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A Functional Approach to Gynecologic Pain
Published in Sahar Swidan, Matthew Bennett, Advanced Therapeutics in Pain Medicine, 2020
Though, as discussed, physiologic ovarian cysts are present in all women of reproductive age, uterine fibroids, or leiomyomas, are a common finding as well. They are a benign, monoclonal growth of cells from the fibroblasts and smooth muscle of the myometrium. They are classified as submucosal (within the uterine cavity), intramural (within the wall), or subserosal (arising at the serosal surface). They are most commonly asymptomatic55 and in most women should be seen as normal anatomic variants. The prevalence and likelihood of being symptomatic are highly associated with African-American race.56 When symptomatic, they are associated with abnormal uterine bleeding, and for bulk-related symptoms or discomfort. Bulk-related symptoms arise from an enlarged and irregularly shaped uterus, and may put pressure on the bladder, bowel, or vasculature. Though they may increase dysmenorrhea and dyspareunia, acute pain from fibroids is unlikely outside the scenario of torsion of a pedunculated fibroid, or degeneration of a large fibroid that has outgrown its blood supply. Myomas are frequently visualized on imaging and can be assumed to be benign; the incidence of leiomyosarcoma is fortunately low, and such malignancies are not believed to arise out of benign fibroids.57
Ultrasound
Published in John C. Petrozza, Uterine Fibroids, 2020
Caitlin R. Sacha, Bryann Bromley
Subserosal fibroids are located between the serosa and the myometrium (Figure 8.10). Some subserosal fibroids become pedunculated, and the stalk attachment typically has a feeder vessel (Figure 8.11a and b). The stalk may not be visible with ultrasound if the pedicle is thin. Broad ligament fibroids may extend from the uterus into the peritoneum and can be confused with adnexal masses. In these cases, the identification of the normal ovary separate from the mass is critical. Additionally, ultrasound can potentially delineate lesion attachment to the uterus (or ovary) using gentle prodding with the probe as an extension of a bimanual exam to evaluate whether or not the lesion moves independently from the uterus or ovary [2]. If delineation between a solid ovarian mass and a pedunculated or parasitic fibroid remains uncertain, MRI may potentially be helpful [3] (see Chapter 29).
The female reproductive system
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Tumours may arise from any of the tissue elements of the uterus, such as smooth muscle, blood vessels, and nerves. By far the most common of these lesions is the leiomyoma (fibroid), which is a benign tumour arising from smooth muscle. These lesions are usually multiple and to some extent oestrogen-dependent. They present in a variety of ways, including abnormal vaginal bleeding, a pelvic mass, or pelvic pain. The pain may occur as a result of ‘red degeneration’ which typically occurs during pregnancy but may also be seen as a consequence of progestogen therapy. Macroscopically, the tumours are well circumscribed and may be submucosal (Figure 15.10), intramural, or subserosal. Submucosal and subserosal fibroids are often polypoid: submucosal fibroids may present as a polyp within the endometrial cavity. Microscopically, leiomyomas are composed of interlacing fascicles of smooth muscle cells. There is debate about whether leiomyomas ever become malignant, forming a leiomyosarcoma, or whether leiomyosarcomas are malignant from the start. From a practical point of view, it is important to identify leiomyosarcomas because they can metastasize (often to the lungs).
Sudden rupture with internal bleeding and shock following torsion and necrosis of a large uterine leiomyoma
Published in Journal of Obstetrics and Gynaecology, 2019
Yi-Lin Chen, Li-Ru Chen, Kuo-Hu Chen
To our best knowledge, this is the only report to describe tumour rupture and subsequent internal bleeding and shock following acute torsion, ischaemia and necrosis of a subserosal leiomyoma. Although CT or MRI examinations have a better role in predicting twisted leiomyoma compared with ultrasonography (Roy et al. 2005; Marcotte-Bloch et al. 2007), this is not the case in our patient. Before the twisted leiomyoma ruptured, this retro-uterine mass was too large to ‘mask’ the adjacent adnexa or other bowels to establish a correct diagnosis. The only clue for making a correct diagnosis was the heterogeneous change on pelvic ultrasonography, implying possible internal bleeding from a twisted uterine leiomyoma (Figure 1(C)). Because an early survey and surgical exploration are crucial to avoid further life-threatening conditions such as consumptive coagulopathy or sepsis by ischaemic gangrene and peritonitis (Shrestha et al. 2011); if suspected, a gynaecologic consultation, survey and treatment should be considered without delay. Awareness of the condition and a high index of suspicion are keys to a correct diagnosis and prompt intervention, which is important to effective management of this potentially life-threatening condition (Saffar et al. 2017).
Oncologic Effectiveness and Safety of Bursectomy in Patients with Advanced Gastric Cancer: A Systematic Review and Updated Meta-Analysis
Published in Journal of Investigative Surgery, 2018
Luigi Marano, Karol Polom, Alberto Bartoli, Alessandro Spaziani, Raffaele De Luca, Laura Lorenzon, Natale Di Martino, Daniele Marrelli, Franco Roviello, Giampaolo Castagnoli
In conclusion, bursectomy represents a surgical procedure that might be able to improve overall survival in serosa positive gastric cancer patients. However, a definitive conclusion could not be made because of the studies’ methodological limitations. Our results may help in planning tailored treatment for different subgroups of patients and we suppose that especially patients with serosa positive as well as posteriorly extruded cancers has to be taken into account for future studies. This meta-analysis points to the urgent need of high quality, large-scaled, clinical trials with short- as well as long-term evaluation comparing bursectomy with non bursectomy procedures, in a controlled randomized manner, helping future researches and establishing a modern and tailored approach to gastric cancer. To this address, a large-scale multicentric Phase III trial is currently underway for macroscopically subserosa or serosa-positive gastric cancer in Japan (JCOG 1001) [48] and we are waiting for the results that will provide important information about the role of bursectomy at radical gastrectomy.
Reduction of Abdominal Adhesions with Elecrospun Fiber Membranes in Rat Models
Published in Journal of Investigative Surgery, 2018
Junsheng Li, Guanghui Ren, Weiyu Zhang
Animal experiments were approved by the Animal Ethics Committee of ZhongDa Hospital. A total of 64 rats were randomly divided into four groups. All the animals were fasted for at least 12 hr immediately before surgery. After hair removal, the abdomen was cleaned with 1% antiseptic povidone–iodine solution. The surgical procedure was conducted under general anesthesia using intra-abdominal injection of pentobarbital sodium (30 mg/kg). A 2-cm skin incision was made through the midline of abdomen. The cecum was exposed and abrased with moderate pressure using back of scalpel knife. Petechial subserosal hemorrhages developed in all cases (Figure 1). After different treatments were accorded to the four groups, the abdominal cavity was closed by a running 4-0 absorbable suture. The animals were sacrificed after two and four weeks. Samples for histological analysis were fixed in 10% phosphate-buffered formalin for 48 hr.