Extirpation Of Uterus Research Articles

The fetus gender value in the structure of obstetric pathology in pregnant women with gestational diabetes mellitus

Objective: To study the obstetric pathology and delivery outcomes in pregnant women with gestational diabetes depending on the sex of the fetus.Materials and Methods: A retrospective analysis of 2014 histories of pregnancy and childbirth of women with gestational diabetes (GD) over the period of 2018-2021, was carried out. Two groups were formed based on the sex of the fetus: Group 1 (1012 pregnant women) with male fetuses and Group 2 (1002 pregnant women) with female fetuses. For statistical analysis, the proportions (%) were compared using the Pearson’s χ2 (chi-square) test.Results: It was proved that the male sex of the fetus is a risk factor for the GD and concomitant obstetric complications (placental insufficiency, risk of preterm birth, fetal macrosomia). The prevalence of hypotonic bleeding, defects of the placenta, and placenta increta, and related cases of manual control of the uterine cavity and uterus extirpation in mothers of boys with GD was established. Also, in patients of this group, birth injuries consisting in a rupture of the posterior labial commissure were significantly more often registered as a result of childbirth with a large fetus, while cases of cervical rupture prevailed in women with female fetuses.Conclusions: The revealed dependence of the nature of obstetric complications and the course of labor on the sex of the fetus in pregnant women with GD warrant developing a monitoring system that takes into account the gender of the fetus.

Multiple primary cancer in Leser — Trelat syndrome (description of a clinical case)

The article provides information about one of the typical paraneoplastic syndromes — Leser — Trelat syndrome, a condition that develops jointly and sometimes precedes the appearance of a malignant visceral tumor. Brief clinical characteristics of Leser — Trelat syndrome are presented. Its predominant development in elderly and senile patients has been outlined, as well as its predominant association with malignant neoplasms of the gastrointestinal tract (47.7 %), lungs, mammary glands, prostate, kidneys, liver, T‑cell lymphomas (fungal mycosis, Sesari syndrome). Possible atypical relationships of Leser — Trelat syndrome with basalioma of the lower eyelid, skin melanoma are disclosed. Cases of fast (several months) and slow (years) formation of this paraneoplastic syndrome with a typical widespread nature of the lesion and a rare focal localization of keratomas are described. A clinical case with typical manifestations of dermatological paraneoplastic syndrome in the form of Leser — Trelat syndrome in a patient with multiple primary metachronous cancer is presented: right breast cancer (T2N0M0; ER‑, PR‑, HER2neu‑; 2017), right kidney cancer (T1N0M0; 24.02.2020), cancer of the rectum and sigmoid colon (T4N0M0; 22.07.2020). Pathological signs of malignant transformation of female genitals, peripheral lymph nodes were not found. Combined treatment (surgical intervention: resection of right kidney, combined resection of sigmoid colon, extirpation of uterus with appendages, polypectomy of colon in combination with a course of chemotherapy in a neoadjuvant mode) facilitated the resolution of seborrheic adenomas, which confirmed the paraneoplastic nature of Leser — Trelat syndrome.

Prevention of genital prolapse recurrence in elderly women after surgery

Genital prolapse (GP) is one of the leading gynecological diseases and is diagnosed in 30–50% of women, especially the elder ones. Its related disorders lead to social, psychological and clinical disorders in the form of social isolation, depression, sexual dysfunction, etc.Purpose of the study was to optimize the prevention of GP recurrence in elderly women after surgery.Materials and methods. 56 women aged from 60 to 82 with GP of III–IV degree of severity were examined and divided into 2 groups depending on the treatment method and prevention. 26 women in the first group were prescribed vaginal suppositories Revitaxа for 30 days after surgical treatment to increase the GP recurrence prevention. 30 women in the second group underwent traditional surgical treatment of GP without additional local therapy. Surgical treatment of women with GP included transvaginal extirpation of uterus without appendages, anterior colporrhaphy, colpoperineoraphy with levatoroplasty, sacrospinal colpopexy in 39 (69.6%) patients and anterior colporrhaphy, colpoperineoraphy with levatoperoplasty in 17 patients. Operation was supplemented by laparoscopic intervention due to the need to ovary remove in 2 women.Results. The proposed method of GP recurrence prevention in elderly women (unilateral sacrospinal fixation of the vaginal dome during surgical treatment of GP III–IV degrees which was followed by using vaginal suppositories Revitaxа for 30 days) allowed obtaining a 100% result in contrast to 90% in women with surgical treatment of GP without Revitaxа.Conclusion. The unilateral sacrospinal fixation of the vaginal dome during surgical treatment of GP III–IV degrees and using vaginal suppositories Revitaxа for 30 days after surgery is recommended to prevent the recurrence of GP in elderly women

Efficiency of organ-saving operations conducted about early postpartum uterine bleeding and their influence on the quality of women’s lives

Objective: to study the long-term eff ects of massive blood loss in parturition and the early postpartum period on the reproductive function and psychological status of women.Materials and methods: the study included 49 women who were imposed compressive hemostatic sutures in the uterus due to the development of early postpartum hemorrhage. It was carried out a retrospectiveanalysis of medical records, prospective survey - 46 women, tested scales postpartum depression - 46 women and assessment of quality of life using the SF-36 scales - 36 women.Results: the effi ciency of the compression joints method was 98 % (100 % exclusion criteria were coagulopathic obstetric bleeding), in 1 case the application of compression joints was ineff ective, which required uterus extirpation. In 14 women out of 48 (29.1 %), menstrual irregularities were revealed. In 28 (61.5 %) women, postnatal depression was confi rmed. In 30 out of 36 (87 %) women were found to decrease in quality of life. In 8 (16.7 %) women, a recurrent spontaneous pregnancy occurred within 2 years aft er suturing.Conclusion. Compression sutures remain an effective method for stopping postpartum uterine bleeding, allowing women to maintain fertility. However, some factors, including high blood loss, can signifi cantly reduce the quality of women’s lives.

Modern view of intra- and post-operative blood loss prevention during hysteroresectoscopy in patients with submucous uterine leiomyoma

Intrauterine pathology is a complex of diseases, different in etiology and pathogenesis, which are associated with changes in the mucous or muscle membranes of the uterine cavity. In its structure, submucous uterine leiomyoma ranks third with a purity of 6.5%. The introduction of the hysteroresectoscopy method in gynecological practice allowed us to abandon the uterus extirpation in favor of organ-preserving surgery. Since hysteroresectoscopy is an operative intervention, as with any operation, there is a risk of complications. The world statisctics show that the frequency of complications of hysteroscopy varies between 0.4-6%. The objective: to reduce the frequency of intraoperative and postoperative blood loss in patients with submucous uterine leiomyoma during hysteroresectoscopy. Materials and methods. 183 women with submucous uterine leiomyoma was performed. Depending on the chosen treatment strategy, the women were divided into two groups: the main group included 76 patients who received the developed advanced diagnostic and treatment complex. The control group included 107 women, whose inpatient management was carried out in accordance with the current quality standards of medical care. In order to determine the amount of menstrual blood loss during the preoperative period and after 3 months in the operative one, all women were given a clinical interview with filling in the pictogram. Results. The average age of studied women was 31.2±0.34 years. The duration of menstrual discharge was in the range of 7 to 10 days and averaged 9.2±0.2 days. More than half of women - 97 (53.0%) used sanitary tampons along with daily pads. The “super-heavy” volume of menstrual blood loss was typical for 10 women (5.3%). The sizes of individual leiomyoma nodes varied between 1,0 and 3,0 cm in diameter (according to the inclusion criteria) and averaged 1,82±0,29 cm, in women with leiomyoma we noted that myomatous nodes were mapped primarily in blue (dense type according to the classification). Against the background of the developed complex, the average size of leiomatous nodes in patients of the main group significantly differed from the average size of nodes in patients of the control group by an average of 66.4% (the main group – 1.62±0.29; the control group-2.44±0.21; p<0.05). Analysis of hysteroresectoscopic intervention shows that in the main group, increased blood loss that required postoperative administration of uterotonic drugs was registered in 6 (7.9%) cases (the control group – 32 (29.9%) (p<0.05). Postoperative administration of uterotonic drugs in the main group was performed in 14 (18.4%) cases, while in the control group this value was 4.2 times higher and amounted to 82 (76.6%) cases. The “light” volume of blood loss was noted by 36 (33.7%) women in the control group and 50 (65.8%) women in the main group (p<0.05). Conclusions. The use of a two – step approach to intraoperative and postoperative bleeding preventing by applying triptorelin acetate 3.75 mg 28 days before hysteroresectoscopy and terlipresin acetate 0.2 mg 15 minutes before hysteroresectoscopy can significantly reduce the volume of intraoperative (main group – 4 cases (5.3%), control group – 25 cases (23.4%); (p<0.05) and postoperative blood loss (main group – 6 cases (7.9%), control group - 31 cases (28.9%); (p<0.05), reduce the time of endoscopic manipulation; it also reduces the material costs associated with its implementation and also helps prevent postoperative complications. Key words: bleeding, hysteroresectoscopy, intrauterine pathology, intra- and post-operative complications, submucous uterine leiomyoma.

ОПЫТ ПРИМЕНЕНИЯ СИНТЕТИЧЕСКИХ ПРОТЕЗОВ В ХИРУРГИИ ПРОЛАПСА ЖЕНСКИХ ПОЛОВЫХ ОРГАНОВ

Цель. Оптимизация хирургического лечения пролапса женских половых органов (ЖПО).
 Материалы и методы. Проанализирован десятилетний опыт выполнения реконструктивных операций на влагалище с использованием синтетических сетчатых протезов из пролена Gynemesh Soft (слингов) у 194 женщин в возрасте от 42 до 76 лет по поводу пролапса ЖПО.
 Результаты. Влагалищная экстирпация матки выполнена у 93 (47,9%) женщин, по поводу полного выпадения матки - у 43 (22,2%), лейомиомы матки - у 26 (13,4%), рецидивирующих декубитальных язв - у 9 (4,6%), патологии шейки матки - у 9 (4,6%), гиперпластических процессов в эндометрии в период менопаузы, подтвержденных по результатам гистологического исследования - у 6 (3,1%). У 101 (52,1%) пациентки проведено хирургическое лечение пролапса ЖПО с использованием синтетических слингов без предварительной гистерэктомии.
 Обсуждение. Проанализированы типичные осложнения хирургического вмешательства. По данным активного мониторинга, осложнения выявлены у 5,2% пациенток, в том числе у 8 (4,1%) - эрозия влагалища после установки систем Prolift posterior, у 1 (0,5%) - пролапс протеза в мочевой пузырь после применения системы Prolift anterior, у 1 (0,5%) - рецидив пролапса после установки системы Prolift total.
 Выводы. Профилактикой осложнений является точное соблюдение технологии установки имплантата c соблюдением рекомендаций: соответствие площади сетки площади пролабирующей слизистой оболочки, отсутствие натяжения при установке протеза, расположение протеза субфасциально, фиксация сетки в целях предупреждения ее смещения, назначение адекватной адъювантной терапии после операции.
 Ключевые слова. пролапс женских половых органов; осложнения; синтетические сетчатые протезы; рецидивы.

Hereditary Hemorrhagic Telangiectasia and Psychopathology

Hereditary Hemorrhagic Telangiectasia and Psychopathology

The first experience of videolaparoscopic uterus extirpation with bilateral lymphadenectomy

The first experience of videolaparoscopic uterus extirpation with bilateral lymphadenectomy

Surgical treatment of low stage cervical carcinoma: Back to the old days?

Radical hysterectomies for the treatment of cervical carcinoma are being performed laparoscopically by some surgeons. Others combine the laparoscopic lymphadenectomy with a radical vaginal hysterectomy or a radical trachelectomy, like in the Schauta procedure. In this way the procedure resembles the AVRUEL-procedure (Abdominal Vaginal Radical Uterus Extirpation with transperitoneal Lymphadenectomy), as developed in 1957 by Sindram who combined the Wertheim and the Schauta procedure together with abdominal lymphadenectomy in one single operation. Because of the high complication rate in the form of voiding problems and sexual impairment caused by the Schauta part, this operation is no longer performed. In order to pay attention to the morbidity associated in the past with the combined abdomino-vaginal approach compared to the single abdominal approach, we reassembled the data of several large Dutch centers where patients were treated either by the AVRUEL or the abdominal radical hysterectomy.A total of 730 patients underwent an AVRUEL procedure, all carried out between 1957 and 1981. Fistulas occurred in 57 patients (7.8%), long-term urologic complications in 233 patients (32%), and sexual dysfunction in 71 (9.7%) were found. A total of 928 patients underwent an abdominal radical hysterectomy, of whom in 511 cases the complication rates have been described. Twelve fistulas occurred (2%), long-term micturition problems in 55 (10%), and sexual problems in 11 (2%). There was no difference in 5-year survival rates in both groups. From the abovementioned data it is clear, that returning to the old days in terms of a re-introduction of the Schauta procedure is not to be preferred. In order to conclude if the laparoscopically assisted radical vaginal hysterectomy or the trachelectomy are an improvement, they should be carried out according to clearly defined prospective protocols in which data can be compared to those of other techniques with special attention to late complications including micturition and sexual sequelae.

Entwicklungen in der operativen Gynäkologie

Im ausgearbeiteten Text der Abschiedsvorlesung wird die Entwicklung der operativen Gynäkologie anhand der Onkochirurgie, der Uterusexstirpation mit oder ohne Rekonstruktion des Beckenbodens sowie der Korrekturoperationen am Uterovaginalkanal abgehandelt. Es gibt keinen Zweifel, dass endoskopische Chirurgie insbesondere im Bereich der Adnexe und des Cavum uteri grosse Bedeutung gewonnen hat. Die Uterusexstirpation sollte weiterhin die Domäne des vaginalen Vorgehens bleiben. Die für den erfahrenen «Vaginalisten» fast immer überflüssige «laparoskopische Assistenz» sollte sich im Sinne einer Renaissance der vaginalen Technik auswirken. Starke Betonung muss von Seiten der Gynäkologie weiterhin auf die vaginale Rekonstruktion des lädierten Beckenbodens im Rahmen von Inkontinenzoperationen gelegt werden. Fehlbildungen des Uterus werden dank neuer diagnostischer Möglichkeiten häufiger entdeckt, eine Verfeinerung der Diagnostik erscheint unerlässlich, will man verhindern, dass hier ein weiteres Tummelfeld laparoskopischer Polypragmatik entsteht. Die nach Ansicht des Autors vor allem an Universitätskliniken stetig mehr im Argen liegende operative Ausbildung der Fachärzte wird diskutiert.

THE VALUE OF RADIATION THERAPY IN LEIOMYOSARCOMA OF THE UTERUS.

Most reports on uterine leiomyosarcoma state that the lesion is radioresistant (1, 2, 4, 5, 7–10), although significant palliation by radiotherapy to metastatic deposits or to local recurrences following surgical extirpation of uterus, tubes, and ovaries has been described (6). The authors will here summarize pertinent clinical facts about this lesion and detail 4 cases treated at Jefferson Medical College Hospital (Philadelphia), in each of which irradiation appears to have given worthwhile palliation. Incidence In reported series of uterine sarcomas, the leiomyosarcomas make up from 50 to 90 per cent of the total (1–4). Table I lists comparative numbers from three authors. Important also is the question of incidence of sarcomatous degeneration in the benign leiomyomas. Figures vary from 0.13 per cent reported by Corscaden (1) to 0.76 per cent by Kimbrough (12). Vogt reports an incidence of 0.41 per cent in 72,000 cases of myoma (13). No author claims more than 1 per cent, and several factors would appear to operate to reduce this relationship appreciably further, viz: 1. Not all uterine sarcomas are leiomyosarcomas, as illustrated in Table I. Thus many of the earlier reports on incidence of sarcomatous degeneration of fibroids give an overall figure without indicating how many of these lesions were actually indexed mesodermal tumors, stromal sarcoma, etc., all of which can be coincidentally associated with fibroid tumors. 2. There is an appreciable incidence of leiomyosarcoma arising from the myometrium without any associated “fibroids.” Nine of Corscaden's 32 cases did not originate in a myoma; 15 of Aaro's 40 did not (5). 3. A very few “benign” myomas recur or metastasize. 4. There is a serious question as to the validity of the histologic diagnosis of leiomyosarcoma when based on cellular atypism only. Where there is no evidence of invasion of the surrounding myometrium, the tumor is harmless (1). This has been described as a form of “pathologist's cancer” or as the sarcomatous equivalent of carcinoma in situ. Age and Parity The predominant age among patients with uterine leiomyosarcoma is forty through sixty. The authors surveyed listed age ranges of thirty to seventy-four, with a mean of about forty-nine (Corscaden). There is no apparent relation to parity. Total offspring ranged from 0 to 12 in Aaro's series; 45 of his 53 patients were married and 12 of these were nulliparous. Relation to Previous Irradiation Of Aaro's 53 patients, 9 gave a history of previous radium or roentgen therapy to the pelvic organs. In 4 of the 9, tumors were present at the time of irradiation. In the other 5 there was a lapse of fourteen months to six years after irradiation before diagnosis of the uterine sarcoma.

A Case of Myomata of the Uterus, with Pregnancy of Five Months' Duration: Total Extirpation of Uterus and Tumours: Recovery

A Case of Myomata of the Uterus, with Pregnancy of Five Months' Duration: Total Extirpation of Uterus and Tumours: Recovery