Volume 99 ·  Issue 23 ·  2019

This article describes that mannitol should have clear indications in clinical application, and emphasizes that not all craniocerebral injuries (especially brain injuries with normal intracranial pressure) should be routinely used. Mannitol can neither prevent the increase of intracranial pressure after brain injury nor the occurrence of cerebral edema after brain injury. Many patients who do not need to use mannitol in clinic use mannitol, which not only fails to benefit patients, but leads to related complications caused by mannitol abuse, which should be paid attention by clinicians.

Mannitol is the most commonly used first-line drug for the treatment of increased intracranial pressure (ICP), and it is widely used in clinical use^[1]。 However, due to the different understanding of the pathophysiological mechanism of increased ICP and the pharmacological mechanism of mannitol, irregular use of mannitol is common in clinic, such as unindicated use, careless dose and interval, neglect of monitoring during use, etc., which leads to irrational use of mannitol in clinic and related complications^[2]。 Therefore, the Pediatric Neurosurgery Group of the Neurosurgery Branch of the Chinese Medical Association and the Neurocritical Care Management Cooperation Group jointly discussed and wrote the Chinese Expert Consensus on Mannitol Treatment of Increased Intracranial Pressure (referred to as the Consensus), hoping to standardize the use of mannitol through the consensus, avoid abuse and misuse, and improve the rationality, safety and effectiveness of mannitol treatment.

To investigate the predictive value of multimode MRI features for nuclear grade of clear cell renal cell carcinoma (ccRCC).

From January 2016 to October 2017, 381 patients (387 tumors) with ccRCC proven by pathology in Chinese PLA General Hospital First Medical Center were enrolled (male 293, female 88, age 24-87 years old). The clinical and imaging data of these patients were retrospectively analyzed, including clinical information (gender, age, BMI, smoke, hypertension) and preoperative renal MRI. Pre-and post-contrast MRI features were subjectively scored. The largest diameter of each lesion was measured. Two-sample t-test,Chi-squared test and binuary Logistic regression analysis were used to evaluate the predictive efficacy of clinical and MRI data.

According to WHO/ISUP nuclear grade system,all ccRCCs (n=387) were divided into low grade (n=322) and high grade group (n=65). Between two groups, there were significant differences in age and diameter((54±12) vs (59±10) years old, P=0.001; (4.1±2.2) vs (6.2±3.0) cm, P<0.01). In MRI scores,there were significant differences in scores of pseudocapsule, shape and margin,hemorrhage,enhancement degree,cystic-solid,intratumoral vessel,peritumoral vessel, renal sinus invasion, vein thrombosis, lymphadenopathy, necrosis, perinephric invasion and metastasis, DWI signal intensity between high grade group and low grade group (all P<0.01). Binuary Logistic regression analysis showed that shape and margin, enhancement degree and DWI signal intensity were independent predictors for high grade ccRCC (OR=0.181, 95%CI 0.049-0.666; OR=0.393, 95%CI 0.182-0.846; OR=0.336, 95%CI 0.155-0.728). A nomogram model for predicting the risk of high grade ccRCC was constructed.

Multimode MRI features can differentiate low grade and high grade ccRCC. The nomogram developed in this study might aid urologist in the pre-operative prediction of nuclear grade of ccRCC,which might contribute to developing treatment strategy.

To investigate the value of quantitative dynamic contrast enhancement MR imaging (DCE-MRI) parameters in the prediction and evaluation of the response to neoadjuvant chemotherapy in patients with malignant sinonasal tumors by comparing the parameter values before and after chemotherapy.

DCE-MRI was performed in 14 patients (6 male cases, 8 female cases, 16-83 years) with malignant sinonasal tumors before chemotherapy in Beijing Tongren Hospital from January 2012 to December 2013 in which DCE-MRI was performed in 8 patients on the 7th, 21st and 42nd days after chemotherapy. The values of quantitative parameter including K^trans, K_ep, and V_e of the tumor were assessed and the change rate of these quantitative parameter values after chemotherapy was calculated.

Response to chemotherapy of the tumor was found in 11 patients with malignant sinonasal tumors,whereas no response to chemotherapy of the tumor was confirmed in 3 patients. K^trans ((0.75±0.28)/min) and K_ep ((3.23±1.48)/min) values of the tumor before chemotherapy in patients with response to chemotherapy were significantly bigger than those ((0.43±0.41)/min, (1.34±0.42)/min) in patients with no response to chemotherapy (all P<0.01).There was no significant difference in V_e values between two groups (P=0.165). Compared with K^trans values of the tumor before chemotherapy,the change rate of K^trans values decreased more than 40% on the 7th,21st and 42nd days after chemotherapy in the patients with treatment response,whereas the change rate did not decrease significantly in the patients without treatment response.

The bigger K^trans and K_ep values of the tumor before chemotherapy,the better the treatment response of the tumor to chemotherapy.

To explore the value of superb microvascular imaging (SMI) and contrast- enhanced ultrasound (CEUS) in differential diagnosis of small renal masses.

A total of 84 patients with 86 lesions of renal masses were collected from October 2016 to March 2018 in Tianjin Medical University Cancer Institute and Hospital. There were 56 males and 28 females,aged from 29 to 76 years old,with an average age of (54±10) years old. These tumors were all examined by using SMI and CEUS. And the imaging diagnostic results were compared based on the pathological results. Adler semi quantitative analysis of blood flow grading of the tumors were evaluated in SMI,and the evaluation standard was as follows:0-1 grade was benign, 2-3 grade was malignant. Besides,the patterns and enhancement of the small renal masses were observed in CEUS. The main diagnostic criteria of malignant tumors were "fast forward" , "rapid regression" and "high perfusion" . Some special types of renal cell carcinoma were diagnosed by "slow in" , "rapid regression" and "hypo-perfusion" . Benign tumors were diagnosed by "slow in" , "slow down" and "hypo-perfusion" .

Among 86 cases, 76 cases were confirmed as malignant masses and 10 cases were confirmed as benign masses by pathological diagnosis. By SMI, Adler grade of 89.5% (68/76) malignant tumors were 2-3, Adler grade of 6/10 benign tumors were 0-1. By CEUS, 77.6% (59/76) of malignant tumors were "fast forward" , 82.9% (63/76) were "rapid regression" , 76.3% (58/76) were "high perfusion" ; 7/10 of benign tumors were "slow in" , 5/10 were "slow down" and 6/10 were "low perfusion" . The accuracy, sensitivity, specificity, positive predictive value, negative predictive value and AUC of SMI were 86.0%,89.5%, 60.0%, 94.4%,42.9% and 0.747 respectively. The values for CEUS were 89.5%, 92.1%, 70.0%,95.9%, 53.8% and 0.811 respectively.There was no statistical difference in diagnostic efficacy between CEUS and SMI ( P=0.288).

Although there is no statistical significance between SMI and CEUS, the accuracy, sensitivity and positive predictive value of SMI in the diagnosis of small renal masses are higher,which can clearly show micro-vessels and exquisitely detect the low-velocity blood flow in small renal masses. In brief,SMI provides a new method in the differential diagnosis of small renal masses.

To investigate the effect of obstructive sleep apnea (OSA) on cardiac structure and function in patients with acute coronary syndrome (ACS).

A total of 767 patients with ACS consecutively hospitalized at the Emergency & Critical Care Center of Beijing Anzhen Hospital from June 2015 to May 2017 were enrolled in this study. There were 637 males and 130 females. Patients who met the inclusion criteria according to the sleep apnea hypopnea index (AHI) were examined with portable sleep respiration monitoring. Patients were divided into moderate or severe OSA group (AHI≥15, n=389) and non or mild OSA group (AHI<15,n=78). The general information and echocar diographic results were analyzed. The data fitted normal distribution were compared between the groups with independent sample t test.

The body mass index [(27.8±3.6) vs (25.8±3.4) kg/m², t=-7.854, P<0.01], neck circumference [(41.1±4.2) vs (39.3±3.2) cm, t=-6.717, P<0.01] and waist-to-hip ratio (0.99±0.54 vs 0.97±0.53, t=-4.735, P<0.01) at admission were significantly higher in moderate or severe OSA group than those in non or mild OSA group. The left ventricular end-diastolic diameter, inter-ventricular septum thickness, left atrial diameter,right atrial diameter were all significantly higher, and the E/A peak ratio was remarkably lower in the moderate or severe OSA group (t=-2.130, 0.278, -3.045, -2.241, 2.260, all P<0.05).

Moderate or severe OSA may aggravate cardiac remodeling and diastolic function in ACS patients.

To observe the efficacy of drug -coated balloon (DCB) in the treatment of long -segment arterial stenosis in lower extremity.

Were retrospectively analyzed in February 2017 to January 2018,the First Hospital Affiliated to China Medical University of vascular surgical treated 80 patients with lower limb sclerosis of arterial congee appearance (lesion length>10 cm), accept the DCB and stents (BMS) treatment, compared two groups of patients with preoperative and postoperative issue patency rate of target lesion, ABI, Rutherford, amputation rate and the change of clinical symptoms and quality of life.

There were 60 cases in DCB group,20 cases in BMS group and 80 cases in BMS group. The patency rate of DCB group was 83.33% and 75.00% at 6 and 12 months after operation. The patency rate was 85.00% and 65.00% in the BMS group at 6 and 12 months after surgery. ABI, walking distance, Rutherford grade and clinical symptoms were significantly improved in the two groups compared with those before surgery. During the operation, 1 patient in the DCB group presented flow limiting interlayer and 1 patient still had>50% stenosis after predilation, and then underwent stent implantation for remediation.

The treatment of lower limb arterial stenosis with DCB can obtain better near -and medium-term clinical efficacy.

To evaluate the effects of treatment of post-traumatic distal radius partial physeal arrest with physeal bar resection.

From February 2007 to November 2017, 11 children with distal radius physeal arrest received physeal bar resection in the Department of Pediatric Orthopedics, Beijing Jishuitan Hospital. There were 2 females and 9 males. The average age of the patients was (10.1±1.8) years (range,7-13 years). All cases had previous history of distal radius trauma. The average duration from the previous fracture to the physeal bar resection operation was (22.8±3.2) months (range,22 to 41 months). Clinical and radiological evidence of distal radius physeal arrest were suggested in all patients. A CT or MRI scan was performed preoperatively to assess the size of the physeal bridge. Inclusion criteria were patients with a physeal bridge<30% of the physeal area,and with at least 2 years of growth remaining. The physeal bar resection operation was performed with the assistance of either fluoroscopy (5 cases) or intraoperative three dimensional navigation (6 cases). After resection, the void was then filled with bone wax in all cases and distal ulnar epiphysiodesis was conducted in 5 cases. The mean follow-up duration was (3.7±1.6) years (range,1-9 years). The clinical examination data and X ray were obtained during the follow up.

Four cases obtained fully recovery from the operation and the deformity got fully correction. The X ray showed no bone bridge recurred. The deformity did not aggravate in 1 case. The deformity aggravated and subsequent osteotomy was conducted in the left 6 cases. Three cases in the navigation group obtained fully recovery. One case in the fluoroscopy group obtained fully recovery.

The intraoperative three dimensional navigation can precisely locate the bone bridge. The physeal bar resection is an effective technique in some post-traumatic distal radius partial physeal arrest.

Prediction of delayed brain edema after spontaneous intracerebral hemorrhage by magnetic resonance spectroscopy combined with diffusion weighted imaging, and to explore the causes and treatment of delayed brain edema after intracerebral hemorrhage.

The patients with spontaneous cerebral hemorrhage diagnosed by CT from January 2015 to June 2018 in our hospital were analyzed. Magnetic resonance spectroscopy and diffusion weighted imaging examinations were performed on the third day after hemorrhage. It was diagnosed as delayed brain edema that the edema range enlarged more than 1 cm in CT scan on the 14th day Compare with the 7th Day. The patients were divided into the delayed brain edema group and the control group(n=27 for each). The NAA/Cr value and rADC value of the edema area in the two groups were analyzed by T test.

The NAA/Cr value (1.67±0.38) in the edema area of patients with delayed brain edema was significantly decreased Compare with the control group(1.92±0.42), and the rADC value (2.59±0.42) reduced significantly Compare with the control group (2.93±0.51), the differences were statistically significant (P<0.05).

MRS and DWI were susceptive in showing delayed brain edema lesions at hyper-early phase. Combination of MRS and DWI can provide a basis for clinical individual treatment programs selection and prognostic evaluation.

To investigate the clinical characterization, treatment and prognosis of anti-GQ1b antibody syndrome.

The clinical data of 8 patients with positive serum anti-GQ1b antibody from the Department of Neurology of Nanjing Brain Hospital between June 2016 and July 2018 were analyzed retrospectively. Their serums were tested by immunoblotting. Relevant literatures were reviewed to investigate possible pathogenesis.

Of the 8 cases, 4 cases were male, 4 cases were female; their age ranged from 16 to 76 (47±21) years old. Seven of them were with acute onset, the time course of the disease ranged from 2 to 15 (7±4) days. Six cases had a history of influenza prior to the onset of the presenting symptoms. In terms of the clinical manifestations of the eight patients, two were affected with Guillain-Barre syndrome (GBS), two with Cavernous sinus syndrome, one with Miller Fisher syndrome, one with both GBS and spinal cord demyelination, one with Bulbar paralysis, and one with chronic inflammatory demyelinating polyneuropathy (CIDP). The anti-GQ1b antibody IgG in serum was positive in 6 patients, two of whom were combined with positive IgG of anti-GD1b antibody in serum. The anti-GQ1b antibody IgM in serum was positive in 1 patient, and the anti-GQ1b antibody IgM and anti-GT1b antibody IgM in cerebrospinal fluid (CSF) were both positive in the other patient. In terms of the treatment, 3 patients (3/8) received vitamin B treatment only, 2 patients (2/8) received steroid plus vitamin B treatment, 2 patients (2/8) received intravenous immunoglobulin (IVIG) plus vitamin B treatment, and 1 patient (1/8) received steroid plus IVIG treatment. During the 8-33 months’ follow-up after discharge, 6 patients were significantly improved in their symptoms, one with mild diplopia, one with limbs weakness, numbness and difficulty in walking. The symptoms of one patient (case 3) fluctuated twice and recovered again after treatment.

The disease spectrum of anti-GQ1b antibodies syndrome is broad, and main symptom is ophtalmoplegia. Immunotherapy with IVIG and steroid would be beneficial to prognosis.

To investigate the surgical nuances and efficacy of microvascular decompression in patients with coexistent hemifacial spasm and ipsilateral trigeminal neuralgia.

Seventeen patients suffered from coexistent hemifacial spasm and ipsilateral trigeminal neuralgia were treated in Department of Neurosurgery, Henan Provincial People′s Hospital from January 2008 to September 2017. The medical recorders, intra-operative findings and postoperative follow-up results of these patients were reviewed, and the surgical strategies and therapeutic effects of these patients were summarized.

The offending vessels of the patients coexistent hemifacial spasm and ipsilateral trigeminal neuralgia were complex. The tortuous vertebral artery shifted to the suffered side in nine patients (52.9%), among which seven cases had vertebral artery as the offending vessel or indirect offending vessel compressing facial nerve and/or trigeminal nerve. The effective rate was 100%,the cure rate was 94.1%, and the immediate relief rate was 82.4%. All the patients were followed up for more than one year without recurrence.

Patients with coexistent hemifacial spasm and ipsilateral trigeminal neuralgia with tortuous vertebral artery shifted to the affected side were more common. Good surgical nuances and strategies in microvascular decompression are the guarantee of successful surgery.

To compare the perioperative effects of ultrasound-guided serratus anterior plane block (SAPB) and erector spinae plane block (ESPB) in radical mastectomy.

One hundred and fifty patients,undergoing radical mastectomy from May 2016 to Jan 2019,the Second Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University, were randomly divided into SAPB group, ESPB group and control group. Patients in SAPB group and ESPB group were received corresponding blocks before induction of general anesthesia. The control group was only received routine general anesthesia without any block. Patient-controlled intravenous analgesia (PCIA) was performed in all the patients postoperatively. The VAS score at rest or coughing and Ramsay score at 2, 4, 8, 12, 24, 48 h after operation were compared among the three groups. The intraoperative dosages of propofol and remifentanil,press times and sufentanil cumulative dosage of PCIA in 48 hours after operation, postoperative rehabilitation indicators and adverse effects were all compared.

In all the three groups,the VAS scores at rest and coughing increased first and then decreased 2 h to 48 h after operation. The VAS scores in SAPB group and ESPB group were lower than that in control group (P<0.05), whereas, no significant difference was observed between SAPB group and ESPB group (P>0.05). For Ramsay score, among the three groups, there were no significances of the main effects of group and time point, as well as interaction effect (all P>0.05). The intraoperative dosages of propofol and remifentanil in SAPB group and ESPB group were lower than those in control group (P<0.05), the press times and sufentanil cumulative dosage of PCIA after operation were also lower than those in control group (P<0.05). There was no significant difference in feeding time after operation among the three groups (P>0.05). The times of first anal exhaust, ambulation and hospitalization after operation in ESPB group and SAPB group were significantly shorter than those in control group (P<0.05). However, there was no significant difference between ESPB group and SAPB group in postoperative rehabilitation indicators mentioned above (P>0.05). The incidences of skin itching and nausea in ESPB and SAPB groups were lower than those in control group (P<0.05). There was no difference in the incidence of vomiting among the three groups (P>0.05).

Both SAPB and ESPB can provide good and safe analgesia for radical mastectomy,with equivalent performances in analgesia and adverse effect.

To assess the feasibility and safety of endovascular denervation (EDN) with a multi-electrode radiofrequency ablation catheter on beagles.

A total of 18 beagles, (10.2±1.1) kg,of either gender,were provided by the Animal Center of Southeast University (SYXK (Su) 2016-0013). They were divided equally into three groups:the instant euthanizing group, the long-term follow-up group and the sham operation group. Beagles in the instant euthanizing group were euthanized immediately after EDN. Beagles in the long-term follow-up group were euthanized three months after EDN. Beagles in the sham operation group underwent sham operation and were euthanized three months later. Blood biochemistry was measured at baseline, and immediately, 15 days, 30 days and 90 days after the surgery. Computerized tomographic (CT) angiography was determined before the surgery and 60 days after the surgery. Digital subtraction angiography (DSA) was determined 90 days after the surgery. Histopathologic analyses were used to identify the changes of arterial wall and neuron cells.

Beagles in the long-term follow-up group and the sham operation group all underwent EDN successfully without accidental death. No abdominal aortic perforation and peripheral tissue necrosis were found at Necropsy. No vascular injuries were found by CTA and DSA in each group. There was no statistical difference in hematological analyses, 90 days after the surgery:white blood cell:(12.5±1.5)×10⁹/L vs (13.2±0.7)×10⁹/L, P=0.275; red blood cell:(7.0±0.6)×10⁹/L vs (6.3±0.4)×10⁹/L, P=0.089; total bilirubin:(2.9±0.4) μmol/L vs (3.0±0.6) μmol/L, P=0.681; glutamic-pyruvic transaminase:(40±11) U/L vs (37±6) U/L, P=0.168; glutamic oxalocetie transaminase:(51±11) U/L vs (48±9) U/L, P=0.221; urea nitrogen:(7.2±1.2) mmol/L vs (6.9±0.8) mmol/L, P=0.505; creatinine:(60±9) μmol/L vs (59±9) μmol/L, P=0.81; prothrombin time:(7.2±0.7) s vs (7.0±0.7) s, P=0.719. Histopathological analyses showed that there were hypercellular appearance of nerve bundle and thickened perineurium in EDN groups, while normal perineurium around nerve bundle in the sham operation group.

EDN could be applied in beagles safely and feasibly.

This study will explore and optimize the conditions for the construction of the mouse model of endometriosis using the estrogen-releasing thermo-sensitive hydrogel system.

(1) The mice were injected subcutaneously with a gradient concentration of estrogen-releasing thermo-sensitive hydrogel systems, and the blood estrogen concentration was measured 3 days later. And then we draw the curve between mouse blood estrogen concentration and thermo-sensitive hydrogel systems concentration, selecting the most appropriate concentration of estrogen-releasing thermo-sensitive hydrogel systems. (2) To explore the release pattern of estrogen-releasing thermo-sensitive hydrogel system, the mice were injected subcutaneously with the optimal concentration of estrogen-releasing thermo-sensitive hydrogel system, and the blood estrogen concentration was measured on the 1st, 3rd, 5th, 7th and 10th day respectively. (3) We transplanted uteruses from donor mice into the abdominal cavities of recipient mice. The recipient mice were divided into three groups named a, b, and c. Group a was intraperitoneally injected with PBS everyday after transplantation, and group b was intraperitoneally injected with estrogen solution everyday after transplantation. And estrogen-releasing thermo-sensitive hydrogel systems mentioned above were injected subcutaneously to group c once a week. Mice were killed 21 days later to observe the success rate of the endometriosis models.

(1) The concentration of estrogen in mice was linear with the concentration of estrogenin the estrogen-releasing thermo-sensitive hydrogel systems. And 0.8 mg/ml was the most appropriate concentration of the estrogen-releasing thermo-sensitive hydrogel system. (2) The thermo- sensitive hydrogel systems including 0.8 mg/ml estrogen can release estrogen in mice for 7 days and can achieve effective blood estrogen concentration. (3) All mice in group a, b, and c survived. All mice in group b and c showed ectopic cysts, and no cyst was observed in group a.

The construction of the mouse model of endometriosis requires exogenous estrogen. We have found that the novelestrogen-releasing thermo-sensitive hydrogel systems can slowly release estrogen after subcutaneously injection in mice, and the value of the subcutaneously injection of estrogen-releasing thermo-sensitive hydrogel system (0.8 mg/ml) per week to the construction of the mouse model is certain.The estrogen-releasing thermo-sensitive hydrogel system has high application value and is worthy of promotion.

The clinical and laboratory data of 15 patients with connective tissue disease complicated with spontaneous emphysema mediastinum (SPM) from June 2013 to August 2018 in Beijing Chaoyang Hospital were analyzed. Among the 15 cases, 4 cases had common interstitial pneumonia, 3 cases had non-specific interstitial pneumonia, 4 cases showed thin-walled cavities and vesicle-like changes in lung images, and 4 cases showed patch exudative changes in lung. The results showed that patients with primary Sjogren's syndrome and elevated serum lactate dehydrogenase, α-hydroxybutyrate dehydrogenase and serum ferritin, mainly with pulmonary cavity-like lesion, should be more vigilant about SPM.

A case of Wernicke's encephalopathy (WE) complicated by fasting after gastrointestinal surgery is reported. The plain MRI scan of the patient's head showed no obvious abnormality, but the enhanced scan showed abnormal enhancement of the papillary body and midbrain tectal area. Because the sensitivity of skull MRI plain scan to the diagnosis of WE is low, if there is no abnormality in skull MRI plain scan for patients with suspicious WE, enhanced scan should be improved to avoid missed diagnosis.

Persistent ischiatic artery is a rare congenital vascular malformation, and its incidence of concurrent aneurysms is about 44%. This patient had a pulsatile mass in the buttock as the main complaint, accompanied by long-term mild ischemia of the lower limbs. He was diagnosed as persistent ischiatic artery combined with ischiatic aneurysm formation, and underwent endovascular isolation with stent covering. He was followed up for 46 months after operation. The diagnosis and treatment process and follow-up results are reported as follows.

Primitive neuroectodermal tumors (PNET) and Ewing sarcoma (ES) originate from the same family, namely the primitive neuroectoderm, and have the same cytogenetic characteristics. The clinical manifestations of PNET/ES in the chest wall were not specific, the tumor grew rapidly, and the involvement of the pleura was accompanied by chest pain. Chest wall PNET/ES can occur in all ages, but it is more common in the ages of 10 to 30 years. This article reports two patients with PNET/ES. Intrathoracic giant PNET/ES needs to be differentiated from the following diseases: pulmonary blastoma, solitary fibrous tumor, teratoma, schwannoma.

Studies have shown that during normal brain development in rats and humans, Na⁺-K⁺-2Cl^-Co-transporter 1 (NKCC1), K⁺-Cl^-Co-transporter 2 (KCC2) expression patterns were significantly different. Studying the effects of their different expression patterns on the action of gamma-aminobutyric acid (GABA) will not only help to deeply understand the epileptogenic mechanism of epilepsy, but also provide a theoretical basis for the research and development of new antiepileptic drugs. In this paper, the history and progress of NKCC1 and KCC2 studies and the current research status in the mechanism of epilepsy are briefly reviewed.

Uterine scar pregnancy (CSP) after cesarean section can cause uterine curettage and uncontrollable postoperative hemorrhage, uterine rupture, and even hysterectomy. Prophylactic uterine artery embolization (UAE) can reduce the amount of bleeding during curettage, but may lead to severe pulmonary embolism postoperatively, with heavy bleeding still occurring during curettage, secondary decreased menstrual flow and increased risk of recurrent CSP. This article reviews the effectiveness, postoperative complications, impact on fertility and individualization of CSP treatment in UAE.