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Hysterectomy
Kinds of Hysterectomy Terms modified by Hysterectomy Selected AbstractsCOMBINED SPINAL AND EPIDURAL ANAESTHESIA WITH CHLOROPROCAINE FOR HYSTERECTOMYCLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 1 2008Run-Qiao Fu SUMMARY 1The aim of the present study was to determine the clinical efficacy and safety of chloroprocaine (CP) for gynaecological surgery. 2One hundred and twenty gynaecological patients scheduled for hysterectomy were divided randomly into four groups: Group A (n = 30), 2.5% CP 1.0 mL; Group B (n = 30), 2.5% CP 1.2 mL; Group C (n = 30), 2.5% CP 1.4 mL; and Group D (n = 30), 2.5% CP 1.6 mL. The dose of CP used in each group was mixed with 1 mL vehicle containing 5% glucose and 1.5% ephedrine. Spinal anaesthesia was achieved by lumbar puncture in the L2,3 interspace and injection of the mixture. Wherever necessary, CP (2.5%) was used for epidural anaesthesia. 3Although the times to onset and peak effect, as well as the grade of motor block of the lower limbs (Bromage scale), were similar among the four groups, the level of the highest sensory nerve block increased gradually, from T7 (± 1), T6 (± 1), T4 (± 1) to T3 (± 1) in Groups A, B, C and D, respectively. The rate of unsatisfactory spinal anaesthesia was 80 and 16.7% in Groups A and B, respectively, and consequently epidural anaesthesia was superimposed in those patients for surgery to start. Spinal anaesthesia was very satisfactory for surgery in Groups C and D. In contrast, the incidence of hypotension in Groups B, C and D was 6.7, 16.7 and 67.7%, respectively; however, respiratory depression only occurred in Group D in nine cases (30%). No other adverse events or neurologic deficits were found. 4The present results suggest that 30,35 mg CP in a total volume of 2.2,2.4 mL used for spinal anaesthesia in hysterectomy is safe and efficient. The combination of spinal and epidural anaesthesia with 2.5% CP can achieve 100% satisfactory anaesthesia for this type of surgery. [source] Effects of Conjugated Equine Estrogen on Risk of Fractures and BMD in Postmenopausal Women With Hysterectomy: Results From the Women's Health Initiative Randomized TrialJOURNAL OF BONE AND MINERAL RESEARCH, Issue 6 2006Rebecca D Jackson MD Abstract Further analyses from the Women's Health Initiative estrogen trial shows that CEE reduced fracture risk. The fracture reduction at the hip did not differ appreciably among risk strata. These data do not support overall benefit over risk, even in women at highest risk for fracture. Introduction: The Women's Health Initiative provided evidence that conjugated equine estrogen (CEE) can significantly reduce fracture risk in postmenopausal women. Additional analysis of the effects of CEE on BMD and fracture are presented. Materials and Methods: Postmenopausal women 50,79 years of age with hysterectomy were randomized to CEE 0.625 mg daily (n = 5310) or placebo (n = 5429) and followed for an average 7.1 years. Fracture incidence was assessed by semiannual questionnaire and verified by adjudication of radiology reports. BMD was measured in a subset of women (N = 938) at baseline and years 1, 3, and 6. A global index was used to examine whether the balance of risks and benefits differed by baseline fracture risk. Results: CEE reduced the risk of hip (hazard ratio [HR], 0.65; 95% CI, 0.45,0.94), clinical vertebral (HR, 0.64; 95% CI, 0.44,0.93), wrist/lower arm (HR, 0.58; 95% CI, 0.47,0.72), and total fracture (HR, 0.71; 95% CI, 0.64,0.80). This effect did not differ among strata according to age, oophorectomy status, past hormone use, race/ethnicity, fall frequency, physical activity, or fracture history. Total fracture reduction was less in women at the lowest predicted fracture risk in both absolute and relative terms (HR, 0.86; 95% CI, 0.68,1.08). CEE also provided modest but consistent positive effects on BMD. The HRs of the global index for CEE were relatively balanced across tertiles of summary fracture risk (lowest risk: HR, 0.81; 95% CI, 0.62,1.05; mid risk: HR, 1.09; 95% CI, 0.92,1.30; highest risk: HR, 1.04; 95% CI, 0.88,1.23; interaction, p = 0.42). Conclusions: CEE reduces the risk of fracture and increases BMD in hysterectomized postmenopausal women. Even among the women with the highest risk for fractures, when considering the effects of estrogen on other important health outcomes, a summary of the burden of monitored effects does not indicate a significant net benefit. [source] symptom Experience in Women After HysterectomyJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 5 2001Kimberly H. Kim RN Objective: To review the literature addressing the symptom experience of women after hysterectomy. Data Sources: Computerized searches in MEDLINE and CINAHL, as well as texts and references cited in articles. Key concepts in the searches included hysterectomy, sleep disturbance and pain, hysterectomy and fatigue, hysterectomy, depression, and depressed mood. Study Selection: Articles and comprehensive works relevant to key concepts and published after 1970, with an emphasis on new findings from 1990 to 2000. Sixty-four citations were identified as useful to this review. Data Extraction: Data were organized under the following headings: women and hysterectomy, biopsychosocial perspectives, common symptoms after hysterectomy (pain, disturbed sleep, fatigue, depressed mood, anxiety), and significance of review (implications). Data Synthesis: Literature suggests that after a hysterectomy, women experience complications during the postoperative recovery period that may vary with the type of surgical procedure. During this period, the quantity and quality of sleep as well as other symptoms (pain, fatigue, anxiety, and depression) are influenced by various physiologic, psychologic, and social factors. Despite limited evidence that sleep problems may occur frequently during the recovery period, only a few researchers have systematically examined sleep patterns in women after hysterectomy. None of these studies, however, used objective sleep measures or examined multiple dimensions of these women's lives. Conclusions: This review conceptualized the women's symptom experience as the experience of specific symptoms (pain, sleep disturbance, fatigue, depressed mood, and anxiety) that were influenced by biopsychosocial factors. [source] Successful management of uterine arteriovenous malformation by ligation of feeding artery after unsuccessful uterine artery embolizationJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 1 2009Daisaku Yokomine Abstract Uterine arteriovenous malformation (AVM) is a rare and potentially life-threatening disease. The present report describes a postmenopausal patient with uterine AVM manifesting recurrent, massive genital bleeding. Uterine artery embolization (UAE) was scheduled before hysterectomy, but UAE was unsuccessful due to the dilated, tortuous internal iliac arteries, and extremely rapid arterial blood flow. Hysterectomy appeared to carry a potential risk of massive blood loss due to multiple dilated vessels around the uterine corpus and cervix. Therefore, six arteries feeding the uterus were surgically ligated. At 10 months after the operation there have been no episodes of atypical genital bleeding. [source] New Method to Prevent Bladder Dysfunction after Radical Hysterectomy for Uterine Cervical CancerJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 1 2000Dr. Yoshinori Kuwabara Abstract Objective: The purpose was to improve the surgical procedures to prevent bladder dysfunction after radical hysterectomy. Methods: Twelve patients with stage Ib cervical cancer underwent intraoperative electrical stimulation to identify the vesical branches of the pelvic nerves. Autonomic nerve localization in the vesicouterine ligament was examined in 10 patients immunohistochemically. According to the results of the above studies a new method to preserve the vesical branches was developed. Grades of postoperative bladder dysfunction were compared between new (n = 19) and conventional methods (n = 18). Results: Electrical stimulation on the outer surface of the posterior sheath of the vesicouterine ligament caused the increase of intravesical pressure. S-100 protein localized also on this area. Postoperative compliance of the detrusor in cases with the new method demonstrated less decrement from preoperative values than in cases with the conventional method. The new method required significantly fewer days to achieve residual urine volumes less than 50 ml after surgery. Conclusions: The new method significantly reduces bladder dysfunction after radical hysterectomy. [source] Hysterectomy trends in Australia , between 2000/01 and 2004/05AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2010Erin L. HILL Background:, Hysterectomy is a major and common surgical procedure that has the potential to provide relief from ongoing gynaecological problems, but is often associated with negative impacts on health and wellbeing. Research indicates that hysterectomy rates and trends vary widely between and within countries; yet little is known about patterns in Australia. Aims:, This research aimed to describe hysterectomy rates and trends in Australia between 2000/01 and 2004/05. Methods:, This repeat cross-sectional study used routinely collected data from all hospitals in Australia. Data on all women admitted to hospital for a hysterectomy were obtained from the National Hospital Morbidity Database (2000/01,2004/05). Data were analysed by calculating population rates for each type of hysterectomy. Incidence rate ratios were calculated to assess changes over time. Results:, Hysterectomy rates in Australia declined from 34.8 per 10 000 women in 2000/01 to 31.2 per 10 000 women in 2004/05. A decline in the incidence rate for abdominal hysterectomy (from 18.7 to 15.1 per 10 000 women) and the incidence rate for concurrent oophorectomy (from 12.4 to 11.3 per 10 000 women) were also observed during this time period. At each point in time, the highest incidence rates for hysterectomy were for women aged 45,54 years. Conclusions:, Hysterectomy rates in Australia are declining over time and currently appear to be lower than most other countries. More hysterectomies are performed vaginally than in Canada, the USA, the UK and Finland and the rate of concurrent oophorectomy is less than that reported in the USA and the UK. [source] Use of Bakri balloon in post-partum haemorrhage: A series of 15 casesAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2009Srisailesh VITTHALA Background: Post-partum haemorrhage (PPH) is a major complication of delivery. Hysterectomy is commonly performed when medical treatment of PPH fails. We assessed the effectiveness of Bakri balloon tamponade, a non-surgical technique in the management of PPH. Aim(s): Our objective is to report our experience in the use of Bakri balloon in treating PPH. Method: A retrospective study of 15 patients who underwent Bakri balloon insertion after unsuccessful medical management of PPH. Results: Fifteen cases of PPH were managed with Bakri balloon insertion. It was effective in all cases of PPH after vaginal delivery and in four cases of caesarean section; the overall effectiveness was 80%. Conclusion: Insertion of Bakri balloon is a simple alternative procedure in the management of PPH. It should be consider before any further surgical intervention including hysterectomy. Junior doctors and midwives can effectively apply it. It can be used during transfer or while waiting for a surgical procedure to reduce blood loss. [source] Complications of hysterectomy in women with von Willebrand diseaseHAEMOPHILIA, Issue 4 2009A. H. JAMES Summary., Case reports and small case series suggest that women with von Willebrand disease (VWD) are at a very high risk of bleeding complications with hysterectomy. As the procedure may be beneficial to women who suffer from heavy menstrual bleeding and have completed childbearing, an understanding of the true risks involved is essential for appropriate decision making. To estimate the incidence of bleeding and other complications in women with VWD who undergo hysterectomy. The United States Nationwide Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality for the years 1988,2004 was queried for all hysterectomies for non-malignant conditions. Data were analysed based on the NIS sampling design. Bivariate analyses were used to examine the differences between women with and without VWD. Multivariate analysis was used to adjust for potential confounders among women who underwent hysterectomy for heavy menstrual bleeding. 545 of the 1 358 133 hysterectomies were to women with VWD. Women with VWD were significantly more likely to experience intraoperative and postoperative bleeding (2.75% vs. 0.89%, P < 0.001) and require transfusion (7.34% vs. 2.13%, P < 0.001) than women without VWD. One woman with VWD died. While the risk of bleeding complications from hysterectomy in women with VWD is smaller than previously reported, women with VWD did experience significantly more bleeding complications than women without VWD. Nonetheless, for women who have completed childbearing, the risks of hysterectomy may be acceptable. [source] Comparison of the use of electrothermal bipolar vessel sealer with harmonic scalpel in total laparoscopic hysterectomyJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 3 2007Fazli Demirturk Abstract Aim:, The aim of the present study was to compare the use of electrothermal bipolar vessel sealer (EBVS) with harmonic scalpel (HS) during total laparoscopic hysterectomy with respect to operation time, estimated blood loss and related complications. Methods:, A retrospective study was conducted in the university hospital. Forty patients who underwent total laparoscopic hysterectomy and bilateral salpingo-oophorectomy were enrolled. Nineteen hysterectomies were performed with HS and in 21 patients the same surgeons used EBVS. Data about the characteristics of the patients, operation time, estimated blood loss, uterine weights, related complications and length of hospital stay were registered and compared. Results:, Mean procedure time and estimated blood loss were significantly less in the EBVS arm (59.57 ± 3.71 vs 90.95 ± 5.73 min, P < 0.001; 87.76 ± 25.48 vs 152.63 ± 60.90 mL; P < 0.001, respectively). The change in hemoglobin and hematocrit values was found to be more significant in the HS group. Conclusion:, EBVS was found to be less time-consuming and caused less bleeding when compared with HS. [source] Analysis of outcomes of single polypropylene mesh in total pelvic floor reconstruction,NEUROUROLOGY AND URODYNAMICS, Issue 1 2007Kaytan V. Amrute Abstract Aims A 2.5-year outcome analysis was performed on patients who underwent transvaginal repair of total pelvic organ prolapse with single polypropylene mesh. A description of the repair technique using a tension-free 4-point fixation is also reviewed. Methods After proper vaginal dissection, a specially fashioned "H" shaped polypropylene mesh is positioned and fixed at 4-points. With a single piece of mesh, the anterior arms provide mid-urethral and bladder neck support, the mid-portion of the mesh corrects anterior compartment defects, and the posterior arms aid in vaginal vault suspension. Initially, bone anchors were utilized for anterior fixation, but currently a tension-free method is used. A retrospective analysis using chart review was performed on 96 patients who underwent this procedure from January 2000 to June 2005. Additional information was gathered by a telephone survey using a questionnaire. Statistical analysis was performed using Student's t -test, with Sigma Stat®. Results Seventy-six patients (79%) were available with a mean follow-up time of 30.7,±, 1.7 months and mean age of 69.3,±,11.3. Among those with follow-up, 36 patients (47.4%) underwent concurrent hysterectomies. Recurrence of prolapse was reported by four patients (5.2%). Sixty-eight patients (89%) were completely dry or almost dry, defined as an occasional leak. For those with preoperative incontinence (n,=,36), average pad use per day decreased significantly from 2.1,±,0.4 to 0.8,±,0.2 (P,<,0.005) postoperatively. Twelve patients (15.7%) reported of de novo urgency. Six patients required reoperation including excision of vaginal mesh erosion (2), uretholysis for obstruction (1), removal of palpable vaginal suture (1), and recurrent SUI (2). Among the 21 patients who are sexually active, 19 denied any dyspareunia (90.4%). Patient satisfaction was high, as the mean value was 7.9,±,0.3 on a scale of 1 (least satisfied) to 10 (most satisfied). Conclusions Transvaginal repair of complete pelvic prolapse using polypropylene mesh is a safe and efficacious option, with minimal recurrence of prolapse and SUI. While two patients had vaginal erosions, no urethral or bladder erosions occurred. Patient satisfaction was overall favorable. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source] Hysterectomy trends in Australia , between 2000/01 and 2004/05AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2010Erin L. HILL Background:, Hysterectomy is a major and common surgical procedure that has the potential to provide relief from ongoing gynaecological problems, but is often associated with negative impacts on health and wellbeing. Research indicates that hysterectomy rates and trends vary widely between and within countries; yet little is known about patterns in Australia. Aims:, This research aimed to describe hysterectomy rates and trends in Australia between 2000/01 and 2004/05. Methods:, This repeat cross-sectional study used routinely collected data from all hospitals in Australia. Data on all women admitted to hospital for a hysterectomy were obtained from the National Hospital Morbidity Database (2000/01,2004/05). Data were analysed by calculating population rates for each type of hysterectomy. Incidence rate ratios were calculated to assess changes over time. Results:, Hysterectomy rates in Australia declined from 34.8 per 10 000 women in 2000/01 to 31.2 per 10 000 women in 2004/05. A decline in the incidence rate for abdominal hysterectomy (from 18.7 to 15.1 per 10 000 women) and the incidence rate for concurrent oophorectomy (from 12.4 to 11.3 per 10 000 women) were also observed during this time period. At each point in time, the highest incidence rates for hysterectomy were for women aged 45,54 years. Conclusions:, Hysterectomy rates in Australia are declining over time and currently appear to be lower than most other countries. More hysterectomies are performed vaginally than in Canada, the USA, the UK and Finland and the rate of concurrent oophorectomy is less than that reported in the USA and the UK. [source] Evolution of the complications of laparoscopic hysterectomy after a decade: A follow up of the Monash experienceAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2009Jason J. TAN A retrospective review of medical records was performed to assess the incidence and types of significant complications encountered during laparoscopic hysterectomy which would affect the use of a laparoscopic approach versus other routes of hysterectomy. A total of 526 consecutive patients' medical data between January 1994 and August 2007 were reviewed. Two hundred and thirty-two laparoscopic-assisted vaginal hysterectomies and 294 total laparoscopic hysterectomies were performed at Monash Medical Centre, a Melbourne tertiary public hospital, and three Melbourne private hospitals, by or under the supervision of three surgeons. Sixteen significant complications occurred. There were two cases of ureteric fistula, two bladder injuries, two bowel obstructions, four postoperative haematomas, one case of a bladder fistula, four conversions to laparotomy and one superficial epigastric artery injury. Inpatient stay ranged from two to six days. Our complication and inpatient stay rates are consistent with the previously reported rates, although there has been a reduction of incidence of visceral injuries with experience and introduction of new equipment. [source] Complications of laparoscopic hysterectomy: the Monash experienceAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2002J Tsaltas ABSTRACT A retrospective review of medical records was performed to assess the incidence and type of significant complications encountered during laparoscopic hysterectomy. Two hundred and sixty-five consecutive patients were reviewed between the years 1994 and August 2001. Two hundred and thirty-two laparoscopic vaginal hysterectomies and 33 total laparoscopic hysterectomies were performed. The operations were performed at Monash Medical Centre, a Melbourne tertiary public hospital, and two Melbourne private hospitals, by three surgeons. Ten significant complications occurred. There were two cases of ureteric fistula, two bladder injuries, two bowel obstructions, two postoperative haematomas, one case of a bladder fistula and one superficial epigastric artery injury. In-patient stay ranged from two to six days. Our complication and in-patient stay rates are consistent with previously reported rates. [source] Improving survival disparities in cervical cancer between M,ori and non-M,ori women in New Zealand: a national retrospective cohort studyAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2 2010Melissa McLeod Abstract Objective: M,ori women in New Zealand have higher incidence of and mortality from cervical cancer than non-M,ori women, however limited research has examined differences in treatment and survival between these groups. This study aims to determine if ethnic disparities in treatment and survival exist among a cohort of M,ori and non-M,ori women with cervical cancer. Methods: A retrospective cohort study of 1911 women (344 M,ori and 1567 non-M,ori) identified from the New Zealand Cancer Register with cervical cancer (adenocarcinoma, adenosquamous or squamous cell carcinoma) between 1 January 1996 and 31 December 2006. Results: M,ori women with cervical cancer had a higher receipt of total hysterectomies, and similar receipt of radical hysterectomies and brachytherapy as primary treatment, compared to non-M,ori women (age and stage adjusted). Over the cohort period, M,ori women had poorer cancer specific survival than non-M,ori women (mortality hazard ratio (HR) 2.07, 95% confidence interval (CI): 1.63,2.62). From 1996 to 2005, the survival for M,ori improved significantly relative to non-M,ori. Conclusion: M,ori continue to have higher incidence and mortality than non-M,ori from cervical cancer although disparities are improving. Survival disparities are also improving. Treatment (as measured) by ethnicity is similar. Implications: Primary prevention and early detection remain key interventions for addressing M,ori needs and reducing inequalities in cervical cancer in New Zealand. [source] Persistent high rates of hysterectomy in Western Australia: a population-based study of 83 000 procedures over 23 yearsBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 7 2006K Spilsbury Objective, To investigate incidence trends and demographic, social and health factors associated with the rate of hysterectomy and morbidity outcomes in Western Australia and compare these with international studies. Design, Population-based retrospective cohort study. Setting, All hospitals in Western Australia where hysterectomies were performed from 1981 to 2003. Population, All women aged 20 years or older who underwent a hysterectomy. Methods, Statistical analysis of record-linked administrative health data. Main outcome measures, Rates, rate ratios and odds ratios for incidence measures and length of stay in hospital and odds ratios for morbidity measures. Results, The age-standardised rate of hysterectomy adjusted for the underlying prevalence of hysterectomy decreased 23% from 6.6 per 1000 woman-years (95% CI 6.4,6.9) in 1981 to 4.8 per 1000 woman-years (95% CI 4.6,4.9) in 2003. Lifetime risk of hysterectomy was estimated as 35%. In 2003, 40% of hysterectomies were abdominal. The rate of hysterectomy to treat menstrual disorders fell from 4 per 1000 woman-years in 1981 to 1 per 1000 woman-years in 1993 and has since stabilised. Low socio-economic status, having only public health insurance, nonindigenous status and living in rural or remote areas were associated with increased risk of having a hysterectomy for menstrual disorders. Indigenous women had higher rates of hysterectomy to treat gynaecological cancers compared with nonindigenous women, particularly in rural areas. The odds of a serious complication were 20% lower for vaginal hysterectomies compared with abdominal procedures. Conclusion, Western Australia has one of the highest hysterectomy rates in the world, although proportionally, significantly fewer abdominal hysterectomies are performed than in most countries. [source] ThinPrep Pap test of endocervical adenocarcinoma with lymph node metastasis: Report of a case in a 17-year-old woman,DIAGNOSTIC CYTOPATHOLOGY, Issue 9 2010David G. Wagner M.D. Abstract Endocervical adenocarcinoma is an uncommon malignancy that is composed of multiple subtypes and accounts for ,15% of all cervical cancers. In this article, we describe the cytomorphology and differential diagnosis of an AJCC clinical stage IIIb, FIGO IB2 endocervical adenocarcinoma in a 17-year-old woman in a ThinPrep Pap test. The patient was a 17-year-old G0P0 white woman with no significant past medical history and no prior history of cervical dysplasia. She presented to her physician with a putrid vaginal discharge. A sample was sent to cytology that was interpreted as atypical endocervical cells, favor neoplasia. A subsequent cervical biopsy was diagnosed as endocervical adenocarcinoma with villoglandular features and ultimately, a hysterectomy with lymph node dissection was performed. The final diagnosis was endocervical adenocarcinoma with metastasis to three pelvic lymph nodes. The cytomorphology of endocervical adenocarcinoma on ThinPrep Pap test is similar to that described for conventionally-processed Pap smears. This difficult diagnosis should be considered on a ThinPrep Pap test, regardless of age when the characteristic cytomorphology is observed. On a cytology sample, it is advisable to state atypical endocervical cells, adenocarcinoma in situ, or endocervical adenocarcinoma without providing a specific subtype even if there is a predominance of features for a particular subtype. Diagn. Cytopathol. 2010;38:633,638. © 2009 Wiley-Liss, Inc. [source] Primary relapse of acute lymphoblastic leukemia in a cervical smear: A case reportDIAGNOSTIC CYTOPATHOLOGY, Issue 7 2006Akiko Ikuta M.D. Abstract Uterine cervix and corpus are rarely the initial site of relapse in leukemia or lymphoma. We report herein a case of uterine cervical relapse with B-cell acute lymphoblastic leukemia (ALL). The patient, a 60-yr-old woman, had a history of ALL that had been in remission for 2 yr after chemotherapy. She presented with a chief complaint of genital bleeding. In a routine cervico-vaginal Papanicolau smear, abundant atypical lymphoid cells with round-to-oval nuclei, scant cytoplasm, and high nuclear to cytoplasmic ratios was observed. The nuclei of these cells had fine and dark chromatin and thickened nuclear membranes, with one or several nucleoli being visible. Biopsy under colposcope was performed, and a diagnosis of relapse of ALL was confirmed. The ongoing genital bleeding presented a problem with clinical management of the patient. It was decided to proceed with hysterectomy to end that problem and thereafter proceed with therapy directed against the leukemia. Our results suggest that in patients with known extrauterine cancer, the presence of malignancy in uterine cellular samples provides information regarding the extent of the neoplasm. Diagn. Cytopathol. 2006;34:499,502. © 2006 Wiley-Liss, Inc. [source] Litigation cells: Their incidence and classification in gynecologic smearsDIAGNOSTIC CYTOPATHOLOGY, Issue 6 2002Wei Sun M.D. Abstract "Litigation cells" are defined as benign cells which may mimic dysplasia or cancer and might be used by plaintiffs' witnesses to imply that the cytotechnologist or pathologist "missed" cells of dysplasia or cancer. We reviewed 180 cervical smears from 166 patients who had hysterectomy for benign leiomyomas. All smears were performed within 12 months prior to hysterectomy. None of the uteri contained dysplasia or cancer on histologic examination. 90.6% of smears reviewed had at least one cell or cell group with atypia mimicking dysplasia or cancer. These "litigation cells" were classified as follows: parabasal cells, metaplastic squamous cells, degenerated endocervical cells, reactive endocervical cells, endometrial cells, neutrophils, histiocytes, and air-dried cells. Diseases mimicked by these cells included squamous cell carcinoma, high-grade squamous intraepithelial lesion, low-grade squamous intraepithelial lesion, adenocarcinoma, and glandular dysplasia. These "litigation cells" can be correctly classified by experienced cytotechnologists and cytopathologists and recognized as benign. We recommend that in all cases of alleged malpractice against cytotechnologists and/or pathologists the smears should be reviewed by a panel of individuals trained and experienced in cytopathology. The smears should be reviewed without knowledge of the clinical outcome and in an environment that simulates the normal screening practice. Diagn. Cytopathol. 2002;26:345,348. © 2002 Wiley-Liss, Inc. [source] Uterine torsion diagnosed in a mare at 515 days' gestationEQUINE VETERINARY EDUCATION, Issue 10 2010C. López Summary A pregnant mare with a history of prolonged gestation (,515 days) and suspected diagnosis of fetal mummification was examined. Rectal palpation revealed that the left broad ligament of the uterus was dorsal and medial to the right uterine ligament and it was not possible to observe the cervix during vaginal examination. Transabdominal ultrasound revealed fluid in the uterus, fetal membranes and the uterine walls defined and thickened. Free fluid was not seen in the peritoneal cavity. Laboratory tests (blood cell count and clinical chemistry) were normal. Based on clinical history, physical examination and ultrasound findings, a chronic uterine torsion with fetal death was diagnosed and the mare was subjected to exploratory celiotomy. The uterus was strongly adhered to the peritoneum of the ventral abdominal wall and there were multiple adhesions to the colon. Hysterotomy was performed to remove the fetus and to permit repositioning of the uterus. When the fetus was removed, a large devitalised grey tissue area of the right ventral uterine horn was observed. Multiple adhesions prevented a rescue hysterectomy and euthanasia of the patient was performed. During the necropsy, a 180° cranial cervix clockwise uterine torsion was observed. This rare case of uterine torsion appears to be the most chronic case reported in the equine literature. [source] Bernard Soulier syndrome in pregnancy: a systematic reviewHAEMOPHILIA, Issue 4 2010P. PEITSIDIS Summary., Bernard Soulier syndrome (BSS) is a rare disorder of platelets, inherited mainly as an autosomal recessive trait. It is characterised by qualitative and quantitative defects of the platelet membrane glycoprotein (GP) Ib-IX-V complex. The main clinical characteristics are thrombocytopenia, prolonged bleeding time and the presence of giant platelets. Data on the clinical course and outcome of pregnancy in women with Bernard Soulier syndrome is scattered in individual case reports. In this paper, we performed a systematic review of literature and identified 16 relevant articles; all case reports that included 30 pregnancies among 18 women. Primary postpartum haemorrhage was reported in 10 (33%) and secondary in 12 (40%) of pregnancies, requiring blood transfusion in 15 pregnancies. Two women had an emergency obstetric hysterectomy. Alloimmune thrombocytopenia was reported in 6 neonates, with one intrauterine death and one neonatal death. Bernard Soulier syndrome in pregnancy is associated with a high risk of serious bleeding for the mother and the neonate. A multidisciplinary team approach and individualised management plan for such women are required to minimise these risks. An international registry is recommended to obtain further knowledge in managing women with this rare disorder. [source] Complications of hysterectomy in women with von Willebrand diseaseHAEMOPHILIA, Issue 4 2009A. H. JAMES Summary., Case reports and small case series suggest that women with von Willebrand disease (VWD) are at a very high risk of bleeding complications with hysterectomy. As the procedure may be beneficial to women who suffer from heavy menstrual bleeding and have completed childbearing, an understanding of the true risks involved is essential for appropriate decision making. To estimate the incidence of bleeding and other complications in women with VWD who undergo hysterectomy. The United States Nationwide Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality for the years 1988,2004 was queried for all hysterectomies for non-malignant conditions. Data were analysed based on the NIS sampling design. Bivariate analyses were used to examine the differences between women with and without VWD. Multivariate analysis was used to adjust for potential confounders among women who underwent hysterectomy for heavy menstrual bleeding. 545 of the 1 358 133 hysterectomies were to women with VWD. Women with VWD were significantly more likely to experience intraoperative and postoperative bleeding (2.75% vs. 0.89%, P < 0.001) and require transfusion (7.34% vs. 2.13%, P < 0.001) than women without VWD. One woman with VWD died. While the risk of bleeding complications from hysterectomy in women with VWD is smaller than previously reported, women with VWD did experience significantly more bleeding complications than women without VWD. Nonetheless, for women who have completed childbearing, the risks of hysterectomy may be acceptable. [source] The association of plasma androgen levels with breast, ovarian and endometrial cancer risk factors among postmenopausal womenINTERNATIONAL JOURNAL OF CANCER, Issue 1 2010Kim N. Danforth Abstract Although androgens may play an etiologic role in breast, ovarian and endometrial cancers, little is known about factors that influence circulating androgen levels. We conducted a cross-sectional analysis among 646 postmenopausal women in the Nurses' Health Study to examine associations between adult risk factors for cancer, including the Rosner/Colditz breast cancer risk score, and plasma levels of testosterone, free testosterone, androstenedione, dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEAS). All analyses were adjusted for age, laboratory batch and other cancer risk factors. Free testosterone levels were 79% higher among women with a body mass index of ,30 vs. <22 kg/m2 (p -trend <0.01) and 25% higher among women with a waist circumference of >89 vs. ,74 cm (p -trend = 0.02). Consuming >30 g of alcohol a day vs. none was associated with a 31% increase in DHEA and 59% increase in DHEAS levels (p -trend = 0.01 and <0.01, respectively). Smokers of ,25 cigarettes per day had 35% higher androstenedione and 44% higher testosterone levels than never smokers (p -value, F -test = 0.03 and 0.01, respectively). No significant associations were observed for height or time since menopause with any androgen. Testosterone and free testosterone levels were ,30% lower among women with a hysterectomy vs. without (both p -values < 0.01). Overall breast cancer risk was not associated with any of the androgens. Thus, several risk factors, including body size, alcohol intake, smoking and hysterectomy, were related to androgen levels among postmenopausal women, while others, including height and time since menopause, were not. Future studies are needed to clarify further which lifestyle factors modulate androgen levels. [source] Hereditary nonpolyposis colorectal cancer in endometrial cancer patientsINTERNATIONAL JOURNAL OF CANCER, Issue 5 2008Sang Nam Yoon Abstract Endometrial cancer is the second most common cancer in hereditary nonpolyposis colorectal cancer (HNPCC). It has often been overlooked to explore the possibility of HNPCC in endometrial cancer patients. Our study was to investigate how many HNPCC patients existed among endometrial cancer patients. Among patients who underwent hysterectomy for endometrial cancer at Seoul National University Hospital from 1996 to 2004, 113 patients were included, whose family history and clinical data could be obtained and tumor specimens were available for microsatellite instability (MSI) testing and immunohistochemical (IHC) staining of MLH1, MSH2 and MSH6 proteins. There were 4 (3.5%) clinical HNPCC patients fulfilling the Amsterdam criteria II, and 2 (2/4, 50%) of them carried MSH2 germline mutations. There were also 8 (7.1%) suspected HNPCC (s-HNPCC) patients fulfilling the revised criteria for s-HNPCC, and one (1/8, 12.5%) of them revealed MLH1 germline mutation. In 101 patients, who were not clinical HNPCC or s-HNPCC, 11 patients showed both MSI-high and loss of expression of MLH1, MSH2 or MSH6 proteins, and 2 (2/11, 18.2%) of them showed MSH6 germline mutations. In 113 patients with endometrial cancer, we could find 5 (4.4%) HNPCC patients with MMR germline mutation and 2 (1.8%) clinical HNPCC patients without identified MMR gene mutation. Family history was critical in detecting 3 HNPCC patients with MMR germline mutation, and MSI testing with IHC staining for MLH1, MSH2 and MSH6 proteins was needed in the diagnosis of 2 HNPCC patients who were not clinical HNPCC or s-HNPCC, especially for MSH6 germline mutation. © 2007 Wiley-Liss, Inc. [source] Serial factitious disorder and Munchausen by proxy in pregnancyINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 12 2006M. D. FELDMAN Summary Factitious disorder, including Munchausen syndrome, is seldom documented among pregnant patients but can have powerful consequences. We report on a 44-year-old woman who, over a period of two decades, self-induced labour and delivery in five consecutive pregnancies. She precipitated labour by rupturing her own amniotic sac with a fingernail or cervical manipulation, or misappropriating and self-administering prostaglandin suppositories from the hospital unit on which she worked as a nurse. Preterm deliveries resulted in fetal demise in one case and in neonatal intensive care treatment for two of the offspring. One of the surviving children has cerebral palsy attributable to the mother's factitious illness behaviour, which raises the spectre of Munchausen by proxy maltreatment. The patient sought attention and care through the ruses, which have never been uncovered by her obstetric and gynaecologic caregivers. Indeed, she underwent an unnecessary hysterectomy because of the illusion of heavy menstrual bleeding. Most recently, the patient has been engaging in surreptitious autophlebotomy to force blood transfusions. [source] The transversus abdominis plane block: a valuable option for postoperative analgesia?ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2010A topical review The transversus abdominis plane (TAP) block is a newly described peripheral block involving the nerves of the anterior abdominal wall. The block has been developed for post-operative pain control after gynaecologic and abdominal surgery. The initial technique described the lumbar triangle of Petit as the landmark used to access the TAP in order to facilitate the deposition of local anaesthetic solution in the neurovascular plane. Other techniques include ultrasound-guided access to the neurovascular plane via the mid-axillary line between the iliac crest and the costal margin, and a subcostal access termed the ,oblique subcostal' access. A systematic search of the literature identified a total of seven randomized clinical trials investigating the effect of TAP block on post-operative pain, including a total of 364 patients, of whom 180 received TAP blockade. The surgical procedures included large bowel resection with a midline abdominal incision, caesarean delivery via the Pfannenstiel incision, abdominal hysterectomy via a transverse lower abdominal wall incision, open appendectomy and laparoscopic cholecystectomy. Overall, the results are encouraging and most studies have demonstrated clinically significant reductions of post-operative opioid requirements and pain, as well as some effects on opioid-related side effects (sedation and post-operative nausea and vomiting). Further studies are warranted to support the findings of the primary published trials and to establish general recommendations for the use of a TAP block. [source] Clinical pathway for tension-free vaginal mesh procedure: Evaluation in 300 patients with pelvic organ prolapseINTERNATIONAL JOURNAL OF UROLOGY, Issue 3 2009Kumiko Kato Objectives: To evaluate a clinical pathway of discharge on postoperative day 3 for the tension-free vaginal mesh (TVM) procedure in patients with pelvic organ prolapse (POP). Methods: Between May 2006 and December 2007, 305 consecutive women with POP quantification stage 3 or 4 were planned to undergo the TVM procedure in a single general hospital. Excluding five patients with concomitant hysterectomy, a pathway (removal of the indwelling urethral catheter on the next morning, discharge on postoperative day 3) was applied to the remaining 300 patients. The perioperative complications and postoperative hospitalization were prospectively evaluated in this case series. Results: Perioperative complications were: bladder injury (11 cases, 3.7%), vaginal wall hematoma (two cases, 0.7%), rectal injury (one case, 0.3%) and temporary hydronephrosis (one case, 0.3%). None needed blood transfusion. The indwelling urethral catheters were removed on the next morning as in the pathway in 287 cases (95.6%), and none required clean intermittent catheterization at home. Postoperative hospitalization was within 3 days in 280 cases (93.3%). The six cases (2.0%) with longer hospitalization were due to complications (two cases of bladder injury, one of rectal injury, one of blood loss over 200 mL, one of temporary urinary retention, and one of hydronephrosis). Two patients were re-hospitalized within one month due to vaginal bleeding or gluteal pain. Conclusions: Patients generally accepted the pathway of discharge on postoperative day 3 in spite of the Japanese culture preferring a longer hospital stay. [source] Repair of a fistula between the bladder and the perineal skin by femoral gracilis flap interpositionINTERNATIONAL JOURNAL OF UROLOGY, Issue 2 2001Shuichi Osawa Abstract The successful repair of a fistula between the bladder and the perineal skin using a femoral gracilis flap is reported. A 70-year-old woman, who 10 years previously had undergone a total hysterectomy for uterine cancer, developed a fistula between the bladder and the perineal skin after she underwent Mile's operation for rectal cancer. Initially, an attempt was made to repair the fistula by the transabdominal approach. This failed, probably because of the lack of supporting tissue between the bladder and the perineal skin. The second repair was performed with plastic surgeons. A secure three-layer bladder closure was accomplished. A right femoral gracilis flap was developed and rotated 180° to fill the defect in the skin and subcutaneous tissue. Four weeks after surgery, cystography revealed no fistula or urinary leakage and the drainage catheter was removed. Femoral gracilis flap interposition was successful for repair of a fistula between the bladder and the perineal skin when there was no supporting tissue due to extensive exenteration in the surgical removal of rectal cancer and after other repair procedures had been unsuccessful. [source] Impact of the CYP2D6 genotype on post-operative intravenous oxycodone analgesiaACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2010S. T. ZWISLER Background: Oxycodone is a semi-synthetic opioid with a ,-receptor agonist-mediated effect in several pain conditions, including post-operative pain. Oxycodone is metabolized to its active metabolite oxymorphone by O -demethylation via the polymorphic CYP2D6. The aim of this study was to investigate whether CYP2D6 poor metabolizers (PMs) yield the same analgesia post-operatively from intravenous oxycodone as extensive metabolizers (EMs). Methods: Two hundred and seventy patients undergoing primarily thyroid surgery or hysterectomy were included and followed for 24 h post-operatively. The CYP2D6 genotype was blinded until study procedures had been completed for all patients. All patients received intravenous oxycodone as pain treatment for 24 h post-operatively and morphine 5 mg was used as escape medication. A responder was characterized as a patient without the need for escape medication and a positive evaluation in a questionnaire 24 h post-operatively. Results: Twenty-four patients were PM (8.9%) and 246 were EM (91.1%). One PM (4.17%, CI=0.1,21.1) was a non-responder and 42 EM (17.07%, CI=12.6,22.4) were non-responders. The non-responder rate did not differ between the two genotypes (P=0.14). There was no difference in the total consumption of oxycodone between the two genotypes (EM=14.7 mg, CI=13.0,16.4 and PM=13.0 mg, CI=8.9,17.0, P=0.42). The mean oxymorphone/oxycodone ratios were 0.0031 and 0.00081 in the EMs and PMs, respectively (P<0.0001). Conclusion: This study showed for the first time in patients that the oxymorphone formation depends on CYP2D6, but we found no difference in the post-operative analgesic effect of intravenous oxycodone between the two CYP2D6 genotypes. [source] Prevalence and Correlates of Fecal Incontinence in Community-Dwelling Older AdultsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2005Patricia S. Goode MD Objectives: To determine prevalence and correlates of fecal incontinence in older community-dwelling adults. Design: A cross-sectional, population-based survey. Setting: Participants interviewed at home in three rural and two urban counties in Alabama from 1999 to 2001. Participants: The University of Alabama at Birmingham Study of Aging enlisted 1,000 participants from the state Medicare beneficiary lists. The sample was selected to include 25% black men, 25% white men, 25% black women, and 25% white women. Measurements: The survey included sociodemographic information, medical conditions, health behaviors, life-space assessment (mobility), and self-reported health status. Fecal incontinence was defined as an affirmative response to the question "In the past year, have you had any loss of control of your bowels, even a small amount that stained the underwear?" Severity was classified as mild if reported less than once a month and moderate to severe if reported once a month or greater. Results: The prevalence of fecal incontinence in the sample was 12.0% (12.4% in men, 11.6% in women; P=.33). Mean age±standard deviation was 75.3±6.7 and ranged from 65 to 106. In a forward stepwise logistic regression analysis, the following factors were significantly associated with the presence of fecal incontinence in women: chronic diarrhea (odds ratio (OR)=4.55, 95% confidence interval (CI)=2.03,10.20), urinary incontinence (OR=2.65, 95% CI=1.34,5.25), hysterectomy with ovary removal (OR=1.93, 95% CI=1.06,3.54), poor self-perceived health status (OR=1.88, 95% CI=1.01,3.50), and higher Charlson comorbidity score (OR=1.29, 95% CI=1.07,1.55). The following factors were significantly associated with fecal incontinence in men: chronic diarrhea (OR=6.08, 95% CI=2.29,16.16), swelling in the feet and legs (OR=3.49, 95% CI=1.80,6.76), transient ischemic attack/ministroke (OR=3.11, 95% CI=1.30,7.41), Geriatric Depression Scale score greater than 5 (OR=2.83, 95% CI=1.27,6.28), living alone (OR=2.38, 95% CI=1.23,4.62), prostate disease (OR=2.29, 95% CI=1.04,5.02), and poor self-perceived health (OR=2.18, 95% CI=1.13,4.20). The following were found to be associated with increased frequency of fecal incontinence in women: chronic diarrhea (OR=6.39, 95% CI=2.25,18.14), poor self-perceived health (OR=5.37, 95% CI=1.75,16.55), and urinary incontinence (OR=4.96, 95% CI=1.41,17.43). In men, chronic diarrhea (OR=5.38, 95% CI=1.77,16.30), poor self-perceived health (OR=3.91, 95% CI=1.39,11.02), lower extremity swelling (OR=2.86, 95% CI=1.20,6.81), and decreased assisted life-space mobility (OR=0.73, 95% CI=0.49,0.80) were associated with more frequent fecal incontinence. Conclusion: In community-dwelling older adults, fecal incontinence is a common condition associated with chronic diarrhea, multiple health problems, and poor self-perceived health. Fecal incontinence should be included in the review of systems for older patients. [source] Effects of Conjugated Equine Estrogen on Risk of Fractures and BMD in Postmenopausal Women With Hysterectomy: Results From the Women's Health Initiative Randomized TrialJOURNAL OF BONE AND MINERAL RESEARCH, Issue 6 2006Rebecca D Jackson MD Abstract Further analyses from the Women's Health Initiative estrogen trial shows that CEE reduced fracture risk. The fracture reduction at the hip did not differ appreciably among risk strata. These data do not support overall benefit over risk, even in women at highest risk for fracture. Introduction: The Women's Health Initiative provided evidence that conjugated equine estrogen (CEE) can significantly reduce fracture risk in postmenopausal women. Additional analysis of the effects of CEE on BMD and fracture are presented. Materials and Methods: Postmenopausal women 50,79 years of age with hysterectomy were randomized to CEE 0.625 mg daily (n = 5310) or placebo (n = 5429) and followed for an average 7.1 years. Fracture incidence was assessed by semiannual questionnaire and verified by adjudication of radiology reports. BMD was measured in a subset of women (N = 938) at baseline and years 1, 3, and 6. A global index was used to examine whether the balance of risks and benefits differed by baseline fracture risk. Results: CEE reduced the risk of hip (hazard ratio [HR], 0.65; 95% CI, 0.45,0.94), clinical vertebral (HR, 0.64; 95% CI, 0.44,0.93), wrist/lower arm (HR, 0.58; 95% CI, 0.47,0.72), and total fracture (HR, 0.71; 95% CI, 0.64,0.80). This effect did not differ among strata according to age, oophorectomy status, past hormone use, race/ethnicity, fall frequency, physical activity, or fracture history. Total fracture reduction was less in women at the lowest predicted fracture risk in both absolute and relative terms (HR, 0.86; 95% CI, 0.68,1.08). CEE also provided modest but consistent positive effects on BMD. The HRs of the global index for CEE were relatively balanced across tertiles of summary fracture risk (lowest risk: HR, 0.81; 95% CI, 0.62,1.05; mid risk: HR, 1.09; 95% CI, 0.92,1.30; highest risk: HR, 1.04; 95% CI, 0.88,1.23; interaction, p = 0.42). Conclusions: CEE reduces the risk of fracture and increases BMD in hysterectomized postmenopausal women. Even among the women with the highest risk for fractures, when considering the effects of estrogen on other important health outcomes, a summary of the burden of monitored effects does not indicate a significant net benefit. [source] | |||||||||||||||||||||||||||||||