RESUMEN
OBJECTIVE: To evaluate quality of life (QoL) after radiofrequency endometrial ablation (RFEA) for heavy menstrual bleeding among women at high surgical risk. METHODS: An observational study was undertaken among women aged at least 18 years who underwent RFEA at Hanover Medical School, Germany, between June 2010 and November 2012. A validated menorrhagia outcomes questionnaire (MOQ) was used to evaluate QoL and global outcomes among patients at high risk and low risk of complications after major surgery. The high-risk group included women with anemia, coagulopathy, anticoagulation, thromboembolism, transplantation, malignancy, severe cardiovascular or pulmonary disease, and obesity. RESULTS: Overall, 235 women underwent RFEA during the study period. Median follow-up was 13 months (range 3-30). Questionnaire responses were received from 202 (86.0%) women, including 132 (65.3%) high-risk patients. The MOQ total outcome (mean difference 2.0; P = 0.166) and QoL/satisfaction (mean difference 0.8; P = 0.601) scores were similar in the two groups. Success (i.e. symptom relief and no further surgery) was recorded for 119 (90.2%) patients in the high-risk group and 67 (95.7%) patients in the low-risk group (P = 0.155). CONCLUSION: RFEA improved QoL and achieved a high rate of satisfaction for both high- and low-risk patients. RFEA offers a less invasive alternative to hysterectomy and its associated perioperative risks, particularly among high-risk patients.
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Técnicas de Ablación Endometrial/psicología , Menorragia/psicología , Calidad de Vida , Adulto , Anciano , Técnicas de Ablación Endometrial/métodos , Endometrio/cirugía , Femenino , Alemania , Humanos , Menorragia/cirugía , Persona de Mediana Edad , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Uterine myomas are found in 0.3-2.6% of pregnant women. In one case out of ten they cause complications. Treatment is primarily conservative but in cases of failure, surgery cannot be avoided. We present a case of a pregnant woman with myomas. Because of failure of conservative management and severe abdominal pain, we performed a myomectomy at 18 weeks' gestation with preservation of the pregnancy. We describe a modified surgical technique whereby interrupted sutures are first placed around the myoma for haemostasis. We achieved good pregnancy outcome by caesarean section carried out near term. Incidence, presentation, and challenges associated with the management of myomas during pregnancy are briefly discussed.
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Procedimientos Quirúrgicos Ginecológicos/métodos , Leiomioma/cirugía , Complicaciones Neoplásicas del Embarazo/cirugía , Neoplasias Uterinas/cirugía , Adulto , Pérdida de Sangre Quirúrgica/prevención & control , Cesárea , Femenino , Humanos , Leiomioma/diagnóstico por imagen , Ligadura/métodos , Embarazo , Complicaciones Neoplásicas del Embarazo/diagnóstico por imagen , Resultado del Embarazo , Técnicas de Sutura , Adherencias Tisulares/prevención & control , Resultado del Tratamiento , Ultrasonografía , Neoplasias Uterinas/diagnóstico por imagenRESUMEN
Recurrent pregnancy loss is a disease of grave psychological and economic concern. The etiology in the vast majority of the cases is unknown or at best poorly understood. Although Klebsiella pneumonia infections have been reported in humans and animals during pregnancy, there is hardly any information to indicate whether or not these infections may be responsible for early pregnancy loss. We present a review of literature and report for the first time in humans, Klebsiella pneumonia infection in placenta of a 38-year-old secondary recurrent aborter (parity 2 + 3).
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Aborto Espontáneo/microbiología , Enfermedades del Recién Nacido/mortalidad , Infecciones por Klebsiella/mortalidad , Klebsiella pneumoniae , Exposición Profesional , Complicaciones Infecciosas del Embarazo/microbiología , Aborto Habitual/microbiología , Adulto , Femenino , Humanos , Recién Nacido , Enfermedades del Recién Nacido/microbiología , Infecciones por Klebsiella/epidemiología , Masculino , Placenta/microbiología , Embarazo , Factores de Riesgo , Semen/microbiologíaRESUMEN
Recurrent pregnancy loss has been associated with autoimmune responses to membrane phospholipids and alloimmune reactions against paternally derived molecules on the trophoblast. The problem is psychologically and economically stressful as it undermines the capacity of some couples to reproduce and participate effectively in the day-to-day economic activities. This article reviews the adoption of intravenous immunoglobulin as a form of therapy for the clinical management of recurrent pregnancy loss and of selected autoimmune disorders. Side effects, contraindications and safety of use are discussed.
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Aborto Habitual/terapia , Enfermedades Autoinmunes/terapia , Inmunoglobulinas Intravenosas/uso terapéutico , Inmunoterapia , Aborto Habitual/inmunología , Enfermedades Autoinmunes/inmunología , Femenino , Humanos , Embarazo , Complicaciones del Embarazo/inmunología , Complicaciones del Embarazo/terapiaRESUMEN
BACKGROUND: Immunomodulatory strategies such as donor-specific bone marrow or blood transfusions have been used to promote engraftment after intestinal transplants. We previously showed that delivery of donor antigen via the portal vein can effectively reduce the rate of intestinal graft rejection. The purpose of our current study was to investigate the impact of donor-specific cell augmentation (blood versus bone marrow) via the portal vein on cytokine expression in intestinal grafts versus native livers. MATERIAL AND METHODS: We performed heterotopic small intestinal transplants between male Brown-Norway (donor) and female Lewis (recipient) rats. We studied 10 groups according to the type of donor-specific cell augmentation and the use and dose of immunosuppressive therapy. For cell augmentation, donor-specific blood or bone marrow was transfused via the donor portal vein immediately before graft implantation. For immunosuppression, tacrolimus was used post-transplant at a high or low dose. Control rats received neither immunosuppression nor cell augmentation. Tissue samples for histological assessment were obtained at designated time points. RNA was extracted from intestinal graft and native liver biopsies for cytokine measurements (IL-1 alpha, IL-1 beta, IL-2, IL-4, IL-5, IL-6, IFN-gamma, TNF-alpha, and TNF-beta). Chimerism levels were determined using Q-PCR analysis. RESULTS: Without concurrent immunosuppression, neither portal donor-specific blood nor bone marrow transfusion reduced the rate of rejection. With immunosuppression, outcome was significantly better after portal donor-specific blood (versus bone marrow) transfusion. Irrespective of the type of donor-specific cell augmentation, severe rejection caused strong cytokine expression in the grafts of IL-1 alpha, IL-1 beta, IFN-gamma, and TNF-alpha; in the native livers, mainly of TNF-alpha (with IFN-gamma showing hardly any increase). In general, rejection caused stronger cytokine expression in the grafts than in the native livers. Mild rejection correlated well with strong intragraft expression of IL-6, TNF-alpha, and TNF-beta (early rejection markers); severe rejection with IL-1 alpha, IL-1 beta, IFN-gamma, and TNF-alpha (late rejection markers). In addition to cell augmentation per se, the type of cell augmentation also had an impact on cytokine expression in both grafts and native livers. Cell-augmented (versus tacrolimus-treated) rats showed hardly any differences in intragraft cytokine expression, but the expression of almost all cytokines was significantly stronger in the native livers. With immunosuppression, bone marrow infusion increased intragraft cytokine expression of IL-1 alpha, IL-1 beta, IFN-gamma, and TNF alpha, as well as liver cytokine expression of IL-1 beta, compared to blood transfusion. This finding reflected the more advanced rejection stages in the bone marrow infused group; different types of donor-specific cell augmentation had similar effects on liver cytokine expression. In the absence of myoablative therapy, chimerism levels were low, in both cell-augmented and non-cell-augmented groups. CONCLUSIONS: Rejection and donor-specific cell augmentation independently causes differences in intragraft versus native liver cytokine expression after intestinal transplants. Portal donor-specific blood transfusion, as compared with donor-specific bone marrow infusion, lowered the incidence of rejection and diminished intragraft cytokine up-regulation.
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Citocinas/biosíntesis , Rechazo de Injerto/prevención & control , Intestinos/inmunología , Intestinos/trasplante , Hígado/inmunología , Inmunología del Trasplante/inmunología , Animales , Transfusión Sanguínea , Trasplante de Médula Ósea/inmunología , Quimera/inmunología , Femenino , Rechazo de Injerto/tratamiento farmacológico , Rechazo de Injerto/etiología , Inmunosupresores/uso terapéutico , Masculino , Modelos Animales , Vena Porta , Ratas , Ratas Endogámicas Lew , Tacrolimus/uso terapéuticoRESUMEN
UNLABELLED: Rhabdomyosarcomas are the most common soft tissue sarcomas in childhood. The botryoid variant arises in infancy from the vagina or urinary bladder and extremely rarely from the uterine cervix. Treatment regimes range from local excision of the tumour to radical hysterectomy with adjuvant multidrug therapy and/or radiotherapy. In cases of minimal cervical invasion, the less invasive local excision in combination with adjuvant chemotherapy has resulted in excellent survival rates with complete functional preservation of the bladder, rectum, vagina, and ovaries. We present here a 30-year literature review and a case report of a cervical sarcoma botryoides in a 5-year-old girl. CONCLUSION: based on the literature review and our own observation, we recommend minor surgical approaches in combination with chemotherapy as the treatment of choice for early stage I cervical rhabdomyosarcoma.