Low grade Endometrial Stromal Sarcoma of uterine corpus, a clinico-pathological and survey study in 14 cases

BACKGROUND: Endometrial stromal sarcoma (ESS) is a rare disease with probably less than 700 new cases in the USA or Europe per year. The aim of this study was to evaluate the behavior of low-grade endometrial stromal sarcoma (LGESS) in relation to their clinical and pathological features and to identify possible prognostic factors. PATIENTS AND METHODS: Fourteen patients with histologically proven ESS were included in the analysis. Endometrial stromal sarcoma is characterized by proliferations composed of cells with Endometrial stromal cell differentiation. Low-grade endometrial stromal sarcoma has an infiltrating margin and typically show extensive worm-like vessel invasion. RESULTS: The median age was 44.35 ± 6 years. The most common presenting symptom was vaginal bleeding, occurring in twelve patients (86%). Diagnosis was made through Fractional dilatation and curettage in four patients (28.5%). Eight patients had a total abdominal hysterectomy and salpingo-ophorectomy (57%). Radiotherapy as adjuvant therapy was administered to four patients (28.5%). The median follow-up time was 45.6 months (range 24–84). The median overall survival of the 14 patients was 45.35 ± 21 months (range 20–83). Three of 14 patients demonstrated a recurrence of disease at 9, 72, and 96 months respectively. The recurrent diseases were treated with surgery, chemotherapy, and radiotherapy. No patient died of the disease. Clinico-pathological parameters did not significantly differ between patients with and without recurrence, but patients with no myometrial invasion and low mitotic count <= 5/HPF showed longer disease-free survival. CONCLUSION: Five-year survival rate was 93%. Survival probabilities were calculated by the product limit method of Kaplan and Meier that showed, patients with no myometrial invasion and low mitotic count <= 5/HPF have longer disease-free survival, but P value was not significant

Prevalence of Persistent Hypertension Following Delivery Complicated by Hypertensive Disorders and Related Obstetric and Laboratory Risk Factors

This study examined prevalence of persistent hypertension following delivery complicated by hypertensive disorders and related obstetric and laboratory risk factors. This prospective cohort study was conducted in a teaching medical center on 270 women with more than 20 weeks of gestation who were admitted for examination and management of high blood pressure. The patients were followed up for blood pressure in two visits at 6 and 12 weeks postpartum. After 12 weeks, women were assigned to three groups of healthy, prehypertension and persistent hypertension. Background information was reviewed to find independent factors associated with persistency of blood pressure using statistical t-test and logistic regression. In bivariate analysis, relative risk of persistent hypertension was estimated at 95% confidence interval. Of 270 patients (46.2%), 110 patients developed persistent hypertension. Among risk factors, high BMI, delivery in less than 34 weeks of pregnancy, history of preeclampsia, history of diabetes, severe preeclampsia and drug control for PIH were independently associated with persistent hypertension. Abnormal laboratory findings included thrombocytopenia, increased serum uric acid and serum creatinine and severe proteinuria associated with this disorder (P <0.05). Almost one in every two pregnant women with hypertensive disorders was prone to postpartum persistent hypertension. This risk particularly increased in maternal obesity, preterm birth due to preeclampsia and abnormal laboratory findings indicating severe preeclampsia. Therefore, more detailed follow-up of high-risk patients is recommended in puerperal visits for diagnosis and timely treatment

Complications, Bleeding and Satisfaction of Patients with Abnormal Uterine Bleeding through the Integration of Endometrial Degradation and Thermal Balloon Therapy

BACKGROUND AND OBJECTIVE: In the patients diagnosed with abnormal uterine bleeding, if the patient does not respond to drug treatment or is not a good candidate for hysterectomy, endometrial destruction is recommended. The aim of this study was to evaluate complications, blood loss and patient satisfaction regarding this method of treatment. METHODS: This retrospective study was performed on 56 women who admitted to Ayatollah Roohani Hospital of Babol and Imam Hossein Hospital in Tehran, Iran. Upon the diagnosis of abnormal uterine bleeding, they underwent a treatment called "endometrial destruction by thermal balloon". A questionnaire including the following items was completed after the sugery: demographic characteristics, menstrual status, postoperative complications, treatment success and a 12-month post-surgery patient satisfaction. In order to assess the patients’ satisfaction, 4 questions were asked (excellent, good, fair, poor). Successful treatment was defined as 6 months of amenorrhea  after treatment with cavaterm and a reduction in the menstrual blood loss in the form of spotting or volume degression. FINDINGS: Of the 56 patients who were treated with balloon thermal endometrial destruction, 4 were excluded due to the lack of follow-up. The mean age of the patients was 91/5±38/43 years. No complications occurred in any of the new patients, and the percentage of amenorrhea was 23 after the treatment. Twelve months after the surgery, the success of treatment was reported in 46 patients (5/88%) and patient satisfaction was also rated in 45 of the patients (5/86%). CONCLUSION: The results of the study showed that the thermal balloon treatment had no major side effects. Thus, it could be inferred that the study was a success in terms of the outcomes and high patient satisfaction. This method could be taken into consideration before a hysterectomy

CavatermTM plus treatment in high � risk surgical patients

Background: The purpose of the study was to evaluate the effectiveness and safety of thermal balloon ablation in women with high anesthetic and surgical risk compared to invulnerable women according to the American Society of Anesthesia (ASA) physical status stratification. Methods: This report was based on a retrospective cohort study of women with heavy menstrual bleeding (HMB) who were eligible for treatment with CavatermTM plus during 2012-2017. Women were classified as high-risk (HR) or low-risk (LR) cohorts based on ASA physical status stratification. The primary outcome includes amenorrhea in the twelfth months after the treatment. Risk adjustments were performed using regression models. Results: This research study consisted of 63 women with mean age 44.42&#177;5.48. Mean of body mass index (BMI) in the HR cohort was higher than the LR cohort (31.48&#177;6.22 vs 26.83&#177; 3.51, P=0.005) and results were also similar considering the uterine length (mm) between HR and LR women (58.27&#177;35.70 vs 30.92&#177; 35.30, P=0.01). The primary outcome of treatment after a one-year follow-up in the two groups (HR and LR) was 31 (93.9) and 15 (78.9), respectively. After adjusting for known confounders including age, uterine length, parity, dysmenorrheal, the adjusted odds ratio was 0.94 (95 CI, 0.14&#8211; 2.5; P= 0.60). Conclusion: For women with high anesthetic and surgical risks derived from serious underlying co morbidities, endometrial ablation can provide a minimally invasive, safe, and effective therapy for heavy menstrual bleeding