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1.
Anaesthesia ; 76 Suppl 4: 46-55, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33682092

RESUMO

A number of benign and malignant gynaecological conditions can cause infertility. Advancements in assisted reproductive technologies have facilitated the rapidly evolving subspecialty of fertility preservation. Regardless of clinical indication, women now have the reproductive autonomy to make fully informed decisions regarding their future fertility. In particular, there has been an increasing interest and demand among patients and healthcare professionals for fertility-sparing surgery. Gynaecologists find themselves continually adapting surgical techniques and introducing novel procedures to facilitate this rapidly emerging field and anaesthetists need to manage the consequent physiological demands intra-operatively. Not only is it important to understand the surgical procedures now undertaken, but also the intra-operative management in an ever evolving field. This article reviews the methods of fertility-sparing surgery and also describes important anaesthetic challenges including peri-operative care for women undergoing complex fertility-sparing surgeries such as uterus transplantation.


Assuntos
Anestésicos/administração & dosagem , Útero/cirurgia , Endometriose/patologia , Endometriose/cirurgia , Feminino , Preservação da Fertilidade , Humanos , Leiomioma/patologia , Leiomioma/cirurgia , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgia , Útero/transplante
2.
Medicine (Baltimore) ; 100(10): e24024, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725815

RESUMO

INTRODUCTION: Uterine fibroids, which are common benign tumors, rarely cause acute complications. We herein report a case of hemoperitoneum associated with uterine fibroid that could be diagnosed preoperatively with contrast-enhanced computerized tomography (CT). PATIENT CONCERNS: A 48-year-old woman with uterine fibroid developed extremely severe lower abdominal pain on the first day of her menstrual period. DIAGNOSIS: Ultrasonography and contrast-enhanced CT revealed a uterine fibroid and extravasation from the dilated vessels of the uterine fibroid. INTERVENTION: Emergent abdominal hysterectomy was performed. OUTCOMES: The total amount of bleeding was 4,600 mL. Intraoperative blood salvage (1,357 mL), 6 units of red blood cells, 4 units of fresh frozen plasma, and 20 units of platelet concentrates were transfused. The postoperative course was uneventful. Pathological examination confirmed a benign uterine fibroid. CONCLUSION: CT could be useful to determine a diagnosis for bleeding from ruptured subserosal uterine fibroid.


Assuntos
Dor Abdominal/diagnóstico , Hemoperitônio/diagnóstico , Leiomioma/diagnóstico , Dor Abdominal/etiologia , Dor Abdominal/cirurgia , Meios de Contraste/administração & dosagem , Feminino , Hemoperitônio/etiologia , Hemoperitônio/cirurgia , Humanos , Histerectomia , Leiomioma/complicações , Leiomioma/cirurgia , Pessoa de Meia-Idade , Recuperação de Sangue Operatório , Cavidade Peritoneal/diagnóstico por imagem , Cavidade Peritoneal/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Útero/irrigação sanguínea , Útero/diagnóstico por imagem , Útero/cirurgia
4.
Georgian Med News ; (310): 150-156, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33658424

RESUMO

Uterine leiomyoma represents the most common pelvic tumor in females, including numerous histological subtypes, from which smooth muscle tumors of uncertain malignancy potential (STUMP) represents the diagnostic challenge. On the other hand, the study of the relapse risk markers after laparoscopic myomectomy is of high interest. We investigated the molecular phenotype of different types of leiomyoma after hysterectomy or laparoscopic surgery in reproductive and menopausal women. Standard immunohistochemistry was used to detect proliferation markers Ki67 and cyclin D1, apoptotic markers Bcl2 and Cas3, and ER and PR. The results of our study indicated that ER expression is significantly higher in relapsed leiomyoma, compared to control group. In addition, relapsed leiomyomas are characterised with high proliferation and apoptotic index. With regard to STUMP despite histological homogeneity, this entity is characterised with the presence of three distinct molecular subtypes, based on proliferation and apoptotic marker expression, which should be used as diagnostic aid in these tumors.


Assuntos
Leiomioma , Leiomiossarcoma , Tumor de Músculo Liso , Neoplasias Uterinas , Feminino , Humanos , Leiomioma/genética , Leiomioma/cirurgia , Recidiva Local de Neoplasia , Fenótipo , Tumor de Músculo Liso/diagnóstico , Tumor de Músculo Liso/cirurgia , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/genética , Neoplasias Uterinas/cirurgia
5.
Pan Afr Med J ; 38: 10, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33520079

RESUMO

Total abdominal hysterectomy is among the commonest gynaecologic surgeries observed in Africa. However, there exists a gap in published data to support this hypothesis. Information on hysterectomies reported from sub-Saharan Africa reflects mostly obstetric indications. A prospective hospital-based study was conducted in Dar es Salaam, Tanzania from March-October 2017. Women attending the facilities with clinical conditions necessitating abdominal hysterectomies were the target population. Each woman was followed from the time of planning for surgery until at most 72-hours post-surgery or discharge from the wards whichever came first. Continuous variables were summarized using median (with corresponding inter-quartile range). Categorical variables were summarized using frequency (%). Data outputs were created using SAS version 9.4. Verbal informal consent was sought from each individual prior to inclusion to this study. We recruited and prospectively followed-up 107 patients. Median age of participants was 42 (IQR: 37-47) years. Uterine leiomyoma (84.1%) was the leading indication for hysterectomy. Only about a third (30.8%) of followed-up women had provisional diagnoses at the time of surgery. None of the study participants reported receipt for confirmatory histological findings of her uterus up to the hospital discharge time post-surgery.


Assuntos
Histerectomia/estatística & dados numéricos , Leiomioma/cirurgia , Neoplasias Uterinas/cirurgia , Adulto , Feminino , Seguimentos , Hospitais , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Tanzânia
7.
BMJ Case Rep ; 14(1)2021 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-33504515

RESUMO

A 39-year-old multiparous Afro-Caribbean woman attended the emergency department with sudden-onset severe right iliac fossa pain. Her inflammatory markers were mildly elevated. Computerised tomography of the abdomen demonstrated features of fat stranding in the right iliac fossa suspicious of acute appendicitis. The scan also noted uterine leiomyomas. The patient was taken to theatre for an emergency diagnostic laparoscopy where her appendix was found to be macroscopically normal. A necrotic heavily calcified parasitic leiomyoma was seen in the right adnexa, free of the uterus and adherent to the greater omentum on a long torted pedicle. The parasitic leiomyoma was successfully removed piecemeal laparoscopically. Complications of leiomyomas, namely, torsion and necrosis, are important differentials in women presenting with sudden-onset lower abdominal pain. A history of sudden-onset severe lower abdominal pain with a background of known leiomyoma should prompt the clerking surgeon to consider a complication of leiomyoma as part of the differential diagnoses.


Assuntos
Calcinose/diagnóstico por imagem , Leiomioma/diagnóstico por imagem , Anormalidade Torcional/diagnóstico por imagem , Neoplasias Uterinas/diagnóstico por imagem , Dor Abdominal/etiologia , Adulto , Apendicite/diagnóstico , Cesárea , Diagnóstico Diferencial , Feminino , Humanos , Laparoscopia , Leiomioma/cirurgia , Inoculação de Neoplasia , Omento , Tomografia Computadorizada por Raios X , Anormalidade Torcional/complicações , Anormalidade Torcional/cirurgia , Neoplasias Uterinas/cirurgia
8.
Zhonghua Wei Chang Wai Ke Za Zhi ; 24(2): 167-172, 2021 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-33508923

RESUMO

Objective: To investigate the safety and feasibility of laparoscopic double-flap technique (Kamikawa) in digestive tract reconstruction after proximal gastrectomy for esophagogastric junction (EGJ) leiomyoma and gastrointestinal stromal tumor (GIST) with the maximum diameter >5 cm. Methods: A descriptive case-series study was used to retrospectively analyze the data of patients with EGJ leiomyoma and GIST undergoing laparoscopic-assisted proximal gastrectomy and double-flap technique (Kamikawa) at the Department of Gastrointestinal Surgery, Guangdong Hospital of Traditional Chinese Medicine from September 2017 to March 2019. All the tumors invaded the cardia dentate line, and the maximum diameter was >5 cm. After the exclusion of patients requiring emergency surgery and complicating with severe cardiopulmonary diseases, a total of 4 patients, including 3 males and 1 female with age of 29-49 years, were included in this study. After laparoscopic-assisted proximal gastrectomy, the residual stomach was pulled out of the abdominal cavity and marked with methylene blue at the proximal end 3~4 cm from the anterior wall of the residual stomach in the shape of "H". The gastric wall plasma muscular layer was cut along the "H" shape, and the space between the submucosa and the muscular layer was separated to both sides along the longitudinal incision line to make the seromuscular flap. The residual stomach was put back into the abdominal cavity. Under laparoscopy, 4 stitches were intermittently sutured at the upside of "H" shape and 4-5 cm from the posterior wall of the esophageal stump. The stump of the esophagus was cut open, and the submucosa and mucosa were cut under the "H" shape to enter the gastric cavity. The posterior wall of the esophageal stump was sutured continuously with the gastric stump mucosa and submucosa under laparoscopy. The anterior wall of the esophageal stump was sutured continuously with the whole layer of the residual stomach. The anterior wall of the stomach was sutured to cover the esophagus. The anterior gastric muscle flap was sutured and embedded in the esophagus to complete the reconstruction of digestive tract. The morbidity of intraoperative complications and postoperative reflux esophagitis and anastomosis-related complications were observed. Results: All the 4 patients completed the operation successfully, and there was no conversion to laparotomy. The median operative time was 239 (192-261) minutes, the median Kamikawa anastomosis time was 149 (102-163) minutes, and the median intraoperative blood loss was 35 (20-200) ml. The abdominal drainage tube and gastric tube were removed, and the fluid diet was resumed on the first day after surgery in all the 4 patients. The median postoperative hospitalization time was 6 (6-8) days. Postoperative pathology revealed 3 leiomyomas and 1 GIST. There were no postoperative complications such as anastomotic leakage or stenosis, and no reflux symptoms were observed. The median follow-up time was 22 (11-29) months after the operation, and no reflux esophagitis occurred in any of the 4 patients by gastroscopy. Conclusion: For >5 cm EGJ leiomyoma or GIST, double-flap technique (Kamikawa) used for digestive tract reconstruction after proximal gastrectomy is safe and feasible.


Assuntos
Junção Esofagogástrica , Esôfago/cirurgia , Tumores do Estroma Gastrointestinal , Leiomioma , Neoplasias Gástricas , Estômago/cirurgia , Adulto , Anastomose Cirúrgica/métodos , Junção Esofagogástrica/cirurgia , Estudos de Viabilidade , Feminino , Gastrectomia/métodos , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Laparoscopia , Leiomioma/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias Gástricas/cirurgia , Retalhos Cirúrgicos , Resultado do Tratamento
11.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5263-5266, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019171

RESUMO

Thermal ablation techniques are increasingly used for the treatment of symptomatic uterine fibroids. Thermal protection of myometrial tissue adjacent to the fibroid from ablation is critical to maximally preserve the uterus. This study presents a bench top experimental setup, using ex vivo bovine muscle as a surrogate tissue, for evaluating collateral thermal damage in tissues during fibroid ablation. The study reports on the effect of applicator insertion angles (67.5° and 90°) into a mock fibroid on the efficacy of treatment. 6 experiments were performed (3 for each insertion angle) with 30 W applied power at 2.45 GHz. The heating duration was restricted to the time at which a thermal dose of 10 cumulative equivalent minutes at 43 °C (10 CEM 43) was accrued at the boundary of the mock fibroid. Results showed that the volume of ablation inside the mock fibroid dropped considerably from 66% to 17% when the applicator insertion angle was changed from 90º to 67.5º, suggesting that insertion angle plays an important role during microwave ablation of fibroid. The proposed setup provides a method for validating computational models for accurate and safe delivery of ablation to target tissues in fibroid treatment.


Assuntos
Leiomioma , Miométrio , Animais , Bovinos , Feminino , Leiomioma/cirurgia , Micro-Ondas , Miométrio/cirurgia , Ablação por Radiofrequência , Útero
12.
Medisur ; 18(4): 712-720, jul.-ago. 2020. graf
Artigo em Espanhol | LILACS | ID: biblio-1125254

RESUMO

RESUMEN Los leiomiomas esofágicos gigantes son neoplasias raras con un curso clínico impreciso; la mayoría se origina en la porción media e inferior del órgano. Para identificar el diagnóstico y tratamiento adecuado se utilizan pruebas de imágenes y endoscópicas. Compartir y divulgar un nuevo reporte de leiomioma esofágico gigante es el propósito de este trabajo, basado en un nuevo caso. El paciente ingresó por disfagia. Las pruebas para el diagnóstico incluyeron radiografía de esófago, estómago y duodeno, endoscopía digestiva superior, tomografía axial computarizada y resonancia magnética nuclear. El paciente se sometió a cirugía mediante toracotomía derecha, se realizó enucleación de un tumor de 10x6x5cm, y se constató integridad de la mucosa. No hubo evidencias de malignidad en el estudio histopatológico. Fue dado de alta ocho días después de cirugía. La toracotomía con enucleación del tumor esofágico es un procedimiento eficaz para tratar a pacientes con leiomioma gigante.


ABSTRACT Giant esophageal leiomyomas are rare neoplasms with an imprecise clinical course; most originate from the middle and lower portion of the organ. Imaging and endoscopic tests are used to identify the proper diagnosis and treatment. The purpose of this work, based on a new case, is to share and disseminate a new report of giant esophageal leiomyoma. The patient was admitted for dysphagia. Diagnostic tests included radiography of the esophagus, stomach, and duodenum, upper digestive endoscopy, computed tomography, and MRI. The patient underwent surgery by right thoracotomy, enucleation of a 10x6x5cm tumor was performed, and the integrity of the mucosa was verified. There was no evidence of malignancy in the histopathological study. He was discharged eight days after surgery. Thoracotomy with enucleation of the esophageal tumor is an effective procedure to treat patients with giant leiomyoma.


Assuntos
Humanos , Masculino , Neoplasias Esofágicas/cirurgia , Neoplasias Esofágicas/diagnóstico por imagem , Toracotomia , Leiomioma/cirurgia
13.
Womens Health Issues ; 30(5): 359-365, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32712008

RESUMO

BACKGROUND: When hysterectomy is used to treat uterine fibroids, a minimally invasive versus open abdominal approach is preferred. Depression and post-traumatic stress disorder (PTSD) may be associated with surgical mode. We sought to examine whether depression and PTSD are associated with minimally invasive hysterectomy (MIH). METHODS: This was a cross-sectional study of veterans with uterine fibroids undergoing hysterectomy in the Department of Veterans Affairs between 2012 and 2014. Diagnoses and procedures were identified by International Classification of Disease, Ninth Revision, codes. MIH was defined as laparoscopic, vaginal, or robotic-assisted versus open abdominal. A dichotomous variable indicated presence of depression or PTSD. Clinical variables, including uterine size, were abstracted from the medical record. We employed generalized linear models to estimate adjusted percentages and 95% confidence intervals (CIs) of MIH by presence of depression or PTSD and sequentially adjusted for sociodemographic variables and health indicators (model 1), and then gynecologic and reproductive history variables, including uterine size (model 2). RESULTS: We included 770 veterans in our analytic sample. Veterans with depression or PTSD were more likely than those without such diagnoses to have a MIH (49% vs. 42%). Differences were attenuated in model 1 (47% [95% CI, 37%-57%] vs. 43% [95% CI, 34%-52%]) and no longer detectable in model 2 (45% [95% CI, 36%-54%] vs. 44% [95% CI, 36%-52%]). CONCLUSIONS: Veterans with depression or PTSD were more likely that those without to have a MIH, possibly owing to smaller uterine size, suggesting that they may be undergoing hysterectomy earlier in the disease process. Further research is needed to understand whether this reflects high-quality, patient-centered care.


Assuntos
Depressão/epidemiologia , Histerectomia/métodos , Leiomioma/cirurgia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Estados Unidos/epidemiologia , United States Department of Veterans Affairs , Veteranos , Adulto Jovem
14.
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
16.
Obstet Gynecol ; 136(2): 365-368, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32649495

RESUMO

BACKGROUND: Morcellation at the time of minimally invasive hysterectomy or myomectomy for presumed benign indications carries a risk of disseminating undiagnosed uterine malignancies. CASE: A 57-year-old woman with a remote history of laparoscopic hysterectomy with morcellation of a cellular leiomyoma presented with a newly diagnosed complex pelvic mass. Owing to adherence of the mass to the rectum and numerous peritoneal tumor implants, a surgical cytoreductive procedure was performed. The pelvic mass, implants, and original hysterectomy specimen were histologically identical and consistent with low-grade endometrial stromal sarcoma. Owing to lack of tumor-myometrial interface on the original morcellated specimen, this malignant diagnosis was not made at the time of hysterectomy. CONCLUSION: Morcellation of the uterus can hinder an accurate pathologic diagnosis of uterine stromal neoplasms.


Assuntos
Neoplasias do Endométrio/diagnóstico , Histerectomia/métodos , Morcelação/métodos , Sarcoma do Estroma Endometrial/diagnóstico , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Histerectomia/efeitos adversos , Laparoscopia/métodos , Leiomioma/cirurgia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Morcelação/efeitos adversos , Sarcoma do Estroma Endometrial/patologia , Sarcoma do Estroma Endometrial/cirurgia , Miomectomia Uterina/métodos , Neoplasias Uterinas/cirurgia , Útero/patologia
17.
Expert Opin Pharmacother ; 21(14): 1667-1674, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32674616

RESUMO

INTRODUCTION: Uterine fibroids (UF) are benign tumors common in premenopausal women, with strong impact on the health-care systems. For many years, surgery represented the only therapy for symptomatic fibroids. However, clinicians are observing a switch from surgery to noninvasive methods; in particular, medical treatment has been shown to be efficacious in obtaining a bleeding reduction and in ameliorating patient conditions. AREAS COVERED: The authors review the current options available for the treatment of women with UF, with a special focus on the newest one, relugolix. It is an orally active non-peptide Gonadotropin-releasing hormone (GnRH)-receptor antagonist recently licensed for women with symptomatic fibroids. Relugolix is a well-tolerated safe drug; it is effective in inducing a dose-dependent decrease in menstrual blood loss, with faster reduction of heavy menstrual bleeding (HMB) and a greater shrinkage in fibroid volume compared to the current standard of GnRH agonist treatment. EXPERT OPINION: Relugolix is a promising drug for the non-surgical treatment of women with UF. To date, the only published data come from a well-selected Japanese female population study while results from worldwide ongoing studies are ongoing in order to confirm the efficacy of this GnRH agonist receptor.


Assuntos
Leiomioma/tratamento farmacológico , Compostos de Fenilureia/uso terapêutico , Pirimidinonas/uso terapêutico , Receptores LHRH/antagonistas & inibidores , Neoplasias Uterinas/tratamento farmacológico , Feminino , Humanos , Histerectomia , Leiomioma/metabolismo , Leiomioma/cirurgia , Menstruação/efeitos dos fármacos , Compostos de Fenilureia/administração & dosagem , Compostos de Fenilureia/efeitos adversos , Compostos de Fenilureia/farmacocinética , Pré-Menopausa/efeitos dos fármacos , Pirimidinonas/administração & dosagem , Pirimidinonas/efeitos adversos , Pirimidinonas/farmacocinética , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Neoplasias Uterinas/metabolismo , Neoplasias Uterinas/cirurgia
18.
BMC Womens Health ; 20(1): 122, 2020 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-32532271

RESUMO

BACKGROUND: Hysterectomy is one of the most common gynaecological procedures performed worldwide. The magnitude of the complications related to hysterectomy and their risk factors are bound to differ based on locations, availability of resources and level of surgical training. Documented complications rates and their correlates are reported from high income countries while data from low- and middle-income countries including Tanzania is scare. METHODS: This was a hospital based cross-sectional study conducted at a tertiary facility in northern Tanzania where 178 women who underwent elective gynecological hysterectomies in the department of obstetrics and gynecology within the study period were enrolled. Logistic regression was performed to determine the association between risk factors and occurrence of surgical complication where p-value of < 0.05 was considered statistically significant. The degree of correlation between pre-operative clinical and histological diagnosis was determined by kappa correlation test. RESULTS: A total of 75 (42%) of women had surgical complications within 10 days of surgery. Blood transfusion and intra-operative bleeding were the most common complications observed in 34 (19.1%) and 17 (9.6%) women respectively. Independent risk factors for complications included obesity (OR 3.9; 95% CI 1.44-10.46), previous abdominal operations (OR 8.44; 95% CI 2.52-28.26) and longer duration of operation (> 2 h) (OR 5.02; 95% CI 2.18-11.5). Both uterine fibroid and adenomyosis had good correlation of clinical and histological diagnosis (p-value < 0.001). CONCLUSION: Bleeding and blood transfusion were the most common complications observed in this study. Obesity, previous abdominal operation and prolonged duration of operation were the most significant risk factors for the complications. Local tailored interventions to reduce surgical complications of hysterectomy are thus pivotal. Clinicians in this locality should have resources at their disposal to enhance definitive diagnosis attainment before surgical interventions.


Assuntos
Histerectomia/efeitos adversos , Leiomioma/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Perda Sanguínea Cirúrgica , Transfusão de Sangue , Estudos Transversais , Feminino , Ginecologia , Humanos , Leiomioma/cirurgia , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/epidemiologia , Gravidez , Tanzânia/epidemiologia
19.
Medicine (Baltimore) ; 99(22): e20196, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481384

RESUMO

INTRODUCTION: Leiomyoma of peripheral nerve is a rare condition characterized by neuropathy of affected nerve. We herein report a rare presentation of leiomyoma of radial nerve which presented with wrist drop. PATIENT CONCERNS: A 37-year-old man visited our clinic with a history of sudden onset weakness of the wrist dorsiflexion/finger extension of the right side. DIAGNOSIS: T2-weighted with fat saturation image of MRI demonstrated a well-defined, intra-neural, round mass of about 0.8 cm × 0.5 cm within the radial nerve. Excision of mass established the pathological diagnosis of intra-neural leiomyoma. INTERVENTIONS: The patient underwent excision of mass and attached nerve tissue, followed his medial antebrachial nerve graft for repair of the defected radial nerve. OUTCOMES: As of the 1-year follow-up, no symptoms of recurrence have been observed. Also, the strength of wrist dorsiflexion improved to grade 4/5 CONCLUSION:: This rare case demonstrates the importance of MR imaging to differentiate intra-neural leiomyomas from other benign peripheral nerve sheath tumors. Surgical treatment plays an important role in the treatment of patient with intraneural leiomyoma with neurologic deficits.


Assuntos
Leiomioma/complicações , Neoplasias do Sistema Nervoso Periférico/complicações , Nervo Radial , Neuropatia Radial/etiologia , Adulto , Humanos , Leiomioma/diagnóstico por imagem , Leiomioma/cirurgia , Imagem por Ressonância Magnética , Masculino , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/cirurgia , Nervo Radial/diagnóstico por imagem , Nervo Radial/cirurgia
20.
BMC Womens Health ; 20(1): 89, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32357868

RESUMO

BACKGROUND: Extrauterine leiomyomata is an uncommon lesion that can lead to several problems of differential diagnosis, especially when localized in the external genitalia. There are few reports in the English literature and a novel association with Alport's syndrome has been investigated since the 1980s. CASE PRESENTATION: Here, we describe the case of a premenopausal woman who presented with an indolent swelling of the right interlabial fossa that resulted in a Bartholin cyst. In addition to this cyst, a benign leiomyoma of the right side of the clitoris was also found and removed. Our patient refused any further examination, although she was informed that genetic counselling could be organized to rule out an association with Alport's syndrome. CONCLUSIONS: Extrauterine leiomyomata localized in the external genitalia is an uncommon lesion arising from smooth muscle cells around vascular epithelium or erectile tissue. Since an association between extrauterine leiomyomata and Alport's syndrome has been described, genetic testing can be proposed to these patients. Upper intestinal tract symptoms such as dysphagia should prompt a gastroenterological evaluation as an association with an esophageal leiomyomatosis has been described.


Assuntos
Glândulas Vestibulares Maiores/cirurgia , Clitóris/cirurgia , Leiomioma/cirurgia , Adulto , Clitóris/patologia , Feminino , Humanos , Leiomioma/patologia , Masculino
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