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ACG Case Reports Journal Oct 2022Vaginal and uterine varices are well documented in pregnancy, although development of vaginal varices in patients with portal hypertension occurs in an exceptionally...
Vaginal and uterine varices are well documented in pregnancy, although development of vaginal varices in patients with portal hypertension occurs in an exceptionally rare subset. Only 12 cases are reported in the literature; all but 3 of these cases involved patients with a history of hysterectomy, with 1 of the remaining 2 exhibiting partial obliteration of the uterine plexus due to radiation therapy for cervical cancer. We present a case of recurrent vaginal variceal bleeding in a patient with a history of hysterectomy, initially managed with vaginal tamponade and ultimately requiring definitive treatment with transjugular intrahepatic portosystemic shunt insertion.
PubMed: 36247382
DOI: 10.14309/crj.0000000000000878 -
Frontiers in Oncology 2021To evaluate the efficacy and prognosis of fertility-sparing re-treatment on patients with recurrent endometrial cancer (EC) and atypical endometrial hyperplasia (AEH)...
OBJECTIVE
To evaluate the efficacy and prognosis of fertility-sparing re-treatment on patients with recurrent endometrial cancer (EC) and atypical endometrial hyperplasia (AEH) who wish to preserve their uterus after complete remission (CR) for primary conservative therapy.
METHODS
We performed a retrospective study on recurrent EC or AEH patients who received fertility-sparing re-treatment after achieving CR. Data regarding clinicopathological factors, adverse events, treatment efficacy, tumor prognosis, and reproductive outcome were analyzed.
RESULTS
Of the 98 recurrent patients with a median disease-free interval period of 19 (3-96) months, 18 patients decided to receive hysterectomy directly, and 80 patients received fertility-preserving re-treatment. Seventy-one (88.6%) cases achieved CR, 96.0% in AEH and 75.8% in EC patients, with the 6 (3-16) months' median CR time. Seven (8.8%) patients failed to achieve CR and then underwent the hysterectomy: one partial response (PR), four stable disease (SD), and two progressive disease (PD). Forty-nine women attempted to get pregnant after CR, 13 (26.5%) became pregnant, seven (14.3%) successfully delivered, and six (12.2%) miscarried. During the follow-up period, 22 (31.0%) women had developed a second relapse with the median recurrence time of 12 (4-90) months, and 10 patients decided to receive the third round of fertility-sparing treatment. Seven (70.0%) patients, 33.3% in EC and 85.7% in AEH, achieved CR again. Hysterectomy was performed in two (20.0%) patients due to SD. After the third-round treatment, six women had the desire to conceive but no one became pregnant successfully.
CONCLUSION
For patients with recurrent EC and AEH after primary conservative treatment, fertility-preserving re-treatment can still achieve a promising response, and patients have possibilities of completing childbirth.
PubMed: 34568074
DOI: 10.3389/fonc.2021.738370 -
The Journal of International Medical... Feb 2020This study was performed to explore the causes and clinical characteristics of emergency exploratory laparotomy in patients with intractable postpartum hemorrhage.
OBJECTIVE
This study was performed to explore the causes and clinical characteristics of emergency exploratory laparotomy in patients with intractable postpartum hemorrhage.
METHODS
This retrospective study was performed from January 2004 to December 2017. Patients with intractable postpartum hemorrhage were grouped according to the initial pathogenesis as determined by exploratory laparotomy: uterine atony, placental factors, coagulation dysfunction, or uterine rupture.
RESULTS
This study involved 72 patients who underwent emergency exploratory laparotomy, accounting for 0.04% of total deliveries. Uterine preservation surgery and hysterectomy were performed in 31 and 41 patients, respectively. Abnormal events upon returning to the ward were primarily vaginal hemorrhage and pelvic hematoma. The frequency of uterine artery ligation was lower in the hysterectomy group than uterine preservation group. The prothrombin activity level, fibrinogen level, and platelet count before surgery were lower in the hysterectomy group than uterine preservation group. The international normalized ratio and activated partial thromboplastin time were higher in the hysterectomy group than uterine preservation group. In total, 44 patients developed complications.
CONCLUSION
Placental implantation is a primary cause of hysterectomy after emergency laparotomy. However, the possibility of postpartum hemorrhage caused by coagulation disorders should not be ignored.
Topics: Female; Humans; Hysterectomy; Laparotomy; Postpartum Hemorrhage; Pregnancy; Retrospective Studies; Uterine Inertia
PubMed: 31662015
DOI: 10.1177/0300060519879294 -
Translational Cancer Research Mar 2020A 36-year-old woman presented with a history of prolonged menstrual period and increased menstrual volume of 4 months. Ultrasonography showed inhomogeneous echo...
A 36-year-old woman presented with a history of prolonged menstrual period and increased menstrual volume of 4 months. Ultrasonography showed inhomogeneous echo measuring 2.5×1.9×2.2 cm in uterine cavity, and it can be seen that the blood flow signal enters the uterine posterior wall. Trophoblastic disease was not ruled out. But the serum β-human chorionic gonadotropin (hCG) was <0.3 mIU/mL. In order to confirm the diagnosis, the patient was planned to undergo hysteroscopy. Hysteroscopy is an ideal solution for early diagnosis. However, the drawback of hysteroscopy is that only local lesions can be removed. If the infiltration degree is deep, a second hysterectomy is required. Our authors present the first case of epithelioid trophoblastic tumor (ETT) under hysteroscopy. After neoplasm partial resection, histopathological examination revealed ETT. The patient underwent hysterectomy to prevent recurrence.
PubMed: 35117550
DOI: 10.21037/tcr.2019.12.24 -
Archives of Gynecology and Obstetrics Jul 2021Through this study, we aimed to evaluate the effects of different types of placenta previa (PP) on maternal and neonatal outcomes.
PURPOSE
Through this study, we aimed to evaluate the effects of different types of placenta previa (PP) on maternal and neonatal outcomes.
METHODS
This study was conducted in The Third Affiliated Hospital of Guangzhou Medical University and Tongji Hospital between January 2009 and 2019. PP was traditionally classified into four types, namely low-lying placenta, marginal, partial, and complete PP. Previous studies have classified PP into two types, namely low-lying placenta and PP. Based on our clinical experience, we proposed the classification of PP into three types, for the first time, which included low-lying placenta, "marpartial" (marginal and partial) PP, and complete PP. Multivariate logistic regression analysis was performed to determine the effects of different types of PP on maternal and neonatal outcomes.
RESULTS
In total, 4490 singleton pregnancies were complicated with PP. In the four-classification method, compared with women with low-lying placenta, women with complete PP had a risk of placenta accrete spectrum disorders, postpartum hemorrhage (PPH), hemorrhagic shock, severe PPH, blood transfusion, hysterectomy, puerperal infection, preterm labor, NICU admission, and low birth weight. There was no difference in maternal and neonatal outcomes between marginal and partial PP, except for increased chances of preterm labor and low birth weight in partial PP. In the two-classification method, PP was the risk factor for most of the adverse maternal and neonatal outcomes, compared with low-lying placenta.
CONCLUSION
Complete PP and low-lying placenta were associated with the highest and lowest risks of adverse pregnancy outcomes, respectively, whereas clinically similar outcomes were observed between marginal and partial PP. The three-classification of PP may be practical from the clinical perspective.
Topics: Adult; Female; Humans; Infant, Newborn; Placenta Accreta; Placenta Previa; Postpartum Hemorrhage; Pregnancy; Pregnancy Outcome; Retrospective Studies; Risk Factors; Stillbirth
PubMed: 33386958
DOI: 10.1007/s00404-020-05912-9 -
World Journal of Clinical Cases Sep 2022Rhabdomyosarcoma is a soft tissue tumor of primitive mesenchymal cells origin, occurring predominantly in children and adolescents, but extremely rare in adults and the...
BACKGROUND
Rhabdomyosarcoma is a soft tissue tumor of primitive mesenchymal cells origin, occurring predominantly in children and adolescents, but extremely rare in adults and the data regarding its treatment are sparse. Here, we would like to share our experience in the treatment of a locally advanced primary embryonal rhabdomyosarcoma of cervix in a 39-year-old female.
CASE SUMMARY
The patient was admitted with symptoms of intermenstrual bleeding and postcoital bleeding for six months. Physical examination revealed a friable, polyp-like mass (5 cm × 5 cm) in her cervix protruding into the vagina, while the uterus was mobile and normal-sized. Colposcopy-directed biopsy was performed, and a pathological diagnosis of embryonal rhabdomyosarcoma was made. Magnetic resonance imaging of the pelvis showed that the cervical volume was significantly increased, with a hypointense and hyperintense soft tissue mass on the right side, invading the cervical stroma; the mass was 5 cm × 5 cm with a clear boundary and confined to the cervix; there were no obvious findings indicating tumor invasion in the vaginal wall, parametrium, or pelvic wall; no enlarged lymph nodes were observed in the pelvic cavity. Based on our findings, the tumor was classified as stage IA according to the intergroup rhabdomyosarcoma studies criteria and IB3 stage according to The International Federation of Gynecology and Obstetrics 2018. The patient underwent two courses of neoadjuvant chemotherapy and a partial remission was achieved. Subsequently, she underwent laparoscopic radical hysterectomy, bilateral salpingo-oophrectomy and pelvic lymph node dissection and there were no risk factors revealed by postoperative pathological examination. Adjuvant chemotherapy was performed after surgery. The patient was disease-free until the last follow-up, 49 mo after completing the entire treatment.
CONCLUSION
Our experience suggests that neoadjuvant vincristine, dactinomycin, and cyclophosphamide chemotherapy followed by radical surgery and adjuvant chemotherapy might be reasonable therapeutic option for bulky cervical rhabdomyosarcoma in adults without fertility desire. Since large-scale studies on such rare conditions are rather impossible, further case reports and systematic reviews could help optimize the treatment of primary, bulky cervical rhabdomyosarcoma in adults.
PubMed: 36159439
DOI: 10.12998/wjcc.v10.i26.9454 -
Journal of the College of Physicians... Feb 2023To evaluate the safety and effectiveness of Le Fort Partial Colpocleisis (LFPC) in the surgical treatment of pelvic organ prolapse (POP) and to determine the incidence...
OBJECTIVE
To evaluate the safety and effectiveness of Le Fort Partial Colpocleisis (LFPC) in the surgical treatment of pelvic organ prolapse (POP) and to determine the incidence of pop recurrence in postoperative follow-up.
STUDY DESIGN
Cross-sectional study.
PLACE AND DURATION OF STUDY
Ordu University Medical Faculty Training and Research Hospital, Ordu, Turkey, from June 2013 to November 2020.
METHODOLOGY
Sixty-four women (82.8% had uterine prolapsed) who had been operated as LFPC operations were included in the study. Patient's characteristics, medical comorbidities, postoperative outcomes, and operation complications were analysed. POP recurrence was evaluated during the postoperative follow-up period reaching 80 months.
RESULTS
Eight patients (12.5%) had anti-incontinence surgery. Concomitant vaginal hysterectomy was performed in six patients (9.4%) and concomitant anti-incontinence surgery was performed in eight patients (12.5%). There were no serious intraoperative complications such as hematoma formation, and bladder / bowel injury. Postoperative complications were seen in a quarter of the patients (16/64) and most of them resolved spontaneously. Three of sixty-four patients (4.7%) were complicated with de novo urinary incontinence and all cases were healed without the need for treatment. In the current study, none of the patients reported POP recurrence on average over three years of follow-up.
CONCLUSION
There was a low frequency of intraoperative and postoperative complications in LFPC surgery. In addition, no POP recurrence was observed in any patient during long-term follow-up. Therefore, the LFPC procedure was described as a good surgical option in the selected elderly population with POP.
KEY WORDS
Colpocleisis, Le fort partial colpocleisis, Pelvic organ prolapse.
Topics: Humans; Female; Aged; Vagina; Cross-Sectional Studies; Pelvic Organ Prolapse; Urinary Bladder; Postoperative Complications; Treatment Outcome; Retrospective Studies; Gynecologic Surgical Procedures
PubMed: 36797633
DOI: 10.29271/jcpsp.2023.02.212 -
Journal of Minimally Invasive Gynecology Nov 2022To demonstrate laparoscopic management of a molar scar ectopic pregnancy.
STUDY OBJECTIVE
To demonstrate laparoscopic management of a molar scar ectopic pregnancy.
DESIGN
Stepwise demonstration of the technique with narrated video footage.
SETTING
Cesarean scar ectopic pregnancy and molar pregnancy are 2 separate extremely rare pathologies with an incidence range from 1/1800 to 1/2500 of all pregnancies for the former [1,2]. The concurrence of both cesarean scar ectopic and molar pregnancy is furthermore exceptionally rare, and there are only 8 reported cases of cesarean scar molar pregnancy in literature till date [3]. There is a high risk of uterine rupture, uncontrolled hemorrhage, hysterectomy, and significant maternal morbidity owing to thin myometrium and fibrous scar after cesarean section [4,5]. Knowledge and awareness about this clinical condition aid in early diagnosis and reduced morbidity. Here, we present a rare case of cesarean scar ectopic pregnancy that was operated for failed medical management and diagnosed to be molar scar ectopic pregnancy intraoperatively.
INTERVENTIONS
Total laparoscopic approach to molar scar ectopic pregnancy excision involved the following steps, strategies to minimize blood loss, and complete enucleation of tissue: (1) Hysteroscopy to localize the scar ectopic and its type and size (2) Bladder dissection to expose scar (3) Intramyometrial injection of vasopressin (4) Use of harmonic scalpel to delineate the gestational sac (5) Complete evacuation of products of conception (6) Excision of scar tissue (7) Uterine repair in 2 layers CONCLUSION: There are only 8 reported cases of cesarean scar molar pregnancy in literature till date, and all patients had at least 2 previous uterine curettages with abnormally increased β-hCG levels. The clinical manifestations were varied, the most common symptom being vaginal bleeding for a period >1 month, including our case [3]. Considering the limitations of ultrasound, magnetic resonance imaging, and serum hCG levels in the differential diagnosis of molar cesarean scar pregnancy from normal cesarean scar pregnancy, postoperative specimen should be sent for histologic examination [6]. As seen in our case, the possibility of molar pregnancy at cesarean scar ectopic site should be kept in mind in cases with rising β-hCG levels despite continuous medical interventions, which was being medically managed for 3 months. Our case is the first to be successfully managed with laparoscopic surgery as the previously reported cases were managed with suction evacuation, chemotherapy, laparotomy, or hysterectomy [3].
Topics: Humans; Pregnancy; Female; Cicatrix; Cesarean Section; Pregnancy, Ectopic; Laparoscopy; Chorionic Gonadotropin, beta Subunit, Human; Hydatidiform Mole; Uterine Neoplasms
PubMed: 36007836
DOI: 10.1016/j.jmig.2022.08.008 -
Journal of Robotic Surgery Jun 2023As robotic-assisted surgery (RAS) expands to smaller centres, platforms are shared between specialities. Healthcare providers must consider case volume and mix required...
As robotic-assisted surgery (RAS) expands to smaller centres, platforms are shared between specialities. Healthcare providers must consider case volume and mix required to maintain quality and cost-effectiveness. This can be informed, in-part, by the volume-outcome relationship. We perform a systematic review to describe the volume-outcome relationship in intra-abdominal robotic-assisted surgery to report on suggested minimum volumes standards. A literature search of Medline, NICE Evidence Search, Health Technology Assessment Database and Cochrane Library using the terms: "robot*", "surgery", "volume" and "outcome" was performed. The included procedures were gynecological: hysterectomy, urological: partial and radical nephrectomy, cystectomy, prostatectomy, and general surgical: colectomy, esophagectomy. Hospital and surgeon volume measures and all reported outcomes were analysed. 41 studies, including 983,149 procedures, met the inclusion criteria. Study quality was assessed using the Newcastle-Ottawa Quality Assessment Scale and the retrieved data was synthesised in a narrative review. Significant volume-outcome relationships were described in relation to key outcome measures, including operative time, complications, positive margins, lymph node yield and cost. Annual surgeon and hospital volume thresholds were described. We concluded that in centres with an annual volume of fewer than 10 cases of a given procedure, having multiple surgeons performing these procedures led to worse outcomes and, therefore, opportunities should be sought to perform other complimentary robotic procedures or undertake joint cases.
Topics: Male; Humans; Robotic Surgical Procedures; Robotics; Prostatectomy; Outcome Assessment, Health Care; Hospitals
PubMed: 36315379
DOI: 10.1007/s11701-022-01461-2 -
International Journal of Gynecological... Mar 2021To describe oncologic and obstetric outcomes in patients diagnosed with cervical cancer during pregnancy who had a successful delivery after neoadjuvant chemotherapy.
OBJECTIVE
To describe oncologic and obstetric outcomes in patients diagnosed with cervical cancer during pregnancy who had a successful delivery after neoadjuvant chemotherapy.
METHODS
A multicenter retrospective review was conducted in 12 institutions from six Latin American countries, between January 2007 and December 2018. Data collected included clinical characteristics, neoadjuvant chemotherapy agents, treatment, obstetric and oncologic outcomes.
RESULTS
Thirty-three patients were included. Median age was 34 years (range 31-36). Twenty (60.6%) women were diagnosed at early stage (IB), and 13 (39.4%) with locally advanced stage (IIA-IIIB) according to FIGO 2009 classification. Carboplatin and paclitaxel was the most frequent combination used (60.6%). Partial and complete response rates were 27.3% and 9.1%, respectively. Median gestational age at delivery was 35 weeks (range 34-36). All patients had live births delivered by cesarean section. Obstetric pathology: pre-term labor, placenta percreta or intra-uterine growth restriction, was documented in seven patients (21.2%). Two (6.1%) neonates had low birth weight. Definitive treatment was primary chemo-radiation in 19 (57.6%) patients, radical hysterectomy in 11 (33.3%), abandoned radical hysterectomy with para-aortic lymphadenectomy and ovarian transposition in 1 patient (3.0%), and no further treatment in 2 (6.1%) patients. After a median follow-up of 16.3 months (range 2.0-36.9), 8 (26.7%) patients had recurrent disease. Of these, four (13.3%) died due to disease.
CONCLUSION
Neoadjuvant chemotherapy may be offered to patients wishing to preserve an ongoing pregnancy in order to achieve fetal maturity. Long-term consequences of chemotherapy in the child are yet to be determined.
Topics: Adult; Antineoplastic Agents; Carboplatin; Cesarean Section; Female; Humans; Latin America; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Paclitaxel; Pregnancy; Pregnancy Complications, Neoplastic; Retrospective Studies; Uterine Cervical Neoplasms
PubMed: 33649015
DOI: 10.1136/ijgc-2020-001764