A RETROSPECTIVE ANALYSIS OF UNEXPECTED UTERUS MALIGNOMAS’ APPEARANCE BY USING POWER MORCELLATION AND ELABORATION OF FOLLOW-UP DATA BETWEEN 2008 AND 2016 LEVERKUSEN MUNICIPAL HOSPITAL

I. Abstract Introduction: Due to the development of minimal invasive surgery (MIC), power electromechanical morcellation (EMM) has become a routine technique. Despite important advantages of morcellation, it may lead to dissemination of uterine tissue throughout the peritoneal cavity and thus spread of occult malignant cells which would result in upstaging of the cancer. The aim of this study was to estimate the frequency and clinical impact of unexpected malignoma after morcellation in a patient cohort at our department. Materials and methods: This retrospective study included patients treated for symptomatic fibroids between 2008-2016 who underwent laparoscopic or robotic myomectomy or hysterectomy with use of EMM. Results: A total of 471 patients were analysed, 51.7% had received laparoscopic supracervical hysterectomy (LASH), 17.9% total laparoscopic hysterectomy (TLH) and 30.6% laparoscopic myomectomy. An unexpected malignancy occurred in 3 of 471 patients representing 0.63%. All three cases histological report showed a diagnosis of sarcoma [2 x leiomyosarcoma (LS), 1 x endometrial stroma sarcomas (ESS)]. All patients underwent secondary surgery for complete surgical staging and no histological dissemination of sarcoma was found. However, two of three patients experienced tumor recurrence after 36 and 63 months. One of the patients with intraabdominal recurrence underwent a third surgery achieving complete resection once more. The second patient had a distant metastasis in the sternum. The third patient had no evidence of recurrence within follow-up of 31 months after surgical staging operation. At final follow-up all patients were in good general health. Conclusion: There is an inherent risk of spreading occult malignoma in EMM. Potential risk factors indicating occult malignancies need to be considered preoperatively. In high-risk patients EMM should be avoided. The outcome of unexpected morcellated malignoma even with adequate secondary surgery and potential differences in prognosis remain unclear. The small number of cases within the cohort does not allow any definite statements.Zusammenfassung Einleitung: Durch die Entwicklung der minimal-invasiven Chirurgie wurde das elektromechanische Morcellement (EMM) als Routinetechnik etabliert. Trotz der wichtigen Vorteile des Morcellements, birgt das Verfahren jedoch prinzipiell das Risiko der Verbreitung von Uteruszellen im Bauchraum und daher bei okkultem Malignom zum Upstaging des Tumorstadiums. Das Ziel dieser Arbeit war die Erhebung der Prävalenz morcellierter maligner Befunde in unserer Abteilung und die Abschätzung der klinischen Konsequenzen für Patientinnen. Patientinnen und Methodik: In dieser retrospektiven Studie wurden alle Patientinnen, die zwischen 2008-2016 aufgrund von symptomatischen Myomen in unserer Abteilung mittels laparoskopischer Myomektomie oder Hysterektomie behandelt wurden eingeschlossen. Ergebnisse: Es wurden insgesamt 471 Patienten eingeschossen, hiervon hatten 51,7% eine LASH, 17,9 % eine TLH und 30,6% eine laparoskopische Myomektomie erhalten. Bei 3 von 471 Patientinnen wurde ein zufälliges Malignom entdeckt, dies entspricht 0,63%. In allen drei Fällen wurde histologisch ein Sarkom nachgewiesen [2 x Leiomyosarkom (LS), 1 x endometriales Stromasarkom (ESS)]. Die Patientinnen wurden mit einer Re-Operation zur Komplettierung des operativen Stagings behandelt, histologisch konnte keine Disseminierung des Sarkoms nachgewiesen werden. Jedoch kam es bei zwei von Patientinnen zu einem Rezidiv nach 36 und 63 Monaten. Eine der Patientinnen mit intrabdominalem Rezidiv konnte mit einer dritten Operation behandelt werden, wobei eine vollständige Resektion erreicht werden konnte. Bei der zweiten Patientin wurde eine Sternummetastase festgestellt. Die dritte Patientin hatte nach Follow-up von 31 Monaten nach der Operation kein Hinweis für ein intraabdominales Rezidiv. Die Patientinnen waren alle beim letzten Follow-up in einem gutem Allgemeinzustand. Schlußfolgerung: Es besteht ein inhärentes Risiko für die Disseminierung von okkulten Sarkomzellen bei Verwendung der EMM. Risikofaktoren für das Vorliegen von okkulten Uterusmalignomen sind präoperativ zu berücksichtigen. Bei Patientinnen mit hohem Risiko für okkulte Malignome sollte ein EMM vermieden werden. Die prognostischen Auswirkungen nach akzidentellem Morcellement von Uterusmalignomen auch mit adäquater sekundärer Operation sind nicht eindeutig geklärt. Aufgrund der geringen Fallzahl innerhalb des Kollektivs können keine präzisen Aussagen getroffen werden

Ectopic pregnancy in noncommunicating horn of unicornuate uterus: 3D-ultrasound and primary laparoscopic management.

Unicornuate uterus with pregnancy in the noncommunicating rudimentary horn is extremely rare. Diagnosis requires awareness, high suspicion index, 3D ultrasound, and MRI. If missed, it can be catastrophic. Treatment varies across literature. We present a case where detection was done by 3D ultrasound and primary laparoscopic surgery done for treatment

Impact of lifestyle and diet on endometriosis: a fresh look to a busy corner

Endometriosis is a chronic inflammatory disorder with a prevalence of six to ten percent in women of childbearing age. As long as the aetiology of endometriosis is not fully understood and the disease has no definitive treatment, an examination of the environmental factors or interventions that could modify or cure endometriosis would greatly benefit women suffering from this chronic condition. This literature review utilized the electronic databases PubMed, EMBASE, and MEDLINE until February 2021. Studies indicate that fish oil may have a positive effect on reducing endometriosis-related pain due to the effects of pro-inflammatory prostaglandins derived from omega-3 fatty acids. The same effect was seen with the introduction of antioxidant vitamins C, D, and E. There is clinical viability of a low fermentable oligo-, di-, and monosaccharides and polyols diet to successfully reduce the symptoms of patients who suffer from both endometriosis and irritable bowel syndrome. Despite the low level of evidence, there are frequent associations between endometriosis and gastrointestinal conditions in addition to the influence of various nutritional factors on the disease. The management of endometriosis requires a holistic approach focused on reducing overall inflammation, increasing detoxification, and attenuating troublesome symptoms. A dietician may provide great benefit in the management of these patients, especially at younger ages and in early stages. High-level evidence and welldesigned randomized studies are lacking when it comes to studying the effect of lifestyle and dietary intake on endometriosis. Inarguably, further research with a more extensive focus is needed

Midterm Fire Danger Prediction Using Satellite Imagery and Auxiliary Thematic Layers

Wildfires constitute a significant environmental pressure in Europe, particularly in the Mediterranean countries. The prediction of fire danger is essential for sustainable forest fire management since it provides critical information for designing effective prevention measures and for facilitating response planning to potential fire events. This study presents a new midterm fire danger index (MFDI) using satellite and auxiliary geographic data. The proposed methodology is based on estimations of a dry fuel connectivity measure calculated from the Moderate Imaging Spectrometer (MODIS) time-series data, which are combined with biophysical and topological variables to obtain accurate fire ignition danger predictions for the following eight days. The index’s accuracy was assessed using historical fire data from four large wildfires in Greece. The results showcase that the index predicted high fire danger (≥3 on a scale within [ 1 , 4 ] ) within the identified fire ignition areas, proving its strong potential for deriving reliable estimations of fire danger, despite the fact that no meteorological measurements or forecasts are used for its calculation

Downscaling of MODIS leaf area index using landsat vegetation index

Several organizations provide satellite Leaf Area Index (LAI) data regularly, at various scales, at high frequency, but at low spatial resolution. This study attempted to enhance the spatial resolution of the MODIS LAI product to the Landsat resolution level. Four climatically diverse sites in Europe and Africa were selected as study areas. Regression analysis was applied between MODIS Enhanced Vegetation Index (EVI) and LAI data. The regression equations were used as input in a downscaling model, along with Landsat EVI images and land-cover maps. The estimated LAI values showed high correlation with field-measured LAI during the dry period. The model validation gave statistically significant results, with correlation coefficient values ranging from relatively low (0.25–0.32), to moderate (0.48–0.64) and high (0.72–0.94). Limited samples per vegetation type, the diversity of species within the same vegetation type, land-use/land-cover changes and saturated EVI values affected the accuracy of the downscaling model

Downscaling of MODIS leaf area index using landsat vegetation index

Several organizations provide satellite Leaf Area Index (LAI) data regularly, at various scales, at high frequency, but at low spatial resolution. This study attempted to enhance the spatial resolution of the MODIS LAI product to the Landsat resolution level. Four climatically diverse sites in Europe and Africa were selected as study areas. Regression analysis was applied between MODIS Enhanced Vegetation Index (EVI) and LAI data. The regression equations were used as input in a downscaling model, along with Landsat EVI images and land-cover maps. The estimated LAI values showed high correlation with field-measured LAI during the dry period. The model validation gave statistically significant results, with correlation coefficient values ranging from relatively low (0.25–0.32), to moderate (0.48–0.64) and high (0.72–0.94). Limited samples per vegetation type, the diversity of species within the same vegetation type, land-use/land-cover changes and saturated EVI values affected the accuracy of the downscaling model

Role of laparoscopic hysterectomy in cervical and endometrial cancer: a narrative review

Endometrial cancer is the most common carcinoma of the female genital organs and cervical cancer is the leading cause of cancer death in women worldwide. The aim of this review is to evaluate the role of laparoscopic hysterectomy in patients with endometrial and cervical cancer in this period, and analyze the outcome of hysterectomy in terms of survival. Moreover, we present the historical background, new techniques, the anatomical features, and surgical steps of radical hysterectomy. According to new evidence, minimally invasive surgery in patients with cervical cancer is associated with higher rates of recurrence and mortality compared to the open approach. Despite the numerous explanations offered for this phenomenon, the reasons for these results are unclear. Additional large trials have been launched to reevaluate the above-mentioned data. On contrary, the laparoscopic approach provides surgical outcomes and similar survival rates as open surgery in patients with early endometrial carcinoma. Furthermore, the radicality of hysterectomy does not influence local recurrence rates or overall survival in cases with complete surgical removal of the tumor. A laparoscopic radical hysterectomy is no longer an option in patients with cervical cancer. When minimally invasive surgery is offered, the patients must be counseled in detail about the current debate

An unprecedented occult non-communicating rudimentary uterine horn treated with laparoscopic excision and preservation of both fallopian tubes: a case report and review of the literature

Background!#!Müllerian duct anomalies are congenital malformations of the female genital tract and may be of various types. For decades they have been classified according to the American Society of Reproductive Medicine, which mentions unicornuate uterine malformations as the second subgroup. They result from the arrested development of one of the Müllerian ducts and appear in approximately 1/1000 women. These anomalies are usually diagnosed in the second decade of life, because they tend to remain asymptomatic until adolescence and their initial symptoms may vary. Patients present with symptoms such as dysmenorrhea, infertility, and chronic or acute abdominal pain.!##!Case presentation!#!We report on a 21-year-old Caucasian German patient who suffered from dysmenorrhea for 7 years. After a transvaginal ultrasound and magnetic resonance tomography of the pelvis was performed, the patient underwent a diagnostic hysteroscopy and operative laparoscopy, and was finally diagnosed with a Müllerian duct anomaly presenting with a non-communicating rudimentary uterine horn. The left tube arose directly in orthotopic location from the cornua of uterus, with no connection to the rudimentary uterine horn or structure.!##!Conclusion!#!The anatomic features of this case have not been reported previously and were not consistent with any existing classification. More cases are needed in order to confirm our hypothesis. Gynecologists should always consider Müllerian anomalies as an important differential diagnosis in young patients with abdominal pain

Isthmocele: When Surgery Is Both the Problem and the Solution

This article refers to: Comparison of the Efficacy of Two Laparoscopic Surgical Procedures Combined with Hysteroscopic Incision in the Treatment of Cesarean Scar Diverticulu