablation Looking at Quality of Life Is Needed Yeung PP Jr, Tu F, Bajzak K, Lamvu G, Gusovsky O, Agnelli R, Peavey M, Winer W, Albee R Jr, Sinervo K. Saint Louis University, St. Louis, Missouri; Northshore University, Evanston, Illinois; Memorial University, St. John’s, Newfoundland, Canada; Florida Hospital, Orlando, Florida; SAS Institute, Cary, North Carolina; Duke University, Durham, North Carolina; Center for Endometriosis Care, Atlanta, Georgia

A Multi-Center Study of Patients After Excision of Endometriosis: Do We Need Another Randomized Comparative Trial of Excision Versus Ablation? Yeung P Jr, Gusovsky O, Agnelli R, Peavey M, Tu F, Bajzak K, Lamvu G, Winer W, Albee R Jr, Sinervo K. Department of Obstetrics, Gynecology & Women’s Health, Saint Louis University; Director, Saint Louis University Center for Endometriosis, Saint Louis, MO; School of Medicine, Saint Louis University, Saint Louis, MO SAS Institute, Cary, NC; Department of Obstetrics & Gynecology, Duke University, Durham, NC; Northshore University Health System, Evanston, IL; Memorial University, St. John’s, Newfoundland, Canada; Florida Hospital, Orlando, FL; Center for Endometriosis Care, Atlanta, GA