1/4. Cyclical haematuria sequel to uterine myomectomy: a case report.A thirty-year old married nulliparous lady had a difficult myomectomy done by a general practitioner one year prior to presentation. Two months after the operation, she had her menstruation, but with a concurrent total, painless haematuria. This combination continued for nine months before her family physician referred her to the urological clinic. Full urological work-up revealed an iatrogenic vesico-uterine fistula, but the features were not consistent with those of the classical vesico-uterine fistula syndrome. Transabdominal fistulectomy not only controlled the haematuria but also helped the patient to achieve a viable pregnancy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/4. A uterine cavity-myoma communication after uterine artery embolization: two case reports.OBJECTIVE: To report two cases of uterine cavity-myoma fistula as a medical complication after uterine artery embolization. DESIGN: Case report. SETTING: women's Medical Center/Viscomi Institute, Sao Paulo, brazil. PATIENT(S): Two patients presenting with symptomatic myomatous uterus: a 40-year-old woman with increased abdominal volume and hypermenorrhea, and a 42-year-old woman with pelvic pain and infertility. INTERVENTION(S): uterine artery embolization, hysteroscopic follow-up, and laparoscopic myomectomy. MAIN OUTCOME MEASURE(S): Hysteroscopic follow-up after uterine artery embolization. RESULT(S): The patients underwent uterine artery embolization. In the months that followed, a subsequent surgical hysteroscopic follow-up was performed to eliminate the necrotic material of the degenerated myomas. The two patients presented the same outcome 1 year after the uterine artery embolization had been performed: a communication between the uterine cavity and a degenerated myoma. Laparoscopic correction of the uterine wall defect was performed afterward. CONCLUSION(S): Because embolization is a growing option for the treatment of leiomyoma, it is important that potential complications be reported, especially if the patients want to become pregnant. The natural history of the fistula and its consequences are unknown, and physicians should be aware of these complications. Hysteroscopic follow-up was important in the diagnosis of the two cases.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/4. Cystic degeneration of a leiomyoma masquerading as a postoperative abscess.Leiomyomas are common tumors that usually have a typical sonographic appearance. With degeneration, however, the sonographic findings may be completely uncharacteristic. We report a case of a multicystic anterior uterine wall mass detected at antenatal sonography in an asymptomatic patient. Differential diagnosis included myoma, varicosity, hematoma, abscess, uterine anomaly, and pelvic neoplasm. At cesarean section, the mass was confirmed to be a myoma. Postoperatively, an ultrasound was performed by the radiology service during evaluation of suspected endometritis and the mass was interpreted as an endometrial abscess. This case illustrates that myomas can present with sonographic features consistent with a number of pathologic disorders. This variable pattern of echogenicity may sometimes create difficulty in establishing a correct diagnosis. The case also demonstrates the importance of communication between services and the need for not only antenatal but also postpartum and gynecologic ultrasound studies to be performed by physicians trained in sonographic findings of the abnormal uterus.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/4. Denial of illness: a reappraisal.The authors attempt to understand the nature of denial of illness by an examination of two patients with serious and disfiguring physical disorders who postponed medical treatment for over a decade. Both patients subsequently had dramatic negative reactions to the therapeutic efforts of physicians caring for them. Various social, experiential, and characterologic determinants are discussed. In addition, the authors argue that the illness served important organizing functions: it sheltered these patients from the exigencies of everyday life; it allowed them to defeat the physician's efforts to effect a cure; and, finally, the disfigured physical state appeared to correspond to their internalized defective self-image and self-esteem.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |