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1.
Mymensingh Med J ; 30(4): 907-912, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34605455

RESUMO

Uterine leiomyoma is a common gynecological problem throughout the world. As 50% hysterectomies in black and 40% in Australians are performed due to fibroid, in our country also it is assumed that about 40%-50% hysterectomies are done due to fibroid uterus. Thus leiomyoma constitute a major public health cost to the community in terms of outpatient attendance and hospital cost for surgery. This is a descriptive type of cross sectional study among 50 patients having leiomyoma of uterus in the department of Obs and Gynae, BSMMU hospital from March 2011 to August 2011. The objective of the study is to find out the risk associated with leiomyoma, to find out the common presenting features of uterine leiomyoma and to find out best options for management. Study results showed that 62% patients were in the age group 36-45 years, 48%patients were in para1-2 group, 32% patients used combined oral contraceptive pill for contraception. Sixty percent (60%) patients presented with progressive menorrhagia and palpable mass was found in 62% cases. About 46% patients had associated medical conditions like hypertension, diabetes, obesity. Total abdominal hysterectomy was done in 32% cases. TAH with unilateral or bilateral salpingoophorectomy was done in 40% cases. Myomectomy was done in 20% cases. There is a scope for large scale study about risk factors of uterine leiomyoma like obesity, diabetes mellitus, hypertension, use of hormonal contraceptive, racial differences, different treatment modalities etc. Treatment should be individualized. However in this connection a good referral system and good communication has got a tremendous contribution in the proper management of such problems.


Assuntos
Leiomioma , Neoplasias Uterinas , Adulto , Austrália , Estudos Transversais , Feminino , Humanos , Histerectomia , Leiomioma/diagnóstico , Leiomioma/epidemiologia , Leiomioma/cirurgia , Pessoa de Meia-Idade , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/epidemiologia , Neoplasias Uterinas/cirurgia , Útero
2.
Mymensingh Med J ; 30(4): 997-1002, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34605469

RESUMO

The residual ovary syndrome (ROS) occurs in patients where one or both ovaries are conserved at the time of hysterectomy. It occurs mostly within 10 years of hysterectomy. Residual ovary syndrome usually requires surgery and histology varies from some physiological cysts to benign or even malignant neoplasms. The objectives of the study were to analyze the etiopathology of re-operation for ROS and to find out their clinical presentations. This cross-sectional observational study was conducted in the department of Obstetrics and Gynaecology, BSMMU during a period of 5 years from January 2014 to December 2018. All consecutive patients admitted with residual ovary syndrome (ROS) at the department of Obstetrics and Gynaecology and also in Gynae-oncology department at Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh. Total 40 cases were enrolled according to selection criteria and sampling technique was purposive. The mean age of the study populations was 42.20±7.13 years. All of the study populations were parous except one who was nulliparous. The mean age of hysterectomy was 37.25±6.44 years. The indication of primary surgery by hysterectomy was fibroid in 50% of cases; others were abnormal uterine bleeding, pelvic inflammatory disease etc. After primary surgery majority (77.5%) of the study populations presented with chronic pain with or without dyspareunia and 20% presented with lump in abdomen either symptomatic or asymptomatic. Around half (57.5%) of the patients were presented within 5 years and 82.5% within 10 years of hysterectomy. Per-operative findings of secondary surgery for ROS were mainly extensive peri-ovarian and peritoneal adhesions involving surrounding structures. Among them majority (77.5%) of the cases were presented with various types of cystic and complex masses in the ovaries. Histopathological reports of residual ovary were functional cysts 35.0% (n=14), Corpus luteal cyst 12.5% (n=5), endometriotic cyst 12.5% (n=5), benign ovarian tumours 37.5% (n=15) and malignant ovarian tumour 2.5% (n=1). ROS, usually requires surgery which in most of the cases becomes troublesome due to presence of extensive adhesions with surrounding structures. So, decision is crucial whether to remove or conserve apparently healthy ovaries found at hysterectomy in pre-menopausal women. Moreover decision of hysterectomy in premenopausal women should be taken very judiciously as several medicines are available for conservative management. Usually indications of hysterectomy are benign.


Assuntos
Cistos Ovarianos , Neoplasias Ovarianas , Adulto , Estudos Transversais , Feminino , Humanos , Histerectomia , Pessoa de Meia-Idade , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/epidemiologia , Neoplasias Ovarianas/cirurgia , Gravidez
3.
BMJ Case Rep ; 14(9)2021 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-34593553

RESUMO

A 40-year-old woman presents with recurrent secondary postpartum haemorrhage (PPH) following her third normal vaginal delivery. Histology from subsequent evacuation of the uterus confirmed that she had subinvolution of the placental implantation site. Hysterectomy is the most common method of managing this condition and recurrent PPH, most often due to significant vaginal bleeding. We present a case of subinvolution of the placental implantation site with recurrent PPH managed with medical treatment alone, to offer a fertility-sparing treatment option.


Assuntos
Hemorragia Pós-Parto , Adulto , Parto Obstétrico , Feminino , Humanos , Histerectomia , Placenta , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/cirurgia , Gravidez , Útero
4.
BMJ Case Rep ; 14(10)2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34598970

RESUMO

Placenta accreta spectrum disorder varies from minimally adherent placenta to deeply invasive placenta. Placenta percreta is a rare cause for uterine rupture and the incidence of morbidly adherent placenta is on the rise due to increase in the rates of caesarean section. We report a case of a 32-year-old, G2P1L1 who presented to us at 27 weeks in a state of haemodynamic shock with intrauterine fetal death. She had a history of prior caesarean section complicated by postpartum haemorrhage requiring B-Lynch suturing. With an initial diagnosis of caesarean scar rupture, she underwent an emergency laparotomy. Intraoperatively, the caesarean scar was found to be intact and uterine fundal rupture with placental protrusion identified. She underwent caesarean hysterectomy and was discharged in a stable condition. The histopathology report confirmed the diagnosis of placenta percreta.


Assuntos
Placenta Acreta , Ruptura Uterina , Adulto , Cesárea/efeitos adversos , Feminino , Humanos , Histerectomia , Placenta , Placenta Acreta/diagnóstico por imagem , Placenta Acreta/etiologia , Placenta Acreta/cirurgia , Gravidez , Suturas , Ruptura Uterina/etiologia , Ruptura Uterina/cirurgia
5.
BMJ Case Rep ; 14(9)2021 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-34531234

RESUMO

We report a case of a 36-year-old gravida 2 para 1 woman at 38 weeks of gestation. A caesarean section was performed for severe pre-eclampsia, intrauterine growth restriction and oligohydramnios. The patient suffered postoperative bleeding, and exploratory laparotomy was performed. Uterine atonia, Couvelaire uterus and left adnexal haematoma were found, requiring a supracervical hysterectomy. As COVID-19 pneumonia and superimposed bacterial infection developed, the patient was mechanically ventilated in the intensive care unit. Remdesivir and meropenem were initially administered, but were changed to levofloxacin and ciprofloxacin following antibiotic sensitivity tests. Blood culture grew Enterococcus galinarum Meanwhile, bleeding of the incisional wound occurred, which was controlled by the cessation of heparin therapy and regular wound care. With intensive monitoring and multidisciplinary management, the patient's condition improved, and she was discharged from the hospital on day 25 from admission.


Assuntos
COVID-19 , Cesárea , Adulto , Feminino , Humanos , Histerectomia , Gravidez , Gestantes , SARS-CoV-2
6.
Ceska Gynekol ; 86(4): 250-257, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34493050

RESUMO

OBJECTIVE: Description of the case of recurrence of a rare malignant Brenner ovarian tumour. METHODS: Author observation and literature resources. RESULTS: Occurrence of a rare malignant Brenners tumor in a 66-year-old patient. After radical surgery (abdominal hysterectomy with bilateral adnexectomy, pelvic and paraaortic lymphadenectomy, omentectomy and appendectomy) and after adjuvant chemotherapy, recurrence of the disease was observed after 30 months. CONCLUSIONS: The case report describes rare occurrence of a malignant Brenner tumour and its relapse.


Assuntos
Tumor de Brenner , Neoplasias Ovarianas , Idoso , Tumor de Brenner/cirurgia , Feminino , Humanos , Histerectomia , Recidiva Local de Neoplasia/cirurgia , Neoplasias Ovarianas/cirurgia
7.
Harefuah ; 160(9): 583-585, 2021 09.
Artigo em Hebraico | MEDLINE | ID: mdl-34482670

RESUMO

INTRODUCTION: Vesico-vaginal fistula, is a known complication that can occur following damage to the bladder wall during pelvic surgery or prolonged birth. Prompt and accurate diagnosis and timely repair are essential for a quick solution to the problem, and a reduction in medico-legal claims. Successful treatment requires an accurate assessment of the size and the location of the fistula, determination of timing and the surgical technique. There is an approach that advocates postponing the surgery for several months until "tissue healing" subsides and some advocate immediate repair. In our department, the surgery is performed early, immediately upon diagnosis without delay. The aim of the work is to define the clinical manifestation of fistula after surgery, to analyze the factors, and to summarize the experience of an early intervention. METHODS: We reviewed the records of consecutive patients undergoing repair of urogenital fistulas at our institution. Patients with only vesico-vaginal fistulas were included. We recorded demographic characteristics, as well as surgical data, and postoperative complications were also collected. The follow-up period was at least 3 months. RESULTS: A total of 67 women with urogenital fistulas were identified, of whom 37 were only with vesico-vaginal fistulas. Iatrogenic injury, during hysterectomy was the main cause in 70.3%; 2 women were treated conservatively. A repair in the vaginal approach was performed in 31 women, and in 4 women the repair was performed in the abdominal approach, of them, two underwent urethral re-implantation simultaneously. Complications included sepsis in one case, and vaginal cuff dehiscence in another. The success rate of the repair was 92%. Recurrence occurred in 3 patients, of whom 2 had a history of previous radiation. CONCLUSIONS: A vesico-vaginal fistula can be successfully repaired by early repair, without delay, thus saving the patient considerable distress and discomfort.


Assuntos
Fístula Vesicovaginal , Feminino , Humanos , Histerectomia , Resultado do Tratamento , Fístula Vesicovaginal/diagnóstico , Fístula Vesicovaginal/etiologia , Fístula Vesicovaginal/cirurgia
8.
JNMA J Nepal Med Assoc ; 59(239): 622-625, 2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34508502

RESUMO

INTRODUCTION: Pelvic surgery is the most common cause of iatrogenic ureteral injury. The incidence of ureteric injuries varies between skilled and inexperienced surgeons. The study aims to determine the prevalence of ureteric injuries sustained during hysterectomy in a tertiary care center of Nepal. METHODS: A descriptive cross-sectional study involving the women attending the gynecological outpatient department of a tertiary care center of Nepal, for various benign and malignant conditions and later on underwent hysterectomy from June 2019 to June 2020 was done after obtaining ethical clearence from the Institutional Review Committee (Reference No. 245). Convenient sampling method was used. The data were entered in Excel and analyzed using Statistical Package for Social Sciences version 17. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: Altogether, 1 (0.63%) (0.55-0.71 at 95% Confidence Interval) out of 159 patients sustained the ureteric injury during hysterectomy in a tertiary care center of Nepal. The injury was seen during the exploratory laparotomy for adnexal mass. The injury was recognized intraoperatively and was repaired with double J stenting. A total of 159 patients were enrolled in the study that had undergone hysterectomy over one year for various benign and malignant conditions. Out of which 21 (13.2%) had undergone surgeries for malignant conditions and 138 (86.79%) for benign conditions. CONCLUSIONS: Iatrogenic ureteric is still a major cause of harm and concern in hysterectomy. Patients with ureteric injury should be evaluated and intervened at the earliest.


Assuntos
Histerectomia , Estudos Transversais , Feminino , Humanos , Histerectomia/efeitos adversos , Nepal/epidemiologia , Prevalência , Centros de Atenção Terciária
9.
Am J Case Rep ; 22: e932916, 2021 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-34497258

RESUMO

BACKGROUND Giant cell carcinoma of the endometrium is one of the rare variants of endometrial carcinoma, with a very limited number of reported cases and limited follow-up data. The purpose of this case report is to present yet another example of endometrial giant cell carcinoma, discuss its differential diagnosis and management course, and review all previously reported cases. CASE REPORT We report a case of a 71-year-old woman who presented with vaginal bleeding. Her laboratory investigations were within normal limits except for her glycated hemoglobin, which was 10%. Ultrasound and computed tomography scans showed an endometrial mass invading the myometrium. Microscopically, the tumor is comprised almost exclusively of multinucleated giant cells. The patient underwent a total robotic hysterectomy with bilateral salpingo-oophorectomy and lymph nodes dissection, and she is currently undergoing adjuvant radiotherapy. CONCLUSIONS Giant cell carcinoma of the endometrium is a rare diagnosis that can be established by histopathological examination after excluding the other common giant cell-rich lesions that may occur in the endometrium.


Assuntos
Carcinoma de Células Gigantes , Neoplasias do Endométrio , Idoso , Neoplasias do Endométrio/diagnóstico , Neoplasias do Endométrio/cirurgia , Endométrio , Feminino , Humanos , Histerectomia , Ultrassonografia
10.
Rev Assoc Med Bras (1992) ; 67(3): 426-430, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34468609

RESUMO

OBJECTIVE: To determine if there is a difference between uterine incision techniques (vertical vs. transversal) in terms of clinical results. METHODS: All women with leiomyomas who underwent open abdominal myomectomy (n=61) between March and August 2016 at the Gynecology and Obstetrics Clinic at the Women's Health Research and Training Hospital Zekai Tahir Burak were included, and the clinical results were included and prospectively reviewed. RESULTS: The estimated blood loss during myomectomy increased in the transversal group compared with the vertical group (809.33±483.34 versus 405.32±180.95 mL, p<0.001). The average operation duration was 60 min, and the patients got discharged on the second day after surgery. No intergroup statistical differences were observed in the surgical procedure. CONCLUSIONS: Surgeons should give preference to the most viable incision depending on the size and location of the leiomyoma.


Assuntos
Laparoscopia , Leiomioma , Miomectomia Uterina , Neoplasias Uterinas , Perda Sanguínea Cirúrgica/prevenção & controle , Feminino , Hemorragia , Humanos , Histerectomia , Leiomioma/cirurgia , Gravidez , Miomectomia Uterina/efeitos adversos , Neoplasias Uterinas/cirurgia
11.
World J Surg Oncol ; 19(1): 288, 2021 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-34579736

RESUMO

BACKGROUND: Minimally invasive surgery for early cervical cancer is debated. We developed this new vaginal-assisted gasless laparoendoscopic single-site radical hysterectomy for early cervical cancer, and we aimed to evaluate the feasibility and safety of this surgical procedure and observe the early oncologic outcomes. METHODS: From January 2019 to August 2020, patients with early cervical cancer who underwent vaginal-assisted gasless laparoendoscopic single-site radical hysterectomy were studied retrospectively. The clinical characteristics, pathologic outcomes, perioperative outcomes, and follow-up details of the patients were recorded. RESULTS: Forty-eight patients underwent vaginal-assisted gasless laparoendoscopic single-site radical hysterectomy were included, 14 (29.2%) with stage IB1, 13 (27.1%) with stage IB2, 7 (14.6%) with stage IB3, 10 (20.8%) with stage IIA1, and 4 (8.3%) stage with IA2. The mean age at diagnosis was 50.4 (range 28-72) years old. The mean operative time was 237.3 min (range 162-393), and the mean estimated blood loss was 246.5 ml (range 80-800). No intraoperative complications occurred, and there were no patients who were readmitted. Histological types were distributed as follows: squamous cell carcinoma 72.9%, adenocarcinoma 10.4%, and adenosquamous cell carcinoma 16.7%. There were 2 patients (4.2%) with positive nodes, 20 patients (41.7%) with positive lymphovascular space invasion, and 2 patients (4.2%) with positive parametria. Twenty-eight patients (58.3%) received adjuvant therapy after the operation. With a mean follow-up of 17.7 months (range 6-26), there were no recurrent cases, and 11 patients (22.9%) suffered lower limb lymphoedema. CONCLUSIONS: The vaginal-assisted gasless laparoendoscopic single-site radical hysterectomy might be a feasible technique for early cervical cancer, with promising short-term oncological outcomes and safety. A prospective study with more patients and longer follow-up periods should be performed to further evaluate the safety and oncological outcomes.


Assuntos
Carcinoma Adenoescamoso , Laparoscopia , Neoplasias do Colo do Útero , Adulto , Idoso , Carcinoma Adenoescamoso/cirurgia , Feminino , Humanos , Histerectomia/efeitos adversos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Projetos Piloto , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgia
12.
JNMA J Nepal Med Assoc ; 59(240): 814-817, 2021 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-34508482

RESUMO

Cervical carcinoma is the most common cause of mortality due to cancer in Nepal. Carcinosarcoma is a very rare subtype of cervical cancer which is characterized by the presence of both epithelial and mesenchymal malignant component. It constitutes less than 1% of cervical carcinoma. Due to the low occurrence of the disease, most of the data on treatment and prognosis are based on case reports and series. Here, we report a case of 69 years, female with cervical cancer (FIGO IIA2). Histopathological and immunohistochemical analysis of cervical biopsy initially showed primary adenosarcoma of the cervix. The tumor was non-responsive to primary treatment with concurrent chemoradiation. Later she was treated with abdominal hysterectomy and bilateral salpingo-oophorectomy. The final histopathology of the resected specimen showed a sarcomatous component along with carcinomatous changes in the endocervical glands favouring the diagnosis of carcinosarcoma of the cervix.


Assuntos
Adenossarcoma , Carcinossarcoma , Neoplasias do Colo do Útero , Adenossarcoma/cirurgia , Idoso , Carcinossarcoma/diagnóstico , Carcinossarcoma/cirurgia , Feminino , Humanos , Histerectomia , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/terapia
13.
BMJ Case Rep ; 14(9)2021 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-34518171

RESUMO

A woman in her mid-20s presented with bleeding at 18 weeks gestation from a cervical 'polyp'. Histopathology demonstrated a rare small cell neuroendocrine of the cervix. There were only 18 cases of neuroendocrine tumours of the cervix in and around pregnancy in the literature, so the evidence base for treatment was scarce. She was treated with neoadjuvant chemotherapy, using a regimen used for small cell neuroendocrine tumours of the lung, to allow for fetal lung maturity. Disease initially responded, then progressed and she was delivered at 32 weeks by caesarean radical hysterectomy. Adjuvant treatment included further chemotherapy and radical pelvic radiotherapy. The woman and her child are doing well over 6 years after treatment, although the woman has significant side effects of both radical surgery and radiotherapy. This case emphasises the need for excellent communication between multidisciplinary professionals, patients and their families and using external colleagues to help with rare clinical problems.


Assuntos
Tumores Neuroendócrinos , Neoplasias do Colo do Útero , Adulto , Feminino , Humanos , Histerectomia , Terapia Neoadjuvante , Gravidez , Neoplasias do Colo do Útero/cirurgia
14.
Rev Assoc Med Bras (1992) ; 67(5): 753-758, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34550268

RESUMO

OBJECTIVE: A surgery is essential for the management of early endometrial carcinoma. Due to the comorbidities associated with the disease, the complications of surgery are common. Laparoscopic surgery may reduce surgical complications but also have oncological risks. We aimed to compare recurrence and overall survival (OS) associated with laparoscopy and laparotomy for early endometrial cancer. METHODS: We included women treated for presumed early endometrial carcinoma at the Clinics Hospital of Ribeirão Preto Medical School from January 1998 to December 2017. We designed a 1:2 propensity score-matched case-control and compared the patients' characteristics, short-term outcomes, recurrence, and OS. RESULTS: A total of 252 women were included in this study, 168 underwent laparotomy, and 84 underwent laparoscopy. The two groups were well balanced according to most of the variables, and obesity was a characteristic of patients in both groups. Laparoscopy was associated with increased surgical time (194.7 min vesus 165.6 min; p<0.001) and reduced rate of surgical complications (6.5% versus 0; p=0.038). Laparoscopic surgery was not associated with the risk of tumor recurrence (HR: 0.41, 95%CI 0.14-1.19, p=0.100) or all-cause mortality (HR: 0.49, 95%CI 0.18-1.35, p=0.170). CONCLUSION: Laparoscopy was safe in terms of oncological outcomes and was associated with a lower rate of surgical complications. Our data support the use of minimally invasive surgery as the preferential approach in the management of early endometrial carcinoma.


Assuntos
Neoplasias do Endométrio , Laparoscopia , Estudos de Casos e Controles , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Histerectomia , Laparotomia , Recidiva Local de Neoplasia/epidemiologia , Estadiamento de Neoplasias , Pontuação de Propensão , Estudos Retrospectivos
15.
Nat Commun ; 12(1): 5448, 2021 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-34521855

RESUMO

Mechanical forces in a constrained cellular environment were recently established as a facilitator of chromosomal damage. Whether this could contribute to tumorigenesis is not known. Uterine leiomyomas are common neoplasms that display relatively few chromosomal aberrations. We hypothesized that if mechanical forces contribute to chromosomal damage, signs of this could be seen in uterine leiomyomas from parous women. We examined the karyotypes of 1946 tumors, and found a striking overrepresentation of chromosomal damage associated with parity. We then subjected myometrial cells to physiological forces similar to those encountered during pregnancy, and found this to cause DNA breaks and a DNA repair response. While mechanical forces acting in constrained cellular environments may thus contribute to neoplastic degeneration, and genesis of uterine leiomyoma, further studies are needed to prove possible causality of the observed association. No evidence for progression to malignancy was found.


Assuntos
Aberrações Cromossômicas , Reparo do DNA , Leiomioma/genética , Complexo Mediador/genética , Paridade , Neoplasias Uterinas/genética , Adulto , Fenômenos Biomecânicos , Quebras de DNA de Cadeia Dupla , Feminino , Expressão Gênica , Humanos , Histerectomia , Cariótipo , Leiomioma/etiologia , Leiomioma/patologia , Leiomioma/cirurgia , Mutação , Miócitos de Músculo Liso/metabolismo , Miócitos de Músculo Liso/patologia , Miométrio/metabolismo , Miométrio/patologia , Gravidez , Cultura Primária de Células , Estudos Prospectivos , Neoplasias Uterinas/etiologia , Neoplasias Uterinas/patologia , Neoplasias Uterinas/cirurgia
16.
BMC Womens Health ; 21(1): 329, 2021 09 11.
Artigo em Inglês | MEDLINE | ID: mdl-34507569

RESUMO

BACKGROUND: Decreased ovarian function and reserve is one of the complications of hysterectomy. In this study, we aimed to compare anti-müllerian hormone (AMH) levels between total abdominal hysterectomy (TAH), and total laparoscopic hysterectomy (TLH). METHODS: In this prospective cohort study, serum levels of AMH were compared between the groups undergoing TAH + bilateral salpingectiomy and TLH, in 66 patients (33 in each group) who referred to the hospitals of Shiraz University of Medical Sciences for hysterectomy during one years of work. The collected information included age, weight, gravidity, parity, regularity of menstrual cycle, uterine weight, blood loss during surgery, and serum levels of AMH before and 6 months after surgery, compared between groups. RESULTS: Most patients (88% in TAH and 73% in TLH group) aged 40-50 years. Mean age, weight, parity of patients was similar in both groups, while blood loss was significantly less in TLH group (P < 0.01). Median (IQR) of pre-surgical AMH values were 0.40 (0.55) ng/ml in the TLH group and 0.92 (1.23) ng/ml in the TAH group (P = 0.12) that decreased to 0.29 (0.44) ng/ml in the TLH group and 0.15 (0.31) ng/ml in the TAH group (P = 0.02). Also Median (IQR) of the difference between pre and post-surgical AMH values were 0.12 (0.31) and 0.58 (1.17) in TLH and TAH group, respectively (P = 0.003). CONCLUSION: The serum levels of AMH decreased significantly after both methods of hysterectomy (laparoscopy and laparotomy), while this decrease was greater in TAH group that shows.


Assuntos
Laparoscopia , Reserva Ovariana , Hormônio Antimülleriano , Estudos de Coortes , Feminino , Humanos , Histerectomia/efeitos adversos , Lactente , Estudos Prospectivos , Salpingectomia
17.
Medicine (Baltimore) ; 100(38): e27148, 2021 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-34559103

RESUMO

BACKGROUND: Endometrial carcinoma is a prevalent form of cancer. In fact, its incidence ranks fourth among European and North American females. Moreover, it is the most common gynecological malignant disease. Laparotomy, bilateral salpingo-oophorectomy, total abdominal hysterectomy, etc were common methods adopted in conventional open surgery. Recent developments in laparoscopic surgery (LPS) has made it more effective. The present study aims to compare the outcomes between LPS and a conventional open surgical procedure to treat stage II endometrial carcinoma patients. METHODS: A comprehensive search will be conducted on Cochrane library, PubMed, Web of Science, EMBASE, and China National of Knowledge Infrastructure to collect LPS and conventional open surgery in treating stage II endometrial carcinoma. The search will consider all articles published since the inception of the databases till July 2021. A pair of scholars will perform independent screening of the literature and extracted data to evaluate the bias risk in the selected studies. Afterwards, RevMan5.3 software will be used to conduct a meta-analysis. CONCLUSION: This study will conduct a meta-analysis to compare the clinical efficacy of LPS and conventional open surgery in the treatment of stage II endometrial carcinoma.


Assuntos
Neoplasias do Endométrio/cirurgia , Neoplasias do Endométrio/mortalidade , Neoplasias do Endométrio/patologia , Feminino , Humanos , Histerectomia , Laparoscopia , Metanálise como Assunto , Estadiamento de Neoplasias , Complicações Pós-Operatórias , Revisões Sistemáticas como Assunto
18.
Gan To Kagaku Ryoho ; 48(8): 1069-1071, 2021 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-34404079

RESUMO

This report describes the case of a 36-year-old woman with stage ⅠB1 cervical adenocarcinoma that was diagnosed when her fetus was at 19 weeks of gestation. Both she and her family strongly hoped that her pregnancy could continue. After approval by the Ethics Committee of our hospital, she was treated with paclitaxel and carboplatin. At 32 weeks of gestation, the patient delivered a 1,518 g female newborn via cesarean section. A radical hysterectomy with pelvic lymphadenectomy was performed after delivery. The newborn had Apgar scores of 3 at 1 minute and 5 at 5 minutes. No external malformations were observed. The Kyoto Scale of Psychological Development 2001 was used for cognitive assessment. Although the Language-Social Developmental Quotient score was 65 and developmental delay was observed at 1 year 8 months, the score improved to 98 at 3 years 5 months. The child was followed up until the age of 6 years 2 months and showed no developmental delay. Presentation of this case is important because there are few reports in Japan about the development of children of cancer patients who are exposed to anticancer drugs during pregnancy.


Assuntos
Complicações Neoplásicas na Gravidez , Neoplasias do Colo do Útero , Adulto , Cesárea , Criança , Desenvolvimento Infantil , Feminino , Humanos , Histerectomia , Gravidez , Complicações Neoplásicas na Gravidez/tratamento farmacológico , Complicações Neoplásicas na Gravidez/cirurgia , Neoplasias do Colo do Útero/cirurgia
19.
BMJ Case Rep ; 14(8)2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34404659

RESUMO

A 37-year-old nulliparous woman with abnormal uterine bleeding and a uterine mass suggestive of a leiomyoma not responding to medical therapy was submitted to two hysteroscopies with histological analysis. The first one showed a 'leiomyoma' and the second a 'uterine smooth muscle tumour of uncertain malignant potential/epithelioid leiomyosarcoma, with positivity for hormonal receptors'. The patient was submitted to a total hysterectomy with bilateral salpingo-oophorectomy, and the microscopic examination of the tumour revealed a 'uterine tumour resembling ovarian sex-cord tumours'. According to the literature, most cases are diagnosed in postmenopausal women and have a favourable prognosis. These rare tumours have uncertain malignant potential and have no established treatment protocol, but it appears that a fertility-sparing approach is possible once they are well diagnosed.


Assuntos
Leiomioma , Leiomiossarcoma , Tumor de Músculo Liso , Neoplasias Uterinas , Adulto , Feminino , Humanos , Histerectomia , Leiomioma/diagnóstico por imagem , Leiomioma/cirurgia , Leiomiossarcoma/diagnóstico por imagem , Leiomiossarcoma/cirurgia , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias Uterinas/cirurgia
20.
J Int Med Res ; 49(8): 3000605211039809, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34433340

RESUMO

OBJECTIVE: We conducted a meta-analysis and systematic review to evaluate the effects of dexmedetomidine on the hemodynamics of patients undergoing hysterectomy. METHODS: We searched the Medline, Embase, and Cochrane Central Register of Controlled Trials databases for clinical randomized controlled trials (RCTs) that allowed direct or indirect comparisons of hemodynamic indicators. We also searched nine English-language databases up to April 2021 to identify relevant research. The Cochrane risk-of-bias tool for RCTs was applied to assess the methodological quality of the eligible studies. The meta-analysis was conducted using RevMan 5.4 software. RESULTS: Nine trials were included in this systematic review. The effect of dexmedetomidine on heart rate during surgery was significantly smaller than that of other sedatives. Intraoperative systolic and diastolic blood pressure and mean arterial pressure were more stable in the dexmedetomidine group compared with the control group. The postoperative modified Observer's Assessment of Alertness Score was also better in the dexmedetomidine compared with the control group. CONCLUSIONS: Dexmedetomidine increases hemodynamic stability in patients undergoing hysterectomy, reduces the cardiovascular stress response during surgery, and effectively prevents postoperative adverse reactions, with good safety.


Assuntos
Dexmedetomidina , Pressão Sanguínea , Dexmedetomidina/uso terapêutico , Feminino , Hemodinâmica , Humanos , Hipnóticos e Sedativos , Histerectomia
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