scholarly journals Case Report of a Rare Nonpuerperal Uterine Inversion Managed with Uterosacral Ligament Hysteropexy

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Ali Azadi ◽  
Alexandra Wolfe ◽  
Greg J. Marchand
Keyword(s):  
Uterine Prolapse ◽  
Operative Procedure ◽  
Uterine Fibroids ◽  
Stage Iv ◽  
Ureteral Injury ◽  
Uterosacral Ligament ◽  
The Novel ◽  
Uterine Inversion ◽  
Vaginal Myomectomy

Nonpuerperal uterine inversions are rare. Typically occurring in older women, they are most commonly due to transcervical mass expulsion. Diagnosis is often difficult because of vague symptomatology, presentation, and unknown course of the pathology. Surgical correction is often necessary in the presence of active bleeding or prolapse severity causing urinary retention. This case of nonpuerperal inversion presented to the emergency department with vaginal bleeding and mass protrusion. The examination was consistent with POPQ stage IV prolapse and uterine inversion secondary to cervical expulsion of multiple uterine fibroids. Because of full cervical dilation and concerns of ureteral injury with an extirpative procedure, vaginal myomectomy was performed with concomitant robotic uterosacral ligament hysteropexy. The operative procedure and postoperative course were uncomplicated, and discharge occurred on post-op day 1. She remained asymptomatic at the 6-month follow-up encounter. Though uterine preservation has been performed in cases of uterine inversion to maintain fertility, there are no reported cases of concomitant hysteropexy being completed for correction of POPQ stage IV prolapse simultaneously encountered. Additionally, the novel robotic approach has not been documented. This case illustrates the short-term success of robotic uterosacral hysteropexy as an additional option of care with potentially less morbidity when compared to hysterectomy for advanced stage uterine prolapse with nonpuerperal uterine inversion.

CHRONIC UTERINE INVERSION ASSOCIATED WITH FIBROID - A CASE REPORT

2016 ◽  
Vol 1 (2) ◽  
Author(s):  
J. K. Goel ◽  
Shanti Sah ◽  
Shashi Bala Arya ◽  
Ruchica Goel ◽  
Nandini Agarwal
Keyword(s):  
Case Report ◽  
Coming Out ◽  
Uterine Prolapse ◽  
Uterine Fibroids ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Lower Abdomen ◽  
Uterine Inversion ◽  
History Of ◽  
Fibroid Polyp

Introduction: Uterine inversion is a condition in which the uterus turns inside out with prolapse of fundus through the cervix into or outside vagina. Chronic inversion cases are rare. We present a rare case of chronic uterine inversion associated with uterine fibroids. Case Report: A 42 year old female, P3 L3 , was admitted with complains of menorrhagia and pain 3 3 lower abdomen for 1 month. Speculum examination revealed a fleshy polyp filling whole of vagina. Upon per vaginal examination size of mass could not be assessed and cervical lips could not be felt. So, a provisional diagnosis of fibroid polyp was made. Per-operatively inversion of tube and ovaries along with a sessile submucosal fundal fibroid polyp of size 10 x 8 cm was found. A revised diagnosis of chronic uterine inversion with sessile fibroid polyp was made. Patient then underwent Total Abdominal Hysterectomy with bilateral Salpingooophrectomy. Conclusion: Chronic inversion should be kept as a differential diagnosis in a patient with history of irregular bleeding associated with dragging pain of lower abdomen and feeling of a mass coming out of introitus. Pre operatively it should be differentiated from fibroid polyp, uterine prolapse and prolapsed hypertrophied ulcerated cervix.

scholarly journals Sacrospinous hysteropexy versus vaginal hysterectomy with uterosacral ligament suspension in women with uterine prolapse stage 2 or higher: observational follow-up of a multicentre randomised trial

BMJ ◽  
2019 ◽  
pp. l5149 ◽  
Author(s):  
Sascha F M Schulten ◽  
Renée J Detollenaere ◽  
Jelle Stekelenburg ◽  
Joanna IntHout ◽  
Kirsten B Kluivers ◽  
...  
Keyword(s):  
Vaginal Hysterectomy ◽  
Uterine Prolapse ◽  
Uterosacral Ligament ◽  
Uterosacral Ligament Suspension ◽  
Recurrent Prolapse ◽  
Composite Outcome ◽  
Repeat Surgery ◽  
Sacrospinous Hysteropexy ◽  
Apical Compartment

Abstract Objective To evaluate the effectiveness and success of uterus preserving sacrospinous hysteropexy as an alternative to vaginal hysterectomy with uterosacral ligament suspension in the surgical treatment of uterine prolapse five years after surgery. Design Observational follow-up of SAVE U (sacrospinous fixation versus vaginal hysterectomy in treatment of uterine prolapse ≥2) randomised controlled trial. Setting Four non-university teaching hospitals, the Netherlands. Participants 204 of 208 healthy women in the initial trial (2009-12) with uterine prolapse stage 2 or higher requiring surgery and no history of pelvic floor surgery who had been randomised to sacrospinous hysteropexy or vaginal hysterectomy with uterosacral ligament suspension. The women were followed annually for five years after surgery. This extended trial reports the results at five years. Main outcome measures Prespecified primary outcome evaluated at five year follow-up was recurrent prolapse of the uterus or vaginal vault (apical compartment) stage 2 or higher evaluated by pelvic organ prolapse quantification system in combination with bothersome bulge symptoms or repeat surgery for recurrent apical prolapse. Secondary outcomes were overall anatomical failure (recurrent prolapse stage 2 or higher in apical, anterior, or posterior compartment), composite outcome of success (defined as no prolapse beyond the hymen, no bothersome bulge symptoms, and no repeat surgery or pessary use for recurrent prolapse), functional outcome, quality of life, repeat surgery, and sexual functioning. Results At five years, surgical failure of the apical compartment with bothersome bulge symptoms or repeat surgery occurred in one woman (1%) after sacrospinous hysteropexy compared with eight women (7.8%) after vaginal hysterectomy with uterosacral ligament suspension (difference−6.7%, 95% confidence interval −12.8% to−0.7%). A statistically significant difference was found in composite outcome of success between sacrospinous hysteropexy and vaginal hysterectomy (89/102 (87%) v 77/102 (76%). The other secondary outcomes did not differ. Time-to-event analysis at five years showed no differences between the interventions. Conclusions At five year follow-up significantly less anatomical recurrences of the apical compartment with bothersome bulge symptoms or repeat surgery were found after sacrospinous hysteropexy compared with vaginal hysterectomy with uterosacral ligament suspension. After hysteropexy a higher proportion of women had a composite outcome of success. Time-to-event analysis showed no differences in outcomes between the procedures. Trial registration trialregister.nl NTR1866.

Outcomes and Postoperative Complications of Robot-Assisted Laparoscopic Hysterosacropexy: Initial Experience

2015 ◽  
Vol 95 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Maria Angela Cerruto ◽  
Carolina D'Elia ◽  
Francesca Maria Cavicchioli ◽  
Stefano Cavalleri ◽  
Matteo Balzarro ◽  
...  
Keyword(s):  
Uterine Prolapse ◽  
Pelvic Organ ◽  
Consecutive Series ◽  
Complication Rates ◽  
Early Complications ◽  
Robot Assisted ◽  
Female Patients ◽  
The Mean ◽  
Record Review

Background: Pelvic organ prolapse is a common condition, affecting about 50% of women with children. The aim of our study was to evaluate results and complication rates in a consecutive series of female patients undergoing robot-assisted laparoscopic hysterosacropexy (RALHSP). Materials and Methods: We performed a medical record review of female patients with uterine prolapse who had consecutively undergone RALHSP from February 2010 to 2013 at our department. Results: Fifteen patients were included in the analysis. All patients had uterine prolapse stage ≥II and urodynamic stress urinary incontinence. The mean age was 58.26 years. According to the Clavien-Dindo system, 4 out of 15 patients (26.6%) had grade 1 early complications and 1 patient had a grade 2 complication. At a median follow-up of 36 months, there was a significant prolapse relapse rate of 20% (3/15). Conclusion: In our hands RALHSP is easy to perform, with satisfying mid-term outcomes and a low complication rate.

Cure of Interstitial Cystitis and Non-Ulcerating Hunner’s Ulcer by Cardinal/Uterosacral Ligament Repair

2021 ◽  
pp. 1-4
Author(s):  
Kay Scheffler ◽  
Oliver W. Hakenberg ◽  
Peter Petros
Keyword(s):  
Interstitial Cystitis ◽  
Uterine Prolapse ◽  
English Literature ◽  
German Literature ◽  
Uterosacral Ligament ◽  
Original Intention ◽  
Uterosacral Ligaments ◽  
Bladder Symptoms ◽  
Posterior Fornix ◽  
The Relationship

A serendipitous cure in a 73-year-old woman of Hunner’s ulcer, urge, nocturia, apical prolapse by a tissue fixation system tensioned minisling (TFS) which reinforced the cardinal, and uterosacral ligaments (USLs) led us to analyse the relationship between Hunner’s ulcer and known pain conditions associated with USL laxity. The original intention was to cure the “posterior fornix syndrome” (PFS), uterine prolapse, and associated pain and bladder symptoms by USL repair. A speculum inserted preoperatively into the posterior fornix alleviated pain and urge symptoms, by mechanically supporting USLs. Hunner’s ulcer, along with pain and other PFS symptoms were cured by USL repair. The concept of USL laxity causing chronic pelvic pain and bladder problems is not new. It was published in the German literature by Heinrich Martius in 1938 and by Petros in the English literature in 1993. These findings raise important questions. As PFS symptoms are identical with those of interstitial cystitis (IC), are PFS and IC similar conditions? If so, then patients with IC who have a positive speculum test are at least theoretically, potentially curable by USL repair. These questions need to be explored.

scholarly journals Waning antibody responses in COVID-19: what can we learn from the analysis of other coronaviruses?

Infection ◽  
2021 ◽  
Author(s):  
Ali Hamady ◽  
JinJu Lee ◽  
Zuzanna A. Loboda
Keyword(s):  
Cross Reactivity ◽  
Antibody Responses ◽  
The Novel ◽  
Incidence And Mortality ◽  
Antibody Titres ◽  
Human Coronaviruses ◽  
Public Health Strategies ◽  
Antibody Dynamics

Abstract Objectives The coronavirus disease 2019 (COVID-19), caused by the novel betacoronavirus severe acute respiratory syndrome 2 (SARS-CoV-2), was declared a pandemic in March 2020. Due to the continuing surge in incidence and mortality globally, determining whether protective, long-term immunity develops after initial infection or vaccination has become critical. Methods/Results In this narrative review, we evaluate the latest understanding of antibody-mediated immunity to SARS-CoV-2 and to other coronaviruses (SARS-CoV, Middle East respiratory syndrome coronavirus and the four endemic human coronaviruses) in order to predict the consequences of antibody waning on long-term immunity against SARS-CoV-2. We summarise their antibody dynamics, including the potential effects of cross-reactivity and antibody waning on vaccination and other public health strategies. At present, based on our comparison with other coronaviruses we estimate that natural antibody-mediated protection for SARS-CoV-2 is likely to last for 1–2 years and therefore, if vaccine-induced antibodies follow a similar course, booster doses may be required. However, other factors such as memory B- and T-cells and new viral strains will also affect the duration of both natural and vaccine-mediated immunity. Conclusion Overall, antibody titres required for protection are yet to be established and inaccuracies of serological methods may be affecting this. We expect that with standardisation of serological testing and studies with longer follow-up, the implications of antibody waning will become clearer.

A Novel Surgical Technique for Large Frontoencephalocele Management: The Mercy Ships Approach

FACE ◽  
2021 ◽  
pp. 273250162097932
Author(s):  
Naikhoba C. O. Munabi ◽  
Eric S. Nagengast ◽  
Gary Parker ◽  
Shaillendra A. Magdum ◽  
Mirjam Hamer ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Intraoperative Complications ◽  
Complication Rates ◽  
The Novel ◽  
Middle Income ◽  
Middle Income Countries ◽  
Lumbar Drain ◽  
Cerebral Herniation ◽  
Long Nose

Background: Large frontoencephaloceles, more common in low and middle-income countries, require complex reconstruction of cerebral herniation, elongated nose, telecanthus, and cephalic frontal bone rotation. Previously described techniques involve multiple osteotomies, often fail to address cephalad brow rotation, and have high complication rates including up to 35% mortality. This study presents a novel, modified, single-staged technique for frontoencephalocele reconstruction performed by Mercy Ships. This technique, which addresses functional and aesthetic concerns with minimal osteotomies, may help improve outcomes in low resources settings. Methods: Retrospective review was performed of patients who underwent frontoencephalocele reconstruction through Mercy Ships using the technique described. Patient data including country, age, gender, associated diagnoses, and prior interventions were reviewed. Intraoperative and post-operative complications were recorded. Results: Eight patients with frontoencephalocele (ages 4-14 years) underwent surgery with the novel technique in 4 countries. Average surgical time was 6.0 ± 0.9 hours. No intraoperative complications occurred. Post-operatively 1 patient experienced lumbar drain dislodgement requiring replacement and a second had early post-operative fall requiring reoperation for hardware replacement. In person follow-up to 2.4 months showed no additional complications. Follow-up via phone at 1 to 2 years post-op revealed all patients who be satisfied with surgical outcomes. Conclusions: Reconstruction of large frontoencephaloceles can be challenging due to the need for functional closure of the defect and craniofacial reconstruction to correct medial hypertelorism, long nose deformity, and cephalad forehead rotation. The novel surgical technique presented in this paper allows for reliable reconstruction of functional and aesthetic needs with simplified incision design, osteotomies, and bandeau manipulation.

Synthese neuer Pyridin-C-nukleoside der 2 ,3 -Didesoxyribose durch „inverse“ [4+2]-Cycloaddition Synthesis of Novel Pyridine-C-nucleosides of 2,3-Dideoxyribose by „Inverse“ [4+2]-Cycloaddition

1997 ◽  
Vol 52 (7) ◽  
pp. 851-858 ◽  
Author(s):  
Gunther Seitz ◽  
Johanna Siegl
Keyword(s):  
Cycloaddition Reaction ◽  
Alder Reaction ◽  
Diels Alder ◽  
The Novel ◽  
Protecting Group ◽  
Enol Ethers ◽  
Inverse Electron Demand ◽  
Diels Alder Reaction ◽  
Cyclic Ketene Acetals

The anomeric imido esters 5 and 6, appropriate precursors for C-nucleoside synthesis, were prepared and utilized as heterodienophiles in a Diels-Alder reaction with inverse electron demand to yield the novel, protected 1.2.4-triazine C-nucleosides 8 and 9. They could be deprotected by treatment with 70% trifluoroacetic acid to furnish the free C-nucleosides 10 and 11. The triazine „aglycon“ of 8 contains an electron deficient diazadiene system, highly activated to react with various electron rich dienophiles such as enamines, enol ethers and several cyclic ketene acetals in an „inverse“ [4+2]-cycloaddition reaction. The Diels-Alder adducts spontaneously eliminate N2 and after follow-up reactions the O-TBDPS protected pyridine-C-nucleosides 13, 15, 17,19, 21 and 23 are formed. Removal of the protecting group by treatment with CF3CO2H /H2O leads to the corresponding 2’,3’-dideoxy-β-D-ribofuranosyl- pyridines.

scholarly journals SARS-CoV-2/DENV co-infection: a series of cases from the Federal District, Midwestern Brazil

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Heidi Luise Schulte ◽  
José Diego Brito-Sousa ◽  
Marcus Vinicius Guimarães Lacerda ◽  
Luciana Ansaneli Naves ◽  
Eliana Teles de Gois ◽  
...  
Keyword(s):  
Clinical Signs ◽  
Federal District ◽  
Therapeutic Interventions ◽  
Diagnostic Process ◽  
The Novel ◽  
Prevention Measures ◽  
Laboratory Findings ◽  
Novel Coronavirus ◽  
The Impact

Abstract Background Since the novel coronavirus disease outbreak, over 179.7 million people have been infected by SARS-CoV-2 worldwide, including the population living in dengue-endemic regions, particularly Latin America and Southeast Asia, raising concern about the impact of possible co-infections. Methods Thirteen SARS-CoV-2/DENV co-infection cases reported in Midwestern Brazil between April and September of 2020 are described. Information was gathered from hospital medical records regarding the most relevant clinical and laboratory findings, diagnostic process, therapeutic interventions, together with clinician-assessed outcomes and follow-up. Results Of the 13 cases, seven patients presented Acute Undifferentiated Febrile Syndrome and six had pre-existing co-morbidities, such as diabetes, hypertension and hypopituitarism. Two patients were pregnant. The most common symptoms and clinical signs reported at first evaluation were myalgia, fever and dyspnea. In six cases, the initial diagnosis was dengue fever, which delayed the diagnosis of concomitant infections. The most frequently applied therapeutic interventions were antibiotics and analgesics. In total, four patients were hospitalized. None of them were transferred to the intensive care unit or died. Clinical improvement was verified in all patients after a maximum of 21 days. Conclusions The cases reported here highlight the challenges in differential diagnosis and the importance of considering concomitant infections, especially to improve clinical management and possible prevention measures. Failure to consider a SARS-CoV-2/DENV co-infection may impact both individual and community levels, especially in endemic areas.

scholarly journals Comparison of treatment outcomes for native tissue repair and sacrocolpopexy as apical suspension procedures at the time of hysterectomy for uterine prolapse

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sumin Oh ◽  
E. Kyung Shin ◽  
Sowoon Hyun ◽  
Myung Jae Jeon
Keyword(s):  
Treatment Outcomes ◽  
Tissue Repair ◽  
Uterine Prolapse ◽  
Reoperation Rate ◽  
Complication Rates ◽  
Native Tissue Repair ◽  
Apical Suspension ◽  
Native Tissue ◽  
Surgical Failure

AbstractConcomitant apical suspension should be performed at the time of hysterectomy for uterine prolapse to reduce the risk of recurrent prolapse. Native tissue repair (NTR) and sacrocolpopexy (SCP) are commonly used apical suspension procedures; however, it remains unclear which one is preferred. This study aimed to compare the treatment outcomes of NTR and SCP in terms of surgical failure, complication and reoperation rates. Surgical failure was defined as the presence of vaginal bulge symptoms, any prolapse beyond the hymen, or retreatment for prolapse. This retrospective cohort study included 523 patients who had undergone NTR (n = 272) or SCP (n = 251) along with hysterectomy for uterine prolapse and who had at least 4-month follow-up visits. During the median 3-year follow-up period, the surgical failure rate was higher in the NTR group (21.3% vs 6.4%, P < 0.01), with a low rate of retreatment in both groups. Overall complication rates were similar, but complications requiring surgical correction under anesthesia were more common in the SCP group (7.2% vs 0.4%, P < 0.01). As a result, the total reoperation rate was significantly higher in the SCP group (8.0% vs 2.6%, P = 0.02). Taken together, NTR may be a preferred option for apical suspension when hysterectomy is performed for uterine prolapse.

scholarly journals Decelerated tumor growth due to hypothyroidism with prolongation of survival in a patient with lung adenocarcinoma: a case report

2019 ◽  
Vol 48 (3) ◽  
pp. 030006051988530
Author(s):  
Jia Hou ◽  
Shan-Shan Xiong ◽  
Zhao-Qi Huang ◽  
Xing-Dong Cai
Keyword(s):  
Lung Cancer ◽  
Lung Adenocarcinoma ◽  
Immune Checkpoint Inhibitor ◽  
Checkpoint Inhibitor ◽  
Tumor Therapy ◽  
Stage Iv ◽  
Small Cell Lung ◽  
Anti Cancer ◽  
Advanced Stages

Lung adenocarcinoma is a form of non-small-cell lung cancer with high mortality in the advanced stages, and is one of the most common histological subtypes of lung cancer in most countries. Prognosis of lung adenocarcinoma is generally poor, with a median survival of 4–13 months. We report a case of unusually prolonged survival of a patient with advanced lung adenocarcinoma complicated by hypothyroidism. A 71-year-old man with stage IV lung adenocarcinoma presented with hypothyroidism. Surprisingly, without any anti-tumor and anti-hypothyroidism therapy, he survived this lung cancer for longer than 2.5 years before his last follow-up visit. Patients with advanced lung adenocarcinoma rarely survive for longer than 2 years, even after therapy. We hypothesize that hypothyroidism is the cause for this discrepancy. Thyroid hormones can promote growth of carcinoma. Therefore, hypothyroidism appears to be beneficial to anti-cancer therapy. We believe that hypothyroidism, as an adverse event commonly occurring in anti-tumor therapy (e.g., an immune checkpoint inhibitor), might not be able to be completely eliminated.

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