Laparoscopic myomectomy of a large pedunculated fibroid: case report

A 37 year old para 0 + 0 presented with abdominal pain and progressive abdominal swelling. She had no menstrual complains. Abdominal examination revealed a large 30 week non-tender, firm and mobile mass. A pelvic / abdominal ultrasound confirmed a 15.7 x 9.9 cm pedunculated fibroid arising from the uterine fundus. A laparoscopic myomectomy was successfully undertaken, and the morcellated fragments weighed 1490 grams. East African Medical Journal Vol. 85 (7) 2008: pp. 362-36

Ureteric injuries following laparoscopic hysterectomy: A report of three cases

The laparoscopic approach to uterine disorders requires greater skills and expertise but may be associated with longer operating times, and complications when compared to the abdominal approaches. Of the potential complications during laparoscopic hysterectomies, ureteric injures are of a major concern. We report on three ureteric injuries encountered during total laparoscopic hysterectomy and review the relevant literature

Laparoscopic myomectomy in Kenya : A 15 year retrospective review

Objectives: To evaluate the indications,operative techniques, outcomes, limitations and fertility outcomes following laparoscopic myomectomy.Design: Retrospective case analysisSetting: Various Private Hospitals in KenyaSubjects: One thousand and forty three patients who underwent laparoscopic myomectomyResults: The main indications for laparoscopic myomectomy in our review were Menorrhagia (52.1%), Primary Infertility (22.6 %), Secondary Infertility (14.3 %), Abdominal pain ( 8.2 % ) and pressure symptoms (2.8 %). The dominant myomas that were removed were intramural ( 45.4 %), subserous (34.6 %) and sub-mucous (19.9 %) of the cases respectively.Conclusions: Laparoscopic Myomectomy can be performed safely and effectively by adequately trained and skilled Surgeons and offers all the advantages of laparoscopic surgery including less haemorrhage, quicker recovery and return to work. The clinical outcomes are good and there were no major complications. The fertility outcomes are comparable to open myomectomy with better outcomes for sub mucous fibroids and deep intra-mural fibroids indenting the uterine cavity

EMD in periodontal regenerative surgery modulates cytokine profiles: A randomised controlled clinical trial

The enamel matrix derivative (EMD) contains hundreds of peptides in different levels of proteolytic processing that may provide a range of biological effects of importance in wound healing. The aim of the present study was to compare the effect of EMD and its fractions on the cytokine profiles from human gingival fibroblasts in vitro and in gingival crevicular fluid (GCF) in a randomized controlled split-mouth clinical study (n = 12). Levels of cytokines in cell culture medium and in GCF were measured by Luminex over a 2-week period. In the clinical study, levels of pro-inflammatory cytokines and chemokines were increased, whereas the levels of transforming growth factor-α (TGF-α) and platelet-derived growth factor-BB (PDGF-BB) were reduced. The in vitro study showed that EMD and its high and low molecular weight fractions reduced the secretion of pro-inflammatory cytokines and chemokines compared to untreated cells. EMD had an effect on levels of cytokines related to fibroplasia, angiogenesis, inflammation and chemotaxis both in vitro and in vivo, however, the anti-inflammatory effect induced by EMD observed in the in vitro study could not be confirmed clinically

Hysteroscopic surgery at the Aga Khan Hospital, Nairobi

Objectives: To determine the experience, acceptability and outcome of hysteroscopic surgery at the Aga Khan Hospital, Nairobi. Design: A retrospective study. Setting: Aga Khan Hospital, Nairobi. Patients: Between May 2000 and April, 2003, 463 cases of hysteroscopy were undertaken at the Aga Khan Hospital, Nairobi, of these 54 patients (11.7%) underwent various hysteroscopic surgical procedures. A review of these cases and their outcomes are analysed and presented. Results: In a thirty six month period 463 cases of Hysteroscopy were done at the Aga Khan Hospital, Nairobi. Of these 54 cases had operative intervention (11.7%). The case load of diagnostic hysteroscopy increased from 50 in the year 2000, to 206 and 159 respectively in the years 2001 and 2002. By this time, some consultants were performing diagnostic hysteroscopies on their own. The surgical procedures performed included hysterscopic retrieval of " lost "IUCD's, and intrauterine bone spicules and hysteroscopic resection of submucous fibroids (25.9% of the cases), resection of endometrial polyps (25.9%) hysteroscopic synechiolysis, (16.6%) and endometrial resection or ablation (cauterisation) (7.4%). All the patients were reviewed by the consultant pool after one week. Three cases of complications were encountered, two cases of uterine perforation and one case of fluid overload (TURP syndrome) following a resection of a submucous fibroid. Conclusion: Hysteroscopy and hysteroscopic surgery are the established gold standards for the management of intrauterine pathology. The procedures were well accepted amongst patients who had undergone these procedures. Recommendations: In Kenya, gynaecologists still have to embrace change and undergo adequate and sustained training in the various aspects of hysteroscopy, so as to make the proecdures acceptable and accessable to more patients. East African Medical Journal Vol.81(7) 2004: 336-34

Bladder perforation and development of a vesico - vaginal fistula following laparoscopic assisted vaginal hysterectomy: case report

Bladder injury with subsequent development of a Vesico-Vaginal Fistula following a Laparoscopic Assisted Vaginal Hysterectomy is reported. The injury was not recognised intra - operatively or in the immediate post-operative period. On the third post-operative day, the patient complained of abdominal distention, and a reduced urine output was noted. There was no haematuria. Conservative management by continuous bladder drainage was not successful. A low-pressure cystogram done on day eight revealed a bladder leakage. On day 21, a repeat low-pressure cystogram showed a vesico-vaginal fistula. A successful transvesical repair by laparotomy was undertaken on day 23. The possible mechanisms of injury, prevention and the principles of management are discussed. East African Medical Journal Vol. 82(9) 2005: 482-48

Laparoscopic assisted vaginal hysterectomy for benign uterine pathology: is it time to change?

Objective: To determine the acceptability and outcome of laparoscopic assisted vaginal hysterectomy at the Aga Khan Hospital, Nairobi. Design: A retrospective case analysis. Subjects: Two hundrend and twenty nine cases of laparoscopic assisted hysterectomy were undertaken at various hospitals in the presence of the principal author from May 2000 to December 2003. Of these 149 (65.06%) were performed at the Aga Khan Hospital, Nairobi. These cases have been reviewed, analysed and presented. Exclusions: All cases performed at the various other hospitals were excluded, along with those cases of laparoscopic assisted vaginal hysterectomy which are now being performed by other consultants obstetricians and gynaecologists, on their own and who have now learnt the technique Results: Over the last three years, 149 cases of laparoscopic assisted vaginal hysterectomy were undertaken at the Aga Khan Hospital, Nairobi. Annual case load increased from three cases in 2000, to 71 cases by December, 2003. Fifty one percent of the patients were between 46 to 50 years of age, while 93.9% were para 2 + 0 and above. Menorrhagia was the presenting complaint in 55.7%. The operative procedure was performed in 91 to 120 minutes in 58.3% of the cases. Hospital stays were two nights in 95.3%. The complications encountered were bladder injury (3.4%), bowel injury (1.3%), port site herniation (0.67%) and a delayed recognition of bladder injury (0.67%). Conclusion: In Kenya, laparoscopic surgery is gradually being accepted by gynaecologists and general surgeons. The conversion from total abdominal hysterectomy to laparoscopic assisted vaginal hysterectomy for benign uterine pathology is now becoming more popular amongst gynaecologists and patients. With time laparoscopic assistance during hysterectomy will become the norm. East African Medical Journal Vol. 81 No. 5 May 2004: 261-26