1/20. Primary non Hodgkin's lymphoma of the vagina.The genital tract as a primary site of malignant lymphoma in women is extremely rare. This report concerns a 64 year old patient with a primary vaginal non-Hodgkin lymphoma (large cell B lineage according to the REAL classification--centroblastic type according to the Kiel classification--"G" according Working Formulation) with an unusual clinical presentation--pelvic discomfort accompanied by frequent ureteral-like colic. Due to gynecological onset symptoms and the rarity of this extranodal primary site misinterpretation of a primary vaginal lymphoma as a benign inflammatory disease or endometriosis may occur. We emphasize the importance of their recognition and also the differential diagnosis of cervical lymphoma from other neoplastic and non-neoplastic lesions.- - - - - - - - - - ranking = 1keywords = gynecologic (Clic here for more details about this article) |
2/20. Unexpected bleeding disorders.patients with known coagulation deficiencies, either congenital or acquired, may bleed spontaneously with trauma or with surgical intervention. In contrast, however, are the unchallenged patients who bleed in a variety of clinical settings that demand rapid diagnosis so that appropriate therapy can be instituted. In the first section Dr. Louis M. Aledort demonstrates a series of vignettes of actual cases who presented with unexpected bleeding or a screening laboratory abnormality prior to a needed surgical intervention. Settings include dental, oral surgical, obstetrical, surgical and gynecological. The differential diagnoses of these cases are discussed. In the second section Dr. David Green also uses vignettes to demonstrate how the laboratory is used to differentiate the various clinical entities. The choice and priority of required tests indicated by the settings, history, site and type of bleeding, and the syllogisms used to define the abnormality are stressed. In the third section, Dr. Jerome Teitel reviews in detail the therapeutic armamentarium available to the clinician and presents algorithms for the management of these bleeding disorders.- - - - - - - - - - ranking = 1keywords = gynecologic (Clic here for more details about this article) |
3/20. Surgical pelvic packing as a means of controlling massive intraoperative bleeding during pelvic posterior exenteration--a case report and review of the literature.This is a report of a case of gynecological hemorrhage after a posterior pelvic exenteration in patients with vulvar cancer treated by temporary pelvic packing at the Department of gynecology of the Medical University in Gdansk. The packing was successful and the sponges were removed after 24 h. Twenty-eight days after the operation, the patient was transferred to the Department of radiotherapy for supplementary treatment. In patients with severe intraoperative hemorrhage, intra-abdominal packing has been successful as a mode of treatment.- - - - - - - - - - ranking = 1keywords = gynecologic (Clic here for more details about this article) |
4/20. Embolization for hemorrhage of liver metastases from choriocarcinoma.BACKGROUND: Because gestational trophoblastic disease (GTD) is highly sensitive to chemotherapy, life-threatening hemorrhage from metastases can occur especially early after starting therapy. CASES: Two cases of post-term choriocarcinoma with liver metastases complicated by profuse life-threatening hemorrhage are reported. emergency treatment with transcatheter angiographic embolization of the hepatic artery was performed to control bleeding. DISCUSSION: Although embolization of the iliac vessels for gynecologic malignancies, including GTD, have been described, this is the first time that embolization of the hepatic artery to control bleeding from liver metastases in GTD is reported. The use and indications for embolization are expanding, and also in acute hemorrhagic complications in GTD, this intervention should be considered.- - - - - - - - - - ranking = 1keywords = gynecologic (Clic here for more details about this article) |
5/20. Malignant extragastrointestinal stromal tumor presenting as a vaginal mass: report of an unusual case with literature review.The clinical and pathologic features of a malignant extragastrointestinal stromal tumor presenting as a vaginal mass are discussed. A 66-year-old female presented with copious vaginal bleeding and spontaneous passage of tumoral tissue per vagina. Histologic assessment showed a mitotically active spindle cell neoplasm. Immunohistochemical analysis demonstrated the neoplasm to be positive for CD117 (transmembrane tyrosine kinase) and CD34, consistent with a malignant extragastrointestinal stromal tumor. Subsequent clinical examination revealed an 8-cm posterior vaginal wall mass, with probable origin from the rectovaginal septum. This case is unique based on the primacy of presenting gynecologic complaints, and the unusual anatomic location of the lesion. A literature review of the pathologic features of extragastrointestinal stromal tumors and factors predictive of biologic behavior are discussed. Correct tumor diagnosis is emphasized given the effective treatment possible with imatinib for patients with unresectable tumors.- - - - - - - - - - ranking = 1keywords = gynecologic (Clic here for more details about this article) |
6/20. Abdominal packing for intractable obstetrical and gynecologic hemorrhage.hemorrhage continues to be a serious complication of both obstetrical and gynecologic surgeries. physicians have used packing in cases of uncontrollable hemorrhage for many years, and this article reports on a modification of standard packing techniques that prevents some of the limitations of traditional packing. This technique was used in 1 patient after cesarean hysterectomy and 3 patients after debulking surgery for advanced gynecologic cancer. The pack consists of a wide piece of ribbon gauze and a Penrose drain. One end of the ribbon gauze is draped over a layer of surgicel (oxidized regenerated cellulose), while the rest is threaded through a 1-inch Penrose drain tightly folded several times to maintain pressure over the bleeding area. The other end of the Penrose drain, with the ribbon gauze visible within it, is inserted through a stab incision in the ipsilateral side of the lower abdomen. This technique allows for continuous bleeding assessment and easy removal of the gauze at bedside.- - - - - - - - - - ranking = 6keywords = gynecologic (Clic here for more details about this article) |
7/20. Arterial embolization in the management of abdominal and retroperitoneal hemorrhage.In the field of gynecologic oncology, surgical intervention has been the traditional management of postoperative abdominal hemorrhage. Recently, arterial embolization has been reported to effectively control vaginal hemorrhage associated with gynecologic malignancy, obstetrical trauma, and hysterectomy. This study reports the use of arteriographic embolization in the management of six cases of postoperative abdominal and retroperitoneal arterial hemorrhage. Analysis of these cases provides valuable information which enhances the safety and efficacy of this procedure. Results suggest that arterial embolization, by an experienced arteriographer, should be considered early in the postoperative management of abdominal hemorrhage in gynecology and gynecologic oncology.- - - - - - - - - - ranking = 3keywords = gynecologic (Clic here for more details about this article) |
8/20. Supracallosal interhemispheric arachnoid cyst: resolution after intracystic hemorrhage and infection.A case of a large, symptomatic, supracallosal interhemispheric arachnoid cyst is presented. Positive contrast-enhanced computed tomographic (CT) cystography after stereotactic puncture and aspiration demonstrated lack of communication between the cyst and the subarachnoid space or ventricular system. A cystoperitoneal shunt was successful in relieving the patient's symptoms for 5 years. A delayed shunt infection after gynecologic surgery necessitated removal of the shunt, and was complicated by asymptomatic intracystic hemorrhage. Thereafter, serial CT and magnetic resonance imaging scans showed eventual disappearance of the cyst.- - - - - - - - - - ranking = 1keywords = gynecologic (Clic here for more details about this article) |
9/20. Angiographic arterial embolization to control hemorrhage in abdominal pregnancy: a case report.A case is described in which heavy postoperative bleeding from the placental bed after removal of the fetus in an abdominal pregnancy was managed by selective arterial embolization of the placental vascular bed. Selective angiographic embolization is a useful tool in both obstetric and gynecologic complications when hemorrhage fails to respond to other modes of therapy.- - - - - - - - - - ranking = 1keywords = gynecologic (Clic here for more details about this article) |
10/20. Management of factor xi deficiency in gynecologic and obstetric patients.Deficiency of factor XI (plasma thromboplastin antecedent) can result in severe bleeding in women undergoing obstetric or gynecologic procedures, with the highest risk in women of Ashkenazi Jewish background. Most patients do not bleed if treated with sufficient fresh frozen plasma to maintain a factor XI level of 30% or more but occasionally patients may require higher levels. plasma infusion should be continued for several days, even if bleeding does not seem excessive, since delayed bleeding is not uncommon. The use of hepatitis b vaccine and of plasma from a single donor, may reduce the risk of hepatitis.- - - - - - - - - - ranking = 5keywords = gynecologic (Clic here for more details about this article) |
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