Cases reported "Menorrhagia"

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1/29. Successful use of recombinant VIIa (Novoseven) and endometrial ablation in a patient with intractable menorrhagia secondary to FVII deficiency.

    menorrhagia is a well-recognized complication of inherited bleeding disorders. In the past, the only viable option for women who were unresponsive to medical therapy was hysterectomy. Endometrial ablation has been recently developed as an alternative therapy for these patients and is associated with decreased morbidity. We report the successful use of activated recombinant factor vii (FVIIa) and endometrial ablation in the treatment of excessive menstrual blood loss in a 34-year-old women with severe factor vii (FVII) deficiency. Recombinant FVIIa (40 microg/kg) was administered pre-operatively and every 6 h (20 microg/kg) for 24 h postoperatively. The procedure was uncomplicated with a 200 ml surgical blood loss. FVIIa was used because it allowed FVII replacement with a recombinant product and also has the ability to bind to tissue factor expressed at the site of vascular injury, resulting in site-specific thrombin generation. We believe that endometrial ablation with recombinant VIIa should be considered in patients with severe FVII deficiency and menorrhagia unresponsive to medical therapy.
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2/29. Endometrial stromal sarcoma diagnosed after hysteroscopic endometrial resection.

    Endometrial ablation and resection is now common therapy for dysfunctional uterine bleeding that is unresponsive to conservative management. Opponents argue that it may predispose patients to potentially hazardous malignancies of the uterus. In our patient, endometrial resection was performed to treat menorrhagia after a negative workup. Pathologic interpretation of the resected tissue showed a low-grade stromal sarcoma of the endometrium. The woman underwent definitive treatment, which included total abdominal hysterectomy, and has remained recurrence free over the past 3 years. Although rare, uterine malignancies have been documented after hysteroscopic management of menorrhagia. It is suggested that intraoperative endometrial resection or tissue sampling be done to prevent or diagnose endometrial hyperplasia and uterine malignancies.
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3/29. 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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ranking = 2
keywords = operative
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4/29. menorrhagia and adenomyosis in a patient with hyperhomocysteinemia, recurrent pelvic vein thromboses and extensive uterine collateral circulation treatment by supracervical hysterectomy.

    A 37-year-old patient had recurring thromboses, occlusion of the left femoral vein with hereditary hyperhomocysteinemia, hypermenorrhea and anaemia. Conservative therapy with endometrium ablation and gestagene failed. A supracervical hysterectomy was done to preserve the presacral and left lateral, dorsal and caudal collaterals beside the uterus, and prevent a postoperative congestion, especially of the left leg.
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5/29. Hysteroscopic endometrial resection.

    Endometrial resection (TRCE) is a well-examined alternative therapy to hysterectomy in the treatment of menorrhagia that preserves the uterus at long term in at least 70% of patients. The technique and safety considerations are described and an overview of the existing evidence is given. Complication rates (2.5%) and performance of the personal series of 465 operative hysteroscopies including 244 endometrial resections with a follow-up of at least 18 months are shown. 3.3% of patients with endometrial resection needed a hysterectomy up to now (follow-up 18-90 months). The combination of endometrial resection and the insertion of the levonorgestrel hormone-releasing intrauterine device (LNG-IUD) is described. Especially in patients with adenomyosis, the combination of LNG-IUD with endometrial resection augments the success rate. 96 of 99 patients with the combined therapy (TRCE and LNG-IUD) and a follow-up of 18-48 months still have their uterus.
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ranking = 0.5
keywords = operative
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6/29. Uterine necrosis after arterial embolization for postpartum hemorrhage.

    BACKGROUND: Selective embolization is an effective and reputedly safe method of managing pregnancy-related bleeding. However, we report an ischemic uterine necrosis after arterial embolization. CASE: The patient had heavy postpartum bleeding treated by embolization of the uterine arteries using polyvinyl alcohol particles (diameter 150-250 and 300-600 microm) and gelatin sponge pledgets. Her postoperative recovery was complicated by menorrhagia and pelvic pain. Because of the persistent menorrhagia and risk of infection, a hysterectomy was performed. Histopathology of the hysterectomy specimen revealed massive ischemic myometrial necrosis. CONCLUSION: This complication is most likely related to the small size of the particles used. In the management of postpartum bleeding by arterial embolization, the material of choice is gelatin sponge pledgets, and the use of small particles should be avoided.
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7/29. Successful pregnancy after myomectomy using preoperative adjuvant uterine artery embolization.

    A 30-year-old-woman presented with uterine leiomyoma and primary sterility. Abdominal myomectomy was performed; however, one cervical leiomyoma was not resected because of a risk of excessive blood loss. Two years after the procedure, a secondary myomectomy using preoperative adjuvant uterine artery embolization (UAE) was performed because of pronounced menorrhagia and her hope for bearing children. The patient's dysmenorrhea disappeared postoperatively and she conceived spontaneously 3 years after the secondary myomectomy. This case suggests that myomectomy using preadjuvant UAE may be an another approach for the treatment of leiomyoma in patients who wish bear children in the future.
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ranking = 3
keywords = operative
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8/29. Laparoscopic excision of myometrial adenomyomas in patients with adenomyosis uteri and main symptoms of severe dysmenorrhea and hypermenorrhea.

    Preoperative magnetic resonance imaging accurately diagnosed adenomyosis uteri in three women. We performed laparoscopic excision of myometrial adenomyomas and localized portions of adenomyosis uteri in all women in whom the disorder was accompanied by severe dysmenorrhea and hypermenorrhea. We used the same procedure as for laparoscopic myomectomy. There were no intraoperative or postoperative complications, and patients were hospitalized only 3 days. The women's dysmenorrhea and hypermenorrhea disappeared by the end of the first postoperative menses.
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ranking = 2
keywords = operative
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9/29. Laparoscopic management of teratoma of the round ligament.

    This paper describes the case of an asymptomatic woman who underwent laparoscopy as part of a work-up for infertility. A previous transvaginal ultrasound had shown an echogenic adnexal mass, independent of the ovary. The intraoperative finding was a tumor of the round ligament that was resected and determined to be a mature teratoma. The case is reported due to the unusual location for that type of tumor; and in addition, it is the first description of a teratoma in the round ligament managed by laparoscopy.
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ranking = 0.5
keywords = operative
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10/29. Conservative treatment of diffuse uterine leiomyomatosis.

    OBJECTIVE: To describe the conservative treatment of diffuse uterine leiomyomatosis. DESIGN: Descriptive study. SETTING: tertiary care centers. PATIENT(S): Three premenopausal women with diffuse uterine leiomyomatosis associated to persistent menorrhagia, two with desire of becoming pregnant and one with desire of preservation of the uterus. INTERVENTION(S): Preoperative ultrasound showed symmetrically enlarged uteri with innumerable, poorly defined and small-sized (0.5-3 cm) myomas involving all the myometrium. An "extreme" myomectomy was performed in two cases, including the removal of a large portion of corporal myometrium. One patient was treated only medically with GnRH analogues (GnRH-a). MAIN OUTCOME MEASURE(S): Menstrual pattern and, when applicable, ability to conceive and pregnancy outcome. RESULT(S): Regular menses were restored in both patients who underwent surgery: one had no pregnancy desire and the other was not able to conceive after two IVF-ETs. The patient treated with GnRH-a conceived spontaneously as soon as medical treatment was discontinued; at 34 gestational weeks, an emergency cesarean section followed by hysterectomy was performed for vaginal bleeding and a healthy 2,400-g baby was born. CONCLUSION(S): Our experience supports the idea that a conservative approach to uterine leiomyomatosis may result in restoration of normal cycles and eventually in the birth of a viable fetus.
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ranking = 0.5
keywords = operative
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