1/68. Implications for port placement of deep circumflex iliac artery damage at laparoscopy. A cannula injury to the deep circumflex iliac vessels led to substantial morbidity and required surgical repair. Surgeons must increase their awareness of the anatomy of these vessels and place laparoscopic ports to minimize the risk of injury. (J Am Assoc Gynecol Laparosc 6(2):221-223, 1999) ( info) |
2/68. Oral contraceptives: therapeutic uses and quality-of-life benefits--case presentations. Numerous studies have shown that oral contraceptives (OC) provide protection against a wide variety of illnesses and conditions, including loss of bone density, ovarian cysts, menstrual cycle irregularities, dysmenorrhea and menorrhagia, ectopic pregnancy, pelvic inflammatory disease, benign breast disease, endometrial cancer, and ovarian cancer. How OC can be used not only for contraception but also to improve health among women throughout their reproductive years is illustrated by four case presentations: an adolescent with menstrual problems; a 25-year-old mulligravida who wishes to delay childbearing; a 35-year-old who has completed her family and requests tubal ligation; and a 45-year-old with perimenopausal symptoms. In view of their numerous health benefits, OC are to reproductive-age women as hormone replacement therapy is to menopausal women. ( info) |
3/68. Effect of the levonorgestrel-releasing intrauterine system on uterine myomas in a renal transplant patient. The levonorgestrel-releasing intrauterine system (LNG-IUS) has been used in the treatment of both idiopathic menorrhagia and adenomyosis. An electronic search of the on-line medical literature revealed no reports of its use for menorrhagia secondary to uterine myomas. Presented here is the successful treatment of uterine myomas with menorrhagia in a woman with a renal transplant. There was a significant reduction in menorrhagia, dysmenorrhea, and uterine and myoma size with the use of the LNG-IUS. We believe that this system provides an alternative to conventional hysterectomy and gonadotrophin-releasing hormonal analog medical treatment for uterine myomas, with a possibly inhibitory effect on myoma growth. ( info) |
| This is a report of a live birth after conservative surgery for severe adenomyosis following diagnosis by MRI and therapy with GnRH-a. A 33-year-old gravida 1 para 1 woman with a 5-year history of secondary infertility received a gonadotropin-releasing hormone agonist (GnRH-a), leuprolide acetate, for 16 weeks to control symptoms of severe adenomyosis and to treat infertility. However, severe dysmenorrhea recurred after the discontinuation of therapy. Because an elevated serum level of CA-125 and MRI findings suggested that she was experiencing a relapse of adenomyosis, GnRH-a therapy was re-instituted. After 24 weeks of the second therapy, her uterus decreased to normal size and an MRI revealed a localized low-signal-intensity myometrial mass with well-defined borders. We easily resected the localized lesion of adenomyosis using the same technique used to treat uterine leiomyoma. The patient became pregnant after 12 weeks of additional danazol therapy. A healthy male infant was delivered at term by cesarean section. ( info) |
5/68. hematometra in postmenarchal adolescent girls: a report of two cases. We report two cases of unicornuate uterus with functioning rudimentary horn to highlight that Mullerian duct anomalies should be considered in the differential diagnosis of severe dysmenorrhoea even in normally menstruating girls. ( info) |
6/68. Unicornuate uterus with a noncommunicating cavitary, laterally dislocated rudimentary horn presenting with adenomyosis, associated with ipsilateral renal agenesis. Unicornuate uterus with a rudimentary horn is a rare mullerian anomaly. We report a case of a unicornuate uterus with adenomyosis in a laterally dislocated rudimentary horn, which showed a functioning endometrial islands, with associated ipsilateral agenesis of the kidney. ( info) |
7/68. Imaging of membranous dysmenorrhea. Membranous dysmenorrhea is an unusual clinical entity. It is characterized by the expulsion of huge fragments of endometrium during the menses, favored by hormonal abnormality or drug intake. This report describes a case with clinical, US, and MRI findings before the expulsion. Differential diagnoses are discussed. ( info) |
8/68. Balloon endometrial thermoablation--an alternative management of adenomyosis with menorrhagia and dysmenorrhoea. A 45 years old Chinese housewife presented with menorrhagia and dysmenorrhoea due to adenomyosis failed to respond to various medical treatments. She was treated with balloon thermoablation. The total menstrual blood loss (MBL) decreased from 96.94 ml before to 37.57 ml, six months after thermoablation. The pictorial blood loss chart (PBLC) showed similar decrease in blood loss. Dysmenorrhoea was also cured. At three year follow up, there was no recurrence. This is the first report which shows thermoablation decreases MBL objectively and can be tried to treat adenomyosis. ( info) |
9/68. Traditional Chinese medicine: a case of dysmenorrhoea. acupuncture treatment continued for three cycles, undertaken one week prior to menses whereas herbal therapy was maintained for six months. Within this six month time frame Jenny's overall health status had changed dramatically for the better. She was pain free and consequently her life-style had improved to the point where she felt confident to travel overseas for a holiday. To date, Jenny and her mother have kept in touch with clinic staff and no further treatment has been necessary. ( info) |
| BACKGROUND:celiac disease may be subclinical and difficult to diagnose in adults. It has been associated with infertility and miscarriage but rarely with other gynecologic symptoms.CASE:A 43-year-old woman complaining of chronic abdominal and pelvic pain, deep dyspareunia, dysmenorrhea, diarrhea, and a 5-kg weight loss during the last 6 months was referred to our institution. Laboratory and clinical examinations were negative. At laparoscopy, numerous small leiomyomata were seen. A few filmy adhesions between the small bowel and the abdominal wall were lysed. With the exception of deep dyspareunia, all symptoms remitted after surgery, only to recur at 6 months of follow-up. A diagnostic work-up for celiac disease revealed the presence of antigliadin and antiendomysial antibodies. The diagnosis was confirmed at gastroduodenoscopy including biopsy. A gluten-free diet was prescribed, and the patient is now free of symptoms.CONCLUSION:celiac disease should be considered in women presenting with unexplained chronic pelvic pain, dysmenorrhea, and deep dyspareunia. ( info) |