Uterine Origin Research Articles

6962 Natural History of Menstrual Pain and Associated Risk Factors in Early Adolescence

Abstract Disclosure: M. Sofia: None. R. Modarelli: None. S. Molsberry: None. S. Denslow: None. D. Zaccaro: None. C. Kamoun: None. N.D. Shaw: None. Background: Primary dysmenorrhea (PD), or menstrual pain of uterine origin without pelvic pathology, affects up to 93% of adolescents and is a leading cause of school and work absenteeism. The theory that PD only occurs when progesterone levels fall in the late-luteal phase, triggering production of uterine prostaglandins, has dominated the literature. However, recent studies identifying PD among girls with anovulatory cycles cast doubt on this theory. We took advantage of an ongoing longitudinal study of healthy early post-menarchal girls to test the hypothesis that ovulation is associated with increased PD and to explore other participant factors associated with PD. Methods: Participants contributed daily urine samples to measure Cr-corrected LH, estrone conjugates, and pregnanediol-3-glucuronide [PdG], completed menstrual diaries, and reported dysmenorrhea symptoms using the 24-item Menstrual Symptom Questionnaire (MSQ) approximately biannually. A cycle was defined as ovulatory if peak PdG >2500 ng/mg Cr. Scores were natural log-transformed and modeled to assess associations with gynecologic age, ovulation, anxiety, depression, and physical activity exposures using generalized estimating equations with a normal distribution and autoregressive covariance structure. Models were adjusted for age at menarche, baseline BMI Z-score, race, ethnicity, maternal age at menarche, parental education and employment, and gynecologic age (ovulation models only). Results: The 43 participants were 12.38 ± 1.06 years old (mean ± SD) with a gynecologic age of 2.99 ± 2.22 months. The majority were non-Hispanic White and of normal weight. Average maternal age at menarche was 12.64 ± 1.09 years. Among parents of participants, most were both at least college-educated and nearly 50% were both employed. Participants completed 155 MSQs (1-9/participant). Dysmenorrhea scores increased over time (scores 1.14x higher for every 1-year increase in gynecologic age, p<0.001). Dysmenorrhea scores were 1.12x higher (p=0.03) if the preceding cycle was ovulatory vs. anovulatory and 1.11x higher if all cycles in the preceding 6 months were ovulatory vs all anovulatory (p=0.11). Gynecologic age remained significant in models with ovulation-based exposures, and maternal age at menarche was inversely associated with dysmenorrhea score (beta -0.08, p=0.04) in the model with gynecologic age as the exposure. Conclusion: In early-postmenarchal girls, dysmenorrhea scores were higher when associated with ovulatory cycles but also increased over time independent of ovulatory status, suggesting a pathophysiologic role for progesterone and other unknown factors. There was no association between age at menarche, BMI, race/ethnicity, and dysmenorrhea scores whereas maternal age at menarche was inversely associated with dysmenorrhea scores. Presentation: 6/1/2024

S5030 Gastric Ulcers: A Rare Presentation of Metastatic Small Cell Carcinoma of Uterine Origin

S5030 Gastric Ulcers: A Rare Presentation of Metastatic Small Cell Carcinoma of Uterine Origin

Reprogramming of normal fibroblasts into ovarian cancer-associated fibroblasts via non-vesicular paracrine signaling induces an activated fibroblast phenotype

Cancer-associated fibroblasts (CAFs) are key contributors to ovarian cancer (OC) progression and therapeutic resistance through dysregulation of the extracellular matrix (ECM). CAFs are a heterogenous population derived from different cell types through activation and reprogramming. Current studies rely on uncharacterized heterogenous primary CAFs or normal fibroblasts that fail to recapitulate CAF-like tumor behavior. Here, we present that conditioned media from ovarian cancer lines leads to an increase in the activated state of fibroblasts demonstrated by functional assays and up-regulation of known CAF-related genes and ECM pathways. Phenotypic and functional characterization demonstrated that the conditioned CAFs expressed a CAF-like phenotype, strengthened proliferation, secretory, contractility, and ECM remodeling properties when compared to resting normal fibroblasts, consistent with an activated fibroblast status. Moreover, conditioned CAFs significantly enhanced drug resistance and tumor progression. Critically, the conditioned CAFs resemble a transcriptional signature with involvement of ECM remodeling. The present study provides mechanistic and functional insights about the activation and reprogramming of CAFs in the ovarian tumor microenvironment mediated by non-vesicular paracrine signaling. Moreover, it provides a translational based approach to reprogram normal fibroblasts from both uterine and ovarian origin into CAFs using tumor-derived conditioned media. Using these resources, further development of therapeutics that possess potentiality and specificity towards CAF/ECM-mediated chemoresistance in OC are further warranted.

Automatic semantic segmentation of EHG recordings by deep learning: An approach to a screening tool for use in clinical practice

Background and ObjectivePreterm delivery is an important factor in the disease burden of the newborn and infants worldwide. Electrohysterography (EHG) has become a promising technique for predicting this condition, thanks to its high degree of sensitivity. Despite the technological progress made in predicting preterm labor, its use in clinical practice is still limited, one of the main barriers being the lack of tools for automatic signal processing without expert supervision, i.e. automatic screening of motion and respiratory artifacts in EHG records. Our main objective was thus to design and validate an automatic system of segmenting and screening the physiological segments of uterine origin in EHG records for robust characterization of uterine myoelectric activity, predicting preterm labor and help to promote the transferability of the EHG technique to clinical practice. MethodsFor this, we combined 300 EHG recordings from the TPEHG DS database and 69 EHG recordings from our own database (Ci2B-La Fe) of women with singleton gestations. This dataset was used to train and evaluate U-Net, U-Net++, and U-Net 3+ for semantic segmentation of the physiological and artifacted segments of EHG signals. The model's predictions were then fine-tuned by post-processing. ResultsU-Net 3+ outperformed the other models, achieving an area under the ROC curve of 91.4 % and an average precision of 96.4 % in detecting physiological activity. Thresholds from 0.6 to 0.8 achieved precision from 93.7 % to 97.4 % and specificity from 81.7 % to 94.5 %, detecting high-quality physiological segments while maintaining a trade-off between recall and specificity. Post-processing improved the model's adaptability by fine-tuning both the physiological and corrupted segments, ensuring accurate artifact detection while maintaining physiological segment integrity in EHG signals. ConclusionsAs automatic segmentation proved to be as effective as double-blind manual segmentation in predicting preterm labor, this automatic segmentation tool fills a crucial gap in the existing preterm delivery prediction system workflow by eliminating the need for double-blind segmentation by experts and facilitates the practical clinical use of EHG. This work potentially contributes to the early detection of authentic preterm labor women and will allow clinicians to design individual patient strategies for maternal health surveillance systems and predict adverse pregnancy outcomes.

Clinical evaluation of Erand Tail Nabhi Puran in the management of Dysmenorrhea : Pilot Study

Dysmenorrhea is defined as painful menstrual cramps of uterine origin which can be correlated with Udavartini Yonivyapad. It is very common gynecological disorder in females specially in reproductive age. Sometimes it also hampers women’s daily routine. Udavarta Yonivyapad is explained in Ayurveda as a Nanatmaja Vata Vyadhi by Charaka where there is abnormal movement of Vayu in Pakwashay with painful menses. There are different types of NSAIDS, OC pills, painkillers, etc. to give temporary relief from pain but it also has side effects on body if taken in excess amount. In Ayurveda lot of formulations are used for treatment of same. An attempt has been made through Ayurveda classics in regards to dysmenorrhea with Nabhi Puran using Eranda Taila.

Successful clinical approach to the metastatic uterine leiomyosarcoma to the epicardium—a case report

BackgroundUterine leiomyosarcoma is a rare and aggressive tumour with a poor prognosis. Its metastases to the heart are even rarer, especially to the epicardium. The majority of reported cardiac metastases of uterine leiomyosarcoma were in the cardiac chambers or intramyocardial. Surgical resection of the uterine leiomyosarcoma in the early stages is the only definitive treatment for this disease. However, in the cases of cardiac metastasis, surgery is recommended only in emergencies and patients with expected beneficial outcomes.Case presentationOur patient was a 49-year-old female referred to the Department of Cardiac Surgery for scheduled surgery of pericardial neoplasia. The patient underwent a hysterectomy and adnexectomy three years prior owing to the uterine leiomyosarcoma. A regular follow-up magnetic resonance imaging of the abdomen and pelvis discovered neoplasia in the diaphragmic portion of the pericardium. No other signs of primary disease relapse or metastases were found. The patient was asymptomatic. The multidisciplinary team concluded that the patient is a candidate for surgery. Surgery included diastolic cardiac arrest achievement and resection of the tumour. Macroscopically, a parietal layer of the pericardium was completely free from the tumour that invaded only the apical myocardium of the left ventricle. Completed histopathology confirmed the diagnosis of leiomyosarcoma of the uterine origin. Three months after surgery, the patient received adjuvant chemotherapy with doxorubicin and dacarbazine. One year after surgery, there are no signs of new metastases.ConclusionsStrict surveillance of patients with uterine leiomyosarcoma after successful treatment of the early stage of the disease is of utmost importance to reveal metastatic disease to the heart in a timely manner and to treat it with beneficial outcomes. Surgery with adjuvant chemotherapy might be a good approach in patients with a beneficial prognosis. From a surgical point of view, it is challenging to assess the appropriate width of the resection edges to be radical enough and, at the same time, sufficiently conservative to ensure the satisfactory postoperative function of the remaining myocardium and avoid repetitive tumour growth. Therefore, intraoperative histopathology should always be performed.

Evaluation of Uterine Artery Origins on Contrast-Enhanced Magnetic Resonance Images

Background/Aims: The origin of the uterine artery varies widely. The branching patterns of the internal iliac artery are also quite variable. Branching of the internal iliac artery in different ways is important in pelvic surgery. In our study, fertile and infertile groups were created, and the arteries that gave rise to the uterine artery were examined. Methods: A total of 152 uterine arteries (n = 152) were evaluated retrospectively on 3D contrast-enhanced magnetic resonance images. Based on the study of Gomez-Jorge, the types of origin of the uterine artery were obtained. With regards to the incidence of types, differences between the fertile and infertile groups were examined. Results: There was no statistically significant difference between the groups in terms of the incidence of origin types (p = 0.214). Based on the study of Gomez-Jorge, five different types of origins were obtained. The most common was type I (the uterine artery being the first branch of the inferior gluteal artery) origination. Conclusions: There are studies investigating the origin of the uterine artery in literature. We believe that our findings will also contribute to the body of knowledge available.

A Pilot Study On “A Study To Assess The Effectiveness Of Comprehensive Nursing Interventions (Hydrotherapy, Rice Heat Pad, Turmeric Therapy, Acupressure And Self Learning Booklet) On The Level Of Pain Perception And Dysmenorrhea Symptoms Among Adolescent

Background: Menstruation is a natural phenomenon in women after puberty and is often associated with dysmenorrhea (Garg, 2015). Dysmenorrhea is very common, painful menstrual cramps of uterine origin, which is commonly divided into primary dysmenorrhea (pain without organic pathology) and secondary dysmenorrhea (pelvic pain with an identifiable pathologic condition, such as endometriosis or ovarian cysts) (Nagy, 2021). Doctors and other women give a lot of conflicting advice to reduce the pain during dysmenorrhea. To handle menstrual pain, we can utilize either the pharmacological or non-pharmacological methods. Pharmacologically, menstrual pain can be treated with medication. However, Non-pharmacologically, menstrual pain can be reduced by adequate rest, regular exercise (especially walking), water immersion, and pressing pressure points and by drinking traditional herbs such as turmeric water (Armour et al., 2019). Alleviation of pain during menstruation will result in good productivity and confidence among women. Aim of the study: To evaluate the effectiveness of comprehensive nursing interventions (Hydrotherapy, Rice heat pad, Turmeric therapy, Acupressure and Self-learning booklet) on pain perception and dysmenorrhea symptoms among adolescent girls. Methods and design: The study was conducted using a Quantitative approach with Quasi Experimental Time Series with 2 group pretest and posttest design. Forty-Eight adolescent girls in the age group of 13-17 years were selected by using random sampling technique for both experimental and control group. In phase I, Data about background variables was collected before pretest, using socio demographic Performa and menstrual Performa. The researcher has conducted pretest level of Dysmenorrheal symptoms were assessed during first menstrual cycle for the first three days (1st day, 2nd day, 3rd day) by using Numerical Rating scale (NRS) and modified menstrual symptoms questionnaire (MMSQ) to the control group and experimental group. Comprehensive Nursing Interventions ((Hydrotherapy, Rice heat pad, Turmeric therapy, Acupressure and Self-learning booklet) were given to adolescent girls in experimental group on individual basis. Assessment of Effectiveness of Comprehensive Nursing Interventions on level of pain perception and dysmenorrheal symptoms were measured by using same pretest scale. The major findings of the study: Comprehensive Nursing Interventions ((Hydrotherapy, Rice heat pad, Turmeric therapy, Acupressure and Self-learning booklet) is an intervention in reducing Pain perception and dysmenorrheal symptoms as the pre-test mean score, SD and Mean percentage of experimental group shows that Mean (7.42±1.8) and control group Mean (7 ±2.34) on level of pain perception among adolescents with dysmenorrhea. So, the difference is 0.42, not statistically significant. Pretest mean score, SD, and Mean percentage of dysmenorrheal symptoms in experimental group shows that Mean (127.38±8.88) and control group Mean (125.25± 7.66) among adolescents with dysmenorrhea. So, the difference is 2.13, not statistically significant, assessed using student independent t-test. In posttest, there was a significant difference between experimental and control group of adolescent girls. The significant p- values 0.001 indicates, the level of pain perception and dysmenorrheal symptoms score were not similar in both groups, calculated using chi square test. Experimental groups are reduced the 44.20% of pain perception score and 20.67% of dysmenorrheal symptoms score after having comprehensive nursing interventions and control group are reduced only 2.90% of pain perception score and 1.61% of dysmenorrheal symptoms after routine care. There is significant association between posttest level of pain perception and demographic variables of adolescent girls with the age group of 13-14 years and 10th standard and posttest level of pain perception and menstrual variables of adolescent girls with 28 days menstrual cycle and moderate extent of blood loss in experimental group. There is significant association between posttest level of dysmenorrheal symptoms and demographic variables of adolescent girls with the type of family and family history and posttest level of pain perception and menstrual variables of adolescent girls with day of flow and material used in experimental group. Discussion: The findings of the study enlighten the fact that comprehensive nursing interventions can be used as cost-effective interventions and showed higher participant satisfaction during intervention by reducing the level of pain perception and dysmenorrheal symptoms score in adolescent girls with primary dysmenorrhea.

Surgical approach to neglected giant cervical fibroids

Cervical fibroids are rare neoplasms of uterine origin whose management has not been standardized. Cervical fibroids, which can be challenging in surgical management, can become a difficult problem for the surgeon when neglected or asymptomatic and reach gigantic dimensions. Suspending the aorta abdominalis or arteria illiaca communis with vascular tapes and balloting the uterus with the help of vaginal taping while searching for the correct cleavage may reduce the risk of intraoperative hemorrhage and adjacent organ injury, as well as may be guide for the steps of the operation. Management of neglected giant cervical fibroids may not be suitable for testing alternative treatment methods to surgery used in the treatment of uterine neoplasms. However, surgical management will also be challenging. For this reason, the technique we describe can help the surgeon with clues that should be considered in the surgical management of these patients.

Infertility Services for Veterans Enrolled in Veterans Health Administration Care.

Infertility care is provided to Veterans through the Veterans Health Administration (VHA) medical benefits package and includes infertility evaluation and many infertility treatments. Our objective was to examine the incidence and prevalence of infertility diagnoses and the receipt of infertility healthcare among Veterans using Veterans Health Administration (VHA) healthcare from 2018 to 2020. Veterans using the VHA and diagnosed with infertility during October 2017-September 2020 (FY18-20) were identified in VHA administrative data and through VA-purchased care (i.e., community care) claims. Infertility was categorized among men as azoospermia, oligospermia, and other and unspecified male infertility, and among women as anovulation, infertility of tubal origin, infertility of uterine origin, and other and unspecified female infertility using diagnosis and procedure codes (ICD-10, CPT). A total of 17,216 Veterans had at least one VHA infertility diagnosis in FY18, FY19, or FY20, including 8766 male Veterans and 8450 female Veterans. Incident diagnoses of infertility were observed in 7192 male Veterans (10.8/10,000 person (p)-years) and 5563 female Veterans (93.6/10,000 p-years). A large proportion of Veterans who were diagnosed with infertility received an infertility-related procedure in the year of their incident diagnosis (males: 74.7, 75.3, 65.0%, FY18-20 respectively; females: 80.9, 80.8, 72.9%, FY18-20 respectively). In comparison to a recent study of active duty servicemembers, we found a lower rate of infertility among Veteran men and a higher rate among Veteran women. Further work is needed to investigate military exposures and circumstances that may lead to infertility. Given the rates of infertility among Veterans and active duty servicemembers, enhancing communications between Department of Defense and VHA systems regarding sources of and treatment for infertility is essential to help more men and women benefit from infertility care during military service or as Veterans.

Surgically Treated Brain Metastases from Uterine Origin: A Case Series and Systematic Review

We aimed to describe our institutional case series of 9 surgically treated uterine brain metastases and perform a survival analysis through a systematic review and a pooled individual patient data study. This study was divided into 2 sections: 1) a retrospective, single center patient series assessing outcomes of neurosurgical treatment modalities in patients with malignancy arising in the uterus with brain metastases and 2) a systematic review of the literature between 1980 and 2021 regarding treatment outcomes of individual patients with intracranial metastasis of uterine origin. Pooled cohort survival analysis was done via univariate and Cox regression multivariable analysis and Kaplan-Meier curves. Final statistical analysis included a total of 124 pooled cohort patients: one hundred fifteen patients from literature review studies plus 9 patients from our institution. Median age at the time of diagnosis was 54 years. Median time from diagnosis of the primary cancer to brain metastasis was 19 months (0-166 months). Surgery and radiotherapy resulted in the highest median OS of 11 months (P < 0.001). Multivariable analyses indicated that the presence of more than one central nervous systemlesion had an increased risk on OS (P= 0.003). Microsurgery, stereotactic radiosurgery, and whole brain radiotherapy remain the evidence-based mainstay applicable to the treatment of multiple brain metastases. Brain metastases of cancer arising in the uterus appear to result most often in multiple lesions with dismal prognosis. The seemingly most efficacious treatment modality is surgery and radiotherapy. However, this treatment is often not an option when more than 1 or 2 brain lesions are present.

Characterization of Fertility Clinic Attendees in the Abu Dhabi Emirate, United Arab Emirates: A Cross-Sectional Study.

This study describes the primary and secondary infertility in patients attending fertility clinics and reports factors associated with primary infertility. A cross-sectional survey was conducted in two fertility clinics in Abu Dhabi Emirate, United Arab Emirates (UAE) between December 2020 and May 2021. The collected information covered sociodemographic, lifestyle, medical, and fertility-related characteristics. The mean age and age at marriage (±SD) of the 928 patients were 35.7 (±6.7) and 25.2 (±6.3) years, respectively. Of the total, 72.0% were obese and overweight, 26.6% reported a consanguineous marriage, and 12.5% were smokers. Secondary infertility (62.5%) was more frequent than primary infertility (37.5%). Primary infertility was inversely associated with age (aOR, 0.94, 95% CI: 0.91-0.98) and not being overweight (aOR, 0.6, 95% CI: 0.4-0.9) while positively associated with a nationality other than Middle Eastern nationality (aOR, 1.9, 95% CI: 1.1-3.3), married for ≤5 years (aOR, 6.0, 95% CI: 3.9-9.3), in a nonconsanguineous marriage (aOR, 2.4, 95% CI: 1.5-3.9), having a respiratory disease (aOR, 2.3, 95% CI: 1.1-4.6), an increased age at puberty (aOR, 1.2, 95% CI: 1.0-1.3), and self-reported 6-<12 months (aOR, 2.4, 95% CI: 1.2-5.1) and ≥12 months (aOR, 3.4, 95% CI: 1.8-6.4) infertility. Patients with primary infertility were more likely to be diagnosed with infertility of an ovulation, tubal, or uterine origin (aOR, 3.9, 95% CI: 1.9-7.9). Secondary infertility was more common than primary infertility. Several preventable fertility-related risk factors including overweight, smoking, and diabetes were found to be common among the fertility clinic attendees.

Computed tomography can differentiate vaginal-origin from uterine-origin lesions in bitches.

To investigate typical computed tomography (CT) features for the differentiation of vaginal from the uterine origin in dogs. 7 healthy Beagles in the prospective study and 5 bitches in the retrospective study. In the prospective study, dual-phase CT images were obtained from sexually intact female Beagles (n = 7) during anestrus and estrus. On the CT images, the vagina and uterine horns, body, and cervix were assessed for diameter, attenuation, and contrast enhancement pattern. In the retrospective study, CT features of large vaginal lesions (leiomyoma, leiomyosarcoma, adenocarcinoma, hematocolpos, and Gartner's duct cyst) were assessed in 5 bitches. In normal bitches, the cervix was thicker with strong central enhancement compared to the uterus and vagina. The uterine artery, which enters the mesometrium at the level of the cervix, was clearly visualized and assisted in identifying the cervix. In bitches with large vaginal masses, uterine arteries were displaced by the lesions and could not be used to locate the cervix. In 4/5 dogs with vaginal masses, identification of the cervix allowed the determination of the organ of origin. In 1 dog with adenocarcinoma, CT vaginography was additionally required for determining the origin of mass. Results from this study indicate that the cervix, recognized in CT as focal thickening of the uterus with central enhancement, may be used as a landmark for the differentiation between the uterus and vagina in bitches.

SURG-07. SURGICALLY TREATED BRAIN METASTASES FROM UTERINE ORIGIN: A CASE SERIES AND SYSTEMATIC REVIEW

Abstract INTRODUCTION Brain metastases from uterine origin have an incidence of 0.7-1.1%. Due to their rarity, there exists scarce literature entailing their neurosurgical treatment and outcomes. OBJECTIVE To report case management and outcomes of nine patients with brain metastases from uterine origin, as well as a systematic literature review findings focused on their neurosurgical treatment and outcomes. METHODS This study was divided into two parts: (1) a retrospective, single-center patient series assessing neurosurgical outcomes in patients with primary uterine cancer with brain metastases and (2) a systematic review of the literature between 1980 and 2021 assessing outcomes of patients with primary uterine cancer metastasized to the brain. RESULTS We report a case series at our single institution consisting of nine patients identified to have metastases to the brain from uterine origin that were treated with neurosurgical intervention. A total of 26 CNS lesions were identified among the 9 cases, with a mean number of lesions of 2.9 (1-7). The median age at the time of primary uterine cancer diagnosis was 49 years (26-80 years), with a median time from diagnosis to CNS metastasis of 19.5 months (3-54 months). The most common cerebral regions affected were the frontal lobe (42.3%) and the cerebellum (23%). Median progression free survival (PFS) and overall survival (OS) following intervention were 6.5 and 17.4 months, respectively. Stereotactic radiosurgery (SRS) alone resulted in the highest PFS and OS of 20.3 and 39 months, respectively. Sixteen studies were included in the systematic analysis. The mean OS was 13.3 months (3-41.1 months). CONCLUSION Brain metastases from uterine origin seem to most frequently result in multiple symptomatic lesions with additional concurrent metastasis to other organs. The most effective treatment modality appeared to be SRS alone. There is limited data on sole SRS treatment, so additional research regarding this modality is encouraged.

Use of Vascular Clips to Ligate Uterine Arteries for Dissection of Anterior Lower Uterine Wall Outpouching from Bladder

<h3>Study Objective</h3> To present a difficult anterior compartment surgery in which vascular clips were utilized to ligate the uterine arteries prior to dissection of the bladder from a lower uterine wall outpouching during a robotic-assisted hysterectomy. <h3>Design</h3> Demonstration of the technique using narrated surgery video footage. <h3>Setting</h3> The uterine blood supply is typically ligated at the level of the internal os during a typical hysterectomy. When adhesive disease presents abnormal anatomy, there are multiple methods to secure the uterine arteries. This includes identifying it at the pelvic brim branching from the internal iliac artery, identifying the median umbilical artery and tenting upwards to find the uterine artery origin, or following the ureter down to the ureteric tunnel as it crosses under the uterine artery. The latter method was used in this case and the uterine arteries were ligated with vascular <h3>Patients or Participants</h3> A patient with 6 prior cesarean deliveries and subsequent development of an anterior lower uterine wall outpouching was found to have malpositioned IUD within this defect, resulting is persistent pelvic pain. <h3>Interventions</h3> Robotic-assisted hysterectomy was performed in a case of extensive anterior compartment adhesions, with several strategies for safe dissection and minimal blood loss: 1. Placement of ureteral stents prior to start of case 2. Dissection of uterine arteries retroperitoneally down to the ureteric tunnels and ligation with vascular clips to secure blood supply prior to dissection of the bladder 3. Backfill the bladder to help define the peritoneal reflection between bladder and lower uterine segment 4. Assess for bladder injury by backfilling after dissection <h3>Measurements and Main Results</h3> N/A. <h3>Conclusion</h3> Here, we demonstrate several strategies for difficult bladder dissection from a lower uterine wall outpouching to minimize blood loss, maintain visualization, and avoid injury to bladder or ureters.

8887 Hysteroscopic Intramyometrial Injection of Botulinum Toxin As Treatment for Chronic Pelvic PAIN of Uterine Origin

<h3>Study Objective</h3> to demonstrate the surgical technique of the intramyometrial application of botulinum toxin Hysteroscopic approach for the management of pelvic pain of uterine origin. <h3>Design</h3> A step-by-step description was made for the application of intramyometrial botulinum toxin via hysteroscopic. <h3>Setting</h3> Advanced gynecology laparoscopic and pelvic pain unit. <h3>Patients or Participants</h3> Patients with painful uterine syndrome who follows the diagnostic criteria: the presence of localized pain in the pelvis, colic or sensation of uterine contraction outside the cycle, dysmenorrhea, dyspareunia, physical examination findings of pain on uterine palpation as a uterine trigger. <h3>Interventions</h3> hysteroscopic Intramyometrial application of Botulinum Toxin for treatment of chronic pelvic pain of uterine origin. <h3>Measurements and Main Results</h3> Intramyometrial application of botulinum toxin under hysteroscopic guidance with general anesthesia, use of Bettochi's hysteroscope and surgical steel needle for cystoscopy (5 Fr, 30 cm) through the working channel, use of saline solution as a means of distention, vaginoscopy, entry into the endocervical canal and endometrial cavity, evaluation of the cavity, location of the ostium, injection of botulinum toxin type A dilution (200 IU in 20 cc SSN) application of 1 cc per point distributed on the anterior and posterior face of the uterine wall. <h3>Conclusion</h3> Hysteroscopic intramyometrial application of Botulinum toxin can be a treatment option in patients with chronic pelvic pain of uterine origin when conventional treatment fails. It is an easily reproducible procedure, with few side effects and effective in pain control in selected patients.

Hysteroscopic Botox: A Novel Pelvic Pain Treatment

<h3>Study Objective</h3> The objectives of this video are to describe the patient selection criteria, procedural steps, and postoperative care for hysteroscopic onabotulinumtoxinA (Botox) injection as a treatment for pelvic pain. <h3>Design</h3> N/A<b>.</b> This tutorial video demonstrates the surgical technique of hysteroscopic Botox administration. <h3>Setting</h3> Hysteroscopic Botox injections are administered through an operative hysteroscope introduced into the endometrial cavity. The procedure is performed in an operating room setting with the patient in dorsal lithotomy position. <h3>Patients or Participants</h3> Hysteroscopic Botox treatment can be considered in patients with pain of uterine origin who have failed conservative pelvic pain therapy, have normal pelvic imaging, and a laparoscopy negative for endometriosis. Patients ineligible for the procedure include those with an allergy to Botox or with any contraindication to hysteroscopy. Caution is warranted in patients pursuing pregnancy, as the effect of treatment on fertility is unknown. <h3>Interventions</h3> After diagnostic hysteroscopy confirms a normal endometrial cavity, a resection device is used to thin the entirety of the endometrium. 200 Units of Botox mixed with 3 mL of injectable saline is drawn into a syringe which is loaded into a control flow administration device. A hysteroscopic needle is attached to the tip of the syringe. Hysteroscopy is resumed, the needle is advanced through the operative channel, and the dilute Botox solution is injected into the myometrium at even intervals throughout the endometrial cavity. <h3>Measurements and Main Results</h3> Patient response is evaluated two weeks following the procedure using a numeric pain scale. If the patient reports significant benefit, the procedure may be repeated at six months. <h3>Conclusion</h3> Hysteroscopic Botox administration is a novel treatment approach for refractory uterine pain. One observational study demonstrates improvement in patient pain scores postoperatively. A randomized control trial is needed to confirm the efficacy of this treatment.

Effects Of High Intensity Aerobics and Pelvic Clock Exercises in Primary Dysmenorrhea

Dysmenorrhea is very unpleasant sensation with the presence of painful cramps of uterine origin that occur during menstruation. Prevalence rate of dysmenorrhea is 50% in females’ population. Evidence tells that inactive lifestyle as well as poor diet is main reason of primary dysmenorrheal as well as women who exercise have a reduced incidence of dysmenorrhea. Objectives: To find the effectiveness of high intensity aerobics and pelvic clock exercises in primary dysmenorrhea. Methods: The study design was randomized control trials. Purposive sampling technique was used. Girls aged 17–24 years with regular menstrual cycle and unmarried girls were included. Athletes, married women with gynecological abnormalities were excluded. A structured 8 weeks’ program (3 days in a week, 1hour per day) was given to Group A including set of London bridges (8 mins), Jumping lunges (8 mins), Mountain climbers (8 mins), Quadruped bent knee hip extension (8 mins), Warm up 10 minutes, 25 minutes for high intensity aerobics. Group B were assigned 25 minutes for Pelvic clock exercises (gradually increased during with weeks) performed from 12 to 6 o’clock, as instructed to move from 3 o clock to 9 o clock. Then movement in a clockwise manner from 12 to 3 to 6 to 9 and then back to 12 o’ clock. Outcome measures were calculated by visual analog scale VAS, DASS 21 and self-administered questionnaire for dysmenorrhea symptoms. Results: Both techniques were effective for managing the patients of pain during menstruation, but patients who were treated with high intensity aerobics exercise showed more significant result as compared to another group with p-value &lt; 0.05. Conclusions: High intensity aerobics and Pelvic clock exercises in primary dysmenorrhea, both are effective but high intensity aerobics had given more efficient results

THE COMPARATIVE STUDY OF USG AND MDCT IN THE EVALUATION OF PELVIC MASSES IN FEMALES

Introduction: Pelvic masses in females of all ages are a routine gynaecological issue for which healthcare is sought, and in a populous country like India, these masses form a significant part of the disease burden. The evaluation of the female pelvis is a radiological necessity and a challenge. The foremost aim for any imaging modality in this scenario is to rule out malignancy in the mass, and further to characterise and define the mass so as to guide appropriate management of the patient. Of the wide range of imaging modalities available, ultrasonography and computed tomography are commonly available and extensively used for the evaluation of the varied female pelvic masses. We studied the ultrasonography and multi detector computed tomography findings and their usefulness in the diagnosis and characterization of various pelvic masses in females. Methodology: It was a prospective observational study, ranging over the duration of one and a half years,of 100 female patients fulfilling inclusion criteria, who underwent ultrasonography and multidetector computed tomography scanning in the Department of Radiodiagnosis at RNT medical college, Udaipur. Pelvic masses were evaluated for origin, size, margins, composition, vascularity, ascites, lymphadenopathy and other features to characterise as benign or malignant. Final diagnosis was by histopathological correlation. Results: The most common age group belonged to 35-45 years group (22%) followed by 55-65 years group (21%). Mean age for benign masses was 35.84 years and for malignant masses was 51.64 years. Ovarian origin was the commonest followed by uterine origin. Features like solid areas, ill-defined margins, lymphadenopathy and ascites favoured malignancy. Most common pathologies were adenocarcinoma ovary, carcinoma cervix, benign ovarian cysts and uterine fibroids. Conclusion: Ultrasonography is often the first imaging study performed in patients with symptoms related to the pelvis. Results indicated higher diagnostic capability of CT as a problem-solving tool. Overall diagnostic accuracy of CT was higher than USG in characterising both benign and malignant pelvic masses.

Gastrointestinal stromal tumor as mimicking gynecological mass finding on CT scan imaging: A case report.

IntroductionGastrointestinal stromal tumor (GIST) is a term to describe the distant spread (metastasis) of primary tumors to the peritoneal cavity.Case presentationA 48-year-old woman complained of dilated stomach, stomachache, and nausea. Laboratory findings showed an increase in the tumor marker, CA-125147 U/mL and also LDH 350 U/L while quantitative total β HCG and CEA were normal. Ultrasonography showed dominantly a huge solid mass with the cystic component in pelvic cavity extended to the abdominal cavity, with vascularized on Doppler ultrasound, difficult to identify uterine or adnexa origin. Afterward, an abdominal CT scan with and without contrast was performed and showed a solid mass with cystic and necrotic component impression originating from GI tract with feeding branch of an artery mesenteric, attached to the mesenteric small bowel and peritoneal carcinomatosis. Core biopsy and immunohistochemical were also performed with the result suggesting GIST.DiscussionThe diagnosis of GIST was established based on laboratory findings, abdominal ultrasound, abdominal CT-scan, and confirmation of GIST.ConclusionThe diagnosis of GIST can be distinguished from gynecological mass despite their similarities.