abdominal hysterectomy
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2022 ◽  
Vol 4 (2) ◽  
pp. 495-498
Author(s):  
Parvathi Pillai

Introduction: Some of the ovarian lesions become functional and secrete hormones that bring endometrial changes like hyperplasias and polyps. This study aimed to find endometrial changes associated with different types of cystic lesions of the ovary. Materials and Methods: A histopathological study done from 2010 -2013 on all the total abdominal hysterectomy specimens with bilateral oophorectomy having cyst size more than 3cms, with a detailed clinical history received in the Department of Pathology, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry. A total of 112 cases were collected analyzed and statistically correlated. Results: Out of the 112 cases of cystic lesions of the ovary 67% showed endometrium within normal limits, 33% of cystic lesions of ovary showed polyps, simple hyperplasia without atypia, complex hyperplasia without atypia. Among non-neoplastic lesions, follicular cyst produced the most endometrial changes, followed by benign surface epithelial lesions. Granulosa cell tumor was found to induce polyp as well as simple hyperplasia without atypia. Two out of three malignant lesions showed endometrial changes followed by benign lesions. The majority of the cystic lesions of the ovary encountered are non-neoplastic lesions (59%) and follicular cysts were more common (97%). Endometrial hyperplasia of both simple and complex types without atypia was found with serous cystadenoma. Conclusions:  From the current study it implicates the necessity of assessing cystic lesions of the ovary like a follicular cyst, luteal cyst, granulosa cell tumors as they can become functional leading to endometrial changes that can form a fertile ground for carcinomas.


Author(s):  
Alireza Saliminia ◽  
Fatemeh Golpayegani

Background: The occurrence of bleeding during major surgeries is common and requires timely and accurate management in the prevention and treatment of hypovolemia and hemodynamic instability during and after surgery. This study evaluated the correlation and agreement between the two protocols determining the status of the hypovolemia during hysterectomy. Methods: This study was a randomized single-blinded clinical trial. The study population included 30 patients undergoing Total Abdominal Hysterectomy in Shariati Hospital in Tehran between 2015 and 2016. The patients were randomly assigned to two groups using a randomized table of numbers, so that in the FTc group, fluid therapy was performed based on the FTc index and in the PVI group based on the PVI index. The changes in FTc and PVI values were recorded every 5 minutes and the changes in the two indicators from the beginning to the end of the treatment were evaluated. At the beginning and end of the surgery, an arterial blood gas analysis (ABG) was also performed. The amount of bleeding during operation and urinary output were recorded in two groups. Results: There was no significant difference across the two groups in total fluid intake during surgery, mean volume of blood loss, mean urine output, and duration of surgery. The arterial blood gas status was also similar in both groups at the beginning and the end of the operation. We found a strong adverse correlation between FTC and PVI indices at the different time points evaluated within the surgery. In total, there was a strong correlation between the mean FTC and the mean PVI during the first hour (r=-0.765, P < 0.001) and the second hour (r=-0.941, -P < 0.001) of operation. Considering the cut-off point of 350msec for the FTC and 13% for the PVI in predicting hypovolemia, the agreement between the two protocols in fluid therapy during the first hour after surgery was 79.8% and 76.6%. Conclusion: There is a strong and significant correlation between the two FTC (with a cut off of 350) and PVI (with a cut point of 13%) to predict need for fluid therapy.


2022 ◽  
Vol 33 ◽  
pp. e00371
Author(s):  
Caroline S. Kwon ◽  
Jennifer Dai ◽  
Mark V. Sauer

2022 ◽  
Vol 21 (1) ◽  
pp. 203-247
Author(s):  
Thais Martins Gomes de Oliveira ◽  
Cristine Alves Costa de Jesus

Introduction: The surgical treatment of organ removal seems to meet a number of pathologies that emerge as health needs of populations. In this context, the state of uncertainty is installed.Objective: To investigate the uncertainty in illness in surgical patients of organ removal.Method: Cross-sectional study developed with patients admitted to the surgical outpatient clinic of a university hospital. Sociodemographic and clinical variables were collected, in addition to applying Mishel uncertainty in illness scale.Results: The profile of medical diagnoses in the 60 participants showed that the most frequent diseases were the neoplasms. As for the scale application, 68% of the participants presented scores greater than or equal to 80 points. The value found for the Cronbach’s Alpha was 0.842. The surgical procedures abdominal hysterectomy and mastectomy, which were the most prevalent for the participants, are associated with uncertainty domains.Conclusions: High levels of uncertainty demonstrated the need for the management of this condition. The psychosocial aspects of surgical treatments are disregarded at the expense of the clinical restoration, circumstances that neglect the patient’s emotional suffering. The improvement of communication between the health professional and the patient can influence to prevent the manifestation of the lack of information, one of the forms of expressing uncertainty. Aspects such as the patient’s socioeconomic profile, educational level and income must be taken into account in the surgical treatment of organ removal. The uncertainty experienced by these patients needs to be better known and widely disseminated to gain prominence in the health care setting. Introducción: El tratamiento quirúrgico de la extirpación de órganos parece satisfacer una serie de patologías que surgen como necesidades de salud de las poblaciones. En este contexto, se instala el estado de incertidumbre.Objetivo: Investigar la incertidumbre de la extracción de un órgano en pacientes quirúrgicos.Método: Estudio transversal realizado con pacientes hospitalizados en la clínica quirúrgica de un hospital universitario. Variables sociodemográficas y clínicas fueron recogidas, además, se aplicó la escala de incertidumbre en la enfermedad de Mishel.Resultados: El perfil de diagnósticos médicos en los 60 participantes mostró que las enfermedades más frecuentes fueron las neoplasias. Con relación a la aplicación de la escala, el 68% de los participantes presentaron puntuaciones mayores o iguales a 80 puntos. El valor hallado para el alfa de Cronbach fue de 0,842. Los procedimientos quirúrgicos histerectomía abdominal y mastectomía, que fueron los más frecuentes para los participantes, están asociados con áreas de incertidumbre.Conclusiones: Los altos niveles de incertidumbre demostraron la necesidad de la gestión de esta condición. Los aspectos psicosociales de los tratamientos quirúrgicos son desconsiderados a expensas de la restauración clínica, circunstancias en que se descuida el sufrimiento emocional del paciente. La mejora de la comunicación entre los profesionales de la salud y el paciente puede influir para prevenir la manifestación de la falta de información, una de las formas de la expresión de la incertidumbre. Aspectos como el perfil socioeconómico del paciente, el nivel educativo y los ingresos deben tenerse en cuenta en el tratamiento quirúrgico de la extracción de órganos. La incertidumbre experimentada por estos pacientes debe conocerse mejor y difundirse ampliamente para que estos aspectos se destaquen en el entorno de la atención médica. Introdução: O tratamento cirúrgico de retirada de órgãos surge para atender a uma diversidade de patologias que emergem como necessidade de saúde apresentadas pelas populações, sendo considerado um procedimento que provoca no paciente sentimentos de incerteza.Objetivo: Investigar a incerteza na doença, em pacientes cirúrgicos submetidos à retirada de órgão.Método: Estudo transversal desenvolvido com pacientes internados na clínica cirúrgica de um hospital universitário. Coletaram-se as variáveis sociodemográficas e clínicas e aplicou-se a escala da incerteza na doença de Mishel (MUIS).Resultados: O perfil de diagnósticos médicos nos 60 participantes revelou que as doenças mais frequentes foram as neoplasias. Quanto a aplicação da escala, 68% dos participantes apresentaram escores maiores ou iguais a 80 pontos. O valor encontrado para o Alpha de Cronbach foi de 0,842. Os procedimentos cirúrgicos, histerectomia via abdominal e mastectomia, os quais foram os mais prevalentes para os participantes, se associam aos domínios da incerteza.Conclusões: Elevados níveis de incerteza evidenciaram a necessidade do manejo dessa condição. Os aspectos psicossociais dos tratamentos cirúrgicos acabam secundarizados em detrimento do reestabelecimento clínico, circunstância em que se negligencia o sofrimento emocional do paciente. A melhora da comunicação entre o profissional da saúde e o paciente pode influenciar para que não ocorra a manifestação da falta de informação, uma das formas de expressão da incerteza. Aspectos como perfil socioeconômico do paciente, escolaridade e renda devem ser levados em consideração no tratamento cirúrgico de retirada de órgãos. A incerteza vivenciada por esses pacientes precisa ser mais conhecida e amplamente disseminada para ganhar destaque no ambiente de saúde.  


Medicina ◽  
2021 ◽  
Vol 58 (1) ◽  
pp. 34
Author(s):  
Radomir Aničić ◽  
Aleksandar Rakić ◽  
Rastko Maglić ◽  
Dragutin Sretenović ◽  
Aleksandar Ristić ◽  
...  

Epitheliod trophoblastic tumor (ETT) account for only 1–2% of all the cases of gestational trophoblastic neoplasia (GTN), with a reported mortality rate of 10–24%. ETT is derived from chorionic type intermediate trophoblastic cells, which appears to be the reason for the only slightly elevated βhCG levels in these patients. We present a case of a 42-year-old patient who was admitted to the clinic eight months after Caesarean delivery, for irregular vaginal bleed with normal values of beta-human chorionic gonadotropin (βhCG). A 6 × 5 cm hematoma was evacuated from the isthmic uterine segment during the operation, and the histopathological exam of the tissue surrounding the hematoma revealed ETT. There were no metastatic lesions on the thoracal, abdominal, and pelvic CT. The second ultrasonographic exam revealed tumefaction of 5 cm at the site from the previous surgical procedure. Color Doppler imaging revealed no central nor peripheral blood flow. The patient underwent a total abdominal hysterectomy with bilateral adnexectomy without adjuvant chemotherapy. This appears to be one of the shortest intervals from the anteceded gestational event until the diagnosis of this tumor, along with the absence of the significant ultrasonographic feature of the ETT-peripheral Doppler signal pattern. We underline that, even with normal values of βhCG, irregular vaginal bleeding following the antecedent gestational event should always arouse suspicion of GTN.


2021 ◽  
Vol 11 ◽  
pp. 67
Author(s):  
Sai Swarupa Reddy Vulasala ◽  
Dheeraj Reddy Gopireddy ◽  
Khaled Mohamed ◽  
Chandana Lall

Leiomyomas, also termed as fibroids, are benign smooth, muscle neoplasms seen in 70–80% of women by the age of 50 years. Uterine artery embolization (UAE) is a minimally invasive procedure that involves cessation of vascular supply to the fibroids, by infusion of gelatinous microspheres into the uterine arteries. Pyomyoma is a suppurative leiomyoma, secondary to infection of necrotic tissue. It is an infrequent complication of uterine artery embolization (UAE). Pyomyoma can lead to sepsis, peritonitis, and respiratory distress syndrome resulting in high morbidity and mortality. Due to its rarity, high suspicion is crucial in the diagnosis, and prompt treatment is recommended to reduce mortality. Ultrasound, computed tomography, and magnetic resonance imaging assist in diagnosis. We present a case of a 44-year-old woman with ruptured pyomyoma, following an UAE intervention. The patient was treated with total abdominal hysterectomy and salpingo-oophorectomy along with peritoneal irrigation and drainage.


2021 ◽  
Vol 81 (04) ◽  
pp. 406-410
Author(s):  
Viviana García ◽  
◽  
Franco Calderaro Di Ruggiero ◽  
Jorge Hoegl ◽  
Carlos Quintero ◽  
...  

Choriocarcinoma represents a type of malignant tumor of gestational trophoblastic disease. It can develop after a molar pregnancy, miscarriage, normal or ectopic pregnancy. Generally its seat site is the uterine body; infrequent places such as the cervix have been described. We report the case of a 37-year-old patient is reported, VI gestations IV deliveries I cesarean section I molar pregnancy, with abnormal uterine bleeding, which is referred to the Hospital Oncology Service. On gynecological examination, an exophytic mass is observed in the cervix. A biopsy was taken that reported: Gestational choriocarcinoma and plasma levels of β-hCG were verified: 13805 IU / L. A total abdominal hysterectomy was performed with preservation of the ovaries. It was concluded as stage I of the International Federation of Gynecology and Obstetrics and 8, according to the score of the World Health Organization (ST I: 8), for which adjuvant was indicated. Currently no evidence of disease. Keywords: Choriocarcinoma, gestational trophoblastic disease, cervix.


2021 ◽  
Vol 17 (8) ◽  
pp. 55-60
Author(s):  
O.V. Filyk ◽  
A.V. Ryzhkovskyi

Background. The effectiveness and widespread use of regional anesthesia in combination with a multimodal approach to perioperative analgesia allow them to be used for an increasing number of patients, including those undergoing surgery in gyneco­logy. The purpose of the study was to determine the effectiveness of transversus abdominis plane block as a component of multimodal analgesia compared to no regional methods of analgesia for a total abdominal hysterectomy. Materials and methods. We conducted a retrospective single-center study at the Department of Anaesthesiology and Intensive Care and the Department of Gynecology of Yuriy Semenyuk Rivne Regional Clinical Hospital (Ukraine). The study included patients aged 40–65 years with symptomatic fibroids complicated by vaginal bleedings, who required a total abdominal hysterectomy (supravaginal amputation of the uterus with ovaries). Exclusion criteria were: patient’s refusal to participate in the study at any of its stages, ASA class > IV, body mass index > 40 kg/m2, use of opioid receptor agonists/agonists-antagonists before surgery, uncontrolled arterial hypertension, heart rhythm disorders. Forty-three patients were included in data analysis. Results. It was found that the level of pain on visual analogue scale in the first group reached its maximum values at h12 and h24 stages of the study and was 4.8 [3.3; 5.8] and 5.3 [3.9; 6.4] points, respectively, while in patients of the second group at same stages of the study pain seve-rity was 2.7 [2.3; 3.5] and 2.1 [1.6; 4.1] points (p < 0.05). Significant differences were found in heart rate between the first and the second groups at h24 stage of the study (93 [87; 98] bpm in the first group and 72 [63; 79] bpm in the second, p = 0.05). There were no significant differences in mean blood pressure at all stages of the study; however, there was a tendency towards a decrease in these data throughout the study in the first group of patients. The ave-rage daily dose of nalbuphine at h24 stage has a tendency (p = 0.07) towards a decrease in the second group (40.9 ± 1.1 mg/day) compared with the first group (51.4 ± 2.9 mg/day). At h72 stage, the need in nalbuphine was significantly lower (p < 0.05) in the second group (5.8 ± 0.8 mg/day) compared to the first group (22.5 ± 4.1 mg/day). The average length of hospital stay in the first group was 6.8 ± 0.5 days, in the second one — 4.2 ± 0.2 days (p < 0.05). Conclusions. The use of bilateral transversus abdominis plane block with 0.25% bupivacaine and dexamethasone showed a tendency towards a reduction in the need for nalbuphine in the first postoperative day by 25.7 %, on the third postoperative day — by 3.9 times (p < 0.05). The length of hospital stay in the second group was decreased by 2.6 days compared to the first group (p < 0.05).


Author(s):  
Gabriele M. Iacona ◽  
Serge Harb ◽  
Venkatesh Krishnamurthi ◽  
James J. Yun

AbstractThe objective of this study was to explain step by step how to achieve a complete resection of an intravascular leiomyoma. A 48-year-old woman was referred to our institution with progressive dyspnea on exertion, lightheadedness, and previous history of total abdominal hysterectomy and bilateral salpingo-oophorectomy for a uterine leiomyoma echocardiography, computed tomography, and magnetic resonance imaging of the heart and abdomen/pelvis were performed and an intracaval mass with extension into the right heart and pulmonary artery was identified. After multidisciplinary review, a single-stage sternotomy–laparotomy procedure on cardiopulmonary bypass (with beating heart, mild hypothermia, and no deep hypothermic circulatory arrest) ensured complete resection of a giant intravenous leiomyoma (IVL). Multidisciplinary approach, multimodality imaging, and single-stage sternotomy–laparotomy procedure on cardiopulmonary bypass (with heart beating and mild hypothermia) ensure complete resection of IVL.


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