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1.
Zhonghua Fu Chan Ke Za Zhi ; 54(12): 848-853, 2019 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-31874475

RESUMO

Objective: To study influencing factors which cause the endometrial diseases in patients with breast cancer after operation. Methods: A retrospective study was performed on 212 breast cancer post-operation patients with endometrial diseases between June 2006 and January 2018 in Women's Hospital School of Medicine Zhejiang University to analyse the factors which influenced the endometrial diseases. Results: The abnormal uterine bleeding and endometrial thickness were related to the severity of endometrial disease in patients with breast cancer, and they were independent risk factors for breast cancer patients to have endometrial cancer (P<0.05) . When the diagnostic cut off value of endometrial thickness was ≥0.49 cm, the sensitivity and specificity to endometrial cancer were 78% and 25%, respectively. The average endometrial thickness was (0.56±0.39) cm in patients who were treated by selective estrogen receptor modulator (SERM) after gynecological surgery, which was significantly thicker than that of aromatase inhibitor (AI) group [ (0.33±0.23) cm] and no treatment group [ (0.44±0.28) cm, P<0.05]. The endometrial disease recurrent rate and reoperation rate in SERM group were (26.2%, 14.3%) slightly higher than that of AI group (9.5%, 4.8%) and no treatment group (21.6%, 4.9%), but there were not significant differences (all P>0.05). Conclusions: The clinical symptom of abnormal uterine bleeding and thickening endometrium are risk factors for breast cancer patients to have endometrial cancer. The endometrial thickness has high predictive value for breast cancer patients to diagnose endometrial cancer. The SERM treatment increases the endometrial thickness, recurrent rate and reoperation rate in post-operation patients.


Assuntos
Antineoplásicos Hormonais/efeitos adversos , Inibidores da Aromatase/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/cirurgia , Hiperplasia Endometrial/induzido quimicamente , Neoplasias do Endométrio/induzido quimicamente , Endométrio/efeitos dos fármacos , Moduladores de Receptor Estrogênico/efeitos adversos , Moduladores Seletivos de Receptor Estrogênico/efeitos adversos , Hemorragia Uterina/etiologia , Antineoplásicos Hormonais/uso terapêutico , Inibidores da Aromatase/uso terapêutico , Neoplasias da Mama/patologia , Quimioterapia Adjuvante , Terapia Combinada , Hiperplasia Endometrial/epidemiologia , Hiperplasia Endometrial/patologia , Neoplasias do Endométrio/epidemiologia , Neoplasias do Endométrio/patologia , Endométrio/patologia , Moduladores de Receptor Estrogênico/uso terapêutico , Feminino , Humanos , Estudos Retrospectivos , Moduladores Seletivos de Receptor Estrogênico/uso terapêutico , Índice de Gravidade de Doença , Ultrassonografia
2.
Medicine (Baltimore) ; 98(51): e18446, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31861017

RESUMO

Thrombosis is one of the serious complications related to prophylactic balloon occlusion of the abdominal aorta (PBOAA). This study aims to retrospectively analyze the efficacy and safety of continuous low-flow infusion of diluted heparin saline to prevent this complication related to PBOAA and further to provide the theory and evidences for using PBOAA.A study was carried out at our hospital from March 2016 to December 2018. Women with pernicious placenta previa (PPP) were treated PBOAA to prevent massive bleeding during CS. According to whether continuous low-flow infusion of diluted heparin saline was used to prevent catheter-related thrombosis or not, they were divided into 2 groups, the test group and the control group. The incidence of thrombosis between the 2 groups was compared and the effective treatment of thrombosis was also discussed. The comparison of nonparametric values was accomplished by using Fisher exact test. Statistical significance was set at P < .05.There were 31 women with PPP who received PBOAA during CS who were included in our study. Six of 19 women in control group (31.6%) developed thrombotic complications, while none of 12 women in test group. There were statistically significant differences in the incidence of thrombosis between the 2 groups (P = .037). There was no statistically significant difference in the amount of estimated blood loss and blood transfusion during CS between the 2 groups, nor was there statistically significant difference in the hospital days after CS (P > .05). All 6 women with thrombotic complications had no positive symptoms and thrombotic sequelae. The managements of thrombus included systemic anticoagulation, catheter-directed thrombolysis, and catheter-directed anticoagulation. One of the 6 women was lost to follow-up, and the thrombus of the other 5 women were completely dissolved. No other adverse outcomes or complications related to PBOAA were observed in all women in this study.Continuous low-flow infusion of diluted heparin saline is a safe procedure when PBOAA is performed for patients with PPP. It can effectively reduce or even avoid thrombosis without increasing intraoperative blood loss during CS for PPP patients.


Assuntos
Anticoagulantes/administração & dosagem , Aorta Abdominal , Oclusão com Balão/efeitos adversos , Heparina/administração & dosagem , Trombose/prevenção & controle , Adulto , Cesárea/efeitos adversos , Feminino , Humanos , Placenta Prévia/etiologia , Gravidez , Estudos Retrospectivos , Trombose/etiologia , Hemorragia Uterina/etiologia , Hemorragia Uterina/prevenção & controle
3.
Zhonghua Fu Chan Ke Za Zhi ; 54(11): 756-762, 2019 Nov 25.
Artigo em Chinês | MEDLINE | ID: mdl-31752459

RESUMO

Objective: To evaluate the clinical characteristics and diagnostic strategies of early hydatidiform mole. Methods: A retrospective cohort study was conducted of 526 women with hydatidiform mole who underwent suction curettage and were confirmed by histopathology in Dalian Maternal and ChildHealth Care Hospital from Feb. 2013 to Feb. 2018, including 484 women with gestational age less than or equal to 12 weeks (the early group) and 42 women with gestational age greater than 12 weeks (the late group). The clinical characteristics between the two groups were compared, and the pathological diagnosis and pre-evacuation ultrasound examination of the early group were further discussed. Results: Compared with the late group, the clinical characteristics of the early group tended to be atypical, and the incidence of vaginal bleeding, excessive uterine size, theca lutein cysts (>6 cm) and pregnancy complications decreased significantly (all P<0.05). The serum level of ß-hCG in the early group was significantly lower than that in the late group (Z=-2.382, P=0.017). While there was no significant difference in the pre-evacuation ultrasound detection rate between the two groups (53.5% vs 66.7%; χ(2)=2.697, P=0.101). Five hundred and fifteen patients completed the follow-up, and 38 patients with post-mole neoplasia were all cured. There was no significant difference in the malignant transformation rate of hydatidiform mole between the two groups (7.0% vs 11.9%; χ(2)=0.745, P=0.388). In the early group, 302 cases of complete hydatidiform mole (CHM), 179 cases of partial hydatidiform mole (PHM) and 3 cases of unclassified hydatidiform mole (UHM) were histologically diagnosed, according to pathological morphology combined with p57(KIP2) immunohistochemical staining. Compared with pathological diagnosis, the overall pre-evacuation ultrasound detection rate in the early hydatidiform mole was 53.5% (259/484), which was significantly better for complete (78.1%, 236/302) versus partial (11.7%, 21/179) hydatidiform moles (χ(2)=199.224, P<0.01). There was significantly weak negative correlation between the overall ultrasound detection rate and gestational age of hydatidiform mole (r=-0.211, P<0.01). The gestational age of early PHM was significantly longer than that of CHM (68.0 vs 58.5 days; Z=-8.048, P<0.01). Conclusions: The clinical presentations of early hydatidiform mole are not typical. Although ultrasound examination identifies only about half of hydatidiform moles, ultrasonography is still an important auxiliary examination method. Morphological examination combined with p57(K)IP2 immunohistochemical staining could effectively diagnose early hydatidiform mole, so as to reduce the missed diagnosis of hydatidiform mole.


Assuntos
Mola Hidatiforme/diagnóstico , Hemorragia Uterina/etiologia , Neoplasias Uterinas/diagnóstico , China/epidemiologia , Gonadotropina Coriônica Humana Subunidade beta/sangue , Feminino , Idade Gestacional , Humanos , Mola Hidatiforme/epidemiologia , Mola Hidatiforme/patologia , Mola Hidatiforme/cirurgia , Incidência , Gravidez , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia , Hemorragia Uterina/epidemiologia , Neoplasias Uterinas/epidemiologia , Neoplasias Uterinas/patologia , Neoplasias Uterinas/cirurgia , Curetagem a Vácuo
4.
Pan Afr Med J ; 33: 211, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31693718

RESUMO

Introduction: Different diagnostic tools are available to evaluate endometrial focal lesion such as hysteroscopy, sonohystrography and transvaginal ultrasound. The present study aimed to determine the diagnostic value of saline infusion sonohystrography (SIS) in diagnosis of intrauterine lesions in women with Abnormal Uterine Bleeding (AUB). Methods: This cross-sectional study recruited 100 married women with chief complain of AUB referred to gynecologic clinics at the Amir Al-Momenin hospital, Semnan, Iran from March 2014 to February 2016. All participants were in the reproductive age and post-menopausal period that showed abnormal endometrial thickness or endometrial focal lesions through transvaginal ultrasound. Participants underwent SIS, hysteroscopy plus focal lesion resection and endometrial biopsy in order. The gold standard was the histopathology of endometrial specimen reported by pathologist. Results: Mean±SD age of women was 41.2±11.3 years. To diagnose the overall focal lesions, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the SIS were 79.6, 89.1, 89.6, and 78.8% respectively. These figures were 75.0, 87.5, 82.5 and 81.7%, respectively to diagnose polyps. The SIS sensitivity, specificity, PPV and NPV values to diagnose the myomas were 60.0, 97.8, 75.0, and 95.7% respectively. Conclusion: Findings show that, SIS probably is a proper method for detecting endometrial focal lesion including polyps and myomas. Future studies may help to define further advantages of this procedure.


Assuntos
Histeroscopia/métodos , Solução Salina/administração & dosagem , Doenças Uterinas/diagnóstico , Hemorragia Uterina/etiologia , Adulto , Estudos Transversais , Feminino , Humanos , Irã (Geográfico) , Leiomioma/diagnóstico , Leiomioma/patologia , Leiomioma/cirurgia , Pessoa de Meia-Idade , Pólipos/diagnóstico , Pólipos/patologia , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Ultrassonografia/métodos , Doenças Uterinas/patologia , Doenças Uterinas/cirurgia , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/patologia , Neoplasias Uterinas/cirurgia
5.
Medicine (Baltimore) ; 98(38): e17246, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567990

RESUMO

RATIONALE: Uterus-like masses (ULMs) are rare benign lesions that resemble the uterus. PATIENT CONCERNS: Here, we describe the case of a woman with a ULM in the right broad ligament. A 51-year-old woman with a 2-month history of irregular vaginal bleeding was found to have a mass in the right broad ligament. Imaging studies revealed a solid-cystic lesion, suggestive of an endometrial cyst with malignant transformation. INTERVENTIONS: She underwent prompt surgery for the removal of the mass. Intraoperatively, the uterus and ovaries appeared normal, and an 8-cm-long mass was observed in the right broad ligament without any connection to the uterus or ovaries. The mass was successfully excised. DIAGNOSES: Postoperative histopathological examination showed that the cystic mass was filled with a blackish-brownish fluid and that it had thick walls resembling the uterine myometrium. The cyst center was lined by endometrial glands that were positive for cytokeratin as well as estrogen and progesterone receptors, and by stromal cells that were positive for CD10. OUTCOMES: The patient recovered well and has had no further symptoms during 2 years of follow-up. LESSONS: We have reported a case of ULM in the right broad ligament in a Chinese woman. Although ULMs are rare, they should be considered in the differential diagnosis for pelvic masses.


Assuntos
Ligamento Largo , Coristoma/diagnóstico , Doenças dos Genitais Femininos/diagnóstico , Útero , Ligamento Largo/patologia , Ligamento Largo/cirurgia , Coristoma/patologia , Coristoma/cirurgia , Diagnóstico Diferencial , Feminino , Doenças dos Genitais Femininos/patologia , Doenças dos Genitais Femininos/cirurgia , Humanos , Pessoa de Meia-Idade , Hemorragia Uterina/etiologia
7.
Medicine (Baltimore) ; 98(35): e16895, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464920

RESUMO

RATIONALE: Methotrexate (MTX) is an antimetabolite of folic acid, which is used for management of ectopic pregnancy. MTX-related toxicity may include cutaneous mucosal damage, bone marrow suppression, gastrointestinal disorders (gastritis, diarrhea, hematitis), liver and kidney function damage, pulmonary toxicity, cardiac toxicity, and nerve toxicity. However, it is not usual for vulvar edema induced by low-dose methotrexate. PATIENT CONCERNS: In this case report, we described a patient with severe vulvar edema and oral cavity ulceration and scalp ulceration induced by low-dose MTX treatment for ectopic pregnancy. Her presenting complaints were pain in the vulva, oral cavity, and scalp. DIAGNOSES: The patient was diagnosed based on clinical findings for MTX toxic reactions. INTERVENTIONS: Vulva was disinfectioned with iodide and Kangfuxin solution, her mouth was rinsed with mouthwash. Three compound glycyrrhizin tablets were orally administered (3 times/day). After 10 days, the broken skin and mucous membrane healed. OUTCOMES: The vulvar edema and oral cavity ulceration and scalp ulceration healed. LESSONS: Our study demonstrated that even low-dose MTX can be induced skin and mucosal injury, patients and doctors should timely detection of drug toxicity reactions, immediately rescue, prompt discontinuation of medication, and symptomatic treatment to avoid accidental occurrence.


Assuntos
Metotrexato/administração & dosagem , Metronidazol/administração & dosagem , Gravidez Ectópica/tratamento farmacológico , Vaginite por Trichomonas/tratamento farmacológico , Doenças da Vulva/induzido quimicamente , Dor Abdominal/etiologia , Administração Oral , Adulto , China , Feminino , Ácido Glicirrízico/administração & dosagem , Ácido Glicirrízico/uso terapêutico , Humanos , Injeções Intramusculares , Materia Medica/administração & dosagem , Materia Medica/uso terapêutico , Metotrexato/efeitos adversos , Metronidazol/uso terapêutico , Gravidez , Gravidez Ectópica/diagnóstico , Resultado do Tratamento , Hemorragia Uterina/etiologia , Doenças da Vulva/tratamento farmacológico
8.
J Obstet Gynaecol Res ; 45(9): 1913-1917, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31304654

RESUMO

AIM: This article retrospectively analyzed the efficacy and safety of vaginoscopy in the treatment of adolescent abnormal uterine bleeding (AUB) in 204 cases of AUB. METHOD: From January 1, 2007 to December 31, 2017, 204 patients with intact hymen who were admitted to our hospital due to AUB received vaginoscopy, and vaginoscopy did not damage the hymen. In this study, 4.5 mm and 6.5 mm hysteroscopy were used with a pumping fluid pressure of 100-120 mm Hg and a flow rate of 400 mL/min. All 204 vaginoscopy was successfully completed in intravenous anesthesia. RESULTS: Postoperative pathological examination confirmed that of the 204 patients, 53 patients had simple hyperplasia. There were 53 cases of polyps, 50 cases of endometrial gland hyperplasia and disordered arrangement, 35 cases of proliferative phase endometrium, five cases of bleeding phase endometrium, partial glandular secretion, three cases of complex hyperplasia and one case of decidua like change. Follow-up data from 64 patients showed that 34 patients were effective after treatment. Stepwise logistic regression analysis suggested that endometrial thickness was associated with treatment outcome (HR, 0.875, 95% CI, 0.786-0.974, P = 0.014). There was no significant difference in drug use between patients with effective and ineffective treatment. CONCLUSION: 'No-touch' vaginoscopy is feasible for the diagnosis and treatment of adolescent AUB without destroying the intact hymen.


Assuntos
Histeroscopia/métodos , Hemorragia Uterina/cirurgia , Vagina/cirurgia , Adolescente , Estudos de Viabilidade , Feminino , Humanos , Estudos Retrospectivos , Resultado do Tratamento , Hemorragia Uterina/etiologia
10.
Taiwan J Obstet Gynecol ; 58(4): 541-544, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31307748

RESUMO

OBJECTIVE: The aim of the present study was to describe various hysteroscopic findings of previous cesarean delivery scar defects (PCDS), and evaluate the relationship between these findings and abnormal uterine bleeding. MATERIALS AND METHODS: This was a retrospective study including patients with abnormal uterine bleeding after a cesarean section. Transvaginal ultrasound and hysteroscopy were used to detect the origin of the symptoms, and the gynecological symptoms and hysteroscopic findings were recorded. Relationships between the hysteroscopic findings and abnormal uterine bleeding were evaluated. RESULTS: Ninety-six (82.8%) patients presented with intermenstrual bleeding. The most common findings of scar defects on hysteroscopy were increased local vascularization (74.1%) and oozing spots (47.4%). Increased local vascularization on the defect was significantly related to intermenstrual bleeding (p = 0.048). CONCLUSION: This study categorized different findings of PCDS under hysteroscopy. Increased local vascularization on the scar defect was significantly related to intermenstrual bleeding.


Assuntos
Cesárea/efeitos adversos , Cicatriz/diagnóstico , Cicatriz/etiologia , Histeroscopia/métodos , Hemorragia Uterina/epidemiologia , Adulto , Cesárea/métodos , Cicatriz/epidemiologia , Estudos de Coortes , Comorbidade , Feminino , Humanos , Incidência , Gravidez , Prognóstico , Estudos Retrospectivos , Medição de Risco , Taiwan , Hemorragia Uterina/etiologia , Hemorragia Uterina/cirurgia
12.
Medicine (Baltimore) ; 98(29): e16433, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335697

RESUMO

RATIONALE: Endometrial neuroendocrine carcinoma is a rare histological subtype of endometrial cancer, divided into low-grade neuroendocrine carcinoma (carcinoid) and high-grade neuroendocrine carcinoma (small cell and large cell neuroendocrine carcinoma). It is characterized by high invasiveness and poor prognosis. L/SCNEC is an extremely rare pathological type of endometrial carcinoma, and the number of reports on this condition is few globally. PATIENT CONCERNS: A 54-year-old Chinese female presented with vaginal bleeding. DIAGNOSES: Outpatient hysteroscopy and endometrial biopsy were performed, and the pathological examination revealed that cervix was invaded by endometrial malignancy. The patient underwent a laparoscopic radical hysterectomy was diagnosed with the mixed large and small cell neuroendocrine carcinoma (L/SCNEC) of the endometrium combined with serous carcinoma III C2 (FIGO2009). INTERVENTIONS: Chemotherapy-radiotherapy-chemotherapy "sandwich" treatment was performed as postoperative therapy. OUTCOMES: After three chemotherapy circles, the patient showed no evidence of further disease progression. LESSONS: L/SCNEC is a rare and invasive disease. Once diagnosed, comprehensive treatments including surgery, radiotherapy, and chemotherapy can prolong the survival of patients and improve the prognosis.


Assuntos
Carcinoma Neuroendócrino , Carcinoma de Células Pequenas , Quimioterapia Adjuvante/métodos , Cistadenocarcinoma Seroso , Neoplasias do Endométrio , Endométrio/patologia , Histerectomia/métodos , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Biópsia/métodos , Carcinoma Neuroendócrino/patologia , Carcinoma Neuroendócrino/fisiopatologia , Carcinoma Neuroendócrino/terapia , Carcinoma de Células Pequenas/patologia , Carcinoma de Células Pequenas/fisiopatologia , Carcinoma de Células Pequenas/terapia , Terapia Combinada , Cistadenocarcinoma Seroso/patologia , Cistadenocarcinoma Seroso/fisiopatologia , Cistadenocarcinoma Seroso/terapia , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/fisiopatologia , Neoplasias do Endométrio/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Gradação de Tumores , Invasividade Neoplásica , Estadiamento de Neoplasias , Resultado do Tratamento , Hemorragia Uterina/diagnóstico , Hemorragia Uterina/etiologia
13.
Ceska Gynekol ; 84(3): 240-246, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31324117

RESUMO

OBJECTIVE: To summarize the current knowledge about pathogenesis, diagnostics, symptomatology and the treatment of adenomysis. DESIGN: Review article. SETTING: The Centre of Assisted Reproduction, ISCARE I.V.F., Prague. METHODS: Analysis of literature and current studies. RESULTS: This article reviews etiology, diagnostics and classification of adenomyosis, medical and surgical management options and the fertility implication of adenomyosis. CONCLUSION: Uterine adenomyosis is characterized by the presence of endometrial glands in myometrium and usually manifests by pelvic pain, abnormal uterine bleeding or infertility. Although adenomyosis and endometriosis share a number of features, they are considered to be two different entities. Recent improvements of imaging techniques such as transvaginal ultrasound and magnetic resonance imaging have affected the detection of adenomyosis. Adenomyosis has a negative impact on IVF results.


Assuntos
Adenomiose , Endometriose/patologia , Doenças Uterinas , Útero/patologia , Adenomiose/classificação , Adenomiose/complicações , Adenomiose/diagnóstico , Adenomiose/terapia , Feminino , Humanos , Infertilidade Feminina/etiologia , Dor Pélvica/etiologia , Doenças Uterinas/classificação , Doenças Uterinas/complicações , Doenças Uterinas/diagnóstico , Doenças Uterinas/terapia , Hemorragia Uterina/etiologia
14.
Int J Gynaecol Obstet ; 146(3): 289-295, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31172522

RESUMO

OBJECTIVE: To establish a risk scoring system to predict the successful treatment of cesarean scar pregnancy. METHODS: A prospective observational study was conducted between June 2016 and March 2018 in a tertiary care center. Patients received evacuation followed by uterine artery embolization and laparoscopic local resection/hysterectomy successively as salvage measures if necessary. Optimal scaling regression determined the extent of each potential prognostic factor predicted. RESULTS: Out of 228 women, 144 cases required evacuation before recovery, 73 women required uterine artery embolization, and 11 women eventually required laparoscopic surgery. Six variables were included in the predictive model: number of cesarean deliveries; maximal diameter of gestational sac; remnant myometrial thickness; grading of Doppler signals; presence of fetal heartbeat; and location of gestational sac. A 10-point scoring system was established by weighting their prediction of the method of successful treatment. In the risk score rank of 1-4, only 4 (2.8%) out of 142 women needed uterine artery embolization as a salvage treatment, while in the risk score rank of 8-10, 41 (80.4%) cases needed uterine artery embolization; laparoscopic operations were performed by physicians for the other 10 (19.6%) cases. CONCLUSION: The successful treatment of cesarean scar pregnancy was accurately predicted by a 10-point scoring system. CHINESE CLINICAL TRIALS REGISTRY: ChiCTR-OOC-16008467.


Assuntos
Histerectomia/efeitos adversos , Gravidez Ectópica/cirurgia , Embolização da Artéria Uterina/métodos , Hemorragia Uterina/cirurgia , Adulto , Cesárea/efeitos adversos , Cesárea/estatística & dados numéricos , China , Cicatriz/complicações , Cicatriz/cirurgia , Feminino , Humanos , Histerectomia/estatística & dados numéricos , Gravidez , Gravidez Ectópica/etiologia , Estudos Prospectivos , Resultado do Tratamento , Hemorragia Uterina/etiologia
15.
BMC Pregnancy Childbirth ; 19(1): 147, 2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31046694

RESUMO

BACKGROUND: The study was designed to compare the role of infrarenal aortic artery balloon occlusion (IAABC) with internal iliac artery balloon occlusion (IIABOC). METHODS: One hundred seventy-four cases with placenta accreta were retrospectively analyzed.74 cases who had IAABC were in group A, while the others who had IIABOC were in group B. RESULTS: Amount of estimated blood loss (EBL), the rate of major blood loss, the rate of blood transfusion and uterine packing, length of hospitalization were not different in both groups. The rate of uterine artery embolization (UAE), balloon occlusion time, operation time and fetus radiation dose in group A were less than those in group B. CONCLUSIONS: IAABC resulted in better clinical outcomes than IIABOC.


Assuntos
Aorta Abdominal/cirurgia , Oclusão com Balão/estatística & dados numéricos , Artéria Ilíaca/cirurgia , Placenta Acreta/cirurgia , Embolização da Artéria Uterina/estatística & dados numéricos , Adulto , Transfusão de Sangue/estatística & dados numéricos , Feminino , Humanos , Duração da Cirurgia , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/etiologia , Gravidez , Estudos Retrospectivos , Resultado do Tratamento , Hemorragia Uterina/epidemiologia , Hemorragia Uterina/etiologia , Útero/cirurgia
16.
Fertil Steril ; 112(1): 140-148.e12, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31056314

RESUMO

OBJECTIVE: To determine the most effective analgesia for pain relief during the outpatient endometrial biopsy (OEB) or outpatient hysteroscopy with endometrial aspiration (EA). DESIGN: Systematic review and network meta-analysis of randomized controlled trials. SETTING: Not applicable. PATIENT(S): Pre- or postmenopausal women undergoing OEB or outpatient hysteroscopy with EA for evaluation of uterine pathology. INTERVENTION(S): We conducted an electronic search of the following bibliographic databases: Medline via PubMed, SCOPUS, Web of Science, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials (CENTRAL). MAIN OUTCOME MEASURE(S): The intensity of pain during, immediately after, and 10-30 minutes after procedure assessed by the 10-cm visual analog scale. RESULT(S): Lidocaine spray was the most effective medication for reducing pain during OEB (P-score = 0.83) and immediately after OEB (P-score = 0.96). On the other hand, naproxen sodium was the most effective medication for reducing pain during outpatient hysteroscopy with EA (P-score = 1.00), followed by misoprostol plus lidocaine (P-score = 0.87). CONCLUSION(S): Lidocaine spray, either alone or with topical application of lidocaine, is the most effective medication for reducing the pain during and after the OEB. Naproxen sodium is the most effective analgesic option during outpatient hysteroscopy with EA.


Assuntos
Assistência Ambulatorial/métodos , Analgésicos/administração & dosagem , Biópsia/efeitos adversos , Endométrio/patologia , Histeroscopia/efeitos adversos , Manejo da Dor/métodos , Dor/prevenção & controle , Hemorragia Uterina/patologia , Analgésicos/efeitos adversos , Anestésicos Locais/administração & dosagem , Anti-Inflamatórios não Esteroides/administração & dosagem , Feminino , Humanos , Lidocaína/administração & dosagem , Naproxeno/administração & dosagem , Metanálise em Rede , Dor/diagnóstico , Dor/etiologia , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Sucção/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Hemorragia Uterina/etiologia
17.
J Coll Physicians Surg Pak ; 29(6): 577-579, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31133160

RESUMO

A 44-year female was admitted to the hospital, complaining of vaginal bleeding. Ultrasound imaging revealed two masses in the pelvic cavity, measuring 6.6 x 3.4 x 1.8 cm and 8.2 x 4.7 x 3.7 cm in size. After surgical debulking of the tumours, the patient underwent abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic disease dissection, appendicectomy, omentectomy, and pelvic lymph node dissection. Histological and immunochemical examinations confirmed the diagnosis of serous carcinomas in both ovaries involving the right tubal fimbria, the omentum, pelvic nodules, and the endometrium. Ovarian serous carcinoma spreading to the endometrium is a rare phenomenon and may mimick a primary uterine serous cercinoma. Although difficult, it is important to distinguish concomitant independent primary tumours from metastases because the most appropriate management strategy and prognosis differs in both.


Assuntos
Carcinoma Endometrioide/secundário , Cistadenocarcinoma Seroso/patologia , Neoplasias do Endométrio/secundário , Procedimentos Cirúrgicos em Ginecologia/métodos , Histerectomia/métodos , Neoplasias Ovarianas/patologia , Neoplasias do Colo do Útero/secundário , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biópsia , Carcinoma Endometrioide/patologia , Carcinoma Endometrioide/cirurgia , Cistadenocarcinoma Seroso/cirurgia , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Excisão de Linfonodo , Metástase Linfática , Estadiamento de Neoplasias , Neoplasias Ovarianas/cirurgia , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgia , Hemorragia Uterina/etiologia
19.
BMJ Case Rep ; 12(3)2019 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-30936330

RESUMO

Carcinosarcoma of the uterine cervix is a very rare tumour that has been described in less than 70 cases in the literature. It is less common compared with carcinosarcoma of the uterine corpus and it can have two origins: the Müllerian ducts and the mesonephric duct remnants. The association of mesonephric carcinoma with a sarcomatous component was reported in only 11 cases, including the following. We describe a case of a 64-year-old woman, presenting with vaginal bleeding and a cervical lesion reported as a sarcoma of endometrial stroma in the first biopsy. After exclusion of distant disease, she was submitted to radical surgery and the final histopathological examination showed a carcinosarcoma of the cervix with mesonephric origin.


Assuntos
Neoplasias Ósseas/secundário , Carcinossarcoma/diagnóstico , Colo do Útero/patologia , Mesonefroma/patologia , Neoplasias do Colo do Útero/diagnóstico , Hemorragia Uterina/etiologia , Carcinossarcoma/patologia , Carcinossarcoma/terapia , Quimioterapia Adjuvante , Evolução Fatal , Feminino , Humanos , Histerectomia , Excisão de Linfonodo , Pessoa de Meia-Idade , Ovariectomia , Salpingectomia , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/terapia
20.
Emerg Med Clin North Am ; 37(2): 153-164, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30940364

RESUMO

Abnormal uterine bleeding (AUB) unrelated to pregnancy affects 20% to 30% of women at some point in life and is a common emergency department (ED) and urgent care (UC) presentation. AUB is a complex condition with extensive terminology, broad differential diagnosis, and numerous treatment options, yet few published evidence-based guidelines. In the ED or UC setting most affected patients are often more frustrated than acutely ill. These factors can make for a challenging patient encounter in the EC/UC setting. This article reviews acute and chronic AUB in the nonpregnant patient and suggests a simplified approach for its evaluation and management.


Assuntos
Hemorragia Uterina/etiologia , Doença Aguda , Emergências , Serviço Hospitalar de Emergência , Feminino , Humanos , Ressuscitação , Hemorragia Uterina/terapia
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