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Abdominal Radiology (New York) Aug 2018
Review
Topics: Female; Humans; Ovarian Cysts; Ovary; Ultrasonography
PubMed: 29198005
DOI: 10.1007/s00261-017-1414-y -
Journal of Minimally Invasive Gynecology May 2021To review short- and long-term complications associated with intraoperative rupture of benign ovarian cysts. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To review short- and long-term complications associated with intraoperative rupture of benign ovarian cysts.
DATA SOURCES
The Cochrane Central Register of Controlled Trials, BIOSIS, Medline (Ovid), Web of Science, ClinicalTrials.gov, and Google Scholar were searched using the following terms and their combinations: "spillage," "rupture," "leakage," "ovarian cyst," "teratoma," "dermoid," "operative," "surgery," "outcome."
METHODS OF STUDY SELECTION
Randomized controlled and observational studies evaluating the operative outcomes of surgical treatment of ovarian cysts with intraoperative spillage compared with those of surgical treatment of ovarian cysts without spillage were included. A systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed.
TABULATION, INTEGRATION, AND RESULTS
A total of 28 studies were included in the qualitative analysis and 12 in the quantitative analysis. Ovarian cyst diameter was not found to be associated with the risk for spillage (relative risk [RR] 0.75; 95% confidence interval [CI], -0.33 to 1.82). Intraoperative benign ovarian cyst rupture was not associated with adverse short- and long-term outcomes such as reoperation (RR 1.16; 95% CI, 0.39-3.48), infertility (RR 0.73; 95% CI, 0.15-3.63), transient fever (RR 3.22; 95% CI, 0.83-12.51), and readmission (RR 1.00; 95% CI, 0.33-2.98). However, intraoperative spillage was found to be associated with increased risk for benign recurrence (RR 3.1; 95% CI, 1.05-9.14). A subgroup analysis of the studies that included only dermoid cysts showed an association between intraoperative cyst rupture and postoperative chemical peritonitis (RR 9.36; 95% CI, 1.20-73.28).
CONCLUSION
Intraoperative ovarian cyst spillage of a benign cyst is associated with limited adverse clinical outcomes. Although the surgical approach (minimally invasive vs open) should not be affected by the concern regarding an intraoperative cyst rupture, maximal efforts should be made to prevent intra-abdominal spillage.
Topics: Female; Humans; Laparoscopy; Neoplasm Recurrence, Local; Ovarian Cysts; Peritonitis; Postoperative Complications; Teratoma
PubMed: 33279627
DOI: 10.1016/j.jmig.2020.11.025 -
Ceska Gynekologie 2016To summarize literature data on peripheral precocious puberty. (Review)
Review
OBJECTIVE
To summarize literature data on peripheral precocious puberty.
DESIGN
A literature review.
SETTING
Středomoravská nemocniční a.s., hospital Šternberk, Department of Obstetrics and Gynaecology, University Hospital, Medical Faculty, Palacky University, Olomouc.
METHODS AND RESULTS
We searched in PubMed using the key words stated below according to date and published since 1980.Peripheral precocious puberty occurs in girls with the frequency 1:400-1000. It develops mainly because of peripheral estrogen secretion, the main cause of which are autonomous ovarian cysts. Other causes include McCune Albright syndrome, juvenile granulosa cell tumor and primary hypothyroidism. Typically, peripheral precocious puberty presents with early breast enlargement followed by development of other secondary sex characteristics. Initial treatment is usually conservative with the exception of juvenile granulosa cell tumor where surgery is warranted. Peripheral precocious puberty anti-estrogen therapy seems promising but neither data on its influence on fertility nor data comparing it to surgical treatment are available. Due to the risk of progression into central precocious puberty or McCune Albright syndrome, long-term follow-up is necessary.
CONCLUSION
Peripheral precocious puberty should be managed in pediatric gynecology outpatient office and often subsides spontaneously. However, it can also be a sign of malignancy. In most cases, conservative therapy is preferred with medical treatment and surgery warranted in complicated cases. However, optimal treatment has not been established yet.
Topics: Female; Fibrous Dysplasia, Polyostotic; Granulosa Cell Tumor; Humans; Hypothyroidism; Ovarian Cysts; Ovarian Neoplasms; Puberty, Precocious
PubMed: 27897024
DOI: No ID Found -
Reproductive Biology and Endocrinology... Jun 2023This study aimed to explore the optimal time of laparoscopic cystectomy for unilateral ovarian endometrioma patients and evaluate the influence on ovarian reserve. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
This study aimed to explore the optimal time of laparoscopic cystectomy for unilateral ovarian endometrioma patients and evaluate the influence on ovarian reserve.
MATERIALS AND METHODS
This prospective randomized controlled study included 88 women with unilateral ovarian endometrioma at a tertiary teaching hospital. All patients received their first identified diagnosis of ovarian endometrioma by ultrasound (> 4 cm and ≤ 10 cm) and were administered an oral contraceptive pill (OC) for one cycle before laparoscopy. They were randomly divided into two groups: laparoscopy at the late luteal phase (group LLP) (n = 44) (termination of OC for two days) and laparoscopy at the early follicular phase (group EFP) (n = 44) (day 3 after menstruation). Basic clinical characteristics were recorded. Serum Anti-Müllerian hormone (AMH) levels were measured at various times to predict ovarian reserve. Serum levels of Anti-Müllerian hormone (AMH) were measured at several time sites to predict the ovarian reserve; AMH and leukocyte esterase (LE) levels of the endometrioma wall were measured.
RESULTS
Before surgery, serum AMH levels decreased in both groups from preoperative to one week and six months postoperatively. In contrast, the difference values of group EFP were larger than those of group LLP at postoperative one week and postoperative six months (1.87 ± 0.97 vs. 1.31 ± 0.93, P = 0.07; 1.91 ± 1.06 vs. 1.54 ± 0.93, P = 0.001). The mean rates of postoperative serum AMH decline were 37.92% and 46.34% in group EFP, significantly higher than those in group LLP (25.83% vs. 31.43%, P < 0.001). Ovarian endometrioma wall AMH of group LLP was significantly lower than that of group EFP ([22.86 ± 3.74] vs. [31.02 ± 5.23], P < 0.001). Meanwhile, ovarian endometrioma LE concentration of group LLP was significantly higher than that of group EFP ([482.83 ± 115.88] vs. [371.68 ± 84.49], P<0.001). There was also a significant inverse correlation between leukocyte esterase and AMH concentration in an ovarian endometrioma cyst wall (r=-0.564, P<0.001).
CONCLUSION(S)
The optimal time for laparoscopic cystectomy for patients with first identified unilateral ovarian endometrioma is the late luteal phase, which reduces ovarian tissue loss and preserves ovarian reserve effectively and safely.
Topics: Humans; Female; Endometriosis; Prospective Studies; Anti-Mullerian Hormone; Ultrasonography; Laparoscopy; Ovarian Reserve; Ovarian Cysts
PubMed: 37370122
DOI: 10.1186/s12958-023-01109-2 -
Saudi Medical Journal Jul 2015To review cases of ovarian cysts managed at a University Hospital, and to identify the factors necessitating the use of laparotomy over laparoscopy. (Review)
Review
OBJECTIVES
To review cases of ovarian cysts managed at a University Hospital, and to identify the factors necessitating the use of laparotomy over laparoscopy.
METHODS
We carried out a retrospective chart review of all cases of ovarian cysts diagnosed and managed at the Department of Obstetrics and Gynecology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia between January 2010 and August 2014. All data collected from medical record charts, patents details, clinical presentations, ovarian cysts description, and pathology type were recorded, and management by laparoscopy or laparotomy was identified. Ethical approval was obtained from ethical hospital committee.
RESULTS
There were 244 cases of ovarian cysts during the study period. The age ranged from 3 months to 77 years of age. The parity from 0-6. The height range from 37-180 cm. The weight range from 3-161 kg, and calculated body mass index ranged from 12-47. Out of 244 patients diagnosed, 165 were married (67.4%). Of those, only 16 patients were pregnant (6.6%). The most common presentation was abdominal pain in 142 patients (58.2%). Only 79.9% were ovarian cysts, and 17.5% were either para-ovarian or retroperitoneal. The right ovaries were affected in 63.1%, and only 18.9% were bilateral. The types of ovarian cysts included functional cysts 33.2%, benign cyst-adenoma 19.3%, and dermoid cysts 12.3%.
CONCLUSION
Factors associated with laparotomy management rather than laparoscopy included older age more than 35, single, pregnant, or patients presenting with abdominal pain, and more than one cyst.
Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Female; Humans; Infant; Middle Aged; Ovarian Cysts; Retrospective Studies; Young Adult
PubMed: 26108588
DOI: 10.15537/smj.2015.7.11690 -
BMJ Open Sep 2021To summarise the available evidence on frequency of ovarian cyst development during mammalian target of rapamycin inhibitors (mTORi) treatment. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To summarise the available evidence on frequency of ovarian cyst development during mammalian target of rapamycin inhibitors (mTORi) treatment.
METHODS
PubMed/Medline and EMBASE databases were searched, from 1990 up to March 2020, using the following keywords: 'tacrolimus', 'sirolimus', 'temsirolimus', 'everolimus', 'deforolimus', 'mTOR' and 'ovarian cysts' (Limit: Human, English, full article). Studies were selected for the review if they met the following criteria: clinical studies, studies reporting original data, studies reporting the number of patients using mTORi, studies reporting the number of patients with ovarian cysts.We selected 7 of 20 retrieved studies. Study design, population, sample size, criteria for diagnosis of ovarian cysts, drug doses and follow-up length were extracted. Pooled estimate of incidence was calculated for ovarian cysts as a percentage, with 95% CI.
RESULTS
Four hundred-six women were included in the selected studies. The pooled incidence was 37.0% (95% CI 16.0% to 58.1%) for all ovarian cysts, and 17.3% (95% CI 5.6% to 29.1%) for clinically significant ovarian cysts. Based on two articles, comparing mTORi and non-mTORi for immunosuppression, pooled OR for ovarian cyst incidence was 4.62 (95% CI 2.58 to 8.28).
CONCLUSION
Ovarian cyst development is a common adverse event during immunosuppression treatment with mTORi. These cysts are benign conditions, but they require pelvic ultrasound follow-up and in some cases hospital admission and surgery.
Topics: Everolimus; Female; Humans; Incidence; Ovarian Cysts; Pelvis; TOR Serine-Threonine Kinases
PubMed: 34561260
DOI: 10.1136/bmjopen-2020-048190 -
Archivos Argentinos de Pediatria Jun 2018The appropraite surgical treatment to pediatric patients with ovarian lesions are heterogeneous and ovarian preservation is desirable in children. The aim of this study...
INTRODUCTION
The appropraite surgical treatment to pediatric patients with ovarian lesions are heterogeneous and ovarian preservation is desirable in children. The aim of this study is to the discuss findings related to a set of patients who were operated on for ovarian lesions.
PATIENTS AND METHODS
A retrospective study carried out in 13 years on 56 patients under the age of 17. These patients were divided into 3 groups according to ovarian pathologic diagnosis: 25 with functional (cyts and torsion), 18 with epithelial ovarian lesions and 13 with germ cell tumours. These three groups were compared in terms of menarche, torsion, age, duration, size, pain, mass, vomiting, irregular menstruation, location and operation type.
RESULTS
Follicle cysts, serous cyst adenomas and teratomas were the most common in these groups. The mean age of the patients was 12.18±4.84 years. The most common symptoms and signs were abdominal-pelvic pain (85.7%) and swelling(37.5%). Torsion was seen in 21 patients (37.5%), mean mass size was found to be 10.46±6.55 cm. A salpingo-oophorectomy (SO) was performed in 38 patients and cyst excision (CE) was performed in 18 patients. In premenarcheal cases, torsion was seen more in menarcheal cases and in the functional lesion group. CE was performed more often in the functional and t SO was performed often in the epithelial and germ cells groups.
CONCLUSION
Torsion and functional ovarian pathologies are thought to be common in premenstrual ages and malign lesions are very rare in all age groups so we recommend ovarian protective surgery should be preferred.
Topics: Abdominal Pain; Adolescent; Age Factors; Child; Child, Preschool; Female; Humans; Infant; Neoplasms, Germ Cell and Embryonal; Organ Preservation; Ovarian Cysts; Ovarian Diseases; Ovarian Neoplasms; Pelvic Pain; Retrospective Studies; Salpingo-oophorectomy; Torsion Abnormality
PubMed: 29756706
DOI: 10.5546/aap.2018.eng.e356 -
Journal of General Internal Medicine Aug 2022Anticoagulation poses unique challenges for women of reproductive age. Clinicians prescribing anticoagulants must counsel patients on issues ranging from menstruation... (Review)
Review
Anticoagulation poses unique challenges for women of reproductive age. Clinicians prescribing anticoagulants must counsel patients on issues ranging from menstruation and the possibility of developing a hemorrhagic ovarian cyst to teratogenic risks and safety with breastfeeding. Abnormal uterine bleeding affects up to 70% of young women who are treated with anticoagulation. As such, thoughtful clinical guidance is required to avoid having young women who are troubled by their menses, dose reduce, or prematurely discontinue their anticoagulation, leaving them at increased risk of recurrent thrombosis. Informed by a review of the medical literature, we present current recommendations for assisting patients requiring anticoagulation with menstrual management, prevention of hemorrhagic ovarian cysts, and avoiding unintended pregnancy. The subdermal implant may be considered a first-line option for those requiring anticoagulation, given its superior contraceptive effectiveness and ability to reliably reduce risk of hemorrhagic ovarian cysts. All progestin-only formulations-such as the subdermal implant, intrauterine device, injection, or pills-are generally preferred over combined hormonal pills, patch, or ring. Tranexamic acid, and in rare cases endometrial ablation, may also be useful in managing menorrhagia and dysmenorrhea. During pregnancy, enoxaparin remains the preferred anticoagulant and warfarin is contraindicated. Breastfeeding women may use warfarin, but direct oral anticoagulants are not recommended given their limited safety data. This practical guide for clinicians is designed to inform discussions of risks and benefits of anticoagulation therapy for women of reproductive age.
Topics: Anticoagulants; Female; Humans; Ovarian Cysts; Pregnancy; Warfarin
PubMed: 35641728
DOI: 10.1007/s11606-022-07528-y -
The Journal of Emergency Medicine Jun 2022Abdominal pain and constipation are common presenting symptoms of pediatric patients presenting to the emergency department. Sometimes these symptoms are related to...
BACKGROUND
Abdominal pain and constipation are common presenting symptoms of pediatric patients presenting to the emergency department. Sometimes these symptoms are related to uncomplicated constipation from stool burden, and other cases may be secondary to more serious pathologies, including obstruction from intra- or extra-intestinal compression. Point-of-care ultrasound (PoCUS) can be helpful in discerning the etiology for this undifferentiated symptomatology.
CASE REPORT
A 14-year-old girl presented with 3 days of constipation and abdominal pain. This was similar to previous symptoms that resolved with laxatives. This time, however, her symptoms were associated with one episode of vomiting. PoCUS expanded a narrow differential with the discovery of a large ovarian cyst. This finding helped to expedite her transfer to a pediatric hospital for definitive treatment in the operating room. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Constipation is one of the leading reasons pediatric patients present to the ED with abdominal pain. PoCUS can detect uncommon causes of constipation, especially pathologies associated with large volumes of fluid, such as a large ovarian cyst, bladder outlet obstruction, or small bowel obstruction.
Topics: Abdominal Pain; Adolescent; Child; Constipation; Emergency Service, Hospital; Female; Humans; Intestinal Obstruction; Ovarian Cysts; Ultrasonography
PubMed: 35400506
DOI: 10.1016/j.jemermed.2022.01.022 -
Journal of Comparative Pathology Apr 2022Despite their high prevalence, the aetiopathogenesis of ovarian cysts in guinea pigs (Cavia porcellus) is unknown. We examined tissue samples of cystic ovaries from 20...
Despite their high prevalence, the aetiopathogenesis of ovarian cysts in guinea pigs (Cavia porcellus) is unknown. We examined tissue samples of cystic ovaries from 20 guinea pigs by histopathology and immunohistochemistry for CD10 antigen, and determined the concentrations of Na, K, Cl, oestradiol and progesterone in the cyst fluid. Cystic rete ovarii were found in all 20 guinea pigs but no follicular cysts. Concentrations of Na (142.2 ± 5.04 mmol/l), K (5.6 ± 0.76 mmol/l) and Cl (116.1 ± 5.25 mmol/l) corresponded to extracellular, rather than intracellular, fluid indicating that rete ovarii cysts in guinea pigs are transudative in nature. A positive correlation was found between Na and Cl concentrations (r = 0.7713, P <0.0001). The mean concentrations of oestradiol (61.9 ± 17.44 pg/ml) and progesterone (2.7 ± 5.42 ng/ml) in the cyst fluid were higher than expected because the rete epithelium is not known to have steroidogenic activity. A negative correlation was found between oestradiol and progesterone concentrations in cyst fluid (r = -0.4296, P = 0.0178). Possible pathogenetic mechanisms of cystic rete ovarii in guinea pigs are discussed.
Topics: Animals; Cyst Fluid; Electrolytes; Estradiol; Female; Guinea Pigs; Ovarian Cysts; Progesterone
PubMed: 35305709
DOI: 10.1016/j.jcpa.2022.01.003