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Singapore Medical Journal Oct 1989The term gestational trophoblastic disease encompasses a wide spectrum of disorders ranging from the benign hydatidiform mole to the malignant choriocarcinoma and... (Review)
Review
The term gestational trophoblastic disease encompasses a wide spectrum of disorders ranging from the benign hydatidiform mole to the malignant choriocarcinoma and placental site trophoblastic tumor. Recent advances in cytogenetics and pathological criteria have brought to light the occurrence of the partial mole, which is probably more common than the complete mole. The World Health Organisation has proposed a classification to rectify the current confusion that exists with clinical and pathological terms. Evacuation of the uterus followed by meticulous followup with sensitive beta subunit Human Chorionic Gonadotropin assay remain the cornerstone of management of molar pregnancy. Prompt chemotherapy is the most important aspect in managing malignant sequelae. Newer chemotherapy regimes have helped to salvage failures from the usual drugs. Judicial use of surgery in metastatic trophoblastic disease can reduce the duration and toxicity of chemotherapy. All patients with gestational trophoblastic disease should be managed in a tertiary care centre with the expertise and facilities easily available to manage these cases.
Topics: Carbimazole; Choriocarcinoma; Female; Humans; Hydatidiform Mole; Hysterectomy; Pregnancy; Propylthiouracil; Uterine Neoplasms
PubMed: 2694375
DOI: No ID Found -
The Journal of Urology Sep 1975Urologists have been reticent to approach vesicovaginal fistulas via the vaginal route. The Latzko partial colpocleisis seems to be an easier, faster and less traumatic...
Urologists have been reticent to approach vesicovaginal fistulas via the vaginal route. The Latzko partial colpocleisis seems to be an easier, faster and less traumatic procedure than advocated in the literature. The success rate is high and the procedure is highly recommended.
Topics: Female; Humans; Hysterectomy; Methods; Urinary Catheterization; Vagina; Vesicovaginal Fistula
PubMed: 1142520
DOI: 10.1016/s0022-5347(17)67036-8 -
Journal of Minimally Invasive Gynecology 2007Endometrial hyperplasia is found in 2% to 10% of women with abnormal uterine bleeding (AUB). Up to 43% of patients with cytologic atypia harbor coexisting...
STUDY OBJECTIVE
Endometrial hyperplasia is found in 2% to 10% of women with abnormal uterine bleeding (AUB). Up to 43% of patients with cytologic atypia harbor coexisting adenocarcinoma, and approximately 20% to 52% of atypical hyperplasias, if untreated, progress to cancer. The objective of this study was to estimate the incidence of atypical endometrial hyperplasia encountered during routine resectoscopic surgery in women with AUB and to evaluate the role of resectoscopic surgery in the management of women with AUB and atypical endometrial hyperplasia who refused and/or were at high risk for hysterectomy.
DESIGN
Prospective cohort study (Canadian Task Force classification II-3).
SETTING
University-affiliated teaching hospital.
PATIENTS
From January 1990 through December 2005, the senior author (GAV) performed primary resectoscopic surgery in 3401 women with AUB. Among these, there were 22 women with atypical (17 complex, 5 simple) endometrial hyperplasia.
INTERVENTIONS
All women underwent hysteroscopic evaluation and partial (n = 3) or complete (n = 19) endometrial electrocoagulation and/or resection. Subsequently, 6 women had hysterectomy and bilateral salpingo-oophorectomy (BSO).
MEASUREMENTS AND MAIN RESULTS
The median (range) for age, parity, and body mass index were 55 years (24-78 years), 2 (0-4), and 30.1 kg/m2 (22.5-52.2 kg/m2), respectively. Among the 3401 women, there were 22 cases of atypical endometrial hyperplasia, 12 of which were incidentally diagnosed at the time of hysteroscopy (complex 10, simple 2, incidence 0.35%). After hysteroscopic diagnosis or confirmation of diagnosis, 6 women underwent hysterectomy and BSO. Of the remaining 16 women, followed for a median of 5 years (range 1.5-12 years), 1 was lost to follow-up, 1 had only a biopsy to preserve fertility, 1 died from lung cancer after 4 years, and 1 died from colon cancer after 5 years. One patient developed endometrial cancer after 10.5 years with postmenopausal bleeding. She remains alive and well 3.5 years after hysterectomy and BSO. The remaining 11 patients are amenorrheic at a median follow-up of 6 years (range 1.5-12 years).
CONCLUSIONS
Resectoscopic surgery in 3391 women with AUB detected 12 incidental cases of atypical endometrial hyperplasia (incidence 0.35%). Skillful resectoscopic surgery may be an alternative to hysterectomy in women with AUB and atypical endometrial hyperplasia, who refuse or are at high-risk for hysterectomy and who are compliant with regular and long-term follow-up.
Topics: Adult; Aged; Biopsy; Cohort Studies; Electrocoagulation; Endometrial Hyperplasia; Female; Humans; Hysterectomy; Hysteroscopy; Metrorrhagia; Middle Aged; Prospective Studies; Treatment Outcome
PubMed: 17218233
DOI: 10.1016/j.jmig.2006.08.007 -
BMC Surgery May 2022Transvaginal intestinal evisceration is an extremely rare surgical emergency with potentially fatal consequences. Only a few more than 100 cases with this pathology have...
BACKGROUND
Transvaginal intestinal evisceration is an extremely rare surgical emergency with potentially fatal consequences. Only a few more than 100 cases with this pathology have been described in the literature. Aetiology is also unclear and multifactoral.
CASE PRESENTATION
We report the case of an 80-year-old female who presented with sudden severe abdominal pain and spontaneous small bowel evisceration through the vagina along with associated high-grade uterine prolapse. The loops and their mesentery appeared edematous, thickened and dusky, but without apparent necrosis. An urgent laparotomy was performed with subsequent reduction of the prolapsed small bowel into the abdomen, hysterectomy, partial resection of the vagina and vaginal closure. Additional cholecystectomy was necessary because of the visible pathologic changes of the gallbladder. The postoperative period was uneventful. The unique feature of our case is that there was no trigger factor (trauma, constipation or a coughing episode that would increase the intra-abdominal pressure), provoking the vaginal rupture and intestinal evisceration through it in the context of pelvic floor weakness.
CONCLUSIONS
Early detection and surgical management are crucial for preventing bowel ischemia and abdominal sepsis. If the eviscerated intestine is ischaemic and non-viable, this requires resection and anastomosis. The approach should be individualized and performed by a multidisciplinary team.
Topics: Abdominal Pain; Aged, 80 and over; Female; Humans; Hysterectomy; Intestine, Small; Laparotomy; Uterine Prolapse; Vagina
PubMed: 35509095
DOI: 10.1186/s12893-022-01615-x -
Gynecologic Oncology Aug 1991Bladder dysfunction thought to be due to partial denervation has been described following radical hysterectomy. Some patients experience acute and chronic rectal...
Bladder dysfunction thought to be due to partial denervation has been described following radical hysterectomy. Some patients experience acute and chronic rectal dysfunction characterized by difficulty with defecation and loss of defecatory urge. To define this abnormality, anorectal pressure profiles were examined in 15 patients with Stage I carcinoma of the cervix before and after radical hysterectomy. Profiles were done using standard anorectal manometry with a water-infused system. In all patients preoperative manometric profiles were normal; postoperative studies were abnormal in all patients. Features seen include altered relaxation of the internal sphincter, increased distension needed to trigger relaxation, and decreased rectal sensation; external sphincters and resting internal sphincters were unchanged. Postoperatively, 12 patients reported problems with rectal function. A physiologic defect is definable in patients undergoing radical hysterectomy; this suggests disruption of the spinal reflex arcs controlling rectal emptying. These physiologic abnormalities correlate with the clinical symptomatology experienced by some patients. Continuing definition and evaluation of management options in this situation should be useful in developing effective therapy for rectal dysfunction following radical hysterectomy.
Topics: Defecation; Female; Humans; Hysterectomy; Manometry; Rectal Diseases; Rectum; Uterine Cervical Neoplasms
PubMed: 1894168
DOI: 10.1016/0090-8258(91)90329-4 -
European Journal of Gynaecological... 2008A case of cervical cancer associated with irreducible procidentia successfully treated with external beam radiation and extracorporeal HDR-AL with concomitant... (Review)
Review
Cervical cancer associated with genital prolapse--a brief review of the literature and long-term results of successful treatment with radiochemotherapy and surgery in a very frail patient.
BACKGROUND
A case of cervical cancer associated with irreducible procidentia successfully treated with external beam radiation and extracorporeal HDR-AL with concomitant chemotherapy followed by obliterative vaginal surgery is reported for the first time.
CASE
A 73-year-old woman presented in frail condition suffering from a huge, irreducible uterovaginal procidentia combined with a squamous cell carcinoma of the cervix in FIGO Stage IIa. Successful treatment consisted of sequential application of combined radiotherapy with concurrent cisplatin chemotherapy followed by total vaginal hysterectomy and partial colpectomy with colpocleisis according to the Labhardt method. The five-year follow-up documents the excellent long-term results with regard to cervical cancer and pelvic floor stability.
CONCLUSION
Especially in patients ineligible for extended surgery, radiochemotherapy followed by an obliterative surgical approach is feasible without aberrant wound healing and constitutes a suitable and efficient option for treating carcinomas of the cervix associated with irreducible genital prolapse.
Topics: Aged; Antineoplastic Agents; Carcinoma, Squamous Cell; Chemotherapy, Adjuvant; Cisplatin; Female; Frail Elderly; Humans; Hysterectomy, Vaginal; Neoadjuvant Therapy; Radiotherapy, Adjuvant; Uterine Cervical Neoplasms; Uterine Prolapse
PubMed: 18592794
DOI: No ID Found -
Obstetrics and Gynecology Clinics of... Dec 2001Major advances in treatment for epithelial ovarian cancer have occurred over the last decade, giving hope to patients and families. Surgery remains a cornerstone of... (Review)
Review
Major advances in treatment for epithelial ovarian cancer have occurred over the last decade, giving hope to patients and families. Surgery remains a cornerstone of therapy. In early-stage epithelial ovarian cancer, a meticulous staging procedure should be performed to aid in determining patients who require appropriate adjuvant therapy and patients who can be monitored. The patient with advanced epithelial ovarian cancer significantly benefits from aggressive cytoreductive surgery and chemotherapy, affording the patient higher rates of complete response and partial response. In the new millenium, new therapeutic modalities should enhance the current response rates.
Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Cyclophosphamide; Female; Humans; Hysterectomy; Infusions, Parenteral; Melphalan; Middle Aged; Neoplasm Staging; Ovarian Neoplasms; Reoperation; Second-Look Surgery
PubMed: 11766150
DOI: 10.1016/s0889-8545(05)70234-5 -
Zhonghua Fu Chan Ke Za Zhi Mar 2016To evaluate the effect and safety of a modified Prolift procedure, without preceding partial trachelectomy or hysterectomy for pelvic organ prolapse (POP) with...
OBJECTIVE
To evaluate the effect and safety of a modified Prolift procedure, without preceding partial trachelectomy or hysterectomy for pelvic organ prolapse (POP) with coexistent cervical elongation.
METHODS
Clinical data of 72 patients that underwent a modified Prolift procedure for POP with coexistent cervical elongation, between December 2008 and June 2012 in Fuzhou General Hospital of Nanjing Military Command was retrospectively analysed. A comparison was carried out between preoperative and postoperative parameters of pelvic organ prolapse quantitation system (POP-Q), and an objective evaluation was made according to the overall cure rate and recurrence rate. Pelvic floor distress inventory-short form 20 (PFDI-20) was used to investigate the subjective cure rate and improvement of symptoms.
RESULTS
Patients were followed up at median 52 months (36-78 months). One bladder perforation and one rectum perforation occurred during the procedure. Four patients (6%, 4/72) had uterine prolapse at 9-19 months after the opertaion and had transvaginal hysterectomy laterly. The overall anatomical correction rate was 94% (68/72). Six patients (8%, 6/72) had mesh exposures at 3-9 months after the opertaion. Scores of PFDI-20 decreased sifnificantly after the procedure (118.2±25.2 vs 12.1±8.0 vs 12.5±9.5 vs 13.0±9.9, P< 0.05). The patients' satisfaction rate was 92% (66/72).
CONCLUSION
This modified Prolift procedure, without preceding partial trachelectomy or hysterectomy, could effectively and safely correct POP with coexistent cervical elongation.
Topics: Female; Gynecologic Surgical Procedures; Humans; Hysterectomy; Patient Satisfaction; Pelvic Floor; Pelvic Organ Prolapse; Postoperative Complications; Postoperative Period; Plastic Surgery Procedures; Retrospective Studies; Severity of Illness Index; Surgical Mesh; Surveys and Questionnaires; Trachelectomy; Treatment Outcome
PubMed: 27030495
DOI: 10.3760/cma.j.issn.0529-567X.2016.03.003 -
The Veterinary Record
Topics: Animals; Dog Diseases; Dogs; Female; Hysterectomy; Obstetric Labor Complications; Pregnancy; Uterine Prolapse
PubMed: 7434511
DOI: 10.1136/vr.106.18-20.420 -
Journal of Gynecology Obstetrics and... Oct 2020Inserts Essure® were used as a definitive sterilization method from 2001 to 2017. They have been used for more than 750,000 procedures. Gynecological or extra...
Surgical removal of essure® micro inserts by vaginal hysterectomy or laparoscopic salpingectomy with cornuectomy: Case series and follow up survey about device-attributed symptoms resolution.
INTRODUCTION
Inserts Essure® were used as a definitive sterilization method from 2001 to 2017. They have been used for more than 750,000 procedures. Gynecological or extra gynaecological adverse events have been reported by patients. The objective of the study is to evaluate the resolution of symptoms attributed to Essure® micro-inserts after surgical removal.
METHODS
Monocentric retrospective study. Patients who had surgical removal of Essure® micro-inserts between January 2017 and April 2019 were included. The removal was performed by bilateral salpingectomy with cornuectomy by laparoscopy or vaginal hysterectomy. Symptoms were reported preoperatively, 4-8 weeks after withdrawal (early assessment) and 6-24 months after withdrawal (later assessment).
RESULTS
Ninety patients had a surgical removal of Essure® micro-inserts. Fifty-two vaginal hysterectomies and thirty-five laparoscopic salpingectomies were performed. The main symptoms reported are pelvic pain (70 %), fatigue (66.7 %) and heavy bleeding menstruations (53.3 %). One month after surgery, 46.7 % of patients have a major improvement of symptoms and 51.1 % a partial resolution. The major improvement rate is not significantly different between laparoscopic salpingectomy and vaginal hysterectomy (51.5 % versus 42.3 %) (p = 0.23). At 24 months, results improved with 83.3 % major improvement.
CONCLUSION
Surgical removal may be effective for treating most women with attributed device symptoms. Vaginal hysterectomy and laparoscopic salpingectomy with cornuectomy seem to have an equivalent rate for the resolution of extra-gynecological symptoms.
Topics: Adult; Female; Humans; Hysterectomy, Vaginal; Laparoscopy; Middle Aged; Pelvic Pain; Retrospective Studies; Salpingectomy; Sterilization, Tubal; Treatment Outcome; Uterus
PubMed: 32492524
DOI: 10.1016/j.jogoh.2020.101781