scholarly journals Nonpuerperal Uterine Inversion: What the Gynaecologists Need to Know?

2020 ◽  
Vol 2020 ◽  
pp. 1-12 ◽  
Author(s):  
R. P. Herath ◽  
M. Patabendige ◽  
M. Rashid ◽  
P. S. Wijesinghe
Keyword(s):  
Case Reports ◽  
Treatment Options ◽  
Treatment Algorithm ◽  
Surgical Techniques ◽  
Clinical Problem ◽  
Abdominal Hysterectomy ◽  
Uterine Inversion ◽  
Surgical Access ◽  
Surgical Methods ◽  
Presentation Methods

Introduction. Nonpuerperal uterine inversion (NPUI) is a rare clinical problem with diagnostic and surgical challenges. The objective of our study was to review the literature on NPUI and describe causative pathologies, diagnosis, and different surgical options available for treatment. Materials and Methods. A comprehensive literature review was carried out on MEDLINE and Google Scholar databases to look for NPUI using the term “non-puerperal uterine inversion,” and further went through the cross-references of the published articles. Data are published case reports from 1911 to September 2018. Of the 153 published cases, 133 reports had adequate details of surgery for analysis. These reports were analyzed, concerning the clinical presentation, methods of diagnosis, and surgical treatment. Results. Mean age of the women was 46.3 years (standard deviation: 18, N = 153). Leiomyoma remained the commonest (56.2%) aetiology. While malignancies contributed to 32.02% of cases, 9.2% were idiopathic. High degree of clinical suspicion and identification of unique features on ultrasonography and magnetic resonance imaging enable prompt diagnosis. In cases of uncertainty, laparoscopy or biopsy of the mass was used to confirm the diagnosis. Hysterectomy or repositioning and repair of the uterus are the only treatment options available. The surgical methods implemented were analyzed in three aspects: route of surgical access, method of repositioning, and final surgical procedure undertaken. The majority (48.8%) had only abdominal access, while 27.1% had both abdominal and vaginal access. Haultain procedure was the most useful procedure for reposition (18.0%) of the uterus. The majority (39.7%) required abdominal hysterectomy with or without debulking of the tumour abdominally, while 15.0% had uterine repair after repositioning. We reviewed the different surgical techniques and described and proposed a treatment algorithm. Conclusions. Fibroids were the commonest cause for NPUI. Malignancies accounted for one-third of cases. A combined abdominal and vaginal approach, followed by hysterectomy or repair after repositioning, seems to be better for nonmalignant cases.

The place of conventional anal fistula surgeries among modern surgical techniques included in the current anal fistula treatment algorithm

Nowa Medycyna ◽  
2016 ◽  
Vol 23 (4) ◽  
pp. 0-0
Author(s):  
Małgorzata Kołodziejczak ◽  
Przemysław Ciesielski
Keyword(s):  
Anal Fistula ◽  
Treatment Algorithm ◽  
Surgical Techniques ◽  
Fistula Tract ◽  
Recurrence Rates ◽  
Surgical Methods ◽  
Preparatory Stage ◽  
Anal Fistula Surgery ◽  
Advancement Flaps ◽  
Fistula Treatment

The high percentage of complications after anal fistula surgery have resulted inattempts to seek new surgical solutions, which involve both improving the existing conventional surgical methods, as well as the introduction of modern surgical techniques. Classical surgical methods, such as fistulotomy, fistulectomy and Hippocrates’ procedure (loose or cutting setons) still have their place in the modernfistula treatment algorithm, however, some of the indications have changed (e.g. Hippocrates’ technique) and even new indications have been introduced. The noveltiesare represented e.g. by the use of a loose seton as a preparatory stage in innovativesurgical techniques, such as laser obliteration, injecting stem cells into the fistula tractor ligation of intersphincteric fistula tract (LIFT). Advancement flaps were replacedby LIFT and laser techniques due to similar indications, higher efficacy and lowerinvasiveness of the latter ones. On the other hand, the LIFT procedure was replacedby laser obliteration in the treatment of non branching trans-sphincteric fistulasas a less invasive and equally effective method. Although techniques for closing thefistula tract with a plug or adhesives are still considered as minimally invasive, theyare unfortunately associated with high recurrence rates. Recently a new solutionhas appeared. It is known as BioLIFT and combines LIFT with the anal fistula plug.The estimated effectiveness of this procedure is 68.8%.

scholarly journals Treatment of paediatric trigger finger: a systematic review and treatment algorithm

2018 ◽  
Vol 12 (3) ◽  
pp. 209-217 ◽  
Author(s):  
M. E. Womack ◽  
J. C. Ryan ◽  
V. Shillingford-Cole ◽  
S. Speicher ◽  
G. D. Hogue
Keyword(s):  
Systematic Review ◽  
Treatment Options ◽  
Treatment Algorithm ◽  
Surgical Techniques ◽  
Rare Condition ◽  
Small Sample ◽  
Trigger Finger ◽  
Review Of The Literature ◽  
Level Of Evidence ◽  
Number Of Patients

Purpose Paediatric trigger finger (PTF) is a rare condition as seen by the lack of studies published about paediatric populations. Due to this general lack of information, the steps to employ to correct this disorder, whether surgically or non-surgically, have not yet reached consensus status. The objective of this study is to review the published literature regarding treatment options for PTF in order to develop a proposed step-wise treatment algorithm for children presenting with trigger finger. Methods A systematic review of the literature was conducted on PubMed to locate English language studies reporting on treatment interventions of PTF. Data was collected on number of patients/fingers seen in the study, the category of the fingers involved, the number of patients/fingers undergoing each intervention and reported outcomes. Results Seven articles reporting on 118 trigger fingers were identified. In all, 64 fingers were treated non-surgically, with 57.8% (37/64) resolving. In all, 54 fingers were initially surgically treated, with 87% (47/54) resolving. In total, 34 fingers did not have resolution of symptoms following primary treatment, and 27 fingers received follow-up treatment, with 92.6% (25/27) resolving. Overall, 92.4% (109/118) of fingers achieved resolution of symptoms after all treatments were completed. Conclusion Limitations for this study included few prospective studies and small sample sizes. This is likely due to the rarity of PTF. This review of the literature indicated that a step-wise approach, including non-operative and surgical techniques, should be employed in the management of PTF. Level of Evidence III This work meets the requirements of the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses).

Treatment Options for Scrotal Migration of Ventriculoperitoneal Shunts: Case Illustration and Systematic Review of 48 Cases

2021 ◽  
Author(s):  
Thomas Hauser ◽  
Christian Auer ◽  
Johanna Ludwiczek ◽  
Wolfgang Senker ◽  
Philip-Rudolf Rauch ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hernia Repair ◽  
Case Reports ◽  
Treatment Options ◽  
Treatment Algorithm ◽  
Shunt Revision ◽  
Illustrative Case ◽  
Ventriculoperitoneal Shunts ◽  
Repeat Migration ◽  
Shunt Migration

Abstract BACKGROUND Scrotal migration of intact or disconnected tubing is a rare complication of ventriculoperitoneal shunts. While some illustrative case reports can be found in the literature, a systematic review on treatment options is lacking. OBJECTIVE To propose the first literature-based treatment algorithm on scrotal shunt migration. METHODS We conducted a literature search using the keywords: “VP,” “ventriculoperitoneal,” “shunt,” and “scrotum.” We identified 36 publications with 48 cases reported including our index case. RESULTS Median age at presentation was 13.5 mo (3 d to 65 yr) which was 4 mo (3 d to 72 mo) after last shunt-related surgery. All patients had scrotal swelling, 39 (81%) patients presented without other symptoms, 4 (8%) had additionally local pain, and 4 (8%) patients presented with symptoms of shunt dysfunction. Treatment was surgically in all but one case where spontaneous resolution without repeat migration occurred. In 3 of 4 patients who had either subcutaneous shortening or abdominal repositioning of the shunt without hernia repair, scrotal shunt migration recurred within the following month. Whereas the surgical treatment with reposition of the migrated catheter back into the peritoneal cavity via a groin incision plus hernia repair yielded a definite treatment in all 26 performed cases, the revision rate was significantly higher in the shunt revision without hernia repair cohort (P = .0009). CONCLUSION Scrotal shunt migration is a rare shunt complication with good recovery when treated surgically. We recommend hernia repair in addition to either manual or surgical repositioning of migrated tubing.

scholarly journals Postoperative vault hematoma following vaginal hysterectomy: case reports

2018 ◽  
Vol 7 (9) ◽  
pp. 3884
Author(s):  
Amit Gupta ◽  
Tanu Verma ◽  
Bharti Gupta ◽  
Anju Vij ◽  
Rajinder Kumar
Keyword(s):  
Vaginal Hysterectomy ◽  
Vaginal Bleeding ◽  
Case Reports ◽  
Surgical Techniques ◽  
Abdominal Hysterectomy ◽  
Early Postoperative Period ◽  
The Other ◽  
Persistent Fever ◽  
Post Operative Period ◽  
Gynaecologic Surgery

Postoperative vault hematoma is almost a universal consequence of gynaecologic surgery. It usually occurs after vaginal or abdominal hysterectomy. At one end there can be are minimal collection of peritoneal fluid or blood which is clinically insignificant whereas at the other end is the hematoma and abscess requiring active intervention for the patient to recover. We here present two cases of vault hematoma following vaginal hysterectomy which were reported to our institution in recent times. In both cases hematomas were infected. Ultrasonography was used to accurately identify and define the extent of hematomas. The patients underwent vault exploration and drainage. Post-operative period remained uneventful. Postoperative vault hematoma can be diagnosed in the early postoperative period of gynaecologic surgery. It is important to consider the possibility of vault haematoma in patients with persistent fever and vaginal bleeding after hysterectomy. The hematoma cavity can be easily entered to drain hematoma or abscess completely, expediting the recovery of the patient. Refining surgical techniques will significantly reduce the risk of vault hematoma. 

scholarly journals Management of Nonpuerperal Uterine Inversion Using a Combined Vaginal and Abdominal Approach

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Ferid A. Abubeker ◽  
Mulugeta Misgina ◽  
Ahmed Ebabu ◽  
Eyerusalem Fekade ◽  
Biruck Gashawbeza
Keyword(s):  
Clinical Diagnosis ◽  
Imaging Techniques ◽  
Power Doppler ◽  
Surgical Techniques ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Clear Understanding ◽  
Uterine Inversion ◽  
Abdominal Approach ◽  
3D Power Doppler

Introduction. Nonpuerperal uterine inversion is an extremely rare clinical condition. As such, some cases will have to be managed without prior experience. Clinicians must have a high index of suspicion to make the diagnosis and a clear understanding of the principles of recommended surgical techniques. Here, we report a case of nonpuerperal uterine inversion managed using a combined vaginal and abdominal approach. Case Presentation. A 70-year-old postmenopausal woman presented with profuse vaginal bleeding and protruding mass per vagina. Examination showed a solitary globular mass attached to an inverted uterus. A clinical diagnosis of nonpuerperal uterine inversion was made. A vaginal approach was used to first remove the mass followed by an abdominal approach to reposition the uterus using the Haultain procedure. Subsequently, total abdominal hysterectomy with bilateral salpingo-oophorectomy was done without complication. Histologic examination showed myoma with adenomyosis. Conclusion. Advanced imaging techniques such as 3D power Doppler and MRI have signature signs to confirm the clinical diagnosis of uterine inversion. Short of these diagnostic modalities, however, carefully conducted clinical examination including examination under anesthesia, and pelvic ultrasonography can be valuable tools to reach at a diagnosis. A combined vaginal and abdominal surgical approach can facilitate repositioning and/or hysterectomy when there is a large protruding vaginal mass.

scholarly journals A Radiographic Classification for Retrograde Peri-implantitis

2016 ◽  
Vol 17 (4) ◽  
pp. 313-321 ◽  
Author(s):  
Rucha Shah ◽  
Raison Thomas ◽  
AB Tarun Kumar ◽  
Dhoom Singh Mehta
Keyword(s):  
Bone Loss ◽  
Classification System ◽  
Case Reports ◽  
Treatment Options ◽  
Treatment Algorithm ◽  
Case Series ◽  
Apical Part ◽  
Pubmed Database ◽  
Standard Classification ◽  
Radiographic Classification

ABSTRACT Background Retrograde peri-implantitis (RPI) is an inflammatory disease that affects the apical part of an osseointegrated implant, while the coronal portion of the implant sustains a normal bone-to-implant interface. It is a diagnostic and therapeutic dilemma for implantologists. There is lack of a standard classification system and a definite treatment algorithm for the same. This article aims to introduce a classification system for RPI based on the radiographic amount of bone loss around an implant apex. Materials and methods A search of PubMed database was conducted with the keywords “retrograde peri-implantitis” and “implant periapical lesion.” Preoperative intraoral periapical (IOPA) radiographs of implants with RPI in case reports/case series were compiled. A total of 54 IOPAs from 36 articles were compiled and were assessed. Results Three different classes were proposed. The amount of bone loss from the apex of the implant to the most coronal part of radiolucency was calculated as a percentage of the total implant length and classified into one of the three classes: Mild, moderate, and advanced. Treatment options and prognosis have been suggested for each class. Conclusion The proposed classification may allow for an easy and reproducible radiographic assessment of the RPI lesion and may serve as a guideline to prognosis and treatment planning. How to cite this article Shah R, Thomas R, Kumar ABT, Mehta DS. A Radiographic Classification for Retrograde Periimplantitis. J Contemp Dent Pract 2016;17(4):313-321.

scholarly journals Vesicoureteral reflux: From prophylaxis to surgery

2017 ◽  
Vol 11 (1-2S) ◽  
pp. 13 ◽  
Author(s):  
Anne-Sophie Blais ◽  
Stéphane Bolduc ◽  
Katherine Moore
Keyword(s):  
Surgical Treatment ◽  
Vesicoureteral Reflux ◽  
Active Surveillance ◽  
Treatment Options ◽  
Treatment Algorithm ◽  
Surgical Techniques ◽  
Treatment Decision ◽  
Pediatric Urology ◽  
The Right

Vesicoureteral reflux (VUR) is one of the most common pathologies encountered in pediatric urology. Better understanding of the evolution of VUR and new endoscopic surgical techniques in the last decades have led to major changes in the management of this pathology. However, the treatment algorithm remains complex and is composed of a wide variety of options, from active surveillance to surgical treatment. Herein, we propose to review treatment options for VUR in order to help clinicians make the right treatment decision for the right patient.

scholarly journals Characteristics and Treatment Challenges of Non-Clear Cell Renal Cell Carcinoma

Cancers ◽  
2021 ◽  
Vol 13 (15) ◽  
pp. 3807
Author(s):  
Pierangela Sepe ◽  
Arianna Ottini ◽  
Chiara Carlotta Pircher ◽  
Andrea Franza ◽  
Melanie Claps ◽  
...  
Keyword(s):  
Renal Cell ◽  
Kinase Inhibitors ◽  
Clear Cell ◽  
Case Reports ◽  
Treatment Options ◽  
Single Agent ◽  
Growth Factor Receptor ◽  
Mtor Inhibitors ◽  
Cell Renal Cell Carcinoma ◽  
Clear Cell Rcc

Non-clear cell renal cell carcinomas (RCC) comprise several rare and poorly described diseases, often characterized by bad prognosis and with no standard treatments available. The gap in their clinical management is linked to the poor molecular characterization in handling the treatment of non clear-cell RCC with untailored therapies. Due to their rarity, non-clear RCC are in fact under-represented in prospective randomized trials. Thus, treatment choices are based on extrapolating results from clear cell RCC trials, retrospective data, or case reports. Over the last two decades, various options have been considered as the mainstay for the treatment of metastatic RCC (mRCC), including angiogenesis inhibitors, vascular endothelial growth factor receptor inhibitors, other tyrosine kinase inhibitors (TKIs), as well as MET inhibitors and mammalian targeting of rapamycin (mTOR) inhibitors. More recently, the therapeutic armamentarium has been enriched with immunotherapy, alone or in combination with targeted agents that have been shown to significantly improve outcomes of mRCC patients, if compared to TKI single-agent. It has been widely proven that non-clear cell RCC is a morphologically and clinically distinct entity from its clear cell counterpart but more knowledge about its biology is certainly needed. Histology-specific collaborative trials are in fact now emerging to investigate different treatments for non-clear cell RCC. This review summarizes pathogenetic mechanisms of non-clear cell RCC, the evolution of treatment paradigms over the last few decades, with a focus on immunotherapy-based trials, and future potential treatment options.

scholarly journals Fetus in fetu: two case reports from North African country

2021 ◽  
Vol 69 (1) ◽  
Author(s):  
Moutaz Ragab ◽  
Omar Nagy Abdelhakeem ◽  
Omar Mansour ◽  
Mai Gad ◽  
Hesham Anwar Hussein
Keyword(s):  
Histopathological Examination ◽  
Case Reports ◽  
Abdominal Mass ◽  
Mature Teratoma ◽  
Surgical Techniques ◽  
Rare Condition ◽  
Mass Effect ◽  
Fetus In Fetu ◽  
Vascular Connection ◽  
First Case

Abstract Background Fetus in fetu is a rare congenital anomaly. The exact etiology is unclear; one of the mostly accepted theories is the occurrence of an embryological insult occurring in a diamniotic monochorionic twin leading to asymmetrical division of the blastocyst mass. Commonly, they present in the infancy with clinical picture related to their mass effect. About 80% of cases are in the abdomen retroperitoneally. Case presentation We present two cases of this rare condition. The first case was for a 10-year-old girl that presented with anemia and abdominal mass, while the second case was for a 4-month-old boy that was diagnosed antenatally by ultrasound. Both cases had vertebrae, recognizable fetal organs, and skin coverage. Both had a distinct sac. The second case had a vascular connection with the host arising from the superior mesenteric artery. Both cases were intra-abdominal and showed normal levels of alpha-fetoprotein. Histopathological examination revealed elements from the three germ layers without any evidence of immature cells ruling out teratoma as a differential diagnosis. Conclusions Owing to its rarity, fetus in fetu requires a high degree of suspicion and meticulous surgical techniques to avoid either injury of the adjacent vital structures or bleeding from the main blood supply connection to the host. It should be differentiated from mature teratoma.

scholarly journals Squamous cell carcinoma of the scrotum in HIV: two case reports

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Jeff John ◽  
Ken Kesner ◽  
John Lazarus
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Case Reports ◽  
Treatment Options ◽  
Punch Biopsy ◽  
Delayed Treatment ◽  
Clinical Presentations ◽  
T1 N0 M0

Abstract Background Squamous cell carcinoma (SCC) of the scrotum was the first malignancy known to be associated with exposure to an occupational carcinogen—in this case, soot trapped in the breeches of chimney sweeps. Better civil rules and regulations and the replacement of hearths with other forms of heating have rendered SCC of the scrotum a rarity. We report two cases of scrotal SCC with vastly differing clinical presentations and management. Case presentation Case 1 had T1 N0 M0 disease and presented with a small (< 2 cm), innocuous-looking, non-healing ulcer of eight years duration. A punch biopsy revealed a superficially invasive SCC confirmed on immunohistochemical profiling. A wide local excision of the lesion was subsequently performed. Follow-up at three years showed no signs of recurrence. Case 2 presented with T4 N1 M1 disease and rapidly progressing locally destructive mass. A punch biopsy of the scrotal lesion confirmed invasive moderately differentiated focally keratinising SCC. The metastatic evaluation confirmed the presence of metastatic, extensive para-aortic lymphadenopathy. He was managed with cisplatin-based chemoradiotherapy. Conclusion Early detection and management of patients with SCC of the scrotum are essential. If the diagnosis is delayed, treatment options become limited, and the prognosis is poor. Notwithstanding the rarity of this disease, multicentre trials are needed to provide more precise guidelines as to the optimal management of these patients.

Sign in / Sign up

Export Citation Format

Share Document