MYOMECTOMY DURING CESAREAN SECTION AND ADHESION FORMATION AS A LONG-TERM POSTOPERATIVE COMPLICATION

Objectives: We aimed to evaluate the incidence and features of postoperative adhesion related complications occurring following myolysis or myomectomy performed during cesarean section (C/S). Methods: This cross-sectional study consists of four groups of patients who underwent C/S: group I; myolysis is performed by electric cauterization for small superficial fibroids less than 2 cm. (n: 21), group II; myomectomy is performed for pedunculated fibroids (n: 18), group III; myomectomy is performed for intramural/subserous fibroids less than 5 cm. (n: 23), group IV; control group (n: 19) who did not go through myomectomy. Repeat C/S is performed to study subjects within 1-5 years. All cases are evaluated in terms of mild to moderate adhesions between omentum and uterus, mild to moderate adnexial area adhesions, mild to moderate incision area adhesions and surgical difficulty due to severe adhesions. Results: The incidence of adhesions of omentum and uterus (p= 0.278), mild to moderate adnexial area adhesions (p= 0.831), mild to moderate incision area adhesions (p= 0.804) were similar between the intervention groups (group I, II, and III) and the controls (group IV). Conclusion: Cesarean myomectomy is a safe procedure and can be performed without significant postoperative adhesion formation.Cel pracy: Celem naszego badania była ocena częstości występowania i charakter zrostów pooperacyjnych po zabiegu miolizy lub miomektomii w trakcie cięcia cesarskiego. Metoda: Do badania włączono cztery grupy pacjentek, które miały wykonane cięcie cesarskie (C/S) oraz miolizę powierzchniowego, mniejszego niż 2cm mięśniaka metodą elektrokauteryzacji – grupa I (n:21), usunięcie mięśniaka uszypułowanego – grupa II (n:18), miomektomię mięśniaka wewnątrzściennego/podsurowicówkowego, mniejszego niż 5 cm – grupa III (n:23), nie miały wykonanej miomektomii – grupa IV kontrolna (n:19). Ponowne cięcie cesarskie wykonano u badanych pacjentek w ciągu 1-5 lat. Wszystkie pacjentki oceniono pod kątem małych do średnich zrostów pomiędzy siecią większą i macicą, małych do średnich zrostów w okolicy przydatków, małych do średnich zrostów w okolicy nacięcia powłok i trudności operowania z powodu ciężkich zrostów. Wyniki: Częstość występowania zrostów pomiędzy otrzewną i macicą (p=0,278), małych do średnich zrostów w okolicy przydatków (p=0,831), małych do średnich zrostów w okolicy nacięcia powłok (p=0,804) była podobna pomiędzy badanymi grupami (I,II i III) a grupą kontrolną (IV). Wnioski: Miomektomia podczas cięcia cesarskiego jest bezpieczną procedurą i może być przeprowadzana bez istotnych, pooperacyjnych zrostów

Cardiovascular magnetic resonance of the charcoal heart

We report a case of malignant melanoma metastasis to the heart presenting as complete heart block. The highlight of the case is to demonstrate that silent cardiac metastasis is not uncommon and CMR has the potential to characterize these cardiac metastases and should be used routinely as a screening tool for those cancers with a high chance of cardiac involvement

Malignant Melanoma of Unknown Primary Origin Presenting as Cardiac Metastasis

Malignant melanoma has a very high propensity to metastasize to the heart. However, melanoma may sometimes present as a metastatic lesion in the absence of a primary lesion, which are called melanomas of unknown primary origin. We report a case in which a patient presented with a metastatic maligant melanoma in the right atrium with pericardial effusion and without a primary origin

Low-Dose Misoprostol For Second Trimester Pregnancy Termination In Women With A Prior Caesarean Delivery

Introduction: Termination of Pregnancy (ToP) is an obstetric procedure that can be performed by surgical or medical techniques during the first or second trimester of pregnancy. Medical ToP is recommended in the second trimester owing to its low rate of maternal morbidity. Low-dose misoprostol is an effective option in such cases. Aim: To compare the safety and efficacy of two different vaginal misoprostol regimens for ToP in the second trimester in women with previous Caesarean Deliveries (CDs), against controls. Materials and Methods: This retrospective study was conducted at a university hospital, between January 2005 to December 2014. The study cohort was divided into two groups: history of CD (Group I, n=85) and control (Group II, n=434). The method used for ToP was chosen with respect to history of CD. Four doses of 50 mu g misoprostol and 4 doses of 200 mu g misoprostol were applied vaginally each day, until regular uterine contractions were observed, to Groups I and II, respectively. Indication of ToP, gestational the ToP (weeks), duration from induction to abortion (hours), total misoprostol dose (pg), foetal weight (gram), post-abortion hospitalisation time (day), and any complications were recorded. The Chi-square or Fisher's-Exact test was used for qualitative data, and the Student's t-test or Mann-Whitney U-test was used for quantitative data. The p<0.05 was considered significant. Tests were performed using the SPSS statistical package for Windows, version 17 (SPSS, Chicago, Illinois, USA). Results: The success rate of termination was 91.8% (78/85) in Group I and 99.1% (430/434) in Group II (p<0.001). The median induction to abortion interval was 54.08 +/- 42.85 hours for Group I and 47.19 +/- 31.39 hours in Group II (p=0.371). One case of uterine rupture was recorded in Group I (p=0.164). The incidence of requiring transfusion for haemorrhages was higher in Group I than in Group II (5.9% vs. 1.6%, respectively, p=0.032). Conclusion: Low-dose vaginal misoprostol appears to be a safe and effective procedure for second trimester ToP in women with a history of CD.Wo

Successful Management of a Cornual Pregnancy with a Single High-Dose Laparoscopic Methotrexate Injection

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Methotrexate Therapy For Ectopic Pregnancies: A Tertiary Center Experience

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Outpatient Versus Inpatient Follow-Up For Intrahepatic Cholestasis Of Pregnancy

Aim of the study The optimum management method and the best time of delivery still remain unclear for intrahepatic cholestasis of pregnancy (ICP). We aimed to ascertain whether there is a benefit of close monitoring at hospital. Material and methods We evaluated the maternal and neonatal records of ICPs over a recent five-year period. A total of 35 women and their 38 newborns were analyzed. The impact of hospitalization was evaluated in terms of delivery type, labor induction, preterm delivery, Apgar scores, and neonatal intensive care unit admission. Results The median maternal age was 30.7 years, and median gestation at diagnosis was 34 weeks. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were normal in three patients; 32 (91.4%) women had at least one increased hepatic enzyme level. The median AST level was elevated to 66 U/l (almost two-fold), and the median ALT level was 91 U/l (about three-fold). The median gestation time at delivery was 37 weeks. The preterm delivery rate was 45.7%. The median birth weight was 3020 g, and median Apgar scores were 9 and 10 at the 1st and 5th minutes, respectively. Neonatal intensive care unit admission occurred in 21 neonates (55.3%). During pregnancy follow-up, 22 women (62.8%) were hospitalized during their pregnancies. There was no statistically significant difference between groups in terms of obstetric and perinatal outcomes (p > 0.05). However, the hospitalized pregnant women were found to have higher levels of serum transaminases (p = 0.15 and p = 0.01 for ALT and AST, respectively). Conclusions Hospitalization may be helpful in some ICP cases, especially when enzyme levels are elevated.PubMedWoSScopu