Introduction: Childbirth on a scarred uterus is a major issue for health centers, especially peripheral, due to the major obstetric risks it presents. The objectives were to evaluate the frequency, route of delivery a...Introduction: Childbirth on a scarred uterus is a major issue for health centers, especially peripheral, due to the major obstetric risks it presents. The objectives were to evaluate the frequency, route of delivery and maternal-fetal prognosis of this type of delivery at csref of Kolondiéba. Materials and Methods: This was a retrospective cross-sectional study for one year (1 January 2023-31 December 2023). All patients admitted to the maternity ward of the center with at least one uterine scar and treated in the center were included. We extracted data from partograms, OR records, birth records and obstetric records. Input was done on Excel 2010 and analysis on SPSS.23. Results: The frequency of scarring uterus was 16.8% (217/1285 births). The average age was 27. Pauciparous were most represented (59%). Patients were received from community health centers (44.7%). Prenatal consultation sessions (1 - 3 sessions) were performed at (64.9%). Uterine scars were obstetric in (99%). The cesarean section was performed immediately in (59.4%), it was prophylactic in 17%. The uterine test was attempted in (25.34%) with (69%) success. We recorded 3.6% uterine ruptures, 8.7% postoperative complications, 5.5% stillbirths and one maternal death (0.46%). Conclusion: Births on a scarred uterus are frequent and associated with a high rate of complications.展开更多
BACKGROUND Gynaecologists should be aware of a rare obstructive Mullerian duct abnormality like Robert’s uterus and perform further surgery when necessary.CASE SUMMARY We report a 41-year-old mother of two children w...BACKGROUND Gynaecologists should be aware of a rare obstructive Mullerian duct abnormality like Robert’s uterus and perform further surgery when necessary.CASE SUMMARY We report a 41-year-old mother of two children with Robert’s uterus who was examined and treated by laparoscopy and hysteroscopy.Unlike the existing cases reported in the literature,this patient had a late onset of Robert’s uterus symptoms.Due to right tubal ectopic pregnancy 3 years previously,the patient was treated with right salpingectomy and left tubal ligation but suffered aggravated left lower abdominal pain.She was examined and treated by laparoscopy and hysteroscopy,and is completely asymptomatic at 5-year followup.CONCLUSION The typical obstructive Mullerian abnormality requires further surgery.Combined laparoscopy and hysteroscopy is an effective,minimally invasive technique with better recovery outcomes than traditional transabdominal procedures.展开更多
Malignant non-Hodgkins lymphoma (MHNL) of the uterus is uncommon. We report a case diagnosed on the basis of histologic and immunohistochemical studies of a hysterectomy specimen induced by a very painful pelvic mass ...Malignant non-Hodgkins lymphoma (MHNL) of the uterus is uncommon. We report a case diagnosed on the basis of histologic and immunohistochemical studies of a hysterectomy specimen induced by a very painful pelvic mass in a 50-year-old patient with no previous history of the disease. It was classified as Ann Arbor IV Bb after imaging, given the medullary infiltration and signs of clinical and biological evolutivity: the patient had received two courses of chemotherapy, CHOP protocol. She died 23 days after the second treatment due to a hypertensive crisis.展开更多
The objective is to report a clinical case of vaginal cesarean section performed to expel a dead fetus in scarred uterus. For this indication, vaginal hysterectomy constitutes an alternative to vaginal expulsion with ...The objective is to report a clinical case of vaginal cesarean section performed to expel a dead fetus in scarred uterus. For this indication, vaginal hysterectomy constitutes an alternative to vaginal expulsion with a high risk of uterine rupture and to classic abdominal cesarean section with risk of significant surgical trauma, particularly adhesions. However, this surgical technique, described since the 19th century, remains unknown to many practitioners and few publications exist on the subject throughout the world. Considered obsolete by some practitioners, it retains all its advantages in the practice of modern obstetrics. We report this case of expulsion of fetal death on a tri-scarred uterus performed by vaginal cesarean section at the Health District Reference Health Center (District Hospital) of Commune I in Bamako, Mali in a 37-year-old patient with a pregnancy of 27 weeks of amenorrhea.展开更多
Zymography and in situ hybridization were used to investigate matrixmetalloproteinase -2, -9 (MMP -2, MMP-9) activities and expressions of MMP -2, -9 and TIMP1, -2, -3 (tissue inhibitors of matrix metallo-proteinases)...Zymography and in situ hybridization were used to investigate matrixmetalloproteinase -2, -9 (MMP -2, MMP-9) activities and expressions of MMP -2, -9 and TIMP1, -2, -3 (tissue inhibitors of matrix metallo-proteinases) mRNA in the rat uterus during estrouscycle. The relative activity was semiquanted by using densitometric analysis. The MMP-2(67 kDa) activity in every stage during estrpus cycle was detected by zymography. MMP-2activity was highest at proestrus; higher at estrus and metaestrus; lowest at diestrus. Throughin situ hybridization, MMP -2, -9, TIMP -1~ -3 mRNA mainly in hasal stroma cells of uterineendometrium were detected. The positive signals of MMP -2 and -9 mRNAs in hasal stromacells were shown stronger at proestrus, estrus and metaestrus while they showed the weakest atdiestrus. The expression of MMP -2 mRNA coincided with MMP -2 activity change. MMP-2and -9 mRNAs were also highly expressed in uterine circular muscle at estrus. Weak signals ofMMP -9 mRNA were detected in uterine luminal and glandular epithelial cells at estrus.TIMP -1 mRNA in hasal stroma cells was shown as the strongest expression at estrus andmetaestrus; stronger at proestrus and the weakest at diestrus. TIMP-2 mRNA in basal stromacells was stronger at estrus and diestrus; weaker at proestrus and metaestrus. TIMP -1 and -2mRNAs were also highly expressed in uterine luminal and glandular epithelial cells at estrus.TIMP -3 mRNA in hasal stroma cells revealed the strongest expression at estrus; stronger atdiestrus and metaestrus and showed the weakest at proestrus. The mRNA was also highlyexpressed in uterine circular muscle at estrus. In short, our present results provide evidencethat MMP -2, -9 and TIMP -1~ -3 were involved in rat uterine endometrium reconstructionduring estrous cycle.展开更多
Objective: Pregnancy in a scarred uterus is considered to be high-risk, especially during parturition. Nevertheless, the literature favours vaginal delivery as long as obstetric conditions are favourable. The aim of o...Objective: Pregnancy in a scarred uterus is considered to be high-risk, especially during parturition. Nevertheless, the literature favours vaginal delivery as long as obstetric conditions are favourable. The aim of our study was to contribute to the improvement of delivery management for women with scar uteri at the CHU Communautaire. Methodology: This was a cross-sectional study conducted over an 18-month period from 01 January 2020 to 30 June 2021 on women with scar uterus who came to give birth at the CHU Communautaire maternity unit. The sample was exhaustive;any parturient with a history of scarred uterus of more than one year with a clinically normal pelvis and whose fetus was in cephalic presentation. The following were excluded from the study: pregnant women with a uterine scar of less than one year, fetuses in a non-cephalic vertex presentation, pregnant women with antecedent complicated childbirth at the previous cesarean section, large fetuses informed consent had been obtained from the pregnant women. Anomynia was respected throughout the study. Results: During this period, we recorded 205 parturients with a scar uterus. The incidence of delivery with a scar uterus was 9.5%. Uterine testing was attempted in 85.9% of cases, with a success rate of 75.6%. Factors predictive of a successful uterine test was: maternal age less than 35 years (P = 0.0027), entry into labour at the reference maternity hospital (P Conclusion: Delivery with a scarred uterus is an increasingly frequent occurrence at the Maternity Unit of the CHU Communautaire in Bangui. Uterine testing is the first option if conditions allow, but careful selection of candidates during antenatal care or at the very beginning of labour is necessary for this type of delivery.展开更多
Owing to technical advances and improvement of the software, diffusion weighted imaging and diffusion tensor imaging(DWI and DTI) greatly improved the diagnostic value of magnetic resonance imaging(MRI) of the pelvic ...Owing to technical advances and improvement of the software, diffusion weighted imaging and diffusion tensor imaging(DWI and DTI) greatly improved the diagnostic value of magnetic resonance imaging(MRI) of the pelvic region. These imaging sequences can exhibit important tissue contrast on the basis of random diffusion(Brownian motion) of water molecules in tissues. Quantitative measurements can be done with DWI and DTI by apparent diffusion coefficient(ADC) and fractional anisotropy(FA) values respectively. ADC and FA values may be changed by various physiological and pathological conditions providing additional information to conventional MRI. The quantitative DWI assists significantly in the differentiation of benign and malignant lesions. It can demonstrate the microstructural architecture and celluler density of the normal and diseased uterine zones. On the other hand, DWI and DTI are useful for monitoring the treatment outcome of the uterine lesions. In this review, we discussed advantages of DWI and DTI of the normal and diseased uterus.展开更多
BACKGROUND Uterine myomas are the most common benign gynecological soft tissue tumors in women but polycythemia associated with these tumors is rare.Polycythemia is significantly associated with risk of venous thrombo...BACKGROUND Uterine myomas are the most common benign gynecological soft tissue tumors in women but polycythemia associated with these tumors is rare.Polycythemia is significantly associated with risk of venous thromboembolism(VTE),which is further increased in case of a large pelvic mass and obesity.Here we report the surgical challenges in the case of an obese patient with a giant fibromatous uterus and associated polycythemia.CASE SUMMARY A 42-year-old obese woman was referred to our department for treatment for a huge fibromatous uterus.She suffered of pelvic pressure and abdominal distension and reported severe dyspnea from several months.Laboratory analyses including hemoglobin(Hb)19.2 g/dL and hematocrit(Hct)59.7%were indicative of polycythemia.Arterial blood gas analysis showed arterial oxygen pressure(pO2)of 81.5 mmHg.Abdominal computed tomography confirmed a giant fibromatous uterus measuring 28.2 cm×17 cm×25 cm.To reduce the thromboembolic risk,the patient underwent low molecular weight heparin,phlebotomy twice before surgery,and we opted for a laparoscopic hysterectomy.The uterus weighed 5400 g and the histology confirmed a diagnosis of leiomyoma.We did not find increased erythropoietin levels in the supernatant of the myomatous uterine tissue.There were no complications.On postoperative day 1,the Hb and the Hct levels normalized to 13.3 g/dL and 41.7%,respectively.Arterial blood gas analysis after surgery showed a pO2 of 144.7 mmHg.These results suggested the diagnosis of myomatous erythrocytosis syndrome.The patient was discharged on the second postoperative day in very good condition with no symptoms.CONCLUSION We believe this is the first reported laparoscopic hysterectomy in a patient with a giant uterus,polycythemia and obesity.Multiple VTE risk factors warranted a laparoscopic approach.展开更多
The objective of the study is to investigate the effects of active immunization against gonadotropin releasing hormone agonist （GnRH-A） on secretion of luteinizing hormone （LH） and follicle-stimulating hormone （...The objective of the study is to investigate the effects of active immunization against gonadotropin releasing hormone agonist （GnRH-A） on secretion of luteinizing hormone （LH） and follicle-stimulating hormone （FSH） in the pituitary, and to observe the histological structures and development about ovaries and uteri in female rabbits. 24 female rabbits （Oryctolagus cuniculus） were divided randomly into 4 groups （n=6）, namely, experimental group I （EG-I）, experimental II （EG-II）, experimental III （EG-III）, and control group （CG）. Rabbits were subcutaneously injected with 1.0 mL GnRH-A （alarelin） antigen respectively at concentrations of 100, 100 and 50 μg mL-1 respectively, in EG-I, EG-II and EG-III. Alarelin antigen was re-injected in EG-II and EG-III with the same dosage on 20 d. CG was a blank. The ovarian and uterine samples were collected aseptically at the end of the experiment of 70 d. The tissue slices were observed under light and electron microscopes. Serum concentrations of LH and FSH were measured with ELISA. The results showed that serum LH concentrations in EG-II and EG-III reached the peak levels on 50 and 40 d respectively, and LH level in EG-II exceeded other 3 groups on 50 d （P0.05）. FSH level in EG-II was higher than those in EG-I, CG （P0.01） and EG-III （P0.05） on 40 d. GnRH-A could increase the number of primary follicles, enlarge the primary follicle vertical diameter （PFV） and primary follicle transverse diameter （PFT）, and promote growth and maturation of follicles. The endometrial epithelium thickness （EET） and uterine wall thickness （UWT） in three EGs were less than that in CG （P0.05）. GnRH-A can increase the quantities of mitochondrial cristaes, cortex granules in cytoplasm, broaden and lengthen zona pellucidas and microvilli of oocytes. It also enlarged nuclei of ooxytes and mitochondria, thereby it promoted the development of oocytes. Re-injection of 100 μg alarelin antigen enhanced the secretion of LH and FSH. GnRH-A promoted the growth and maturation of ovaries and follicles, suppressed uterine development, and also influenced histostructure of ovaries and uteri in female rabbits.展开更多
Advent in three-dimensional(3D) imaging technology has seen 3D ultrasound establish itself as a useful adjunct complementary to traditional two-dimensional imaging of the female pelvis. This advantage largely arises f...Advent in three-dimensional(3D) imaging technology has seen 3D ultrasound establish itself as a useful adjunct complementary to traditional two-dimensional imaging of the female pelvis. This advantage largely arises from its ability to reconstruct the coronal plane of the uterus, which allows further delineation of many gynecological disorders. 3D imaging of the uterus is now the preferred imaging modality for assessing congenital uterine anomalies and intrauterine device localization. Newer indications include the diagnosis of adenomyosis. It can also add invaluable information to delineate other endometrial and myometrial pathology such as fibroids and endometrial polyps.展开更多
A 27-year-old patient was diagnosed by hysteroscopy with uterine diverticulum in pregnancy and admitted to the hospital. Under the guidance of hysteroscopy combined with methotrexate, the scraping of the uterus was do...A 27-year-old patient was diagnosed by hysteroscopy with uterine diverticulum in pregnancy and admitted to the hospital. Under the guidance of hysteroscopy combined with methotrexate, the scraping of the uterus was done and operation successfully completed. The management of this case showed that hysteroscopy was a kind of valuable approach to the diagnosis and treatment of uterine diverticulum and curettage of the uterus under hysteroscope combined with drug was a safe, effective and conservative treatment.展开更多
MüLLERIAN duct anomalies （MDA） are abnor- malities occurring in the müllerian duct due to abnormal development of the uterus, cervix and vagina. Reported prevalence of this malformation in general populati...MüLLERIAN duct anomalies （MDA） are abnor- malities occurring in the müllerian duct due to abnormal development of the uterus, cervix and vagina. Reported prevalence of this malformation in general population was 4%-5%. But real figure may be greater because of unawareness of these diseases due to its asymptomatic nature.展开更多
Primitive neuroectodermal tumor (PNET) of uterus is the rare of the rarest among the tumors of female genital tract. We herein reported a 32 years old female operated for lower abdominal lump,which was diagnosed,as PN...Primitive neuroectodermal tumor (PNET) of uterus is the rare of the rarest among the tumors of female genital tract. We herein reported a 32 years old female operated for lower abdominal lump,which was diagnosed,as PNET later confirmed by immunohistochemistry (IHC). She was lost to follow-up and presented 10 months later with recurrence. She was treated with cyclical combination chemotherapy followed by definitive surgery and is in complete remission at present.展开更多
Objective. To analyze the clinical characteristics of fertility and pregnancy in women with congenital uterine malformations and explore optimal treatments to improve the prognosis.Methods. A retrospective study was c...Objective. To analyze the clinical characteristics of fertility and pregnancy in women with congenital uterine malformations and explore optimal treatments to improve the prognosis.Methods. A retrospective study was conducted on the fertility and obstetric outcome in 153 patients with uterine malformations treated in our hospital from January 1984 to December 1998. Twenty - seven cases with other kinds of genital and/or urinary anomalies but with normal uterus during the same period were enrolled as the control group.Results. The infertility rate was 26.6% (34/128), the miscarriage rate 44.3% (86/194), premature birth rate 9.3% (18/194), abnormal fetal presentation rate 28.4% (29/102), the cesarean section rate 61.8% (63/102), and the perinatal mortality rate 11.8% (12/102).Conclusion. Women with congenital uterine malformation usually have higher incidence of infertility and complications during pregnancy and delivery. Bicornuate and septate uterus can be associated with poor obstetric outcome.展开更多
Myoma of uterus has the highest incidence in gynecological tumors.The incidence rate is increasing year by year,which is the main indication for hysterectomy.Non-surgical treatment is often adopted for young patients ...Myoma of uterus has the highest incidence in gynecological tumors.The incidence rate is increasing year by year,which is the main indication for hysterectomy.Non-surgical treatment is often adopted for young patients with fertility requirements.The treatment methods for myoma of uterus are reviewed in this article.展开更多
The uterus bicorne is a uterine malformation whose pathophysiology is known but the etiology remains obscure. Few studies have been interested in this subject. This is the clinical observation of Mrs. X 26-year-old ho...The uterus bicorne is a uterine malformation whose pathophysiology is known but the etiology remains obscure. Few studies have been interested in this subject. This is the clinical observation of Mrs. X 26-year-old housewife nulliparous who consulted for repeated late spontaneous abortions. The clinical examination was normal. The ultrasound revealed a double uterine cavity in Y, in favor of a unicervical bicorne uterus. At hysterosalpingography, the tubes were permeable and the uterus doubled with a single cervix. The treatment consisted of a uterine plasty. The postoperative course was simple. The patient gave birth to a newborn male 20 months after surgery.展开更多
BACKGROUND Acute appendicitis in a solid organ transplant recipient is a rare occurrence, and experience remains limited. Appendicitis in uterine transplant recipients has never been reported. Immunocompromised patien...BACKGROUND Acute appendicitis in a solid organ transplant recipient is a rare occurrence, and experience remains limited. Appendicitis in uterine transplant recipients has never been reported. Immunocompromised patients with acute abdomen often present late and with attenuated symptoms. The differential diagnosis in a transplanted patient is broad and challenging due to possible existing complications associated with the graft, effects of immunosuppression, and altered anatomical relations.CASE SUMMARY A 26-year-old woman suffering from absolute uterine factor infertility received a uterus transplant. In the post-transplant period, she suffered from leukopenia and recurrent acute cellular rejection. Her compliance was suboptimal. She travelled to an exotic destination despite the physician's recommendation not to do so. Following her vacation, she presented with abdominal discomfort, nausea and diarrhoea. There was no sign of acute abdomen;the abdominal ultrasound was negative on day 0. Clostridium difficile colitis was verified and treated with perorally administered vancomycin. On day 4, the discomfort changed to pain;the ultrasound scan revealed a finding suggestive of appendicitis. Surgical exploration revealed perforated appendicitis, and appendectomy was performed.From a surgical point of view, the patient's follow-up was uneventful. The patient underwent a successful embryo transfer 6 months after the appendectomy. The patient gave birth to a healthy boy at the 35 th week of gestation.CONCLUSION A high index of suspicion of an atypical course and symptomatology of acute abdomen should be maintained in immunosuppressed patients.展开更多
Uterine myometrial arteriovenous malformations (AVM) are reported on color doppler ultrasonography as mosaic pattern of blood flow with different peak systolic velocities (PSV) at different places. High PSV within the...Uterine myometrial arteriovenous malformations (AVM) are reported on color doppler ultrasonography as mosaic pattern of blood flow with different peak systolic velocities (PSV) at different places. High PSV within the AVM may require arterial embolization as treatment. However, we present a case of traumatic AVM with incomplete abortion managed by hysteroscopic cold knife evacuation. This case report is of a young patient with off and on vaginal bleeding for <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">3 1/2</span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"> months following 2</span><sup><span style="font-family:Verdana;">nd</span></sup><span style="font-family:Verdana;"> trimester spontaneous abortion. She had undergone dilation and evacuation (D & E) for incomplete abortion. Now the bleeding was heavy and intermittent not responding to medications. The subsequent TVS examination show</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> incomplete abortion with myometrial AVM with high PSV. Hysteroscopic cold knife removal of products of conception resulted in immediate resolution of Uterine AVM.</span></span></span>展开更多
<strong>Background:</strong><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"> A bicornuate uterus is a relatively c...<strong>Background:</strong><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"> A bicornuate uterus is a relatively common and often asymptomatic congenital uterine malformation. </span><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> The aim of this work is to highlight the diagnostic difficulty in this case, as well as its therapeutic and prognostic aspects. We report here the case of a young girl carrying a pregnancy on an undiagnosed unicollis bicornuate uterus, which was initially diagnosed as an unruptured ectopic pregnancy. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> The bicornuate uterus still poses diagnostic difficulties, especially in disadvantaged populations due to the poor accessibility of diagnostic means.</span></span></span></span>展开更多
Uterine rupture is defined as the occurrence of communication between the abdominal and uterine cavity and may be complete or incomplete depending on the degree of involvement of the different layers of the uterus and...Uterine rupture is defined as the occurrence of communication between the abdominal and uterine cavity and may be complete or incomplete depending on the degree of involvement of the different layers of the uterus and surrounding organs. It is a rare complication whose consequences often involve the maternal and fetal prognosis. The majority of uterine rupture occurs on the scarred uterus, its incidence in France is estimated according to the series between 1/1000 and 1/2000 births, it represents 30% of causes of maternal death in the developing countries. The authors report here a case of uterine rupture outside of labor at 33 weeks of age in 32 years old woman, gravida 9 para 8, with no history of uterine surgery discovered during obstetric ultrasound for abdominal pain. During the interrogation, she was alarge multipara and had a child of 15 months. The abdominal ultrasound showed a right lateral corporeal rupture with hemoperitoneum of medium sized and a dead fetus. The emergency laparotomy revealed a right lateral uterine wound approximately 15 cm long with intra-abdominal placenta and a haemoperitoneum of medium sized of about 600 cc and a bladder lesion. After opening the amniotic sac, there was extraction of a dead fetus. The uterine and bladder lesions were repaired followed by bilateral tubal ligation. The patient received 500 cc of whole blood during and 500 cc after the procedure. The postoperative follow-up was simple. This case contributes to the knowledge of this rare and atypical event, and emphasizes the importance of maintaining a suspicion.展开更多
文摘Introduction: Childbirth on a scarred uterus is a major issue for health centers, especially peripheral, due to the major obstetric risks it presents. The objectives were to evaluate the frequency, route of delivery and maternal-fetal prognosis of this type of delivery at csref of Kolondiéba. Materials and Methods: This was a retrospective cross-sectional study for one year (1 January 2023-31 December 2023). All patients admitted to the maternity ward of the center with at least one uterine scar and treated in the center were included. We extracted data from partograms, OR records, birth records and obstetric records. Input was done on Excel 2010 and analysis on SPSS.23. Results: The frequency of scarring uterus was 16.8% (217/1285 births). The average age was 27. Pauciparous were most represented (59%). Patients were received from community health centers (44.7%). Prenatal consultation sessions (1 - 3 sessions) were performed at (64.9%). Uterine scars were obstetric in (99%). The cesarean section was performed immediately in (59.4%), it was prophylactic in 17%. The uterine test was attempted in (25.34%) with (69%) success. We recorded 3.6% uterine ruptures, 8.7% postoperative complications, 5.5% stillbirths and one maternal death (0.46%). Conclusion: Births on a scarred uterus are frequent and associated with a high rate of complications.
文摘BACKGROUND Gynaecologists should be aware of a rare obstructive Mullerian duct abnormality like Robert’s uterus and perform further surgery when necessary.CASE SUMMARY We report a 41-year-old mother of two children with Robert’s uterus who was examined and treated by laparoscopy and hysteroscopy.Unlike the existing cases reported in the literature,this patient had a late onset of Robert’s uterus symptoms.Due to right tubal ectopic pregnancy 3 years previously,the patient was treated with right salpingectomy and left tubal ligation but suffered aggravated left lower abdominal pain.She was examined and treated by laparoscopy and hysteroscopy,and is completely asymptomatic at 5-year followup.CONCLUSION The typical obstructive Mullerian abnormality requires further surgery.Combined laparoscopy and hysteroscopy is an effective,minimally invasive technique with better recovery outcomes than traditional transabdominal procedures.
文摘Malignant non-Hodgkins lymphoma (MHNL) of the uterus is uncommon. We report a case diagnosed on the basis of histologic and immunohistochemical studies of a hysterectomy specimen induced by a very painful pelvic mass in a 50-year-old patient with no previous history of the disease. It was classified as Ann Arbor IV Bb after imaging, given the medullary infiltration and signs of clinical and biological evolutivity: the patient had received two courses of chemotherapy, CHOP protocol. She died 23 days after the second treatment due to a hypertensive crisis.
文摘The objective is to report a clinical case of vaginal cesarean section performed to expel a dead fetus in scarred uterus. For this indication, vaginal hysterectomy constitutes an alternative to vaginal expulsion with a high risk of uterine rupture and to classic abdominal cesarean section with risk of significant surgical trauma, particularly adhesions. However, this surgical technique, described since the 19th century, remains unknown to many practitioners and few publications exist on the subject throughout the world. Considered obsolete by some practitioners, it retains all its advantages in the practice of modern obstetrics. We report this case of expulsion of fetal death on a tri-scarred uterus performed by vaginal cesarean section at the Health District Reference Health Center (District Hospital) of Commune I in Bamako, Mali in a 37-year-old patient with a pregnancy of 27 weeks of amenorrhea.
文摘Zymography and in situ hybridization were used to investigate matrixmetalloproteinase -2, -9 (MMP -2, MMP-9) activities and expressions of MMP -2, -9 and TIMP1, -2, -3 (tissue inhibitors of matrix metallo-proteinases) mRNA in the rat uterus during estrouscycle. The relative activity was semiquanted by using densitometric analysis. The MMP-2(67 kDa) activity in every stage during estrpus cycle was detected by zymography. MMP-2activity was highest at proestrus; higher at estrus and metaestrus; lowest at diestrus. Throughin situ hybridization, MMP -2, -9, TIMP -1~ -3 mRNA mainly in hasal stroma cells of uterineendometrium were detected. The positive signals of MMP -2 and -9 mRNAs in hasal stromacells were shown stronger at proestrus, estrus and metaestrus while they showed the weakest atdiestrus. The expression of MMP -2 mRNA coincided with MMP -2 activity change. MMP-2and -9 mRNAs were also highly expressed in uterine circular muscle at estrus. Weak signals ofMMP -9 mRNA were detected in uterine luminal and glandular epithelial cells at estrus.TIMP -1 mRNA in hasal stroma cells was shown as the strongest expression at estrus andmetaestrus; stronger at proestrus and the weakest at diestrus. TIMP-2 mRNA in basal stromacells was stronger at estrus and diestrus; weaker at proestrus and metaestrus. TIMP -1 and -2mRNAs were also highly expressed in uterine luminal and glandular epithelial cells at estrus.TIMP -3 mRNA in hasal stroma cells revealed the strongest expression at estrus; stronger atdiestrus and metaestrus and showed the weakest at proestrus. The mRNA was also highlyexpressed in uterine circular muscle at estrus. In short, our present results provide evidencethat MMP -2, -9 and TIMP -1~ -3 were involved in rat uterine endometrium reconstructionduring estrous cycle.
文摘Objective: Pregnancy in a scarred uterus is considered to be high-risk, especially during parturition. Nevertheless, the literature favours vaginal delivery as long as obstetric conditions are favourable. The aim of our study was to contribute to the improvement of delivery management for women with scar uteri at the CHU Communautaire. Methodology: This was a cross-sectional study conducted over an 18-month period from 01 January 2020 to 30 June 2021 on women with scar uterus who came to give birth at the CHU Communautaire maternity unit. The sample was exhaustive;any parturient with a history of scarred uterus of more than one year with a clinically normal pelvis and whose fetus was in cephalic presentation. The following were excluded from the study: pregnant women with a uterine scar of less than one year, fetuses in a non-cephalic vertex presentation, pregnant women with antecedent complicated childbirth at the previous cesarean section, large fetuses informed consent had been obtained from the pregnant women. Anomynia was respected throughout the study. Results: During this period, we recorded 205 parturients with a scar uterus. The incidence of delivery with a scar uterus was 9.5%. Uterine testing was attempted in 85.9% of cases, with a success rate of 75.6%. Factors predictive of a successful uterine test was: maternal age less than 35 years (P = 0.0027), entry into labour at the reference maternity hospital (P Conclusion: Delivery with a scarred uterus is an increasingly frequent occurrence at the Maternity Unit of the CHU Communautaire in Bangui. Uterine testing is the first option if conditions allow, but careful selection of candidates during antenatal care or at the very beginning of labour is necessary for this type of delivery.
文摘Owing to technical advances and improvement of the software, diffusion weighted imaging and diffusion tensor imaging(DWI and DTI) greatly improved the diagnostic value of magnetic resonance imaging(MRI) of the pelvic region. These imaging sequences can exhibit important tissue contrast on the basis of random diffusion(Brownian motion) of water molecules in tissues. Quantitative measurements can be done with DWI and DTI by apparent diffusion coefficient(ADC) and fractional anisotropy(FA) values respectively. ADC and FA values may be changed by various physiological and pathological conditions providing additional information to conventional MRI. The quantitative DWI assists significantly in the differentiation of benign and malignant lesions. It can demonstrate the microstructural architecture and celluler density of the normal and diseased uterine zones. On the other hand, DWI and DTI are useful for monitoring the treatment outcome of the uterine lesions. In this review, we discussed advantages of DWI and DTI of the normal and diseased uterus.
文摘BACKGROUND Uterine myomas are the most common benign gynecological soft tissue tumors in women but polycythemia associated with these tumors is rare.Polycythemia is significantly associated with risk of venous thromboembolism(VTE),which is further increased in case of a large pelvic mass and obesity.Here we report the surgical challenges in the case of an obese patient with a giant fibromatous uterus and associated polycythemia.CASE SUMMARY A 42-year-old obese woman was referred to our department for treatment for a huge fibromatous uterus.She suffered of pelvic pressure and abdominal distension and reported severe dyspnea from several months.Laboratory analyses including hemoglobin(Hb)19.2 g/dL and hematocrit(Hct)59.7%were indicative of polycythemia.Arterial blood gas analysis showed arterial oxygen pressure(pO2)of 81.5 mmHg.Abdominal computed tomography confirmed a giant fibromatous uterus measuring 28.2 cm×17 cm×25 cm.To reduce the thromboembolic risk,the patient underwent low molecular weight heparin,phlebotomy twice before surgery,and we opted for a laparoscopic hysterectomy.The uterus weighed 5400 g and the histology confirmed a diagnosis of leiomyoma.We did not find increased erythropoietin levels in the supernatant of the myomatous uterine tissue.There were no complications.On postoperative day 1,the Hb and the Hct levels normalized to 13.3 g/dL and 41.7%,respectively.Arterial blood gas analysis after surgery showed a pO2 of 144.7 mmHg.These results suggested the diagnosis of myomatous erythrocytosis syndrome.The patient was discharged on the second postoperative day in very good condition with no symptoms.CONCLUSION We believe this is the first reported laparoscopic hysterectomy in a patient with a giant uterus,polycythemia and obesity.Multiple VTE risk factors warranted a laparoscopic approach.
基金supported by the State Ethnic Affairs Commission of China (MW2007-ZD-8610)
文摘The objective of the study is to investigate the effects of active immunization against gonadotropin releasing hormone agonist （GnRH-A） on secretion of luteinizing hormone （LH） and follicle-stimulating hormone （FSH） in the pituitary, and to observe the histological structures and development about ovaries and uteri in female rabbits. 24 female rabbits （Oryctolagus cuniculus） were divided randomly into 4 groups （n=6）, namely, experimental group I （EG-I）, experimental II （EG-II）, experimental III （EG-III）, and control group （CG）. Rabbits were subcutaneously injected with 1.0 mL GnRH-A （alarelin） antigen respectively at concentrations of 100, 100 and 50 μg mL-1 respectively, in EG-I, EG-II and EG-III. Alarelin antigen was re-injected in EG-II and EG-III with the same dosage on 20 d. CG was a blank. The ovarian and uterine samples were collected aseptically at the end of the experiment of 70 d. The tissue slices were observed under light and electron microscopes. Serum concentrations of LH and FSH were measured with ELISA. The results showed that serum LH concentrations in EG-II and EG-III reached the peak levels on 50 and 40 d respectively, and LH level in EG-II exceeded other 3 groups on 50 d （P0.05）. FSH level in EG-II was higher than those in EG-I, CG （P0.01） and EG-III （P0.05） on 40 d. GnRH-A could increase the number of primary follicles, enlarge the primary follicle vertical diameter （PFV） and primary follicle transverse diameter （PFT）, and promote growth and maturation of follicles. The endometrial epithelium thickness （EET） and uterine wall thickness （UWT） in three EGs were less than that in CG （P0.05）. GnRH-A can increase the quantities of mitochondrial cristaes, cortex granules in cytoplasm, broaden and lengthen zona pellucidas and microvilli of oocytes. It also enlarged nuclei of ooxytes and mitochondria, thereby it promoted the development of oocytes. Re-injection of 100 μg alarelin antigen enhanced the secretion of LH and FSH. GnRH-A promoted the growth and maturation of ovaries and follicles, suppressed uterine development, and also influenced histostructure of ovaries and uteri in female rabbits.
文摘Advent in three-dimensional(3D) imaging technology has seen 3D ultrasound establish itself as a useful adjunct complementary to traditional two-dimensional imaging of the female pelvis. This advantage largely arises from its ability to reconstruct the coronal plane of the uterus, which allows further delineation of many gynecological disorders. 3D imaging of the uterus is now the preferred imaging modality for assessing congenital uterine anomalies and intrauterine device localization. Newer indications include the diagnosis of adenomyosis. It can also add invaluable information to delineate other endometrial and myometrial pathology such as fibroids and endometrial polyps.
文摘A 27-year-old patient was diagnosed by hysteroscopy with uterine diverticulum in pregnancy and admitted to the hospital. Under the guidance of hysteroscopy combined with methotrexate, the scraping of the uterus was done and operation successfully completed. The management of this case showed that hysteroscopy was a kind of valuable approach to the diagnosis and treatment of uterine diverticulum and curettage of the uterus under hysteroscope combined with drug was a safe, effective and conservative treatment.
文摘MüLLERIAN duct anomalies （MDA） are abnor- malities occurring in the müllerian duct due to abnormal development of the uterus, cervix and vagina. Reported prevalence of this malformation in general population was 4%-5%. But real figure may be greater because of unawareness of these diseases due to its asymptomatic nature.
文摘Primitive neuroectodermal tumor (PNET) of uterus is the rare of the rarest among the tumors of female genital tract. We herein reported a 32 years old female operated for lower abdominal lump,which was diagnosed,as PNET later confirmed by immunohistochemistry (IHC). She was lost to follow-up and presented 10 months later with recurrence. She was treated with cyclical combination chemotherapy followed by definitive surgery and is in complete remission at present.
基金This work was originally published in the National Medical Journal of China (2001 81(7): 415-7) in Chinese.
文摘Objective. To analyze the clinical characteristics of fertility and pregnancy in women with congenital uterine malformations and explore optimal treatments to improve the prognosis.Methods. A retrospective study was conducted on the fertility and obstetric outcome in 153 patients with uterine malformations treated in our hospital from January 1984 to December 1998. Twenty - seven cases with other kinds of genital and/or urinary anomalies but with normal uterus during the same period were enrolled as the control group.Results. The infertility rate was 26.6% (34/128), the miscarriage rate 44.3% (86/194), premature birth rate 9.3% (18/194), abnormal fetal presentation rate 28.4% (29/102), the cesarean section rate 61.8% (63/102), and the perinatal mortality rate 11.8% (12/102).Conclusion. Women with congenital uterine malformation usually have higher incidence of infertility and complications during pregnancy and delivery. Bicornuate and septate uterus can be associated with poor obstetric outcome.
基金Supported by Applied Basic Research Joint Special Fund Project of Yunnan Provincial Department of Science and Technology and Yunnan University of Traditional Chinese Medicine(2018FF001(-046))Key Laboratory of Dai and Yi Medicine in Yunnan Province(2017DG006)+1 种基金National Key Research Program of China(2017YFC1703901)Scientific Research Fund Project of Yunnan Provincial Department of Education(2017ZDX228)
文摘Myoma of uterus has the highest incidence in gynecological tumors.The incidence rate is increasing year by year,which is the main indication for hysterectomy.Non-surgical treatment is often adopted for young patients with fertility requirements.The treatment methods for myoma of uterus are reviewed in this article.
文摘The uterus bicorne is a uterine malformation whose pathophysiology is known but the etiology remains obscure. Few studies have been interested in this subject. This is the clinical observation of Mrs. X 26-year-old housewife nulliparous who consulted for repeated late spontaneous abortions. The clinical examination was normal. The ultrasound revealed a double uterine cavity in Y, in favor of a unicervical bicorne uterus. At hysterosalpingography, the tubes were permeable and the uterus doubled with a single cervix. The treatment consisted of a uterine plasty. The postoperative course was simple. The patient gave birth to a newborn male 20 months after surgery.
文摘BACKGROUND Acute appendicitis in a solid organ transplant recipient is a rare occurrence, and experience remains limited. Appendicitis in uterine transplant recipients has never been reported. Immunocompromised patients with acute abdomen often present late and with attenuated symptoms. The differential diagnosis in a transplanted patient is broad and challenging due to possible existing complications associated with the graft, effects of immunosuppression, and altered anatomical relations.CASE SUMMARY A 26-year-old woman suffering from absolute uterine factor infertility received a uterus transplant. In the post-transplant period, she suffered from leukopenia and recurrent acute cellular rejection. Her compliance was suboptimal. She travelled to an exotic destination despite the physician's recommendation not to do so. Following her vacation, she presented with abdominal discomfort, nausea and diarrhoea. There was no sign of acute abdomen;the abdominal ultrasound was negative on day 0. Clostridium difficile colitis was verified and treated with perorally administered vancomycin. On day 4, the discomfort changed to pain;the ultrasound scan revealed a finding suggestive of appendicitis. Surgical exploration revealed perforated appendicitis, and appendectomy was performed.From a surgical point of view, the patient's follow-up was uneventful. The patient underwent a successful embryo transfer 6 months after the appendectomy. The patient gave birth to a healthy boy at the 35 th week of gestation.CONCLUSION A high index of suspicion of an atypical course and symptomatology of acute abdomen should be maintained in immunosuppressed patients.
文摘Uterine myometrial arteriovenous malformations (AVM) are reported on color doppler ultrasonography as mosaic pattern of blood flow with different peak systolic velocities (PSV) at different places. High PSV within the AVM may require arterial embolization as treatment. However, we present a case of traumatic AVM with incomplete abortion managed by hysteroscopic cold knife evacuation. This case report is of a young patient with off and on vaginal bleeding for <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">3 1/2</span></span></span><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"> months following 2</span><sup><span style="font-family:Verdana;">nd</span></sup><span style="font-family:Verdana;"> trimester spontaneous abortion. She had undergone dilation and evacuation (D & E) for incomplete abortion. Now the bleeding was heavy and intermittent not responding to medications. The subsequent TVS examination show</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> incomplete abortion with myometrial AVM with high PSV. Hysteroscopic cold knife removal of products of conception resulted in immediate resolution of Uterine AVM.</span></span></span>
文摘<strong>Background:</strong><span><span><span style="font-family:;" "=""><span style="font-family:Verdana;"> A bicornuate uterus is a relatively common and often asymptomatic congenital uterine malformation. </span><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> The aim of this work is to highlight the diagnostic difficulty in this case, as well as its therapeutic and prognostic aspects. We report here the case of a young girl carrying a pregnancy on an undiagnosed unicollis bicornuate uterus, which was initially diagnosed as an unruptured ectopic pregnancy. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> The bicornuate uterus still poses diagnostic difficulties, especially in disadvantaged populations due to the poor accessibility of diagnostic means.</span></span></span></span>
文摘Uterine rupture is defined as the occurrence of communication between the abdominal and uterine cavity and may be complete or incomplete depending on the degree of involvement of the different layers of the uterus and surrounding organs. It is a rare complication whose consequences often involve the maternal and fetal prognosis. The majority of uterine rupture occurs on the scarred uterus, its incidence in France is estimated according to the series between 1/1000 and 1/2000 births, it represents 30% of causes of maternal death in the developing countries. The authors report here a case of uterine rupture outside of labor at 33 weeks of age in 32 years old woman, gravida 9 para 8, with no history of uterine surgery discovered during obstetric ultrasound for abdominal pain. During the interrogation, she was alarge multipara and had a child of 15 months. The abdominal ultrasound showed a right lateral corporeal rupture with hemoperitoneum of medium sized and a dead fetus. The emergency laparotomy revealed a right lateral uterine wound approximately 15 cm long with intra-abdominal placenta and a haemoperitoneum of medium sized of about 600 cc and a bladder lesion. After opening the amniotic sac, there was extraction of a dead fetus. The uterine and bladder lesions were repaired followed by bilateral tubal ligation. The patient received 500 cc of whole blood during and 500 cc after the procedure. The postoperative follow-up was simple. This case contributes to the knowledge of this rare and atypical event, and emphasizes the importance of maintaining a suspicion.
