Assuntos
Ruptura Uterina/diagnóstico , Útero/anormalidades , Adulto , Cesárea , Feminino , Humanos , Histerectomia , Recém-Nascido , Masculino , Gravidez , Resultado da Gravidez , Ruptura Uterina/cirurgiaAssuntos
Cerclagem Cervical/métodos , Placenta/fisiologia , Resultado da Gravidez , Nascimento Prematuro/prevenção & controle , Gêmeos Dizigóticos , Incompetência do Colo do Útero/cirurgia , Adulto , Feminino , Morte Fetal , Desenvolvimento Fetal/fisiologia , Seguimentos , Idade Gestacional , Humanos , Paridade , Gravidez , Segundo Trimestre da Gravidez , Gravidez Múltipla , Nascimento a TermoRESUMO
Day-case management of hyperemesis gravidarum was introduced at the Whipps Cross University Hospital in September 2003. A prospective study of patients managed as day cases between September and December 2003 was undertaken. A total of 27 cases were managed as day cases in accordance with set criteria. All were discharged within 24 h of admission. There were no re-admissions. Patient satisfaction, assessed using a questionnaire, revealed an 88% satisfaction rate. Day-case management of hyperemesis gravidarum should be encouraged. The benefits to the patient are considerable.
Assuntos
Hospital Dia , Hiperêmese Gravídica/terapia , Adolescente , Adulto , Estudos de Viabilidade , Feminino , Humanos , Tempo de Internação , Gravidez , Estudos Prospectivos , Resultado do TratamentoRESUMO
This study evaluated the sensitivity and specificity of computerized morphometry in predicting lymph nodes metastases (LNM) in patients with squamous cell carcinoma (SCC) of the vulva. Histologic samples obtained from 20 consecutive cases of SCC of the vulva with positive inguinal LNM were morphometrically assessed and compared with samples from 20 consecutive cases of vulvar SCC negative for LNM. Computerized morphometry was performed on tumor cells and on adjacent nonneoplastic epithelial cells located 2-4 mm from the tumor margins. Computerized morphometric variables of tumor cell nuclei in patients with negative LNM significantly differed from those in patients with positive LNM. Morphometric differences in nuclear size and contour regularity were detected when comparing the nonneoplastic nuclei adjacent to the tumor of both groups. Multivariate analysis showed that the only independent predictors of LNM were the depth of the invasion (P= 0.005) and the mean nuclear roundness of the nonneoplastic nuclei adjacent to the tumors (P= 0.008). Using these variables, a discriminant score revealed a sensitivity of 90% and a specificity of 86.4% for predicting LNM in SCC of the vulva. Our data suggest that cells from the primary tumors with LNM differ morphometrically from primary tumors with no LNM. In addition, normal epithelial cells adjacent to the tumor express morphometric changes between the two groups. The results of our study justify the need for a prospective study of a larger number of patients to evaluate the reproducibility and the clinical use of the data.
Assuntos
Carcinoma de Células Escamosas/secundário , Neoplasias Vulvares/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Núcleo Celular/patologia , Técnicas Citológicas , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Metástase Linfática , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Prognóstico , Reprodutibilidade dos TestesAssuntos
Trabalho de Parto Prematuro/prevenção & controle , Pessários , Adulto , Feminino , Humanos , Gravidez , Resultado da GravidezAssuntos
Hemostasia Cirúrgica/métodos , Placenta Acreta/cirurgia , Hemorragia Uterina/etiologia , Adulto , Feminino , Humanos , Histerectomia , Placenta Acreta/complicações , Placenta Acreta/diagnóstico por imagem , Placenta Prévia , Gravidez , Resultado da Gravidez , Ultrassonografia , Hemorragia Uterina/cirurgiaRESUMO
BACKGROUND: Port-site metastasis (PSM) following laparoscopic surgery for cancer is being increasingly recognized as a potential problem; the majority of cases appear following laparoscopy for a pelvic mass that subsequently proved to be malignant or in the case of a disseminated intraperitoneal disease. The rare cases of PSM following laparoscopy for endometrial and cervical cancer have all been associated with the presence of regional lymph node metastasis or disseminated disease in the peritoneal cavity. We present here a case report of PSM in the absence of spread beyond the primary tumor. CASE: A 48-year-old woman with stage IA1 adenocarcinoma of the cervix was treated with laparoscopically assisted vaginal hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic node dissection. The pathologic study revealed an endocervical adenocarcinoma confined to the cervix with negative lymph nodes. Nine months postoperatively, a cutaneous metastasis at the port-site was diagnosed. This was treated with wide local excision of the recurrence and the port-site track. Explorative laparotomy and para-aortic node sampling showed no evidence of recurrence elsewhere. CONCLUSION: This case emphasizes the risk for PSM in laparoscopic surgery performed for early stage disease.
Assuntos
Adenocarcinoma/secundário , Adenocarcinoma/cirurgia , Laparoscopia/efeitos adversos , Inoculação de Neoplasia , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgia , Adenocarcinoma/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de NeoplasiasRESUMO
Vaginal evisceration is a rare event. This case report describes a 45-year-old woman who presented 8 days following radical hysterectomy and lymph node dissection for stage 1B squamous cell carcinoma of the cervix with small bowel evisceration through the vagina. She was treated by laparotomy and resection anastamosis of a discolored part of the distal ileum.