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2.
BJOG ; 128(1): 87-95, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32575151

RESUMO

OBJECTIVE: To evaluate the effectiveness of virtual reality as a distraction technique in the management of acute pain and anxiety during outpatient hysteroscopy. DESIGN: Parallel group, prospective randomised controlled trial. SETTING: UK University Hospital. METHODS: Forty consenting, eligible women were randomised to virtual reality intervention (immersive video content as a distraction method) or standard care during outpatient hysteroscopy from August to October 2018. MAIN OUTCOME MEASURES: Pain and anxiety outcomes were measured as a numeric rating score (scale 0-10). RESULTS: Compared with standard care, women with virtual reality intervention experienced less average pain (score 6.0 versus 3.7, mean difference 2.3, 95% CI 0.61-3.99, P = 0.009) and anxiety (score 5.45 versus 3.3, mean difference 2.15, 95% CI 0.38-3.92, P = 0.02). CONCLUSION: Virtual reality was effective in reducing pain and anxiety during outpatient hysteroscopy in a mixed-methods randomised control trial. Its wide potential role in ambulatory gynaecological procedures needs further evaluation. TWEETABLE ABSTRACT: Virtual reality can be used as a part of a multimodal strategy to reduce acute pain and anxiety in patients undergoing outpatient hysteroscopy.


Assuntos
Histeroscopia , Pacientes Ambulatoriais , Dor/prevenção & controle , Realidade Virtual , Adulto , Feminino , Hospitais Universitários , Humanos , Medição da Dor , Estudos Prospectivos , Resultado do Tratamento
3.
Zhonghua Yi Xue Za Zhi ; 100(47): 3784-3787, 2020 Dec 22.
Artigo em Chinês | MEDLINE | ID: mdl-33379843

RESUMO

Objective: To investigate the effect of laparoscopic modified with two different sutures on the cesarean incision diverticulum repair. Methods: From July 2018 to July 2019, 35 patients with refertility requirements who were confirmed the diagnosis of caesarean incision diverticulum by hysteroscopy combined with ultrasound, and the muscle layer thickness at the top of diverticulum was less than 3 mm, received modified laparoscopic combined with hysteroscopic surgery in department of gynecological minimally invasive center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Ten patients with history of secondary repair and multiple pelvic operations were excluded. The remaining 25 patients were divided into group A (n=8): underwent laparoscopic "folding suture" , preserving the integrity of the diverticulum of the cesarean incision; Group B (n=17): underwent laparoscopic incision and complete excision of the scar of the diverticulum. The operation time, bleeding volume, postoperative exhaust time, improvement of symptoms and the thickness of muscle layer were compared between the two groups. Results: All patients underwent surgery without complications. 25 patients were followed up one month, three months and half a year after operation, and followed up by telephone for 6-18 months. The operation time of group A and B was (56±12) min, (72±15) min, and the bleeding volume was (40±9) ml and (66±10) ml respectively. The cure rate was 87.5% and 58.8% respectively, the differences were statistically significant (t=6.778, 4.057, χ(2)=5.651, P<0.05). But the postoperative exhaust time was (16±6) h, (18±7) h, and the effective rate was 100.0% and 94.1% respectively, with no significant difference(t=1.967, χ(2)=0.725, P>0.05). Conclusion: Two different suture repair methods under laparoscope are safe and effective for the treatment of diverticulum in cesarean section incision. Among them, the laparoscopic "folding suture" method has a short operation time and preserves the integrity of the myometrium. It is worth popularizing for the elderly patients who has an urgent need for fertility.


Assuntos
Cesárea , Laparoscopia , Idoso , Cicatriz/cirurgia , Feminino , Humanos , Histeroscopia , Gravidez , Suturas , Resultado do Tratamento
4.
Wiad Lek ; 73(9 cz. 2): 2004-2009, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33148849

RESUMO

OBJECTIVE: The aim: To conduct a comparative analysis of the results of ultrasound and hysteroscopic examinations with further histopathological findings and the clinical and anamnestic features of patients with hyperproliferative pathology in order to determine the etiopathogenetic mechanisms of the development of endometrial pathological processes. PATIENTS AND METHODS: Materials and methods: We studied 119 medical records of patients of the Gynecological Department of Minipal Non-Commercial Enterprise "Ternopil Municipal City Hospital No. 2", who applied for medical assistance because of benign endometrial hyperplasia in the reproductive age with a verified diagnosis of "uterine polyp" during 2017-2018. The control group consisted of 30 patients of the same age group, with menstrual disorders with no signs of hyperplastic processes of endometrium. With the consent of the patients, they were treated with diagnostic hysteroscopy in order to study evacuated material from the uterus. The results of the histological study confirmed the absence of signs of hyperplastic processes of endometrium. The results of diagnostic methods were evaluated by comparing the material's histological data with the results of ultrasound and hysteroresectoscopy. RESULTS: Results: Taking into account the results of our research, women with hyperplastic processes of endometrium have the risk of the pathology of the nervous system is in 2.71 times higher (OR=2.71, CI-0.88: 8.33), cardiovascular pathology-in 2.04 (OR=2.04, CI-0.57:7.34), vascular diseases of the lower extremities-in 1.81 times (OR=1.81, CI-0.21:15.32) compared with the control group. While the risk of pathology of the urinary system and organs of vision is only-OR=0.48, CI-0.11:2.03 and OR=0.75, CI-0.08:7.48, respectively. Analyzing the results of the study using ultrasound examination, it was found that endometrial polyposis in combination with uterine leiomyoma was not detected in 3 women (15%), while all the results of hysteroscopy were confirmed by histopathological studies. When the endometrial hyperplastic processes were combined with adenomyosis- according to ultrasound examination a false positive result was obtained in 2 patients (13.3%), and in a hysteroscopic study we determined -1 false positive result. In patients the diagnosis of "endometrial polyp" according to the results of hysteroscopy was not confirmed in 2 women (2 false positive results 2.99%) and in 5 cases of ultrasound examination (5 false negative results 7.46%). The use of ultrasound examinations in patients with endometrial hyperplastic changes, according to our data, made it possible to identify pathology in 88.39% of cases, while the information content of the hysteroscopy was 98.21% (p<0.001). CONCLUSION: Conclusions: Thus, the results of the subjective examination of patients in the gynecological department: complaints, anamnestic data on gynecological and extragenital pathology should be used to identify etiopathogenetic factors and the formation of risk groups for the occurrence of hyperplastic processes of endometrium. Women with cervical erosion, uterine myoma and episodes of herpetic rash on the mucous membranes in past medical history have a higher likelihood of hyperplastic processes of endometrium. The vast majority of patients (63.87%) with polyps of the body of the uterus have a combined hyperproliferative pathology, which requires an individual approach to planning the scope of diagnostic examination and the choice of treatment method. Visualization of endometrium with hysteroscopy is more informative than ultrasound for diagnosing hyperproliferative processes, including uterine polyps. Hysteroscopic polypectomy has a high level of both clinical and economic benefits as well as diagnostic value in patients with hyperplastic processes of endometrium.


Assuntos
Leiomioma , Pólipos , Doenças Uterinas , Endométrio/diagnóstico por imagem , Endométrio/patologia , Feminino , Humanos , Histeroscopia , Leiomioma/patologia , Pólipos/diagnóstico por imagem , Pólipos/patologia , Gravidez , Doenças Uterinas/diagnóstico por imagem
5.
Medicine (Baltimore) ; 99(43): e22712, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120766

RESUMO

BACKGROUND: Although dexmedetomidine has been used as either the anesthetic agent for light sedation or as an adjunct to other sedatives, no study has investigated the usefulness of dexmedetomidine as the main sedative agent for invasive and painful procedures. The purpose of this study was to compare the safety of dexmedetomidine-remifentanil and propofol-remifentanil during monitored anesthesia care (MAC) for hysteroscopy. METHODS: Female patients undergoing hysteroscopy were randomly assigned to either the dexmedetomidine (group D) or the propofol group (group P). The study drug (0.6 ml/kg; dexmedetomidine 2 µg/ml or propofol 4 mg/ml) was loaded for 10 minutes followed by 0.1 to 0.5 ml/kg/hour to maintain a bispectral index of 60 to 80 during the procedure. In both groups, remifentanil was infused using a target-controlled-infusion system with a target concentration of 2 ng/ml and titrated during the procedure. The incidence rates of intraoperative respiratory depression in both groups were compared. Postoperative pain and patients satisfaction were also compared. RESULTS: A total of 69 female patients were included in this study. Dexmedetomidine significantly decrease the incidence of respiratory depression compared with propofol (15/34 [44.1%] vs 5/35 [14.3%], P = .006, group P and D, respectively). Postoperative pain and patients satisfaction score did not differ between the groups. CONCLUSION: The combination of dexmedetomidine-remifentanil can reduce the incidence of respiratory depression without increasing hemodynamic complications compared with propofol-remifentanil for MAC during hysteroscopy.


Assuntos
Analgésicos Opioides/administração & dosagem , Anestésicos Intravenosos/administração & dosagem , Dexmedetomidina/administração & dosagem , Hipnóticos e Sedativos/administração & dosagem , Histeroscopia , Monitorização Intraoperatória , Propofol/administração & dosagem , Remifentanil/administração & dosagem , Adulto , Combinação de Medicamentos , Feminino , Humanos , Pessoa de Meia-Idade , Método Simples-Cego
6.
Medicine (Baltimore) ; 99(42): e22751, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080740

RESUMO

BACKGROUND: The use of hysteroscopy for the diagnosis and treatment of uterine and endometrial abnormalities is often associated with postoperative pain. This randomized controlled trial aimed to assess the efficacy of preoperative intravenous (IV) lidocaine in reducing pain after hysteroscopy. METHODS: In total, 138 patients undergoing elective hysteroscopy at the CHA Bundang Medical Center, Seongnam, Korea were randomly assigned to a control group (n = 69) or a lidocaine group (n = 69), which received normal saline or IV lidocaine at 1.5 mg/kg, respectively. The primary outcome was the incidence of postoperative pain. RESULTS: The incidence of pain was significantly lower in the IV lidocaine group than in the control group at the post-anesthesia care unit (27.3% vs 68.2%, P < .001). The visual analog scale (0-10) score (median [interquartile range]) was lower in the IV lidocaine group than in the control group (0 [0-2]) vs 2 [0-4]), P < .001). The use of rescue analgesics and postoperative nausea and vomiting were similar between the 2 groups. This study demonstrated that administering 1.5 mg/kg of preoperative IV lidocaine can be a simple method to reduce incidence of pain after hysteroscopy. CONCLUSION: Preoperative bolus administration of 1.5 mg/kg of IV lidocaine may be used to decrease incidence of pain after hysteroscopy under general anesthesia.


Assuntos
Anestésicos Locais/administração & dosagem , Histeroscopia , Lidocaína/administração & dosagem , Dor Pós-Operatória/prevenção & controle , Adulto , Feminino , Humanos , Injeções Intravenosas , Cuidados Pré-Operatórios , Escala Visual Analógica
7.
Georgian Med News ; (304-305): 27-32, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32965245

RESUMO

Сhronic endometritis is a medical and social problem that leads to impaired reproductive health of women. Even after elimination of the causative agent of inflammation detect changes in the endometrium by determining immunohistochemical markers (СD 138). The purpose of this study is to analyze the incidence of chronic endometritis in women of reproductive age with reproductive health disorders.; We performed hysteroscopy and determination СD 138 30 patients with recurrent pregnancy loss, 47 women with primary infertility and 36 women who applied for a pregnancy planning examination and endometrial polyps detected during routine ultrasound. In patients with habitual miscarriage, primary infertility, and women in the planning of pregnancy and endometrial polyps, a high frequency of bacterial vaginosis and recurrent inflammatory diseases of the lower parts of the reproductive system was noted (p>0.01). In the study of infectious agents of the lower parts of the reproductive system of patients of all groups found in the pathological growth of ureoplasmic infection and a group of non-specific infections (Enterococcus faecalis, Esherichia coli, Proteus sp, Klebsiella sp, S. aureus, agactactia) (p>0.05). Hysteroscopic changes in endometrial pathology were present in 57% of women with habitual miscarriage and primary infertility (p>0.05). In immunohistochemical examination of the endometrium, chronic endometritis was diagnosed in 80% of patients with habitual miscarriage, in 55% of women with primary infertility and in 61% of women when planning pregnancy and polyps of the endometrium (p>0.01).


Assuntos
Endometrite/complicações , Endometrite/epidemiologia , Infertilidade Feminina/epidemiologia , Endométrio , Feminino , Humanos , Histeroscopia , Gravidez , Saúde Reprodutiva , Staphylococcus aureus
8.
Yonsei Med J ; 61(10): 868-874, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32975061

RESUMO

PURPOSE: To investigate the efficacy and safety of a newly developed thermo-responsive sol-gel, ABT13107, for reducing the formation of intrauterine adhesions (IUAs) after hysteroscopic surgery. MATERIALS AND METHODS: In this multicenter, prospective, randomized trial (Canadian Task Force classification I), 192 women scheduled to undergo a hysteroscopic surgery at one of the eight university hospitals in South Korea were randomized into the ABT13107 group or the comparator (Hyalobarrier®) group in a 1:1 ratio. During hysteroscopic surgery, ABT13107 or Hyalobarrier® was injected to sufficiently cover the entire intrauterine cavity. RESULTS: The patients returned to their respective sites for safety assessments at postoperative weeks 1 and 4 and for efficacy assessments at postoperative week 4. The post-surgery incidence of IUAs was 23.4% in the ABT13107 group and 25.8% in the comparator group; this difference met the criteria for ABT13107 to be considered as not inferior to the comparator. No differences were found in the extent of adhesions, types of adhesions, or the cumulative American Fertility Society score between the two treatment groups. Most adverse events were mild in severity, and no serious adverse events occurred. CONCLUSION: ABT13107, a new anti-adhesive barrier containing hyaluronic acid, was not inferior to the highly viscous hyaluronic acid anti-adhesive barrier, Hyalurobarrier® in IUA formation after hysteroscopic surgery (Clinical trial registration No. NCT04007211).


Assuntos
Géis/administração & dosagem , Ácido Hialurônico/administração & dosagem , Histeroscopia/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Aderências Teciduais/prevenção & controle , Doenças Uterinas/cirurgia , Adulto , Feminino , Géis/uso terapêutico , Humanos , Ácido Hialurônico/uso terapêutico , Incidência , Gravidez , Estudos Prospectivos , República da Coreia , Índice de Gravidade de Doença , Aderências Teciduais/etiologia , Resultado do Tratamento , Doenças Uterinas/etiologia
10.
Womens Health (Lond) ; 16: 1745506520952003, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32833600

RESUMO

Administration of Dienogest prior to hysteroscopic polypectomy is empirically performed, but the physiological effects of Dienogest on endometrial polyps are unclear. We aimed to investigate the effects of Dienogest on the proliferation and inflammation of endometrial polyps. We conducted a retrospective case study on 40 menstruating women who underwent hysteroscopic polypectomy at our hospital. We collected clinical data, and the polyps were divided by morphological appearance. The specimens obtained were immunostained for Ki67 as a marker of cellar proliferation and CD138 as a marker of plasmacytes, which are a hallmark of chronic endometritis. Dienogest significantly suppressed the proliferation status of EPs because Dienogest treatment prior to the operation significantly reduced the Ki67 index (41.25 ± 16.85 vs 7.18 ± 9.82, p < 0.01). We found that sessile-type polyps showed a significantly lower Ki67 index than the pedunculated type (12.28 ± 11.12 vs 2.09 ± 2.73, p = 0.026). The presence of CD138-positive cells was more pronounced in sessile-type polyps than in pedunculated polyps (p = 0.018). However, Dienogest treatment showed no apparent effect on inflammation status, as detected by CD138-positive cells. We revealed that Dienogest suppressed cellular proliferation, and morphological classification of endometrial polyps could be used to predict the responsiveness to Dienogest. However, Dienogest might not affect cellular inflammation.


Assuntos
Antineoplásicos Hormonais/uso terapêutico , Proliferação de Células/efeitos dos fármacos , Endométrio/efeitos dos fármacos , Nandrolona/análogos & derivados , Pólipos/tratamento farmacológico , Adulto , Endométrio/patologia , Feminino , Humanos , Histeroscopia , Pessoa de Meia-Idade , Nandrolona/uso terapêutico , Estudos Retrospectivos , Doenças Uterinas/patologia
11.
N Engl J Med ; 383(5): 440-451, 2020 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-32726530

RESUMO

BACKGROUND: Uterine fibroids, the most common type of tumor among women of reproductive age, are associated with heavy menstrual bleeding, abdominal discomfort, subfertility, and a reduced quality of life. For women who wish to preserve their uterus and who have not had a response to medical treatment, myomectomy and uterine-artery embolization are therapeutic options. METHODS: We conducted a multicenter, randomized, open-label trial to evaluate myomectomy, as compared with uterine-artery embolization, in women who had symptomatic uterine fibroids and did not want to undergo hysterectomy. Procedural options included open abdominal, laparoscopic, or hysteroscopic myomectomy. The primary outcome was fibroid-related quality of life, as assessed by the score on the health-related quality-of-life domain of the Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaire (scores range from 0 to 100, with higher scores indicating a better quality of life) at 2 years; adjustment was made for the baseline score. RESULTS: A total of 254 women, recruited at 29 hospitals in the United Kingdom, were randomly assigned: 127 to the myomectomy group (of whom 105 underwent myomectomy) and 127 to the uterine-artery embolization group (of whom 98 underwent embolization). Data on the primary outcome were available for 206 women (81%). In the intention-to-treat analysis, the mean (±SD) score on the health-related quality-of-life domain of the UFS-QOL questionnaire at 2 years was 84.6±21.5 in the myomectomy group and 80.0±22.0 in the uterine-artery embolization group (mean adjusted difference with complete case analysis, 8.0 points; 95% confidence interval [CI], 1.8 to 14.1; P = 0.01; mean adjusted difference with missing responses imputed, 6.5 points; 95% CI, 1.1 to 11.9). Perioperative and postoperative complications from all initial procedures, irrespective of adherence to the assigned procedure, occurred in 29% of the women in the myomectomy group and in 24% of the women in the uterine-artery embolization group. CONCLUSIONS: Among women with symptomatic uterine fibroids, those who underwent myomectomy had a better fibroid-related quality of life at 2 years than those who underwent uterine-artery embolization. (Funded by the National Institute for Health Research Health Technology Assessment program; FEMME Current Controlled Trials number, ISRCTN70772394.).


Assuntos
Leiomioma/cirurgia , Qualidade de Vida , Embolização da Artéria Uterina , Miomectomia Uterina , Neoplasias Uterinas/cirurgia , Adulto , Feminino , Humanos , Histeroscopia , Análise de Intenção de Tratamento , Complicações Intraoperatórias , Laparoscopia , Leiomioma/terapia , Tempo de Internação , Menorragia , Pessoa de Meia-Idade , Reserva Ovariana , Complicações Pós-Operatórias , Reoperação/estatística & dados numéricos , Embolização da Artéria Uterina/efeitos adversos , Miomectomia Uterina/efeitos adversos , Miomectomia Uterina/métodos , Neoplasias Uterinas/terapia , Útero/cirurgia
13.
Cochrane Database Syst Rev ; 7: CD011174, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32609376

RESUMO

BACKGROUND: Non-tubal ectopic pregnancy is the implantation of an embryo at a site lying outside the uterine cavity or fallopian tubes. Sites include a caesarean scar, the cornua uteri, the ovary, the cervix, and the abdomen. There has been an increasing trend in the occurrence of these rare conditions, especially caesarean scar pregnancy (CSP). OBJECTIVES: To evaluate the clinical effectiveness and safety of surgery, medical treatment, and expectant management of non-tubal ectopic pregnancy in terms of fertility outcomes and complications. SEARCH METHODS: We searched the Cochrane Gynaecology and Fertility (CGF) Group Specialised Register of Controlled Trials, CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, the World Health Organization (WHO) search portal and nine other databases to 12 December 2019. We handsearched reference lists of articles retrieved and contacted experts in the field to obtain additional data. SELECTION CRITERIA: We included randomized controlled trials (RCTs) published in all languages that examined the effects and safety of surgery, medical treatment, and expectant management of non-tubal ectopic pregnancy. DATA COLLECTION AND ANALYSIS: We used Cochrane standard methodological procedures. Primary outcomes were treatment success and complications. MAIN RESULTS: We included five RCTs with 303 women, all reporting Caesarean scar pregnancy. Two compared uterine arterial embolization (UAE) or uterine arterial chemoembolization (UACE) plus methotrexate (MTX) versus systemic MTX and subsequent dilation and suction curettage; one compared UACE plus MTX versus ultrasonography-guided local MTX injection; and two compared suction curettage under hysteroscopy versus suction curettage under ultrasonography after UAE/UACE. The quality of evidence ranged from moderate to very low. The main limitations were imprecision (small sample sizes and very wide confidence intervals (CI) for most analyses), multiple comparisons with a small number of trials, and insufficient data available to assess heterogeneity. UAE/UACE versus systemic MTX prior to suction curettage Two studies reported this comparison. One compared UAE with systemic MTX and one compared UACE plus MTX versus systemic MTX, in both cases followed by a suction curettage. We are uncertain whether UAE/UACE improved success rates after initial treatment (UAE: risk ratio (RR) 1.00, 95% CI 0.90 to 1.12; 1 RCT, 72 women; low-quality evidence; UACE: RR 0.87, 95% CI 0.54 to 1.38; 1 RCT, 28 women; low-quality evidence). We are uncertain whether UAE/UACE reduced rates of complications (UAE: RR 0.47, 95% CI 0.13 to 1.75; 1 RCT, 72 women; low-quality evidence; UACE: RR 0.62, 95% CI 0.26 to 1.48; 1 RCT, 28 women; low-quality evidence). We are uncertain whether UAE/UACE reduced adverse effects (UAE: RR 1.58, 95% CI 0.41 to 6.11; 1 RCT, 72 women; low-quality evidence; UACE: RR 1.16, 95% CI 0.32 to 4.24; 1 RCT, 28 women; low-quality evidence), and it was not obvious that the types of events had similar values to participants (e.g. fever versus vomiting). Blood loss was lower in UAE/UACE groups than systemic MTX groups (UAE: mean difference (MD) -378.70 mL, 95% CI -401.43 to -355.97; 1 RCT, 72 women; moderate-quality evidence; UACE: MD -879.00 mL, 95% CI -1135.23 to -622.77; 1 RCT, 28 women; moderate-quality evidence). Data were not available on time to normalize ß-human chorionic gonadotropin (ß-hCG). UACE plus MTX versus ultrasonography-guided local MTX injection We are uncertain whether UACE improved success rates after initial treatment (RR 0.95, 95% CI 0.56 to 1.60; 1 RCT, 45 women; very low-quality evidence). Adverse effects: the study reported the same number of failed treatments in each arm (RR 0.88, 95% CI 0.40 to 1.92; 1 RCT, 45 women). We are uncertain whether UACE shortened the time to normalize ß-hCG (MD 1.50 days, 95% CI -3.16 to 6.16; 1 RCT, 45 women; very low-quality evidence). Data were not available for complications. Suction curettage under hysteroscopy versus under ultrasonography after UAE/UACE. Two studies reported this comparison. One compared suction curettage under hysteroscopy versus under ultrasonography after UAE, and one compared these interventions after UACE. We are uncertain whether suction curettage under hysteroscopy improved success rates after initial treatment (UAE: RR 0.91, 95% CI 0.81 to 1.03; 1 RCT, 66 women; very low-quality evidence; UACE: RR 1.02, 95% CI 0.96 to 1.09; 1 RCT, 92 women; low-quality evidence). We are uncertain whether suction curettage under hysteroscopy reduced rates of complications (UAE: RR 4.00, 95% CI 0.47 to 33.91; 1 RCT, 66 women; very low-quality evidence; UACE: RR 0.18, 95% CI 0.01 to 3.72; 1 RCT, 92 women; low-quality evidence). We are uncertain whether suction curettage under hysteroscopy reduced adverse effects (UAE: RR 3.09, 95% CI 0.12 to 78.70; 1 RCT, 66 women; very low-quality evidence; UACE: not estimable; 1 RCT, 92 women; very low-quality evidence). We are uncertain whether suction curettage under hysteroscopy shortened the time to normalize ß-hCG (UAE: MD 4.03 days, 95% CI -1.79 to 9.85; 1 RCT, 66 women; very low-quality evidence; UACE: MD 0.84 days, 95% CI -1.90 to 3.58; 1 RCT, 92 women; low-quality evidence). Non-tubal ectopic pregnancy other than CSP No studies reported on non-tubal ectopic pregnancies in locations other than on a caesarean scar. AUTHORS' CONCLUSIONS: For Caesarean scar pregnancies (CSP) it is uncertain whether there is a difference in success rates, complications, or adverse events between UAE/UACE and administration of systemic MTX before suction curettage (low-quality evidence). Blood loss was lower if suction curettage is conducted after UAE/UACE than after administration of systemic MTX (moderate-quality evidence). It is uncertain whether there is a difference in treatment success rates, complications, adverse effects or time to normalize ß-hCG between suction curettage under hysteroscopy and under ultrasonography (very low-quality evidence). There are no studies of non-tubal ectopic pregnancy other than CSP and RCTs for these types of pregnancy are unlikely.


Assuntos
Gravidez Ectópica/terapia , Abortivos não Esteroides/administração & dosagem , Abortivos não Esteroides/efeitos adversos , Viés , Cesárea , Quimioembolização Terapêutica/efeitos adversos , Cicatriz/complicações , Intervalos de Confiança , Dilatação e Curetagem/efeitos adversos , Dilatação e Curetagem/métodos , Feminino , Humanos , Histeroscopia , Metotrexato/administração & dosagem , Metotrexato/efeitos adversos , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Tamanho da Amostra , Ultrassonografia de Intervenção , Artéria Uterina , Embolização da Artéria Uterina/efeitos adversos , Curetagem a Vácuo
14.
Obstet Gynecol ; 136(2): 369-376, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32649501

RESUMO

OBJECTIVE: To assess self-reported readiness of U.S. obstetrics and gynecology residents to perform surgical procedures compared with the perceptions of their program directors. METHODS: The 2019 Council on Resident Education in Obstetrics and Gynecology Survey assessed resident self-confidence and perceived readiness to independently perform common surgical procedures. Concurrently, obstetrics and gynecology residency program directors were surveyed about the readiness of their graduating residents to independently perform the same procedures. RESULTS: The overall response rate was 99.3% for residents (5,473/5,514 examinees attempted to complete the survey) and 83% for program directors (241/292 returned surveys). There were no significant differences in graduating residents and program directors' assessments of graduating residents' surgical confidence in performing cesarean delivery (99.6% [95% CI 98.9-99.9] vs 100% [95% CI 98.2-100.0]), vacuum delivery (96.5% [95% CI 95.2-97.4] vs 98.6% [95% CI 95.9-99.7]), abdominal hysterectomy (95.1% [95% CI 93.6-96.2] vs 96.7% [95% CI 93.3-98.7]) or operative hysteroscopy (99.5% [95% CI 98.9-99.9] vs 100% [95% CI 98.2-100.0]). Ninety percent, 86%, and 69% of graduating residents felt that they could independently perform an abdominal hysterectomy, laparoscopic hysterectomy, and vaginal hysterectomy, respectively, in the event of an emergency. Ninety-seven percent (95% CI 93.3-98.7) of program directors reported their residents could perform a laparoscopic hysterectomy by graduation, as did 93% of graduating resident respondents (95% CI 90.8-94.0). Ninety percent (95% CI 85.3-93.8) of program directors felt their residents could perform vaginal hysterectomies by graduation, compared with 79% (95% CI 76.9-81.8) of fourth-year residents. CONCLUSION: Graduating obstetrics and gynecology residents and their program directors are confident in their abilities to perform the majority of core surgical procedures by graduation. By the second year, more than 90% of residents and their program directors were confident in their ability to perform cesarean deliveries and operative hysteroscopy. Sixty-nine percent and 86% of graduating residents felt comfortable performing vaginal and laparoscopic hysterectomies, respectively.


Assuntos
Competência Clínica , Educação de Pós-Graduação em Medicina , Procedimentos Cirúrgicos em Ginecologia/educação , Procedimentos Cirúrgicos Obstétricos/educação , Cesárea/educação , Feminino , Ginecologia/educação , Humanos , Histerectomia/educação , Histeroscopia , Internato e Residência , Masculino , Obstetrícia/educação , Autoimagem , Autorrelato , Inquéritos e Questionários , Estados Unidos
16.
Ceska Gynekol ; 85(2): 84-93, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32527101

RESUMO

OBJECTIVE: The aim of our study was to analyze a group of patients referred for endometrial biopsy. To evaluate the ultrasound finding of hyperplasia/polyp, the symptomatology of patients related to the result of definitive histology, to determine the severity of individual variables in connection with the detection of precancerosis/cancer. Due to the complexity of information identify women who are suitable for conservative approach. DESIGN: Unicentric retrospective observational study. SETTING: Department of Obstetrics and Gynecology, Masaryk University, University Hospital Brno. METHODS: All patients over 50 years who underwent surgical endometrial biopsy at our department in the period of 2017-2018 (n = 754) were included. We were interested in reasons of indication, the age of patients at the time of the procedure and at the menopause, the presence of risk factors for development precancerosis/cancer (hypertension, diabetes mellitus, using of tamoxifen), number of deliveries and pregnancies, symptomatology, the description of ultrasound scans, the result of histology examination, peroperative and postoperative complications. RESULTS: Perimenopause - the median of endometrial thickness in both benign and malignant histology was 8 mm (p = 0.448), the median of the largest polyp dimension was 18 mm. All patients with precancerosis/malignancy were symptomatic with irregular/excessive bleeding, no carcinoma was found in polyp. Postmenopause - the median of endometrial thickness in benign histology was 7 mm versus 16 mm in precancerosis/malignancy (p < 0.001), the median of the largest polyp dimension was the same in both histologies (13 mm, p = 0.274). The risk of malignancy was more than threefold in bleeding versus asymptomatic patients with both hyperplasia and polyp (OR 3.39, 3.79). In asymptomatic patients the risk of cancer was similar for selected cut-offs (5, 8 and 12 mm), statistically significant only for 12 mm (OR 3.54), while in symptomatic patients the risk was high for all cut-offs, however with wide confidence intervals, statistically significant for cut-offs of 8 mm (minimum 3.58) and 12 mm (minimum 4.94). CONCLUSION: We have shown that symptomatology is a strong risk factor for the presence of precancerosis/malignancy in patients with endometrial hyperplasia or polyp. The thickness of the endometrium or polyp size in asymptomatic patients does not play a major role. Ultrasound alone does not have sufficient accuracy for detection or even screening of endometrial cancer. We recommend a conservative procedure, monitoring changes in the ultrasound scan and symptomatology of the patient over time.


Assuntos
Hiperplasia Endometrial/patologia , Neoplasias do Endométrio/patologia , Pólipos/patologia , Biópsia , Endométrio , Feminino , Humanos , Histeroscopia , Gravidez , Estudos Retrospectivos , Ultrassonografia , Hemorragia Uterina
17.
Medicine (Baltimore) ; 99(26): e20491, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590732

RESUMO

BACKGROUND: Atypical polypoid adenomyoma (APA) is a rare uterine tumor typically found in fertile age and associated with infertility. Among young nullipara women, conservative treatment is proposed despite the high recurrence rate and the association with endometrial cancer.Our aim was to assess the risk of recurrence with different conservative treatments in fertile ages and the prevalence of malignant or pre-malignant associated lesions to better address an adequate patient counselling when treatment modalities are discussed. METHODS: This study is a systematic review and meta-analysis of case reports and case series about APA management and follow-up. A literature search was carried from Medline and Scopus for studies published from January 1, 1980 to December 31, 2018. RESULTS: We included 46 observational studies and 296 cases in fertile women. The prevalence of APA relapse was 44% (CI.95 33-57%) and was lower in cases treated with operative hysteroscopy (22%; CI.95 11-39%) than in cases treated with blind curettage and polypectomy (38%; CI.95 15-67%). The prevalence of the concomitant or during the follow-up diagnosis of endometrial carcinoma was 16% (CI.95 9-29%). The risk of cancer development during follow-up was significantly less in cases treated with histeroscopy (10.56% new cumulative diagnosis at 5 years follow up; CI.95 0-23.7%) than blind curettage and polypectomy (35.5% new cumulative diagnosis at 5 years; CI.95 11.65-52.92%; P < .05). Medical treatment with medroxyprogesterone acetate after surgery does not reduce APA recurrence. Pregnancy was observed in 79% cases in which the desire was expressed. CONCLUSION: This review suggests that conservative treatment performed by operative hysteroscopy is the optimal choice because it lowers the risk of recurrence, improves the accuracy of concomitant carcinoma or hyperplasia diagnosis, and leaves the possibility of future pregnancies.


Assuntos
Adenomioma/terapia , Recidiva Local de Neoplasia/patologia , Neoplasias Uterinas/terapia , Adenomioma/patologia , Antineoplásicos Hormonais/uso terapêutico , Quimioterapia Adjuvante , Tratamento Conservador , Curetagem , Hiperplasia Endometrial/patologia , Neoplasias do Endométrio/patologia , Feminino , Humanos , Histeroscopia , Acetato de Medroxiprogesterona/uso terapêutico , Neoplasias Primárias Múltiplas , Gravidez , Taxa de Gravidez , Neoplasias Uterinas/patologia
19.
Jpn J Clin Oncol ; 50(10): 1157-1161, 2020 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-32564088

RESUMO

BACKGROUND: To date, only few large studies are available concerning the safety and diagnostic concordance rates of outpatient flexible hysteroscopy. In our institution, outpatient hysteroscopy has been routinely and educationally applied Kosuke Tsuji to intrauterine lesions; thus, we retrospectively investigated the institution's outpatient flexible hysteroscopy cases. METHODS: A total of 1591 cases of outpatient flexible hysteroscopy conducted at our institution in 2012-2016 were retrospectively analyzed in terms of their clinical background, complications and diagnostic concordance rates. RESULTS: A total of 1591 cases included 546 cases of benign tumors (317 endometrial polyps, 168 myomas and 61 endometrial hyperplasia), 361 cases of atypical endometrial hyperplasia, 571 cases of endometrial cancers and 113 cases of other diagnoses. No major complications, including uterine perforation, occurred. However, one patient (0.06%) was diagnosed with septic shock caused by intrauterine infection that required prolonged immunosuppressive drug administration. Meanwhile, 335 patients diagnosed with benign tumors through outpatient flexible hysteroscopy underwent operation, and the diagnostic concordance rate was 74.6% (250 cases). However, this rate included 14 cases (4.2%) diagnosed with malignant tumors postoperatively. In preoperative endometrial cancer cases, the sensitivity and specificity for cervical invasion diagnosis were 39.4 and 90.8%, respectively. In addition, only one patient manifested positive ascites cytology intraoperatively, possibly caused by outpatient hysteroscopy. CONCLUSIONS: Outpatient flexible hysteroscopy is highly safe, with a slight negligible effect on ascites cytology. However, the diagnosis should be determined by multidisciplinary approaches, as hysteroscopy alone can miss malignancy.


Assuntos
Histeroscopia/efeitos adversos , Pacientes Ambulatoriais , Neoplasias Uterinas/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Ascite/patologia , Neoplasias do Endométrio/diagnóstico , Neoplasias do Endométrio/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Maleabilidade , Complicações Pós-Operatórias/etiologia , Gravidez , Estudos Retrospectivos , Neoplasias Uterinas/patologia , Adulto Jovem
20.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 47(2): 72-74, abr.-jun. 2020.
Artigo em Espanhol | IBECS | ID: ibc-193714

RESUMO

Los síndromes neurológicos paraneoplásicos son un conjunto de trastornos, raramente asociados a tumores ginecológicos. Su presencia debe alertarnos sobre la posible existencia de un tumor maligno subyacente. Presentamos un caso de miastenia gravis, como manifestación paraneoplásica de un cáncer de ovario primario avanzado


Paraneoplastic neurological syndromes are an unusual diseases rarely associated with gynaecological tumours. Their presence must alert on the possible existence of an underlying malignant tumour. A rare case is presented of myasthenia gravis as a paraneoplastic manifestation of an advanced primary ovarian cancer


Assuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Miastenia Gravis/etiologia , Neoplasias Ovarianas/complicações , Neoplasias Ovarianas/terapia , Polineuropatia Paraneoplásica , Transtornos Neurológicos da Marcha/complicações , Transtornos de Deglutição/complicações , Neurofisiologia , Tomografia por Emissão de Pósitrons , Histeroscopia
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