Cases reported "Menorrhagia"

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1/8. 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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keywords = gynecologic
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2/8. Abnormal genital tract bleeding.

    The etiology of abnormal genital tract bleeding encompasses a wide range of disorders that can be secondary to anatomic changes of the female genital tract, infection, endocrinologic disorders, malignancies, and systemic illness. Appropriate workup is guided by age-related differential diagnoses for abnormal bleeding. Modern diagnostic tools can quickly focus the evaluation and allow timely intervention. Most abnormal genital tract bleeding is uterine bleeding, which is one of the most common gynecologic problems that health care providers will face. It accounts for approximately 15% of office visits and 25% of gynecologic operations. Abnormal uterine bleeding in reproductive-age women is defined as bleeding at abnormal or unexpected times or by excessive flow at the time of an expected menses. The average menstrual cycle length and duration of flow is 28 days and 4 days, respectively, with an average blood loss of 35 cc (1). Any bleeding should be considered abnormal in premenarchal girls and in post-menopausal women except for those with predictable withdrawal bleeding taking hormone replacement therapy. This article will review the categories of abnormal genital tract bleeding and the diagnostic tools needed to establish the correct diagnosis. Common clinical cases will be presented to illustrate the presenting symptoms, differential diagnoses, workup, treatment, and long-term follow-up.
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keywords = gynecologic
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3/8. Posthysterectomy intestinal prolapse after coitus and vaginal repair.

    INTRODUCTION: Transvaginal bowel evisceration following either vaginal or abdominal gynecologic operations is a very rare complication. Furthermore, vaginal cuff rupture with the prolapse of the small bowel through the vagina during sexual intercourse after abdominal hysterectomy in a premenopausal woman is even more rare. However, regardless of the etiology, transvaginal evisceration requires prompt recognition and surgical intervention. CASE REPORT: Here, we report a premenopausal woman who developed transvaginal bowel evisceration during the first postoperative intercourse.
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ranking = 0.25
keywords = gynecologic
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4/8. Arteriovenous malformation of the uterus and pelvis.

    Arteriovenous malformation of the uterus and adnexa is a rare entity; its paucity is established in the gynecologic literature. That does not detract, however, from diagnostic and therapeutic difficulties encountered by the gynecologist faced with the serious problem of hemorrhage and its sequelae. Most reported cases have been treated by hysterectomy. Two patients with conservative management by selective arterial embolization under angiography are detailed herein. The method was successful in one patient and failed in the other.
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ranking = 0.25
keywords = gynecologic
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5/8. factor vii deficiency and surgery. Is preoperative replacement therapy necessary?

    A patient with congenital factor vii deficiency (factor VII was 12%) had gynecologic surgery performed without prophylactic blood-product replacement therapy. blood loss was not excessive. A review of 12 additional patients with factor vii deficiency who underwent surgery without replacement therapy showed that surgical bleeding was uncommon and that there was no relationship between factor VII levels and hemorrhage. It is proposed that patients who bleed may be those who also have a prolonged bleeding time or who have ingested aspirin shortly before surgery. It is all proposed that replacement therapy be available for use if required, but that its routine preoperative use is probably unnecessary in this disorder.
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ranking = 0.25
keywords = gynecologic
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6/8. leiomyosarcoma of the small intestine presenting as a pelvic mass.

    We present a challenging case of differential diagnosis of leiomyosarcoma of the small intestine in a patient presented with a pelvic mass. This 43-year-old Japanese woman complained of hypermenorrhea and was diagnosed as myoma uteri. She underwent partial resection of the ileum with a primary end-to-end anastomosis, omentectomy, and appendectomy, as well as a simple hysterectomy and bilateral salpingo-oophorectomy. CT and MRI indicated an intestinal tumor at the gaseous site. The histological diagnosis was leiomyosarcoma of the small intestine and leiomyoma of the uterus. Although such leiomyosarcomas are rare, they can appear as pelvic masses and must be differentiated from gynecologic disease. Preoperative CT and MRI of the abdomen were useful in obtaining the diagnosis.
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ranking = 0.25
keywords = gynecologic
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7/8. factor v deficiency and menstruation: a gynecologic challenge.

    BACKGROUND: menorrhagia is a well-known complication of factor v deficiency. CASE: A 13-year-old girl with factor v deficiency presented with acute hemorrhage on day 4 of menses. Laboratory assessment revealed a hemoglobin of 36 g/L. The ultrasound appearance of a large loculated cystic mass was consistent with substantial intraperitoneal bleeding. Stabilization with blood products was followed by GnRH agonist therapy. Medical management was instituted effectively. Continued compliance with medication is essential to prevent recurrences. CONCLUSION: factor v deficiency is rare. Coagulation disorders of this nature pose a challenge to gynecologists involved in patient management at the time of menses.
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ranking = 1
keywords = gynecologic
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8/8. Transarterial embolization of the uterine arteries: patient reactions and effects on uterine vasculature.

    BACKGROUND: Therapeutic embolization of the uterine arteries has been successfully used to manage profuse gynecological hemorrhage. In the present study we aimed to investigate whether embolization of uterine arteries may serve as a safe and effective alternative treatment in cases of menorrhagia in fertile and perimenopausal women. As a first step, we have evaluated the methodology, patient reactions and effects on the uterine vasculature. methods: The distal part of the uterine artery was embolized with polyvinyl alcohol particles via catheterization of the right femoral artery. Total abdominal hysterectomy was performed the next day. RESULTS: Bilateral embolization in two patients resulted in considerable pain that required morphine analgesic medication and epidural analgesia. One patient was embolized unilaterally and experienced only slight discomfort with no need for analgesic medication at all, indicating that unilateral embolization is a well-tolerated method. After embolization, angiography showed stagnant flow in embolized vessels without contrast filling of distal branches. angiography of the specimen showed normal vascular architecture in non-treated vessels. In treated vessels the main arterial trunks were patent but all smaller branches were occluded. histology showed that most of the particles lodged in small arteries and that arterioles never showed injected material. CONCLUSION: The study indicates that the procedure involves an efficient occlusion of uterine vessels and that unilateral embolization of uterine arteries is well tolerated.
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ranking = 0.25
keywords = gynecologic
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