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A Functional Approach to Gynecologic Pain
Published in Sahar Swidan, Matthew Bennett, Advanced Therapeutics in Pain Medicine, 2020
Uterine fibroids may also contribute to dysmenorrhea. Fibroids are the most common pelvic tumor in women and are estimated to occur in up to 80% of females.16 Fibroids are discussed in more depth later, but often contribute to painful menses as a correlate to heavy menstrual flow and passage of clots. These bleeding irregularities are thought to arise from molecular dysregulation of angiogenic factors leading to abnormalities of the uterine vasculature and impaired endometrial hemostasis.17
Robotic Myomectomy
Published in Rooma Sinha, Arnold P. Advincula, Kurian Joseph, FIBROID UTERUS Surgical Challenges in Minimal Access Surgery, 2020
Cela Vito, Braganti Francesca, Malacarne Elisa
Uterine myomas are the most common type of pelvic tumor in women; the lifetime risk is about 70–80% [1–3]. They arise in reproductive-age women and are asymptomatic in about 25% of cases [4]. Symptoms are related to their size and location and are represented by abnormal uterine bleeding or compression symptoms (abdominal pressure or pain and urinary or bowel symptoms) [5]. Uterine leiomyomas can also have a negative impact on fertility and be associated with obstetric adverse outcomes [6].
Types of Fibroids
Published in John C. Petrozza, Uterine Fibroids, 2020
Fibroids are the most common pelvic tumor found in women [1], and their existence has been recognized in some of the earliest anatomical descriptions of the uterus, from writings dating back to the first century [2]. The presence of fibroids detected in hysterectomy specimens indicate that there are many fibroids that go clinically unnoticed [3], and if ultrasound is employed for diagnosis, the cumulative incidence by age 50 can be greater than 80% [4].
Prediction of pelvic tumour coverage by magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) from referral imaging
Published in International Journal of Hyperthermia, 2020
Ngo Fung Daniel Lam, Ian Rivens, Sharon L. Giles, Emma Harris, Nandita M. deSouza, Gail ter Haar
One of the major limitations is the small volunteer and patient cohort, which restricts the statistical certainty of the results. This study is also limited to predicting pelvic tumor coverage. However, the proposed patient workflow may be adaptable for other tumor sites. Assessment of the tumor volume that can be successfully ablated will require acoustic propagation and thermal bioeffects modeling. This is the subject of extensive ongoing work. Patient deformation resulting from orientation into the treatment position was only accounted for using the simple assumption that the isocentre-to-skin point distance would remain constant. This produced acceptable results for tumor coverage. However, accurate acousto-thermal modeling requires an accurate description of the medium of propagation, which may require simulation of soft tissues deformation between the gel-pad and the target.
Segmental Ureterectomy is Acceptable for High-risk Ureteral Carcinoma Comparing to Radical Nephroureterectomy
Published in Journal of Investigative Surgery, 2019
Zixiong Huang, Xiaowei Zhang, Xiaopeng Zhang, Qing Li, Shijun Liu, Luping Yu, Tao Xu
Upper urinary tract urothelial carcinomas (UTUCs) account for 5–10% of all urothelial carcinomas.1 Patients with ureteral tumor have worse prognosis than those with renal pelvic tumor.2 Though renal parenchyma-sparing surgery has been proposed to be an alternative choice for ureteral carcinoma in the last decade3 due to its advantages in decreasing perioperative risk and preserving long-term renal function, radical nephroureterectomy (RNU) with bladder cuff excision is regarded as the standard management for patients with high-risk factors.4–6 However, the following scenarios are inevitably encountered in daily practice: (1) the patients' accurate risk stratifications are frequently hard to determine on decision-making points and (2) for some determined high-risk ureteral carcinoma patients, kidney-sparing seems to be a necessity as they often have to receive successive adjuvant therapy, especially chemotherapy.
Endometriosis resembling endometrial cancer in a postmenopausal patient
Published in Climacteric, 2018
B. Suchońska, M. Gajewska, A. Zyguła, M. Wielgoś
An 84-year-old patient presented to the Gynaecological Surgery Outpatient Clinic of the I Gynaecology and Obstetrics Clinic at Warsaw Medical University in July 2016 with a pelvic tumor detected by diagnostic imaging. One week earlier, she had been admitted to the Internal Medicine Ward due to a low-grade fever and abdominal pain accompanied by vomiting and oliguria, and followed by urinary retention. The symptoms had been getting progressively worse for the previous 4 weeks. Ultrasound examination of the abdomen demonstrated a bilaterally dilated pyelocalyceal system, to 22 mm, and a urinary bladder under external pressure from a solid lesion. Noteworthy laboratory results included creatinine 7.1 mg%, increased inflammatory parameters (C-reactive protein 261 mg/dl, white blood cell count 12 000) and pyuria. Her history showed two vaginal deliveries, and her last menstruation was at 50 years of age. The patient was chronically treated for arterial hypertension and paroxysmal atrial fibrillation. A Foley catheter was found in the bladder upon admission. Gynecological examination revealed a clear ectocervix and a small cervix. The uterine body was of normal size and poorly movable. On the right side, in tight contact with the uterus, there was an oval, cohesive structure of 10 cm in diameter. On the left side, the adnexa was not palpable. Per rectum, there was no resistance within the range of the examining finger. Vaginal ultrasound examination showed a uterine body, size 30 × 33 mm; just next to it, on the right side, was an 86 × 68 mm lesion filled with dense content. On the projection of the adnexa on the left side, there were no abnormal reflections. There was no free fluid.