First case of vaginal radical trachelectomy in a pregnant patient

2008 ◽  
Vol 18 (6) ◽  
pp. 1381-1385 ◽  
Author(s):  
H. P. Van De Nieuwenhof ◽  
M. A.P.C. Van Ham ◽  
F. K. Lotgering ◽  
L. F.A.G. Massuger
Keyword(s):  
Cervical Carcinoma ◽  
Radical Hysterectomy ◽  
Treatment Options ◽  
Pregnant Patient ◽  
Clinical Problem ◽  
Radical Trachelectomy ◽  
Lung Maturation ◽  
First Case ◽  
Alternative Approach

Women who present with cervical carcinoma during pregnancy pose for us a clinical problem. In general, three treatment options exist: (i) radical hysterectomy with termination of pregnancy, (ii) a planned delay, or (iii) chemotherapy until lung maturation has occurred, both followed by a radical hysterectomy. Vaginal radical trachelectomy is an alternative approach to preserve the pregnancy. We report on a woman with a stage IBI cervical carcinoma, diagnosed at 16 weeks of gestation treated with vaginal radical trachelectomy. At a gestational age of 36 weeks, a cesarean section was performed, followed by radical hysterectomy. Follow-up of 9 months is uneventful for both the mother and the child. The vaginal radical trachelectomy is a new approach in the treatment of cervical carcinoma during pregnancy.

Angiolymphoid Hyperplasia with Eosinophilia (Histiocytoid Hemangioma): Evaluation of Treatment Options

1993 ◽  
Vol 102 (4) ◽  
pp. 303-308 ◽  
Author(s):  
Mack L. Cheney ◽  
Samir Bhatt ◽  
Paul Googe ◽  
Patricia L. Hibberd
Keyword(s):  
Treatment Options ◽  
Clinical Problem ◽  
Radical Excision ◽  
Angiolymphoid Hyperplasia With Eosinophilia ◽  
Angiolymphoid Hyperplasia ◽  
Immunodeficiency Virus ◽  
Long Term Follow Up ◽  
Proliferative Lesion

Angiolymphoid hyperplasia with eosinophilia is an uncommon benign vascular proliferative lesion of unknown cause. In this report, a case is presented of a patient who was confirmed to be positive for human immunodeficiency virus and in whom the lesion had shown rapid accelerated growth. The case is used to illustrate a variety of therapeutic techniques and to evaluate the effectiveness of the various alternatives in the treatment of this unusual clinical problem. Long-term follow-up after radical excision of the tumor mass is presented.

scholarly journals Approach to the Patient: Management of the Post–Bariatric Surgery Patient With Weight Regain

2020 ◽  
Vol 106 (1) ◽  
pp. 251-263
Author(s):  
Nawfal W Istfan ◽  
Marine Lipartia ◽  
Wendy A Anderson ◽  
Donald T Hess ◽  
Caroline M Apovian
Keyword(s):  
Bariatric Surgery ◽  
Weight Regain ◽  
Early Recognition ◽  
Treatment Options ◽  
Clinical Problem ◽  
Dietary Counseling ◽  
Surgery Patient ◽  
Rate Of Increase ◽  
Bariatric Surgery Patient

Abstract Context Weight regain (WR) after bariatric surgery is emerging as a common clinical problem due to the increase in the number of procedures performed. Early interventions are necessary to curtail the potential recurrence of comorbid conditions. However, it is often difficult to recognize WR early enough to introduce mitigating measures because there are no current guidelines for timely diagnosis and assessment of the severity of this condition. Objective We present a practical approach for the early recognition of WR, based on 11-year follow-up data from our multiethnic bariatric surgery patient population. Methods We classify WR according to the rate of increase in weight relative to nadir weight, normalized per 30-day interval. We also review pertinent literature about the etiologic factors contributing to WR after bariatric surgery. Results According to our algorithm, mild, moderate, and rapid WR are defined as weight increases of 0.2% to <0.5%, 0.5% to 1.0%, and more than 1.0% of nadir weight per 30 days, respectively. Treatment options, including dietary counseling, use of antiobesity medication, and consideration of surgical revision, are described. A case is presented to illustrate the utility of timely identification of WR and the importance of collaboration between bariatric surgeons, obesity medicine specialists, and dietitians. Conclusion Our approach emphasizes the importance of regular long-term follow-up for all bariatric surgery patients.

scholarly journals Radical treachelectomy in treatment of early stages of cervical cancer

2008 ◽  
Vol 55 (4) ◽  
pp. 93-97
Author(s):  
K. Jeremic ◽  
S. Petkovic ◽  
A. Stefanovic ◽  
M. Gojnic ◽  
M. Maksimovic ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
Radical Hysterectomy ◽  
Diagnostic Method ◽  
Early Stage ◽  
Radical Trachelectomy ◽  
Residual Cancer ◽  
Early Stage Cervical Cancer ◽  
Early Cervical Cancer

The aim of the study was to determine if radical trachelectomy with pelvic lymphonodectomy could be a method for treatment of early cervical cancer to preserve fertility. We examined 12 patients who were operatively treated from 1996. to 2006. year. Diagnostic method for cervical cancer was histologic examination, cone or biopsy. Histologic condition was planocelular carcinoma well differenced. Two of the patients had Ia1 stage, seven had Ia2, and three of them had Ib1. We performed abdominal radical trachelectomy with pelvic lymphonodectomy. Resectional edges were patohistologically analyzed ex tempore, as well as lymphonodi, selectively. According to ex tempore analysis we determined if the radical trachelectomy should be done. In one patient resectional edges were positive, so she underwent radical hysterectomy. Postoperatively we found a positive lymphonodus in one patient, so we continued radiation therapy. In twoyear follow-up period we did not find any sign of residual cancer. We concluded that radical trachelectomy with pelvic lymphonodectomy could be appropriate method for treatment of early stage cervical cancer.

scholarly journals Treatment of Cutaneous Warts With Multiple Puncture Technique

Hand ◽  
2018 ◽  
Vol 14 (5) ◽  
pp. 689-690 ◽  
Author(s):  
Joseph S. Mclaughlin ◽  
Thomas J. Fischer ◽  
Gregory A. Merrell
Keyword(s):  
Treatment Options ◽  
Clinical Problem ◽  
Local Area ◽  
Symptom Duration ◽  
Patients Âgés ◽  
Institutional Review ◽  
Cutaneous Warts ◽  
Multiple Puncture ◽  
Puncture Technique

Background: Despite a multitude of treatment options, cutaneous warts on the hands can be a recalcitrant clinical problem. Methods: Based on Current Procedural Terminology ( CPT) billing codes, the office database was searched for a 10-year period of warts treated with a puncture technique after institutional review board approval. Office notes were examined, and patients were contacted to assess wart resolution or the need for further treatment as well as any complications. Results: Of 16 patients who were identified with the treatment and diagnosis, 13 were able to be contacted. Median time to resolution was 22 days with a range of 10 to 30 days. Median size was 10 mm, range of 6 to 20 mm. Patients ages ranged from 7 to 88 years. Symptom duration prior to treatment was a median of 16 months, range of 5 to 48 months. Follow-up median was 6 years, range of 2 to 156 months. Three patients were less than 1 year from treatment, all others had follow-up more than 4 years. Complete resolution was seen in 11 patients (85%). Four patients had resolution of other warts in the local area who were not treated with puncture. Three patients had resolution of untreated warts at distant sites. Other than local tenderness, there were no complications. Conclusions: Barbotage, the multiple puncture of cutaneous warts, may be a reasonable treatment with minimal morbidity.

scholarly journals Rotationplasty for Unplanned Fixation of Pathological Fracture Distal Femoral Osteosarcoma

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Chindanai Hongsaprabhas ◽  
Wittavat Chenboonthai ◽  
Phoomchai Suvaraksakul ◽  
Chris Charoenlap
Keyword(s):  
Pathological Fracture ◽  
Treatment Options ◽  
Distant Metastases ◽  
Definitive Treatment ◽  
Salvage Procedure ◽  
Pathological Study ◽  
First Case ◽  
Complex Procedure ◽  
High Grade Osteosarcoma

Introduction. Rotationplasty had been reported as a salvage procedure for many decades. However, this procedure has not been used for unplanned fixation for pathological fracture of osteosarcoma. Therefore, this is the first case report of rotationplasty for this particular indication. Case Presentation. We report a case of a 22-year-old Thai female patient who sustained a supracondylar fracture at the distal femur and underwent a surgical treatment by open reduction and internal fixation with a distal femoral locking plate and screws. Follow-up radiographic imaging revealed that there were abnormal osteolytic lesions, and conventional high-grade osteosarcoma was diagnosed by a pathological study. There were no distant metastases from Computed Tomography (CT) scan or Technitium-99m bone scintography. After discussing with the patient for treatment options, rotationplasty was chosen for her definitive treatment after 3 courses of neoadjuvant chemotherapy. All of the contaminated tissues were removed during the surgery. The neurovascular bundles were preserved. A standard rotationplasty type A-1 according to the Winkelmann Classification was performed. Postoperative imaging showed satisfactory outcomes, and the wound healed uneventfully. The patient was able to move her ankle as a knee, and external prosthetic fitting was made. Adjuvant chemotherapy was given after a free margin with good tumor necrosis which was achieved as shown in the pathological study. At the patient’s 3-year follow-up visit, she has stable size of lung nodules. She can walk with external prosthesis, limping slightly. Her new knee could move as expected, and she was satisfied with the result of the treatment. Conclusion. Rotationplasty for unplanned fixation of pathological fracture is a complex procedure. Patients often do not select this type of treatment because of the cosmetic acceptance even though it yields a good functional result. Therefore, awareness of the pathological fracture should initially be taken into account to prevent inappropriate fixation which could result in an unnecessary amputation.

scholarly journals Early Cervical Carcinoma and Fertility-sparing Treatment Options: MR Imaging as a Tool in Patient Selection and a Follow-up Modality

Radiographics ◽  
2014 ◽  
Vol 34 (4) ◽  
pp. 1099-1119 ◽  
Author(s):  
Patricia Noël ◽  
Mireille Dubé ◽  
Marie Plante ◽  
Guillaume St-Laurent
Keyword(s):  
Mr Imaging ◽  
Cervical Carcinoma ◽  
Patient Selection ◽  
Treatment Options ◽  
Fertility Sparing

Percutaneous treatment of an intraorbital arteriovenous malformation using a transvenous approach: A case report

2021 ◽  
pp. 159101992199139
Author(s):  
François Dantas ◽  
Tiago Silva e Carvalho ◽  
Róberti Uili Rodrigues Firmino ◽  
Alexandre Amaral Yung ◽  
Renata Caroline Ferreira Gomes ◽  
...  
Keyword(s):  
Vision Loss ◽  
Treatment Options ◽  
Percutaneous Treatment ◽  
Venous Aneurysm ◽  
Superior Ophthalmic Vein ◽  
Direct Puncture ◽  
First Case ◽  
Transvenous Approach ◽  
Actual Prevalence

Intraorbital arteriovenous malformations (AVMs) are extremely rare, and their actual prevalence is unknown. There is no consensus regarding the best treatment options, and the treatment is usually challenging, involving endovascular and other surgical procedures. Herein, we report the case of a patient diagnosed with an intraorbital AVM, presenting with thrombosis and hemorrhage, with rapidly progressive proptosis, chemosis, ophthalmoparesis, and vision loss. Treatment was performed with a transorbital puncture targeting a venous aneurysm of the superior ophthalmic vein, and closure of the AVM was possible with the use of coils and Onyx. We obtained anatomical occlusion of the lesion, and the patient showed progressive improvement of chemosis, vision acuity, and ophthalmoparesis. At six-month’ follow-up, only mild proptosis was noted, and a control digital subtraction angiography confirmed complete closure of the AVM, with no residual lesion. To date, this is the first case of an intraorbital AVM treated with transorbital direct puncture.

Neoadjuvant Chemotherapy Followed by Cesarean Radical Hysterectomy in a Triplet Pregnancy Complicated by Clear Cell Carcinoma of the Cervix: A Case Presentation and Literature Review

2012 ◽  
Vol 22 (7) ◽  
pp. 1198-1202 ◽  
Author(s):  
Ali Ayhan ◽  
Polat Dursun ◽  
Burcu Kisa Karakaya ◽  
Ozlem Ozen ◽  
Cagla Tarhan
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Literature Review ◽  
Cell Carcinoma ◽  
Cervical Carcinoma ◽  
Radical Hysterectomy ◽  
Clear Cell ◽  
Clear Cell Carcinoma ◽  
Term Pregnancy ◽  
Triplet Pregnancy

ObjectiveTo report a triplet pregnancy complicated by clear cell cervical carcinoma that was managed using neoadjuvant chemotherapy followed by caesarean radical hysterectomy.Patient HistoryA 26-year-old woman had a diagnosis of cervical clear cell carcinoma, which was International Federation of Gynecology and Obstetrics stage IB1, at 18 weeks of gestation during a triplet pregnancy. Owing to the patient’s strong desire for full-term pregnancy, 3 cycles of neoadjuvant chemotherapy was administered after magnetic resonance imaging evaluation of the tumor. The patient underwent cesarean delivery and radical hysterectomy at gestational week 32. The hysterectomy specimen revealed stage IB1 clear cell adenocarcinoma of the cervix. The neonates and the mother did not have any complications related to the treatment during 36 months of follow-up.ConclusionTo the best of our knowledge, this is the first report of a triplet pregnancy complicated by cervical clear cell carcinoma that was successfully treated with neoadjuvant chemotherapy and cesarean radical hysterectomy. Our experience and literature review suggest that neoadjuvant chemotherapy for cervical carcinoma diagnosed during pregnancy is associated with excellent oncologic and fetal outcome; therefore, it may be considered as a temporary fertility-sparing approach in selected patients with a strong desire for full-term pregnancy. Nonetheless, additional research and long-term follow-up are needed to reach a more definitive conclusion.

scholarly journals Systemic juvenile xanthogranuloma: a case of spontaneous regression of intramedullary spinal cord, cerebral, and cutaneous lesions

2017 ◽  
Vol 20 (6) ◽  
pp. 556-560
Author(s):  
Anne Morice ◽  
Sylvie Fraitag ◽  
Catherine Miquel ◽  
Christian Sainte Rose ◽  
Stéphanie Puget
Keyword(s):  
Spinal Cord ◽  
Treatment Options ◽  
Multidisciplinary Care ◽  
Benign Disease ◽  
Juvenile Xanthogranuloma ◽  
Cutaneous Lesions ◽  
Intramedullary Spinal Cord ◽  
First Case

Juvenile xanthogranuloma (JXG) is a rare disease that belongs to the non-Langerhans cell histiocytoses. It presents a wide clinical spectrum, usually occurs before 5 years of age, and is commonly confined to the skin; however, it can affect multiple sites, including the nervous system, and can lead to severe disorders. Although JXG is a benign disease that usually regresses spontaneously, several curative treatments have been proposed in cases of organ involvement. Treatment options include corticosteroids, chemotherapy, and radiotherapy; however, these can have severe, long-term adverse effects in children.The authors here describe the first case of spontaneous resolution of an intramedullary spinal cord lesion of JXG associated with cerebral and cutaneous lesions in a young boy with 9 years of follow-up. The initial neurological symptoms resolved without any surgical or medical treatment. This case shows that extracutaneous lesions of JXG, including those with intramedullary spinal cord involvement, can regress without curative treatment—like cutaneous lesions—although both multidisciplinary care and close follow-up should be implemented.

Intention-to-Treat Analysis of Radical Trachelectomy for Early-Stage Cervical Cancer With Special Reference to Oncologic Failures: Single-Institutional Experience in Hungary

2017 ◽  
Vol 27 (7) ◽  
pp. 1438-1445 ◽  
Author(s):  
Robert Póka ◽  
Szabolcs Molnár ◽  
Péter Daragó ◽  
János Lukács ◽  
Rudolf Lampé ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radical Hysterectomy ◽  
Early Stage ◽  
Pelvic Lymphadenectomy ◽  
Radical Trachelectomy ◽  
Eligibility Criteria ◽  
Prognostic Features ◽  
Early Stage Cervical Cancer ◽  
Oncologic Treatment

ObjectiveThe aim of our study was to evaluate clinical and pathological data in order to draw eligibility criteria for oncologically sufficient radical trachelectomy (RT) in early-stage cervical cancer. Reviewing all cases of attempted RT performed at our unit, we focused attention on prognostic indicators of the need for additional oncologic treatment following RT. The analysis was extended by extensive literature review to include previously published cases of oncologic failures.MethodsThe authors retrospectively analyzed data of patients who underwent RT at the Department of Obstetrics and Gynecology, University of Debrecen. Electronic records and case notes of RT cases were reviewed to determine the incidence of abdominal and vaginal route, distribution of clinicopathologic data, and follow-up results of individual cases. Individual procedures were categorized as oncologically insufficient if additional oncologic treatment was necessary following RT. Theoretical eligibility criteria for RT in early-stage cervical cancer were determined retrospectively by selecting prognostic features that were associated with oncologic insufficiency from clinicopathologic indicators of the complete series.ResultsTwenty-four cases of RT were performed by the authors, 15 vaginal RTs with laparoscopic pelvic lymphadenectomy and 9 abdominal RTs with open pelvic lymphadenectomy. Fifteen of 24 cases proved oncologically sufficient. Three cases required immediate conversion to radical hysterectomy because of positive sentinel nodes and/or positive isthmic disc on frozen section. In further 5 cases, final pathology results indicated additional oncologic treatment, that is, radical hysterectomy (n = 2), chemoradiotherapy (n = 2), or chemotherapy (n = 1). One patient among immediately converted cases and another 3 among those who required additional oncologic treatment died of their disease later. There were no other cases of recurrences over a median follow-up of 34 months (range, 12–188 months). Factors that may predict oncologic insufficiency of RT were stage IB1 or greater, tumor size of greater than 2 cm in 1 dimension or greater than 15 mm in 3 dimensions, G3, nonsquamous/adeno histological type, stromal invasion of greater than 9 mm, and lymphovascular space involvement in the primary tumor.ConclusionsMost cases of oncologically insufficient RTs have significant risk features that can be identified preoperatively. There is a need for more clinicopathologic data on oncologic failure of RT cases in order to improve patient selection.

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