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Obstetrics and Gynecology Clinics of... Dec 2001Gestational trophoblastic disease consists of a broad spectrum of conditions ranging from an uncomplicated partial hydatidiform molar pregnancy to stage IV... (Review)
Review
Gestational trophoblastic disease consists of a broad spectrum of conditions ranging from an uncomplicated partial hydatidiform molar pregnancy to stage IV choriocarcinoma with cerebral metastases. Fortunately, with the advent of combination chemotherapy, the patient with advanced-stage disease has a significant chance of achieving complete remission. In addition, several studies have demonstrated that patients with a history of gestational trophoblastic neoplasia do not experience an increased risk of complications with future pregnancies. Patients who have undergone chemotherapy do not seem to experience an increase in the risk for congenital anomalies in their offspring. Patients with a history of hydatidiform molar pregnancy should be advised that they are at increased risk of future molar pregnancies, with a risk of 1% in subsequent gestations after one molar pregnancy and a risk as high as 23% after two molar gestations. Although patients should be reassured regarding their reproductive future, they should be advised to seek prompt medical attention once gestation is suspected so that an early work-up can be initiated if pregnancy is confirmed.
Topics: Antineoplastic Combined Chemotherapy Protocols; Choriocarcinoma; Cyclophosphamide; Female; Humans; Hydatidiform Mole; Hysterectomy; Methotrexate; Neoplasm Staging; Pregnancy; Uterine Neoplasms
PubMed: 11766153
DOI: 10.1016/s0889-8545(05)70237-0 -
Journal of Ayub Medical College,... 2017Metastatic ovarian tumours are extremely rare. The commonest primary site is usually stomach and the metastasis from this site is termed as krukenberg tumour. It...
Metastatic ovarian tumours are extremely rare. The commonest primary site is usually stomach and the metastasis from this site is termed as krukenberg tumour. It accounts for 1-2% of malignant ovarian tumours. We present a case of 14 weeks' pregnancy with metastatic bilateral malignant ovarian tumour is presented. Diagnosis was made on ultrasound. Tumour markers were insignificant. Patient underwent staging laparotomy with total abdominal hysterectomy and bilateral salpingo oophorectomy and partial omentectomy. She also had haematemesis. Endoscopy revealed suspicious growth in stomach, but biopsy report excluded it. Case was handed over to the oncologist for further management.
Topics: Adult; Biomarkers, Tumor; Biopsy; Female; Humans; Hysterectomy; Krukenberg Tumor; Ovarian Neoplasms; Pregnancy; Pregnancy Complications, Neoplastic; Ultrasonography
PubMed: 28712200
DOI: No ID Found -
The Journal of Maternal-fetal &... Dec 2023Resuscitative endovascular balloon occlusion of the aorta for placenta accreta spectrum is used to control maternal hemorrhage during cesarean hysterectomy. This study...
OBJECTIVE
Resuscitative endovascular balloon occlusion of the aorta for placenta accreta spectrum is used to control maternal hemorrhage during cesarean hysterectomy. This study aimed to assess the efficacy of resuscitative endovascular balloon occlusion of the aorta for placenta accreta spectrum by examines the change in the quantitative blood loss after applying resuscitative endovascular balloon occlusion of the aorta.
METHODS
This retrospective cohort study included patients with placenta accreta spectrum who required cesarean hysterectomy ( = 37) between 2003 and 2022 at a tertiary care center. Patients were divided into two groups (with resuscitative endovascular balloon occlusion of the aorta, = 13; without resuscitative endovascular balloon occlusion of the aorta, = 24). The quantitative blood loss was compared between the groups. Generalized linear mixed models were used to examine changes in quantitative blood loss during cesarean hysterectomy after resuscitative endovascular balloon occlusion of the aorta was applied. The operating surgeon was set as the random effect.
RESULTS
Operation time did not differ significantly between the groups ( = .09). The quantitative blood loss was significantly higher in patients who did not undergo resuscitative endovascular balloon occlusion of the aorta (2160 g) than in patients who did (1110 g; < .01). Resuscitative endovascular balloon occlusion of the aorta significantly decreased the quantitative blood loss during cesarean hysterectomy (partial regression coefficient, 2312; 95% confidence interval, 49-4577; < .05).
CONCLUSION
Resuscitative endovascular balloon occlusion of the aorta decreased the quantitative blood loss during cesarean hysterectomy in patients with placenta accreta spectrum without significantly increasing the operation time. This suggests that resuscitative endovascular balloon occlusion of the aorta is effective in patients with placenta accreta spectrum.
Topics: Pregnancy; Female; Humans; Retrospective Studies; Placenta Accreta; Blood Loss, Surgical; Hysterectomy; Aorta; Balloon Occlusion
PubMed: 37408127
DOI: 10.1080/14767058.2023.2232073 -
Female Pelvic Medicine & Reconstructive... 2019This study aimed to compare the ability of abdominal sacrocolpopexy (ASC) with concomitant total vs supracervical hysterectomy to resist downward traction as a measure...
OBJECTIVE
This study aimed to compare the ability of abdominal sacrocolpopexy (ASC) with concomitant total vs supracervical hysterectomy to resist downward traction as a measure of functional anatomic support in human cadavers.
METHODS
Supracervical hysterectomy was performed on unembalmed cadaver specimens, followed by ASC attaching polypropylene mesh to the posterior cervix/vagina only and then the anterior and posterior cervix/vagina. Using a metal bolt placed through the cervix tied to a filament passing through a fixed pulley system, successive weights of 0.5 to 3.0 kg were added to provide increasing loads on the apex (cervix), and the distances traversed by the apex were recorded. The same process was then repeated in each specimen after removal of the cervix (with vaginal cuff closure). One-way and repeated-measures analysis of measure was used for between-group and within-group comparisons, respectively, with P ≤ 0.05 considered statistically significant.
RESULTS
Eight cadavers were examined. At lower weight loads, pulling distances in the 4 groups examined were similar and were not significantly different with the presence or absence of the cervix. At weight loads of 2.5 kg or greater, we noted a trend of increased pulling distances when posterior mesh only was used vs when anterior/posterior mesh was placed, although this difference was not significant. Interestingly, there was tearing of the vaginal wall or partial separation of mesh/sutures attachments to the vagina noted in 3 specimens.
CONCLUSIONS
This study showed no differences in the ability of the cervix (after supracervical hysterectomy) compared with the vaginal cuff (after total hysterectomy) to resist downward traction of successive weights after ASC. Clinical trials are necessary to correlate these findings with prolapse recurrence rates and patient satisfaction following these procedures.
Topics: Cadaver; Cervix Uteri; Female; Humans; Hysterectomy; Pelvic Organ Prolapse; Prostheses and Implants; Surgical Mesh; Vagina; Weight-Bearing
PubMed: 29219861
DOI: 10.1097/SPV.0000000000000532 -
Gynecologic Oncology May 2002To evaluate the urinary tract dysfunction following a radical hysterectomy and to compare the baseline urodynamical parameters of women who had uterine cervical...
OBJECTIVES
To evaluate the urinary tract dysfunction following a radical hysterectomy and to compare the baseline urodynamical parameters of women who had uterine cervical carcinoma with women who had CIN 3.
METHODS
A prospective case-control study was conducted to evaluate preoperative and postoperative urinary tract function of thirty-two cervical carcinoma patients using twenty-seven CIN 3 patients' preoperative urodynamical parameters as a baseline control.
RESULTS
The rate of detrusor instability in women with preoperative cervical carcinoma was higher than that of women with CIN 3 (37.5 % vs. 14.8 %, P < 0.05). In the cervical carcinoma patients, there were 53.1 % who had normal urinary tract function, but after a radical hysterectomy they began voiding by abdominal straining. The impairment of bladder sensation, alteration of bladder capacity and bladder compliance, compromise of detrusor function, reduction of maximal urethral pressure and maximal urethral closure pressure, and the decrease of the pressure transmission ratio were significantly noted after a radical hysterectomy. The rate of genuine stress incontinence did not increase significantly (9.4 % vs. 18.8%, P > 0.05), but the rate of detrusor instability decreased significantly (37.5% vs. 15.6%, P < 0.05) after a radical hysterectomy.
CONCLUSIONS
Changes of urinary tract function after a radical hysterectomy might be related to the partial sympathetic and parasympathetic denervation during a radical dissection. More than half of the women who preoperatively had normal urinary tract function needed to void by abdominal straining after radical surgery.
Topics: Adult; Aged; Carcinoma, Squamous Cell; Case-Control Studies; Female; Humans; Hysterectomy; Middle Aged; Prospective Studies; Urinary Tract; Urodynamics; Urologic Diseases; Uterine Cervical Neoplasms
PubMed: 11972390
DOI: 10.1006/gyno.2002.6614 -
Journal of Medicine and Life 2014Cervical cancer represents the second most frequent malignancy in women worldwide, a significant number of cases still being diagnosed in an advanced stage of the...
Segmentary ureteral resection followed by ureteroneocystostomy associated with radical hysterectomy and partial cystectomy in a patient with bulky residual disease after chemoirradiation for invasive cervical cancer--a case report.
Cervical cancer represents the second most frequent malignancy in women worldwide, a significant number of cases still being diagnosed in an advanced stage of the disease. In some of these cases, local invasion is already present at the moment of diagnosis and even if neo-adjuvant chemoirradiation is performed in some patients, it persists at the moment of surgery. In these cases, more aggressive surgical procedures are needed in order to obtain a good control of the disease. The case of a 50-year-old patient diagnosed with locally advanced cervical cancer invading the right ureter is presented, in whom this aspect was present even after neo-adjuvant chemoirradiation and in whom a total radical hysterectomy with bilateral en bloc adnexectomy with partial cystectomy and the invaded zone of the right ureter was performed. The ureter was then mobilized and reimplanted in the urinary bladder through a neocystostomy. The postoperative course was uneventful.
Topics: Chemoradiotherapy; Cystectomy; Cystostomy; Female; Humans; Hysterectomy; Middle Aged; Neoplasm Invasiveness; Neoplasm, Residual; Ureter; Urinary Bladder; Uterine Cervical Neoplasms
PubMed: 25713622
DOI: No ID Found -
American Journal of Obstetrics and... Mar 2021Gestational trophoblastic disease is a spectrum that includes complete and partial hydatidiform moles, invasive mole, choriocarcinoma, and placental site trophoblastic...
Total laparoscopic hysterectomy in combination with dilation and evacuation of an 18-week-sized uterus with gestational trophoblastic neoplasia: a novel treatment approach.
Gestational trophoblastic disease is a spectrum that includes complete and partial hydatidiform moles, invasive mole, choriocarcinoma, and placental site trophoblastic tumor. Although most cases of gestational trophoblastic neoplasia occur after a molar pregnancy, it can develop after any pregnancy. Suction curettage remains the standard first-line management in a molar pregnancy in patients desiring fertility. However, hysterectomy is a reasonable option in patients that do not desire to preserve fertility. Hysterectomy for gestational trophoblastic neoplasia can be difficult because of the enlarged uterus and prominent uterine vasculature. Traditionally, hysterectomy for gestational trophoblastic neoplasia is usually performed via laparotomy. In this article and accompanying video, we describe and illustrate a minimally invasive technique that demonstrates a safe and feasible laparoscopic removal of an enlarged uterus and illustrates alternative extraction techniques to avoid laparotomy in hysterectomy for gestational trophoblastic disease. In this case, a combination of laparoscopic transection of the vascular pedicles followed by dilation and evacuation was used before colpotomy. The addition of dilation and evacuation allowed us to reduce the overall size of the uterus and remove it intact through the vagina with minimal bleeding, avoiding unnecessary laparotomy. This allowed the patient to have an improved postsurgical recovery experience with minimal blood loss compared with standard laparotomy for gestational trophoblastic neoplasia.
Topics: Adult; Combined Modality Therapy; Female; Gestational Trophoblastic Disease; Humans; Hysterectomy; Laparoscopy; Pregnancy; Pregnancy Trimester, Second; Vacuum Curettage
PubMed: 33197418
DOI: 10.1016/j.ajog.2020.10.046 -
Human Reproduction Update 2015Uterine leiomyomas (fibroids) are highly prevalent benign smooth muscle tumors of the uterus. In the USA, the lifetime risk for women developing uterine leiomyomas is... (Review)
Review
BACKGROUND
Uterine leiomyomas (fibroids) are highly prevalent benign smooth muscle tumors of the uterus. In the USA, the lifetime risk for women developing uterine leiomyomas is estimated as up to 75%. Except for hysterectomy, most therapies or treatments often provide only partial or temporary relief and are not successful in every patient. There is a clear racial disparity in the disease; African-American women are estimated to be three times more likely to develop uterine leiomyomas and generally develop more severe symptoms. There is also familial clustering between first-degree relatives and twins, and multiple inherited syndromes in which fibroid development occurs. Leiomyomas have been described as clonal and hormonally regulated, but despite the healthcare burden imposed by the disease, the etiology of uterine leiomyomas remains largely unknown. The mechanisms involved in their growth are also essentially unknown, which has contributed to the slow progress in development of effective treatment options.
METHODS
A comprehensive PubMed search for and critical assessment of articles related to the epidemiological, biological and genetic clues for uterine leiomyoma development was performed. The individual functions of some of the best candidate genes are explained to provide more insight into their biological function and to interconnect and organize genes and pathways in one overarching figure that represents the current state of knowledge about uterine leiomyoma development and growth.
RESULTS
In this review, the widely recognized roles of estrogen and progesterone in uterine leiomyoma pathobiology on the basis of clinical and experimental data are presented. This is followed by fundamental aspects and concepts including the possible cellular origin of uterine fibroids. The central themes in the subsequent parts are cytogenetic aberrations in leiomyomas and the racial/ethnic disparities in uterine fibroid biology. Then, the attributes of various in vitro and in vivo, human syndrome, rodent xenograft, naturally mutant, and genetically modified models used to study possible molecular mechanisms of leiomyoma development and growth are described. Particular emphasis is placed on known links to fibrosis, hypertrophy, and hyperplasia and genes that are potentially important in these processes.
CONCLUSIONS
Menstrual cycle-related injury and repair and coinciding hormonal cycling appears to affect myometrial stem cells that, at a certain stage of fibroid development, often obtain cytogenetic aberrations and mutations of Mediator complex subunit 12 (MED12). Mammalian target of rapamycin (mTOR), a master regulator of proliferation, is activated in many of these tumors, possibly by mechanisms that are similar to some human fibrosis syndromes and/or by mutation of upstream tumor suppressor genes. Animal models of the disease support some of these dysregulated pathways in fibroid etiology or pathogenesis, but none are definitive. All of this suggests that there are likely several key mechanisms involved in the disease that, in addition to increasing the complexity of uterine fibroid pathobiology, offer possible approaches for patient-specific therapies. A final model that incorporates many of these reported mechanisms is presented with a discussion of their implications for leiomyoma clinical practice.
Topics: Animals; Disease Models, Animal; Estrogens; Female; Gene-Environment Interaction; Guinea Pigs; Humans; Hysterectomy; Leiomyoma; Mediator Complex; Menstrual Cycle; Mice; Mutation; Myometrium; Progesterone; Rats; Receptors, G-Protein-Coupled; TOR Serine-Threonine Kinases; Treatment Outcome; Tuberous Sclerosis Complex 2 Protein; Tumor Suppressor Proteins; Uterine Neoplasms; beta Catenin
PubMed: 26141720
DOI: 10.1093/humupd/dmv030 -
Archives of Gynecology and Obstetrics Jan 2021Abnormally invasive placenta (AIP) is often associated with high maternal morbidity. In surgical treatment, caesarean hysterectomy or partial uterine resection may lead...
INTRODUCTION
Abnormally invasive placenta (AIP) is often associated with high maternal morbidity. In surgical treatment, caesarean hysterectomy or partial uterine resection may lead to high perioperative maternal blood loss. A conservative treatment by leaving the placenta in utero after caesarean delivery of the baby is an option to preserve fertility and to reduce peripartum hysterectomy-related morbidity. Nevertheless, due to increased placental coagulation activity as well as consumption of clotting factors, a disseminated intravascular coagulation (DIC)-like state with secondary late postpartum bleeding can occur.
PURPOSE
Systematic review after the presentation of a case of conservative management of placenta percreta with secondary partial uterine wall resection due to vaginal bleeding, complicated by local hyperfibrinolysis and consecutive systemic decrease in fibrinogen levels.
METHODS
Systematic PubMed database search was done until August 2019 without any restriction of publication date or journal RESULTS: Among 58 publications, a total of 11 reported on DIC-like symptoms in the conservative management of AIP, in the median on day 59 postpartum. In most cases, emergency hysterectomy was performed, which led to an almost immediate normalization of coagulation status but was accompanied with high maternal blood loss. In two cases, fertility-preserving conservative management could be continued after successful medical therapy.
CONCLUSION
Based on these results, we suggest routinely monitoring of the coagulation parameters next to signs of infection in the postpartum check-ups during conservative management of AIP. Postpartum tranexamic acid oral dosage should be discussed when fibrinogen levels are decreasing and D-Dimers are increasing.
Topics: Adult; Cesarean Section; Conservative Treatment; Disseminated Intravascular Coagulation; Female; Fibrinogen; Humans; Hysterectomy; Placenta; Placenta Accreta; Placenta Diseases; Postpartum Hemorrhage; Pregnancy; Pregnancy Outcome
PubMed: 32809062
DOI: 10.1007/s00404-020-05721-0 -
Archivos Espanoles de Urologia 1990Although uncommon, vesical endometriosis is considered an important disease entity due to the diagnostic difficulties it presents and the different therapeutic options...
Although uncommon, vesical endometriosis is considered an important disease entity due to the diagnostic difficulties it presents and the different therapeutic options that are available. A case of long-standing vesical endometriosis that caused considerable suffering to the patient is reported. The foregoing condition was refractory to hormone therapy and late radical surgical treatment by partial cystectomy and hysterectomy failed to achieve good results. The clinical and therapeutic aspects of the present case are compared with those reported elsewhere. We underscore the importance of biopsy by transurethral resection in its diagnosis as well as the need for a more effective therapeutic approach.
Topics: Adult; Biopsy; Cystectomy; Danazol; Endometriosis; Female; Humans; Hysterectomy; Urinary Bladder Neoplasms
PubMed: 2331160
DOI: No ID Found