1/26. Multiple organ dysfunction syndrome induced by whole-body hyperthermia and polychemotherapy in a patient with disseminated leiomyosarcoma of the uterus.OBJECTIVE: Whole-body hyperthermia (WBH) in combination with chemotherapy is a relatively new promising treatment modality for patients with cancer. The objective of this report is to present the development of an acute systemic inflammatory response syndrome (SIRS) with multiple organ dysfunction syndrome (MODS) following WBH in combination with chemotherapy. Although WBH can also induce cytokine production, MODS has not been described before in association with WBH. DESIGN: Case report. The patient was treated with WBH (core temperature 41.8 degrees C using a radiant heat device (Aquatherm) ) in combination with polychemotherapy (ifosfamide, carboplatin and etoposide (ice) ) in the context of a clinical trial for metastatic sarcomas. SETTING: Department of medical oncology and intensive care unit of a university hospital. PATIENT: A 58-year-old Caucasian woman treated for disseminated leiomyosarcoma of the uterus, who developed SIRS with brain dysfunction, hypotension, respiratory failure and renal dysfunction following WBH/ice. INTERVENTIONS: She was successfully treated in the intensive care unit by mechanical ventilation, inotropics and antibiotics. MEASUREMENTS AND RESULTS: There was a remarkable recovery within 2 days: she regained full conciousness, could be extubated, inotropic support was stopped and creatinine levels returned to pre-treatment levels. All cultures remained sterile. After almost complete recovery, 5 days later a second episode of fever during neutropenia occurred and, despite antibiotic treatment, she died of bacteroides distasonis sepsis. CONCLUSION: WBH should be added as a new cause to the already known list of physical-chemical insults which can result in MODS.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/26. A huge 6.2 kilogram uterine myoma coinciding with omental leiomyosarcoma: case report.Surgery for massive abdominal tumors is both interesting and challenging. We present a case involving a multiple uterine myoma weighing 6.2 Kg which coincided with omental leiomyosarcoma. To our knowledge, this is the first report of this type of condition in the English literature. A 44-year-old nulliparous woman had suffered from abdominal pain for a long time. A huge abdominal mass was palpated on physical examination. Computed tomography scanning revealed a huge pelvic-abdominal mass with the possibility of small bowel loops invaded by the mass. A 6-cm omental mass was incidentally found during the subsequent hysterectomy procedure. Perforation of the urinary bladder occurred during the dissection of adhesion. Resection of the omental mass, wide wedge resection of the invaded small bowel, primary repair of the bladder, and hysterectomy were performed. The final pathologic diagnosis was uterine leiomyomata with omental leiomyosarcoma. The patient returned home on postoperative day 14 and was well at the 18-month follow-up examination. The challenge of these tumors lies in their proper diagnosis and surgical management. More case reports and follow-up studies are needed to confirm the efficacy of their management.- - - - - - - - - - ranking = 12.362412936527keywords = physical examination, physical (Clic here for more details about this article) |
3/26. Pregnancy after embolization of uterine myoma: report of 12 cases.OBJECTIVE: To treat uterine myomas with embolization, to look for pregnancy-induced myoma recurrences, and to assess pregnancy course and outcome after embolization. DESIGN: Observational clinical study. SETTING: University of paris VII hospital.Patient(s): Nine women had embolization for symptomatic myoma, with 12 pregnancies observed. INTERVENTION(s): Embolizations were highly selective and performed bilaterally through the uterine arteries with polyvinyl alcohol. MAIN OUTCOME MEASURE(s): pregnant women were evaluated by physical and sonographic examinations. RESULT(s): Before embolization, the mean uterine volume was 450 cm(3), and in six patients polymyomas were present. The median age at embolization was 40 years; the median delay before pregnancy was 9 months; and the median age at first pregnancy outcome was 41 years. Five early miscarriages occurred. The seven other pregnancies were uneventful, although three premature births and one case of late toxemia occurred unrelated to previous embolization. Three women delivered vaginally and four by cesarean section. Neither myoma recurrence nor abnormality in uterine function was observed. CONCLUSION(s): The results of this first series of 12 pregnancies after myoma embolization are promising. If these preliminary results are confirmed, embolization could be a major breakthrough in the management of myoma and could replace conventional medical and surgical treatments.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/26. uterine artery embolization in an undiagnosed uterine sarcoma.BACKGROUND: Uterine sarcomas are rare malignancies that resemble benign uterine leiomyomata. uterine artery embolization is offered increasingly for treatment of uterine leiomyomata, which might lead to embolization of undiagnosed uterine sarcoma. CASE: A 52-year-old woman, gravida 7, para 6, with perimenopausal menometrorrhagia was diagnosed with uterine leiomyomata after physical examination and transvaginal ultrasound. An endometrial biopsy was negative for malignancy. After medical treatment was unsuccessful, she had uterine artery embolization. She then passed a piece of tissue from her vagina, the pathology report of which was necrotic high-grade sarcoma. During surgery we confirmed that the tumor was confined to the uterus. CONCLUSION: Uterine sarcoma cannot be diagnosed except by pathologic examination of a resected specimen. Women considering uterine artery embolization for treatment of apparent leiomyomata should be counseled on the risk of decreased survival by delaying diagnosis and treatment of uterine sarcoma.- - - - - - - - - - ranking = 12.362412936527keywords = physical examination, physical (Clic here for more details about this article) |
5/26. Successful pregnancy in a woman with symptomatic fibroids who underwent laparoscopic bipolar coagulation of uterine vessels.OBJECTIVE: To report a case of successful pregnancy after laparoscopic bipolar coagulation of uterine vessels (LBCUV). DESIGN: Case report. SETTING: University-affiliated tertiary referral center. PATIENT(S): One woman, treated with LBCUV for symptomatic fibroids, who subsequently had a successful pregnancy. INTERVENTION(S): Laparoscopic bipolar coagulation of uterine arteries and anastomotic sites of uterine arteries with ovarian arteries. MAIN OUTCOME MEASURE(S): Patient evaluation by physical and ultrasound examinations. RESULT(S): Complete resolution of menorrhagia and dysmenorrhea was found after LBCUV. Reduction in fibroid size was seen by ultrasound. Two months later, the patient conceived a singleton pregnancy without the use of assisted reproductive technologies. The woman delivered by cesarean section. Neither myoma recurrence nor abnormality in uterine function was observed. CONCLUSION(S): Although fecundity- and pregnancy-related complications after LBCUV for managing uterine fibroids are still unclear, this first case report of successful pregnancy after LBCUV is promising. LBCUV might be a safe and effective alternative to myomectomy and hysterectomy.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/26. Uterine adenomyoma with uterus-like features: a report of two cases.Two uterine adenomyomas with unusual features are presented. Case 1 was a 43-year-old woman who had a 1-year history of menorrhagia and dysmenorrhea. The uterus showed a 3-cm-sized mass attached to the posterior wall of the lower uterine segment. On section, there was a well-circumscribed, submucosal cystic mass with a thick muscular wall. Histologically, the cavities were lined by well-developed secretory-phase endometrium and surrounded by smooth muscle, like a small uterus. Case 2 was a 52-year-old woman who visited the hospital because of itching sensation on the vulva. On physical examination, the mass was found on the left side of the pelvis. The enlarged uterus had an 8-cm-sized protruding mass from the left side of the lower uterine segment. On section, the mass was cystic and solid. Histologically, the cysts were lined by thin basalis-type endometrial glands and stroma, and the solid portion was composed of smooth muscle and fat cells.- - - - - - - - - - ranking = 12.362412936527keywords = physical examination, physical (Clic here for more details about this article) |
7/26. Four ovarian cancers diagnosed during laparoscopic management of 1011 women with adnexal masses.OBJECTIVES: This study was conducted to assess the value of laparoscopic management of adnexal masses. Two concerns we wish to address are the failure to diagnose early ovarian cancer at laparoscopy and worsening the prognosis of stage I cancer by spilling fluid during surgery. STUDY DESIGN: The setting is a predominantly referral-based, private subspecialty practice. All operations were preformed in the outpatient surgical suite of a large suburban hospital. After extensive patient screenings, which included history and physical examination, preoperative serum CA 125 levels (since 1988), and pelvic ultrasonography, 1209 adnexal masses were managed laparoscopically. RESULTS: Of 1011 patients with surgical management, ovarian cancer was discovered intraoperatively in four. CONCLUSIONS: Our findings indicate that with consistent use of frozen sections of all cyst walls and suspicious tissue, laparoscopic management did not alter the prognosis. Neither CA 125 level, pelvic ultrasonography, nor peritoneal cytologic testing had sufficient diagnostic specificity to predict malignancy. Experienced surgeons using intraoperative histologic sampling may safely evaluate adnexal mass laparoscopically.- - - - - - - - - - ranking = 12.362412936527keywords = physical examination, physical (Clic here for more details about this article) |
8/26. Uterine lipoma.Pure lipoma of the uterus is a rare entity and few cases have been reported. They usually develop in postmenopausal women. Clinical symptoms and physical signs are similar to those found in leiomyomas. The histogenesis of these lesions is still unclear. The diagnosis is easily made at the time of surgery or at autopsy, but before this, they may lead to many problems in the differential diagnosis with another uterine tumors. Recent papers suggest the possibility of a preoperative diagnosis made by computed tomography and magnetic resonance imaging. We report a case of a 67-year-old postmenopausal women presented with pelvic pressure and urinary symptoms. Pathological evaluation revealed pure intramural lipoma of the uterus illustrating characteristic morphological and histological findings with no evidence of sarcomata's component.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/26. Idiopathic venous thromboembolism and malignant disease: a case report.BACKGROUND: The association between cancer and venous thromboembolism (VTE) is well known. patients with idiopathic VTE have an increased risk of occult malignancy or subsequent development of cancer, compared with secondary VTE. CASE: A 43-year-old woman presented with idiopathic deep vein thrombosis (DVT) and menorrhagia. She had a history of hereditary non-polyposis colon cancer (HNPCC). One year later, investigations for persistent menorrhagia revealed uterine adenocarcinoma. CONCLUSION: Although there is no evidence that invasive screening for malignancy improves survival, recent findings have suggested that a directed search, based on family history, suspicious physical findings, or abnormal routine blood work, may be appropriate to rule out malignancy in women who present with VTE.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/26. Non-puerperal uterine inversion in association with uterine sarcoma: case report in a 26-year-old and review of the literature.INTRODUCTION: Inversion of the uterus associated with a uterine sarcoma is extremely rare with only 17 cases reported since 1887, so that its clinical presentation and appearance at laparotomy may be confusing. CASE: A 26-year-old woman presented with a vaginal mass and bleeding. At laparotomy, her uterus appeared depressed or concave. The final diagnosis of uterine sarcoma and inversion was unique in her age group. CONCLUSIONS: Uterine sarcoma with inversion can occur in the premenopausal age group. It presents as a vaginal mass with bleeding. As a clue to the diagnosis, the uterus per se may not be palpable or it may appear concave on physical exam or at laparotomy.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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