RESUMO
Purpose: Non-puerperal uterine inversion (NPUI) is a rare gynaecological entity with unknown actual incidence. It presents diagnostic and surgical challenges, due to its rarity and lack of clinical experience. Methods: Case series of 5 NPUI cases. Case Description: (1) A 44-year-old P3A0 presented with chronic profuse vaginal bleeding and a prolapsed pedunculated fibroid measuring 9x8x7 cm. In theatre, the pedunculated fibroid was extirpated. Haultain procedure was performed to reposition the uterus, followed by suturing the uterus. (2) A 65-year-old P4A0 presented with a solid vaginal mass, with brisk bleeding measuring 10x10x8 protruding from the introitus. In theatre, the mass was excised, followed by Kustner procedure and a subtotal hysterectomy. (3) A 46-year-old P1A1 presented with a large pedunculated fibroid, hypovolemic shock and loss of consciousness. Upon presentation, she was in shock and severely anaemic (Hb 1.4 gr/dL). In theatre, the fibroid was excised followed by uterine repositioning. A large left ovarian cyst (Ø 10 cm) was identified. A subtotal hysterectomy and left salpingo-oophorectomy were performed. (4) A 34-year-old P3A0 presented with an acute vaginal lump measuring 10x6x5 cm. She had delivered her infant 2 months prior. In theatre, a Huntington procedure was performed to reposition the uterus, followed by a total abdominal hysterectomy. (5) A 60-year-old P3A0 presented with vaginal mass measuring 10×10×8 cm and chronic profuse vaginal bleeding. In theatre, uterine inversion was diagnosed. A Haultain procedure was performed, followed by a total abdominal hysterectomy and bilateral salpingo-oophorectomy. All cases had presented with vaginal mass and bleeding to varying degrees. The degree of inversion required various procedures (eg, Kustner, Haultain, Huntington) and different forms of hysterectomy. Conclusion: Non-puerperal uterine inversion is a difficult pathology. Management is always surgical with different types of hysterectomy performed. With conservative surgery, Kustner, Huntington and Haultain procedures are indicated according to the severity and uterine position.
RESUMO
BACKGROUND Vesicovaginal fistula (VVF) due to posterior bladder wall and/or anterior vaginal wall necrosis is a condition that leads to urinary incontinence. Both microscopic and macroscopic VVFs severely impact quality of life. They are also associated with frequent recurrence after surgery. A non-surgical intervention for VVF is urgently required. A membrane bilayer could act as a mechanical tamponade and stimulate defect closure. MATERIAL AND METHODS This is an experimental study that explored the characteristics of mucoadhesive bilayer membrane complexes for non-operative treatment of VVF in vitro. We synthesized a mucoadhesive bilayer membrane, and inoculated it with cultured fibroblast cells. The mucoadhesive bilayer membrane was prepared with 3 different treatments: (1) estrogen; (2) lyophilized radiation-sterilized amnion (ALSR), a prepared amniotic membrane; and (3) arginine and glutamine (arginine+glutamine), 2 amino acids associated with wound repair. Expression levels of 3 genes, namely tumor growth factor beta (TGF-ß), lysil oxidase (LOX), and junctional adhesion molecules (JAMs), were measured using the Livak method and polymerase chain reaction (PCR). RESULTS On the fifth day after inoculation, there was no statistically significant difference in expression of the genes in the 3 conditions. However, on the tenth day, gene expression of the LOX and JAMs genes in the fibroblast cells inoculated onto the mucoadhesive bilayer membrane with arginine+glutamine was significantly higher than the expression in the fibroblast cells inoculated onto the mucoadhesive bilayer membrane with estrogen or with ALSR. CONCLUSIONS The mucoadhesive bilayer membrane complex with arginine+glutamine gave rise to the highest expression of the LOX and JAMs genes, indicating that the highest proliferation and cell adhesion were found in cells inoculated with the mucoadhesive bilayer membrane complex with arginine+glutamine.