Tubo-ovarian abscesses in reproductive period. Methodological rationale for organ-saving treatment

2021 ◽  
Vol 20 (1) ◽  
pp. 146-151
Author(s):  
A.I. Davydov ◽  
◽  
M.N. Shakhlamova ◽  
V.A. Lebedev ◽  
◽  
...  
Keyword(s):  
Cytokine Production ◽  
Transvaginal Ultrasound ◽  
Reproductive Period ◽  
Reproductive Age ◽  
Complex Treatment ◽  
Inosine Pranobex ◽  
Choice Of Treatment ◽  
Therapeutic Measures ◽  
Simultaneous Decrease ◽  
Main Component

The issues of complex treatment of patients with tubo-ovarian abscesses (TOA) in the reproductive period were considered, the main component of which is ultrasound minimally invasive surgery – drainage of purulent inflammatory tubo-ovarian mass using transvaginal ultrasound. The technique, indications and contraindications for such treatment were presented. The immune homeostasis of patients with TOA was also studied, and it was shown that they had the expansive nature of proinflammatory changes in cytokine production, as well as activation of the Th1-type lymphocytes with a simultaneous decrease in the Th2-type lymphocytes activity. Therefore, it is appropriate to include immunostimulating agents in the complex of therapeutic measures, particularly inosine pranobex. Conclusion. Drainage of TOA under the control of transvaginal ultrasound can be considered as the choice of treatment of patients of reproductive age. Sixty days after the complex treatment, the proinflammatory nature of cytokine production in these patients changed to mild proinflammatory. Key words: tubo-ovarian abscesses, ultrasound mini-surgery, drainage, inosine pranobex

Innovative approaches to operational treatment of women of reproductive eligibility age with hyperplastic processes of the endometrium

2016 ◽  
pp. 41-45
Author(s):  
V.N. Goncharenko ◽  
Keyword(s):  
Endometrial Hyperplasia ◽  
Histopathological Examination ◽  
Intraoperative Complications ◽  
Transvaginal Ultrasound ◽  
Treatment Algorithm ◽  
Hormone Treatment ◽  
Endometrial Ablation ◽  
Reproductive Age ◽  
Dynamic Monitoring ◽  
Atypical Form

The aim of the study: was improvement of results of surgical treatment of patients of reproductive age eligibility with hyperplastic processes of endometrium (HPE) through the introduction of individualized treatment algorithm with the use of monopolar radio wave and hysteroscopic endometrial ablation. Materials and methods. The study included 62 women with non-atypical form of hyperplasia of the endometrium who were treated at the Center of General gynecology of the clinical hospital «Feofania», gynecological Department at the city maternity hospital № 3 of Kyiv. Depending on the age group, nature of the pathological process and method of treatment is randomized, the distribution of women according to groups: group 1 – 41 women's reproductive eligibility age netipichnaya forms of endometrial hyperplasia (PHEBA and KGEB), who were subjected to hysteroscopic monopolar endometrial ablation; group 2 – 21 female reproductive eligibility age netipichnaya forms of endometrial hyperplasia (PHEBA and KGEB), which was held radiowave ablation of the endometrium (RHAE). In the 1st group the age of patients ranged from 42 to 54 years, mean age was 49.9±4.7 years. In the 2nd group the age of patients ranged from 41 to 53 years, mean age of 51.6±4.3 years. Results. A comparative analysis of the techniques for hysteroscopic monopolar ablation and RHEE showed the fact that for RHEE used local anesthesia, while carrying out hysteroscopic monopolar ablation was necessary intravenous anesthesia. The duration of the hysteroscopic monopolar endometrial ablation was 28.6±5.5 min, RAE – according to the standard method – 44.3±0.3 min. When performing hysteroscopic monopolar endometrial ablation in 2 patients (3.7%) patients observed the signs of intravasation of fluid, increased blood pressure and tachycardia. This syndrome was successfully docked, but in the future, women have conducted a thorough examination. When you run RHAE intraoperative complications have been identified. Conclusion. 1. Women with netipichnaya forms of endometrial hyperplasia eligibility and late reproductive age who do not have reproductive plans as an alternative to hysterectomy, in the presence of contraindications or ineffectiveness of hormone treatment may be recommended or radiowave monopolar hysteroscopic ablation of the endometrium. 2. Monopolar hysteroscopic endometrial ablation is indicated for women with netipichnaya forms of endometrial hyperplasia, can be used in the presence of submucous form of uterine fibroids, postoperative scars on the uterus, but in the absence of adenomyosis II–III degree. The effectiveness of monopolar hysteroscopic endometrial ablation in women with non-atypical form of hyperplasia of the endometrium is 87.8%. 3. Women after endometrial ablation should be under observation for two years. The method of choice for dynamic monitoring of the condition of the uterus in women who underwent endometrial ablation is transvaginal ultrasound which should be performed after 1, 3, 6, 12 and 24 months of follow up. 4. In case of recurrence of hyperplastic process of the endometrium (bleeding, thickening of the M-mode echo according to the ultrasound) shows a hysteroscopy with a mandatory histopathological examination and verification of the diagnosis. Key words: endometrial hyperplasia, women eligibility age, women of reproductive age, ablation of the endometrium.

CLINICAL CASE OF SUCCESSFUL TREATMENT OF INFERTILITY IN A PATIENT WITH FAILURE IVF RESULTS IN ANAMNESIS

2020 ◽  
pp. 61-67
Author(s):  
Kalinkina O.B. ◽  
Tezikov Yu.V. ◽  
Lipatov I.S. ◽  
Aravina O.R.
Keyword(s):  
Assisted Reproductive Technologies ◽  
Transvaginal Ultrasound ◽  
Clinical Manifestations ◽  
Reproductive Function ◽  
Abnormal Uterine Bleeding ◽  
Clinical Situation ◽  
Reproductive Technologies ◽  
Reproductive Age ◽  
Deficiency Anemia ◽  
Number Of Publications

Genital endometriosis is a disease of women of reproductive age, accompanied by infertility in 50% [1]. Adenomyosis can be considered as an endometriosis of the uterus. Histologically, this process is represented by ectopic, non-tumor endometrial glands, and stroma surrounded by hypertrophic and hyperplastic myometrium [2]. Adenomyosis is accompanied by pelvic pain of varying intensity as well as menstrual disorders [1]. The disease is accompanied by significant violations of reproductive function (infertility, unsuccessful attempts at pregnancy and miscarriage, abnormal uterine bleeding). Adenomyosis can be accompanied by a violation of the function of adjacent organs (such as the bladder, rectum). Often, one of the clinical manifestations of adenomyosis is the development of sideropenic syndrome, which is also caused by the development of chronic post-hemorrhagic iron deficiency anemia. This is accompanied by a deterioration in the general condition of patients, a decrease in their ability to work. Despite a large number of publications in Russian and foreign scientific sources devoted to this problem, reproductive doctors and obstetricians-gynecologists often underestimate the role of adenomyosis in pregnancy planning using assisted reproductive technologies. Without interpreting the anamnesis data obtained through an active survey, doctors do not prescribe additional methods for diagnosing this pathology, which is not complex and expensive. To confirm the diagnosis, a transvaginal ultrasound examination of the pelvic organs during the premenstrual period is sufficient. In cases that are difficult to diagnose, the MRI method of the corresponding anatomical area can be used. Underestimation of the clinical picture and under-examination of the patient did not allow prescribing timely correction of the pathology and led to unsuccessful attempts to implement the generative function using assisted reproductive technologies. The conducted examination with clarification of the cause of IVF failures and the prescribed reasonable treatment made it possible to achieve regression of endometriosis foci in this clinical situation, followed by the patient's ability to realize generative function.

scholarly journals Effectiveness of ovarian suspension in preventing postoperative ovarian adhesions in patients with severe pelvic endometriosis—a case-control study

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Zahra Dehbashi ◽  
Shaheen Khazali ◽  
Fateme Davari Tanha ◽  
Farnaz Mottahedian ◽  
Mahsa Ghajarzadeh ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Transvaginal Ultrasound ◽  
Stage Iv ◽  
Clinical Pregnancy ◽  
Reproductive Age ◽  
Deep Infiltrating Endometriosis ◽  
Pelvic Endometriosis ◽  
Double Blind ◽  
Entire Study

Abstract Background Endometriosis can exert obvious negative effects on women’s quality of life. Excisional surgery is among the most effective treatments for severe pelvic endometriosis. The prevalence of severe pelvic adhesions following a laparoscopic examination of severe endometriosis varies between 50 and 100%. Temporary intraoperative ovarian suspension is a method for the reduction of adhesions is in the treatment of severe pelvic endometriosis. Given the importance and the prevalence of endometriosis and its complications, we conducted the present study to determine more effective adhesion-reducing methods with a view to improving the quality of the treatments provided. Methods The present prospective double-blind randomized clinical trial was conducted on 50 women of reproductive age (≥ 19 years) diagnosed with severe pelvic endometriosis on transvaginal ultrasound scans and vaginal examinations at Yas Hospital between 2014 and 2017. Women with severe endometriosis (stage III, stage IV, and deep infiltrating endometriosis) requiring an extensive bilateral dissection of the pelvic walls and the rectovaginal space, with preserved uterus and ovaries, were included in the study. The preoperative severity of ovarian adhesions was assessed in terms of ovarian motility, measured through a combination of gentle pressures applied with the vaginal probe and abdominal pressures applied with the examiner’s free hand. A table of random numbers was used to choose which ovary to suspend. The entire study population received standard general anesthesia. In the laparoscopic examination of the cases with severe endometriosis, both ovaries were routinely suspended to the anterior abdominal wall with PROLENE sutures. At the end of the surgery, one of the ovaries was kept suspended for 7 days, whereas the other ovarian suspension suture was cut. At 3 months postoperatively, all the patients underwent ultrasound scans for the assessment of ovarian motility and adhesions. The severity of pelvic pain was defined according to a visual analog score. After surgery, infertile women were followed for 2-4 years, and were contacted regarding the infertility treatment. Chemical and clinical pregnancy rates was compered between the two groups. Results Three months after laparoscopy, the adhesions were mild in 41 (82%) patients and moderate in 9 (18%) on the suspended side, and mild in 12 (24%) patients and moderate in 38 (76%) on the control side (P < 0.001). The mean dysmenorrhea score was 6.8 ± 1.5 before surgery and 4.5 ± 1.4 after surgery (P < 0.001). The chemical pregnancy rate and clinical pregnancy rate were not different in the suspended and control groups (P = 0. 62, P = 0.64). Conclusions The reduction in adhesions via ovarian suspension surgery promises reductions in the complications of endometriosis.

scholarly journals Paraurethral Leiomyoma in a Postmenopausal Woman: First European Case

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Susy Shim ◽  
Camilla Skovvang Borg ◽  
Huda Galib Majeed ◽  
Peter Humaidan
Keyword(s):  
Smooth Muscle ◽  
Postmenopausal Woman ◽  
Smooth Muscle Cells ◽  
Postoperative Period ◽  
Transvaginal Ultrasound ◽  
Reproductive Age ◽  
Benign Tumors ◽  
Gynecological Examination ◽  
Urethral Pain ◽  
Paraurethral Leiomyoma

Leiomyomas are benign tumors extending from smooth muscle cells and only few cases of paraurethral leiomyomas have been described in the literature. They are often seen in the reproductive age and around 50% of the cases are asymptomatic. We describe a 59-year-old woman with a solid mobile tumor below the symphysis revealed at a gynecological examination. Transvaginal ultrasound and MRI confirmed the tumor and excision of the paraurethral tumor was carried out. The histological examination showed a benign paraurethral leiomyoma. The postoperative period was characterized by urethral pain as well as vaginal leakage of urine.

MODERN ASPECTS OF ULTRASOUND DIAGNOSIS OF ENDOMETRIOID HETEROTOPIAS OF PELVIC CAVITY ORGANS

2020 ◽  
pp. 87-92
Author(s):  
A. S. Novikova ◽  
I. Yu. Kuzmina
Keyword(s):  
Transvaginal Ultrasound ◽  
Clinical Signs ◽  
Transvaginal Ultrasonography ◽  
Transvaginal Sonography ◽  
Pelvic Cavity ◽  
Imaging Method ◽  
Visual Methods ◽  
Timely Diagnosis ◽  
Ultrasound Diagnostics ◽  
Choice Of Treatment

Diagnosis of endometrioid heterotopias of the pelvic cavity is often complicated, because at the initial stage there are no characteristic sonographic signs of this pathology. However, transvaginal ultrasound can be used as the main imaging method in the patients with suspected endometriosis. Due to a wide variety of forms and degrees of endometriosis, the similarity of clinical signs of other diseases, frequent asymptomatic course of the disease are objective difficulties in the correct and timely diagnosis of endometrioid heterotopias of the pelvic cavity. Ultrasonography can be used both to detect and to monitor the dynamics of endometriosis. Transvaginal sonography allows a qualitative detection of endometrioid heterotopias of the pelvis and with a high probability to reveal endometrioid cysts, hydrosalpinx, hematosalpinx, peritoneal endometriosis and is considered the best method of visualization of the endometrium. There were examined 57 patients with various forms of endometrioid heterotopias of the pelvic organs by transvaginal ultrasonography, which was performed on the 5th−9th day of the menstrual cycle. Adenomyosis of various degrees has been diagnosed, which should be understood as a disease consisting of ectopic location of endometrial glands and stroma as well as muscle changes. Due to the variety of forms and degrees of endometriosis, combination with clinical signs of other diseases, often asymptomatic course of the disease, which leads to severe damage to the reproductive system, there are objective difficulties in correct and timely diagnosis of endometrioid heterotopias and pelvic cavity organs. Modern visual methods of transvaginal ultrasonography are the key to correctly determining the stage and extent of endometriosis, which will directly affect the choice of treatment. Key words: endometriosis, heterotopia, ultrasound diagnostics, pelvic cavity.

scholarly journals Hormonal Status of Females in Reproductive Age Group with Benign Breast Disease: A Study of 150 Cases

2018 ◽  
Vol 8 (2) ◽  
pp. 54-57
Author(s):  
Md Monoarul Islam Talukdar ◽  
Nadim Ahmed ◽  
Md Abul Kalam Azad ◽  
Mohammad Emrul Hasan Khan ◽  
Fayem Chowdhury ◽  
...  
Keyword(s):  
Benign Breast Disease ◽  
Small Sample Size ◽  
Breast Disease ◽  
Reproductive Period ◽  
Small Sample ◽  
Reproductive Age ◽  
Base Line ◽  
Fibrocystic Disease ◽  
College Hospital ◽  
Common Diagnosis

Background: Benign disorder of breast in female usually seen in reproductive period of life, is thought to be largely hormone induced and there is a dramatic fall in the incidence after menopause due to cessation of ovarian stimulation.Objectives: To find out the relationship between different types of benign breast disease and hormones acting on breast mainly oestrogen, testesteron and prolactin.Methodology: This is a prospective observational study conducted in the department of surgery, Shaheed Suhrawardy Medical College Hospital. Total 150 female patients of reproductive age were included in the study. Serum levels of oestrogen, testosterone and prolactin were done in all patients. Other relevant radiological and cytological investigations were done accordingly where indicated.Results: Mean age of the study subjects were 28 ±8.46 years. Among the study subjects 64 (42.7%) patients used hormonal contraception, on the other hand 86 patients (57.3%) did not used hormonal contraceptive. 68 (45.3%) patients were non parous, 29( 19.3%) were primi parous and 53 ( 35.3%) were multiparous. 87 (58%) had positive history of breast feeding, 63 (42%) patients did not breast fed their babies. Fibrocystic disease was most common diagnosis among study group followed by fibroadenoma. 96 (64%) patients had fibrocystic disease followed by 38 (25.3%) had fibroadenoma. Mean oestrogen, testosterone and prolactin level was 71.16± 57.63 pg/ml, 0.59 ± 0.42 nmol/L and 22.61 ± 16.65 ng/ml respectively.Conclusion: With this small sample size it is difficult to conclude regarding relation between oestrogen, testosterone, prolactin and benign breast disease. But this study can be used as a base line document regarding benign breast disease, hormone profile, type, distribution and frequency of benign breast disease.J Shaheed Suhrawardy Med Coll, December 2016, Vol.8(2); 54-57

scholarly journals Evaluation of transvaginal ultrasound role in the prediction of adenomyosis: correlation with histopathology

2021 ◽  
Vol 10 (8) ◽  
pp. 2987
Author(s):  
Naglaa Ali M. Hussein ◽  
Mohammed H. El Rafaey
Keyword(s):  
Negative Predictive Value ◽  
Predictive Value ◽  
Transvaginal Ultrasound ◽  
Reproductive Age ◽  
True Positive ◽  
Women Of Reproductive Age ◽  
Presenting Symptoms ◽  
Us Findings ◽  
Histopathological Results ◽  
Symptoms And Signs

Background: Adenomyosis is a common gynecologic disorder that primarily affects women of reproductive age that has reported incidence of 5-70% in surgical and postmortem specimens. The aim of this study was to evaluate the accuracy of various transvaginal sonographic findings in adenomyosis by comparing them with histopathological results and to determine the most valuable sonographic feature in the diagnosis of adenomyosis.Methods: All transvaginal US findings were correlated with those from histologic examination. The frequency of presenting symptoms and signs of adenomyosis were evaluated. Transvaginal US depicted 10 of 12 pathologically proved cases of adenomyosis. Adenomyosis was correctly ruled out in 33 of 38 patients.Results: Transvaginal US had a sensitivity of 83%, a specificity of 86%, and a positive and negative predictive value of 66% and 94%, respectively. Of the 10 patients with true-positive findings at transvaginal US, the myometrium demonstrated heterogeneous with or without the presence of cysts in nine (75%) patients, linear striation in four (33.3%) patients and globular uterus in six (50%) patients. Three (25%) of 12 cases of adenomyosis had an enlarged uterus, adenomyosis was a significant association with high parity.Conclusions: Adenomyosis can be diagnosed with a considerable accuracy by transvaginal ultrasound. The most common sonographic criteria of adenomyosis are heterogeneous myometrial appearance while the most specific criteria are myometrial cysts, sub-endometrial echogenic linear striations and globular configuration of the uterus.

scholarly journals Pregnancy in multiple sclerosis: from scientific aspects to practical

2021 ◽  
Vol 64 (3) ◽  
pp. 78-84
Author(s):  
Anna Belenciuc ◽  
◽  
Ana-Maria Bubuioc ◽  
Olesea Odainic ◽  
Marina Sangheli ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Family Planning ◽  
Immune Reconstitution ◽  
Interferon Beta ◽  
Reproductive Age ◽  
Childbearing Age ◽  
Disease Modifying Drugs ◽  
Choice Of Treatment ◽  
Key Issues ◽  
Disease Modifying

Background: Multiple sclerosis (MS) is a disease that affects young people of reproductive age (20-40 years old), predominantly women. Therefore, almost every patient has questions about pregnancy and breastfeeding. Family planning is one of the key issues in the choice of treatment tactics. Despite the growing number of therapeutic options for individualized treatment, it is still a question how to manage women with MS who become pregnant while taking disease-modifying drugs or want to become pregnant after starting this treatment. Conclusions: Women with MS should not be discouraged from pregnancy due to their illness. It is necessary to proactively discuss pregnancy planning with all women with MS of childbearing age. Based on available data, interferon beta and glatiramer acetate appear to be most suitable for use up until the time of confirmed pregnancy. A large amount of data (more than 1000 cases) obtained from registries shows that use of interferon beta before conception and during pregnancy suggests no evidence of increase in the rate of congenital anomalies or spontaneous abortions. For women with persistent high disease activity, pulsed immune reconstitution therapy gives additional opportunity for family planning after the last dose. The choice between available options for pulsed immune reconstitution therapy should be based on efficacy balanced against the risks.

scholarly journals Endometrial Infertility in Patients of Late Reproductive age (a review)

2020 ◽  
Vol 27 (6) ◽  
pp. 149-163
Author(s):  
K. V. Uryupina ◽  
I. I. Kutsenko ◽  
E. I. Kravtsova ◽  
J. V. Kudlai ◽  
I. I. Kravtsov
Keyword(s):  
Assisted Reproduction ◽  
Endometrial Thickness ◽  
Uterine Cavity ◽  
Endometrial Receptivity ◽  
Female Infertility ◽  
Reproductive Age ◽  
Local Immunity ◽  
Age Related ◽  
Choice Of Treatment ◽  
Uterine Infertility

Background. Endometrial infertility is a frequent cause of failure in assisted reproduction. Causes of endometrial infertility are manifold and require comprehensive assessment for a successful choice of treatment strategy.Objectives. A review of infertility concepts accounting for endometrial infertility in women of late reproductive age.Methods. Bibliographic analysis: sources for review were mined in the PubMed, MedLine, eLibrary and Cyberleninka databases at a depth of 10 years. Keyword queries were: endometrial factors of infertility, uterine infertility [маточные факторы бесплодия], causes of infertility. Selected articles related to female infertility and, particularly, endometrial factors of infertility. Low-informative articles were not considered.Results. A total of 51 sources were analysed, with 36 selected in the review. The reviewed evidence suggests that endometrial female infertility in late reproductive age is associated with cumulative gynaecological pathology and age-related change adversely impacting endometrial receptivity and synchrony with embryo maturation in assisted reproductive protocols.Conclusion. Determining the functional status of endometrium is prerequisite for the outcome prognosis in assisted reproduction due to feasible failures to conceive with a vital embryo but reduced endometrial receptivity. This observation warrants a timely diagnosis and treatment of endometrial disorders prior to having assisted reproductive interventions. Woman’s age is the main predictor of successful pregnancy in IVF/ICSI protocols. Among the main markers of successful implantation is endometrial thickness. Uterine infertility may relate to impaired local immunity and autoimmune responses in uterine cavity. The most common mechanisms of uterine infertility are associated uterine myoma, endometriosis and endometritis. Women with uterine infertility attempting IVF/ICSI procedures often exhibit asynchronous endometrial development relative to the embryo maturity for implantation.

scholarly journals Current management of refractory ascites in patients with cirrhosis

2017 ◽  
Vol 46 (3) ◽  
pp. 1138-1145 ◽  
Author(s):  
Ruihong Zhao ◽  
Juan Lu ◽  
Yu Shi ◽  
Hong Zhao ◽  
Kaijin Xu ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Poor Quality ◽  
Low Flow ◽  
Refractory Ascites ◽  
Pump System ◽  
Choice Of Treatment ◽  
Intrahepatic Portosystemic Shunt ◽  
Therapeutic Measures ◽  
Large Volume Paracentesis ◽  
Traditional Approaches

Liver cirrhosis is a health problem worldwide, and ascites is its principal symptom. Refractory ascites is intractable and occurs in 5%–10% of all patients with ascites due to cirrhosis. Refractory ascites leads to a poor quality of life and high mortality rate. Ascites develops as a result of portal hypertension, which leads to water–sodium retention and renal failure. Various therapeutic measures can be used for refractory ascites, including large-volume paracentesis, transjugular intrahepatic portosystemic shunt, vasoconstrictive drugs, and an automated low-flow ascites pump system. However, ascites generally can be resolved only by liver transplantation. Because not all patients can undergo liver transplantation, traditional approaches are still used to treat refractory ascites. The choice of treatment modality for refractory ascites depends, among other factors, on the condition of the patient.

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