Cases reported "Leiomyoma"

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1/36. Transcatheter uterine artery embolization for the management of symptomatic uterine leiomyomas.

    Transcatheter arterial embolization has been applied traditionally in obstetrics and gynecology for the emergency control of pelvic hemorrhage, usually after failure of conventional surgical measures. Pelvic trauma is the most common, nongynecologic etiology of uncontrollable pelvic hemorrhage requiring use of this hemostatic technique. Recently, elective transcatheter arterial embolization of uterine leiomyomas has been performed to decrease related symptomatology in an attempt to avoid surgical intervention. Our objective was to review current pertinent data regarding this new therapeutic modality. To this goal, all manuscripts published in the literature regarding this topic obtained from a medline search for 1966 through September 1998 were selected and reviewed. Additional sources were identified through cross-referencing. Currently, approximately 193 patients worldwide have been managed with this investigational procedure. Main indications include symptomatic uterine leiomyomata with menometrorrhagia, anemia, or pain. Success rates seem promising with a very low failure rate. This procedure results in significant (uterine and leiomyoma) volume reduction of between 20 and 80 percent. Postprocedural pain is common during the first day after the procedure, often requiring intravenous nonsteroidal antiinflammatory drugs and narcotic analgesia. Rare complications include endometritis, pyometra, and uterine necrosis, which may require hysterectomy. Reported follow-up time ranges between 6 and 60 months. Implications on subsequent fertility have not been established. Although successful pregnancies subsequent to this procedure have been reported, because of the unknown long-term effect of this procedure on fertility or perinatal outcome, this technique should not be performed when future fertility is desired. This review suggests that although not currently accepted as standard of care, transcatheter embolization of the uterine arteries can be considered as a nonsurgical technique for the management of appropriately selected patients. TARGET AUDIENCE: Obstetricians & Gynecologists, family physicians learning OBJECTIVES: After completion of this article, the reader will be able to explain the current indications and contraindications of transcatheter uterine artery embolization of leiomyomas; to identify the various complications of the procedure and the type of embolic materials used; and to estimate the success rate of this procedure in the current literature.
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keywords = gynecologic
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2/36. Spontaneous uterine rupture in the early third trimester after laparoscopically assisted myomectomy. A case report.

    BACKGROUND: The development of new and innovative laparoscopic instruments has allowed a greater number of gynecologic surgeons to laparoscopically remove large, intramural leiomyomata. Cases of both successful pregnancy and uterine rupture following laparoscopic myomectomy have been reported. This is the first report of uterine rupture in pregnancy following a laparoscopically assisted myomectomy. CASE: A 26-year-old, nulligravid woman underwent a laparoscopically assisted myomectomy. While the myomectomy had been performed laparoscopically, the uterine incision had been repaired in layers through a minilaparotomy incision. Two years later she became pregnant and, at 29 weeks' gestation, presented to labor and delivery with contractions and uterine tenderness. Over the next several hours, a nonreassuring fetal heart rate developed, and a cesarean section was performed, revealing hemoperitoneum and uterine rupture at the site of the prior myomectomy. CONCLUSION: The ultimate integrity of a uterine incision may depend not only on how the incision is repaired but also on how it is made. Laparoscopically created uterine incisions may not be as strong as those made at laparotomy, regardless of the method of closure.
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keywords = gynecologic
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3/36. urinary tract injuries during advanced gynecologic laparoscopy.

    urinary tract injuries are important complications of laparoscopic surgery. The intraoperative diagnosis may be delayed, resulting in severe clinical complications, such as fistulas, in the immediate and late postoperative periods. A review of 776 endoscopic procedures revealed 6 urinary tract injuries and postoperative complications during laparoscopy. We believe that surgical experience, intraoperative diagnosis, immediate repair of the lesion, and close follow-up are the main factors contributing to decreased morbidity associated with these injuries.
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4/36. Ischemic uterine rupture and hysterectomy 3 months after uterine artery embolization.

    The exact frequency and extent of complications after uterine artery embolization (UAE) have yet to be documented in the literature. Ischemic necrosis and rupture of the uterus is a theoretical concern of this procedure. Rupture of the uterus from any cause is a very serious gynecologic complication requiring immediate surgical intervention to prevent death. Ischemic necrosis and rupture of the uterus can occur months after UAE. In our patient they occurred 3 months after UAE for treatment of symptomatic uterine myomas, and required hysterectomy. To our knowledge, this is the first report of ischemic uterine rupture after UAE in the united states.
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5/36. Bilateral calcified ovarian fibromas in a patient with sotos syndrome.

    OBJECTIVE: To present a case of bilateral calcified ovarian fibromas in sotos syndrome (cerebral gigantism). DESIGN: Descriptive case study. SETTING: Mackay Memorial Hospital. PATIENT(S): A 26-year-old woman with sotos syndrome and bilateral solid adnexal masses on gynecologic ultrasound. INTERVENTION(S): Surgical removal of an 8 x 6 x 6 cm left ovarian fibroma and a 3 x 2 x 2 cm right ovarian fibroma. MAIN OUTCOME MEASURE(S): Ultrasound. RESULT(S): Histopathologic examination revealed bilateral ovarian fibromas with extensive foci of calcification and occasional ossification. CONCLUSION(S): The presence of bilateral calcified ovarian fibromas in this patient with sotos syndrome may reflect the effects of overgrowth in sotos syndrome on ovarian tumorigenesis or may be a coincidence.
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6/36. bone marrow edema syndrome associated with uterine myoma: a case report.

    A patient with bone marrow edema syndrome of the hip associated with a uterine myoma is presented. A 51-year-old woman could not walk because of severe pain in both hips and had been referred to the authors' institute. magnetic resonance imaging scans showed abnormal intensity on T1- and T2-weighted images in both femoral heads and a large mass arising from the uterus which was diagnosed as a uterine myoma. A 99mTc-methylene diphosphonate scintigraph showed diffuse uptake in both femoral heads. The pain in both hips decreased shortly after a hysterectomy and the patient could walk without crutches within 2 weeks after the gynecologic surgery. magnetic resonance imaging scans taken 8 months after surgery showed high signal intensity on T1- and T2-weighted images, indicating normal bone marrow in the femoral heads. To the authors' knowledge, this is the first case report showing a bone marrow edema syndrome of the hip associated with uterine myoma. The pathophysiologic mechanisms for bone marrow edema syndrome of the hip in the current patient and in pregnancy may be identical. More specifically, a large intrapelvic mass may cause an increase of intrapelvic pressure and subsequent blood stasis in both conditions. The current case suggests the possible factors of bone marrow edema syndrome of the hip which need to be investigated.
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keywords = gynecologic
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7/36. Giant uterine tumors: two cases with different clinical presentations.

    BACKGROUND: Giant uterine tumors are uncommon. However, they may be life threatening because of pressure effects on the lungs and other adjacent organs. Proper surgical management and careful perioperative care are essential to assure a good outcome after excision. CASE: Two women with giant uterine leiomyomata (weighing more then 40 kg [88 lb]) are discussed. In one case the leiomyoma led to severe pulmonary hypertension and respiratory failure necessitating an emergency operation. Abdominal hysterectomy and bilateral salpingo-oophorectomy were successfully carried out in both cases, which are among the largest tumors ever removed with survival of the patient. CONCLUSION: Different clinical manifestations can be expected in cases of giant uterine tumors according to which other organs are secondarily affected. Numerous difficulties may be encountered in the evaluation and removal of these tumors. A combined team consisting of gynecologic, general, and plastic surgeons is necessary for a successful outcome.
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keywords = gynecologic
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8/36. Giant pelvic retroperitoneal leiomyoma arising from the rectal wall.

    BACKGROUND: Pelvic retroperitoneal leiomyomas arising from the rectal wall are rare. We present a case of a giant retroperitoneal leiomyoma mimicking bilateral solid adnexal masses in a postmenopausal woman. CASE: A 54-year-old postmenopausal woman presented with a large abdominopelvic mass. At surgery, the uterus was displaced anteriorly by a large retroperitoneal mass. The rectosigmoid colon was noted to course through the retroperitoneal mass. The patient underwent complete excision of the retroperitoneal mass along with a rectosigmoid resection of the involved colon with primary reanastomosis. Histopathology showed a leiomyoma arising from the muscularis propria of the rectum wall. CONCLUSION: Retroperitoneal masses that extend into the pelvis may mimic adnexal masses and, therefore, represent a rare finding at gynecologic surgery.
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keywords = gynecologic
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9/36. Transvaginal uterine artery ligation in a woman with uterine leiomyomas. A case report.

    BACKGROUND: uterine artery embolization by interventional radiologic techniques is an effective and widely used modality in the management of uterine leiomyomas. Anatomically, uterine arteries can be approached transvaginally with an appropriate surgical technique. In this report, we describe a novel, minimally invasive vaginal technique that also occluded the uterine arteries successfully. CASE: A 45-year-old woman with symptomatic leiomyomas decided to undergo a vaginal hysterectomy. During the procedure, Doppler ultrasonography demonstrated the cessation of blood flow after dissection and ligation of uterine arteries bilaterally without cutting the uterosacral and cardinal ligaments. CONCLUSION: Transvaginal ligation of the uterine arteries is possible. If validated by further clinical investigation, this minimally invasive gynecologic technique could be useful in selected cases of uterine leiomyomas.
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keywords = gynecologic
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10/36. The diagnostic problem of endometrial stromal sarcoma: report on six cases.

    OBJECTIVE: The objective was to look for the incidence and clinicopathologic findings of women in whom the diagnosis of endometrial stromal sarcoma was initially missed. methods: We carried out a retrospective analysis of cases treated at our institution from 1990 to 2002. RESULTS: In 6/15 (40%) women suffering from endometrial stromal sarcoma, the diagnosis initially was missed. The first diagnosis was uterine leiomyoma (n = 2), myxoid leiomyoma (n = 2), cellular leiomyoma (n = 1), or lymphatic disorder (n = 1). The final diagnosis was only made after consultation of a pathologist with a special interest in gynecological oncology. The mean age of this group was only 34 years (range, 18-53). A mean delay in diagnosis of 143 months (range, 24-408) resulted in stage 4 disease in 5/6 women. After a mean follow-up of 16 years (range, 5-43), 4/6 are without macroscopic evidence of disease, 1/6 with evidence of disease, and 1/6 died of disease. CONCLUSION: Especially in younger women, the diagnosis of endometrial stromal sarcoma can be problematic.
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keywords = gynecologic
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