1/7. Abnormal uterine bleeding as a presenting sign of metastases to the uterine corpus, cervix and vagina in a breast cancer patient on tamoxifen therapy.Metastases to the female genital tract from extragenital cancers are uncommon. The ovaries are most often affected with the breast and gastrointestinal tract being the most common sites of the primary malignancy. Metastases to the uterus from extragenital cancers are significantly rarer than metastases to the ovaries and in the majority of cases the ovaries are also involved. A case of metastases restricted to the uterine corpus, cervix and vagina from breast carcinoma, without involvement of the ovaries, is described. The patient who had been on tamoxifen therapy presented with postmenopausal bleeding. The diagnosis of uterine metastases was established during endometrial ablation and confirmed by total abdominal hysterectomy and bilateral salpingo-oophorectomy. This case illustrates that abnormal uterine bleeding in a breast cancer patient, regardless of whether she is receiving or not receiving tamoxifen, should always alert the physician to consider the possibility of uterine metastases from breast carcinoma.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. Vaginoscopy using hysteroscope for diagnosis of vaginal bleeding during childhood: case report.Vaginal bleeding is an uncommon and alarming symptom for children, and serious underlying causes should be excluded. Though vaginal bleeding during childhood was mostly associated with precocious puberty, the physician should keep in mind that local vaginal lesions such infectious vaginitis, vaginal trauma, and vaginal foreign bodies frequently present vaginal bleeding. A 10-year-old girl who denied any traumatic injuries or sexual abuse presented with profuse vaginal bleeding. She had normal development milestones and had no signs of thelarche or adrenarche. Her hymen was intact and the basal measurements of sex hormones including tyrotropic hormone and thyroxine were all within reference ranges. Finally, a laceration of the vaginal wall was found by vaginoscopy using a hysteroscope under general anesthesia and treated using gauze packing. We must emphasize the importance of vaginoscopy and examination under anesthesia in a child with vaginal bleeding to exclude local vaginal lesions. In addition, vaginoscopy using a hysteroscope makes the examination efficient and cost effective.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/7. ethics surrounding the impoverished patient.A case is presented in which an uninsured woman sought care at a medical clinic and then an emergency room, where she was ultimately diagnosed with early cervical cancer. Although cervical cancer at this stage carries an excellent prognosis, the patient was unable to pay for the diagnostic testing, surgery, and additional treatment that she needed and was therefore told that she would be treated in an emergency situation only. The ethics of providing care in a health care system that makes no provision for care of the indigent is discussed, with consideration of obligations of individual physicians as well as of institutions to care for the sick. A single-payer system is advocated as a solution to the problem of providing care to the under- and uninsured.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/7. Abnormal uterine bleeding as a presenting sign of metastasis to the endometrium in a patient with a history of cutaneous malignant melanoma.BACKGROUND: Metastatic melanomas to the uterus are very rare; to our knowledge, only 11 cases have been reported to date. CASE: A 39-year-old multigravid woman with a history of cutaneous malignant melanoma presented with abnormal uterine bleeding. Histopathologic study of the endometrial biopsy showed neoplastic cells containing brown granular pigment among the endometrial glands suggesting melanoma. Immunohistochemical studies demonstrated intense reactivity of tumor cells for S-100 protein and HMB-45 confirming the diagnosis of endometrial metastatic malignant melanoma. A complete clinical workup ruled out metastatic spread to the brain, lungs, skeleton, or abdomen. A total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node sampling were performed. Final pathology examination revealed malignant melanoma limited to the endometrium. CONCLUSIONS: Abnormal uterine bleeding in patients with a history of malignancy should always alert the physician to consider the diagnosis of metastatic spread to the genital tract.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/7. Preservation of uterine integrity via transarterial embolization under postoperative massive vaginal bleeding due to cesarean scar pregnancy.OBJECTIVE: Cesarean scar pregnancy (CSP) is an uncommon type of ectopic pregnancy. It results in uterine rupture and severe hemorrhage during the proceeding gestation. Whether diagnosed early or not, it may cause maternal mortality or morbidity during emergency management. life-saving emergency hysterectomy is usually the treatment of choice when there is profuse bleeding intraoperatively or after initial management. CASE REPORT: A 38-year-old woman with a history of two previous cesarean deliveries was referred to our clinic under the impression of CSP at 11 weeks' gestation. A viable embryo with a crown-rump length of 4.8 cm in the anterior wall of the uterus at the cervico-isthmic region was detected. Under the confirmation of CSP via ultrasonography, she was admitted for management. During hysterotomy, profuse bleeding with 1,000 mL blood loss was noted. After conservative procedure for hemostasis, however, massive vaginal bleeding persisted. As a result, we immediately transferred the patient to receive transarterial embolization (TAE) for bleeding control. The patient was discharged 4 days after the operation and TAE and her period resumed 1 month later. CONCLUSION: Management of CSP is usually accompanied by profuse blood loss. hysterectomy is inevitable if massive blood loss occurs during surgical intervention. For preservation of fertility and avoidance of mortality, our physicians offered an alternative life-saving policy even under catastrophic blood loss.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/7. Misdiagnosis of bilateral ectopic pregnancies: a caveat about operator expertise in the use of transvaginal ultrasound.Reported is the case of a 24-year-old female who presented to the Emergency Department complaining of lower abdominal pain and vaginal bleeding, whose initial transvaginal ultrasound was interpreted as showing a viable intrauterine pregnancy (IUP) of 8 weeks gestation. Repeat transvaginal ultrasound during a subsequent Emergency Department (ED) visit 3 days later revealed bilateral ectopic pregnancies of 6.5 weeks gestation. ED physicians should be familiar with the limitations of transvaginal sonography, and should be wary of early "intrauterine" pregnancies that are diagnosed ultrasonographically by inexperienced operators.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/7. Uterine packing in the combined management of obstetrical hemorrhage.Uterine packing to control obstetrical hemorrhage has been generally discouraged over the past several decades. Intractable uterine hemorrhage postpartum or following an abortion is an extremely vexing management problem for the physician and continues to be a leading cause of maternal mortality. Uterine packing should be considered as a presurgical management tool after lacerations of the lower genital tract, uterine rupture, or retained products have been ruled out and when conventional therapy fails to control uterine hemorrhage. We describe two obstetrical patients with intractable uterine hemorrhage who were managed with uterine packing in combination with other methods of therapy. Causes of obstetrical hemorrhage and techniques of packing the uterus are discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |