ABSTRACT
Undertaking medically assisted reproduction (MAR) is a real ordeal for a couple. Beyond the technical aspect, the physician must also support this patients psychologically and acknowledge their distress. The doctor's first mission is to advise the couple who will remain the sole decision-maker with regard to the actions undertaken.
Subject(s)
Reproductive Techniques, Assisted , HumansABSTRACT
Planning a pregnancy for patients with a history of cancer, including breast cancer, is a clinical situation that becomes more and more common. Several specific items are to be discussed: decrease of fertility after cancer treatment, fertility preservation options, impact of pregnancy on cancer recurrence risk and appropriate interval between cancer and pregnancy. Programming pregnancy after cancer is doable in a multidisciplinary setting, and begins at cancer diagnosis to anticipate the various specific pitfalls. Favor adequate oncologic care remains the leading rule.
Subject(s)
Fertility Preservation , Neoplasms/therapy , Pregnancy , Adult , Age Factors , Antineoplastic Agents/therapeutic use , Breast Feeding , Breast Neoplasms/drug therapy , Breast Neoplasms/genetics , Breast Neoplasms/psychology , Cryopreservation , Female , Fertilization , Genes, BRCA1 , Genes, BRCA2 , Humans , Mutation , Neoplasms/psychology , Ovarian Reserve/physiology , PrognosisABSTRACT
INTRODUCTION: Colouterine fistula is a very rare condition; most cases described in the literature are secondary to complications of diverticulitis in elderly patients. CASE PRESENTATION: We report the case of a 34-year-old African woman who presented with a colouterine fistula secondary to polymyomectomy, which was diagnosed in the setting of severe endometritis. She had a Hartmann procedure and abundant irrigation of her abdominal and uterine cavities followed by placement of a double drainage in order to preserve fertility. This is the first case of a conservative management of the uterus in such conditions. CONCLUSION: Conservative surgery in colouterine fistula should be discussed as an alternative to hysterectomy in young infertile women.
Subject(s)
Intestinal Fistula/surgery , Leiomyomatosis/surgery , Postoperative Complications/surgery , Sigmoid Diseases/surgery , Uterine Diseases/surgery , Uterine Myomectomy , Uterine Neoplasms/surgery , Adult , Endometritis/etiology , Female , Fertility Preservation , Humans , Intestinal Fistula/complications , Intestinal Fistula/diagnostic imaging , Organ Sparing Treatments , Postoperative Complications/diagnostic imaging , Sigmoid Diseases/complications , Sigmoid Diseases/diagnostic imaging , Tomography, X-Ray Computed , Uterine Diseases/complications , Uterine Diseases/diagnostic imagingABSTRACT
BACKGROUND: The aim of this study was to report the false-negative rate of positron-emission tomography (PET) /Computed Tomography (CT) for para-aortic (PA) lymph node (LN) metastasis and to examine if PA lymphadenectomy could be omitted when PET/CT of the pelvic area is negative. PATIENTS AND METHODS: Patients without evidence of extrapelvic disease on preoperative imaging or in the PA area were included. Each patient underwent a laparoscopic PA lymphadenectomy. RESULTS: A total of 61 patients were included. Seven patients (11%) had PALN metastasis. The false-negative rate of PET/CT was 11%. When PET/CT was positive for pelvic nodes, the risk for PA metastasis was 18% versus 8% when PET/CT was negative in the pelvic area (p=0.24). CONCLUSION: The apparent low sensitivity of the PET/CT does not make it a relevant alternative to surgical LN staging when no uptake is visualized in the PA area. However, for patients in whom PET/CT is negative in the pelvic area, the risk of metastasis in the PA area is low.