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Background: Hysterectomy is one of the most common major surgeries performed in gynaecology. post operative pain is an inevitable consequence of surgical incision involving full thickness of abdominal wall given in abdominal hysterectomy. Conventional method of pain management includes use of intravenous and oral NSAIDS and opioid. Use of Intrathecal opioid and epidural analgesia has been explored for post operative management. Regional anaesthesia gives a new ray of hope for post operative pain management. The aim of our study to compare the efficacy of bilateral Quadratus Lumborum block (QLB) and erector spinae plane block (ESPB) for post operative analgesia in total abdominal hysterectomy. Material and Method: This Prospective observational study was carried out among 60 patients, which scheduled for elective surgery after getting approval from ethical committee and informed written consent from all patients, the prospective observational study was conducted on adult patients of either sex satisfying inclusion criteria. In our study patients were randomized into 2 groups (30 patient in each group), group QLB (spinal anaesthesia + USG guided bilateral QL3 block) and group ESPB (spinal anaesthesia + USG guided bilateral ESPB block). Post operative pain using NRS, time for first rescue analgesia and total analgesic requirement of the patient amongst all two groups were observed and compared. Result: The mean NRS on rest and movement both were found to be significantly less in QLB group than ESPB group. Injection fentanyl was used as rescue analgesia for patients with NRS > 4. Patients belonging to group ESPB received rescue analgesia faster and significantly higher amount as compared with group QLB. Conclusion: It can be concluded that patient undergoing total abdominal hysterectomy surgery Quadratus lumborum block and erector spinae plane block, both are effective but Quadratus lumborum block is more effective in decreasing postoperative pain and post operative analgesic consumption and lead to greater patient satisfaction, without any serious side effect oral hemodynamic instability. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the intra and postoperative analgesic effects of sacrococcygeal epidural levobupivacaine with those of lumbosacral levobupivacaine in feline ovariohysterectomy. Thirty-six cats were premedicated with intramuscular acepromazine (0.05 mg/kg) and meperidine (6 mg/kg). Anesthesia was induced with intravenous propofol and maintained with isoflurane in oxygen. The cats were randomly assigned one of the three treatments receiving 0.33% levobupivacaine (0.3 mL/kg) into the sacrococcygeal (S-C group, n=12) or lumbosacral (L-S group, n=12) epidural space, or the same volume of 0.9% saline solution into one of the epidural approaches (Control group, n=12). Intraoperatively, cardiorespiratory variables, end-tidal isoflurane concentration (FE'ISO), and fentanyl requirements were recorded. Postoperative pain was assessed by the UNESP (Universidade Estadual Paulista)-Botucatu multidimensional composite pain scale and the Glasgow feline composite measure pain scale up to 8 hr post-extubation. Morphine was administered as rescue analgesia. Overall FE'ISO and fentanyl requirements were lower in the L-S and S-C compared to the Control (P=0.002-0.048, respectively). There was no significant difference in the cardiorespiratory variables during anesthesia, postoperative pain and rescue analgesia among groups. The time to standing after anesthesia was prolonged in the L-S and S-C groups than in the Control (P<0.001). Lumbosacral and sacrococcygeal epidural levobupivacaine resulted in similar decreases in isoflurane requirements and intraoperative fentanyl supplementation in the cats, with no postoperative benefits. [ABSTRACT FROM AUTHOR]

Background: This comparative study aimed to evaluate the impact of adding dexmedetomidine as an adjuvant to 0.75% isobaric ropivacaine in subarachnoid block for patients undergoing total abdominal hysterectomy. Methods: Fifty female patients within the age range of 35-65 years, classified as ASA grades I and II, were included in this study. They were divided into two groups: Group A (Dexmedetomidine) and Group B (Control). Various parameters were assessed, including the duration of sensory and motor blockade, duration of analgesia, and hemodynamic parameters. Results: The addition of dexmedetomidine significantly prolonged the duration of sensory blockade (142.20 ± 5.61 vs. 74.40 ± 3.91 minutes, p < 0.001), motor blockade (233.80 ± 4.15 vs. 140.80 ± 5.53 minutes, p < 0.001), and analgesia (358.80 ± 7.26 vs. 179.60 ± 7.76 minutes, p < 0.001) compared to the control group. Hemodynamic parameters remained stable, and the incidence of side effects was low. Conclusion: The addition of dexmedetomidine to ropivacaine in subarachnoid block provides prolonged sensory and motor blockade, leading to extended postoperative analgesia, without compromising hemodynamic stability. This approach presents a promising option for pain management in patients undergoing total abdominal hysterectomy. [ABSTRACT FROM AUTHOR]

Non-atypical endometrial hyperplasia is a benign disease without significant somatic genetic changes. Postmenopausal women with non-atypical endometrial hyperplasia have a significant risk of progression to endometrial cancer and persistent endometrial hyperplasia. Most cases of atypical endometrial hyperplasia in postmenopausal women are treated surgically, including hysterectomy. At present, the treatment of postmenopausal women with non-atypical endometrial hyperplasia is still controversial. Correct and timely diagnosis and treatment are of great significance to prevent progression of the lesion. This study mainly provides an updated synthesis of the literature that investigates the etiology, diagnosis and treatment of postmenopausal women with non-atypical endometrial hyperplasia. As of December 2022, a literature search related to postmenopausal non-atypical endometrial hyperplasia was conducted on the PubMed database. For most postmenopausal patients with non-atypical endometrial hyperplasia, regular re-examination should be performed during conservative treatment. For postmenopausal patients with endometrial cancer risk factors, persistent non-atypical endometrial hyperplasia or progesterone contraindications, hysterectomy and bilateral salpingo-oophorectomy should be the first choice. [ABSTRACT FROM AUTHOR]

Background and Objectives: This study aimed to examine the efficacy of tapentadol immediate release (IR) and morphine hydrochloride in the treatment of acute postoperative pain after total abdominal hysterectomy, as well as to examine the frequency of opioid-related side effects in observed patients. Materials and Methods: The prospective observational study was conducted over five months, and it included a total number of 100 patients. The two cohorts had different types of postoperative analgesia, and the effects were observed for 24 h postoperatively, by following the pain scores on NRS (Numerical Pain Scale), contentment with analgesia, and opioid-related side effects. Results: Statistical significance was found when assessing pain 24 h after surgery while coughing, where patients in the tapentadol IR group had significantly higher mean pain scores (p < 0.01). The subjective feeling of satisfaction with postoperative analgesia was statistically significant in the tapentadol IR group (p = 0.005). Vertigo appeared significantly more in patients from the morphine group (p = 0.03). Conclusions: Tapentadol IR (immediate release) and morphine hydrochloride are both effective analgesics used in the first 24 h after total transabdominal hysterectomy. Overall satisfaction of patients with analgesia was good. The frequency of side effects was higher in the morphine group, with statistical significance regarding the vertigo. [ABSTRACT FROM AUTHOR]

Ovariohysterectomy (OVH) is a routine surgical procedure in small animal practices for sterilization and management of several uterine diseases, namely pyometra, cystic endometrial hyperplasia, uterine tumors, rupture, and torsion. Ovariohysterectomy (OVH) offers numerous clinical advantages, but post-operative complications could pose financial challenges for veterinarians due to the inherent risk of malpractice suits and clients owing to the extended recovery period for their pets. The authors reviewed about two dozen peer-reviewed English language articles from PubMed, Scopus, Web of Science, and Google Scholar databases to identify risks and avoidance strategies following OVH. These may include the ones arising from celiotomy (infection, incisional hernias, wound dehiscence, inadvertent injury to organs and adhesions) or affections, such as intraoperative hemorrhage, stump pyometra, ovarian remnant syndrome, ureteral ligation, urinary incontinence, granulomas, fistulous tracts, post-surgery weight gain, and eunuchoid syndrome. This review emphasizes prevention and management methods for each of these complications. Effective surgical techniques play a vital role in preventing hemorrhage, while meticulous resection, ligation, and omentalization of uterine stump reduce the risk of stump pyometra. Complete removal of ovarian tissue and systematic exploration prevent ovarian remnant syndrome. The use of advanced imaging methods, such as ultrasound, fluoroscopy, or CT scans, can greatly aid in identifying and preserving ureters during surgical procedures, thus minimizing the risk of ureteral complications. Strategies to address urinary incontinence, granulomas, and postsurgery weight gain might encompass the use of hormonal therapy involving estradiol analogs or the application of precise surgical techniques involving ureteral reimplantation. Innovative strategies such as auto-transplantation of ovaries are suggested for managing eunuchoid syndrome, while inadvertent prostatectomy and bowel obstruction may simply be avoided by better tissue handling and dissection. In summary, optimizing surgical protocols, incorporating CT scans, using appropriate drug therapies, and continuous education within the veterinary community are crucial for reducing complications associated with OVH. [ABSTRACT FROM AUTHOR]

Background. The coexistence of a granulosa cell tumor with a teratoma is extremely rare and impossible to diagnose preoperatively. For most patients with advanced age and stage, the standard treatment is hysterectomy and bilateral salpingo-oophorectomy; however, fertility-preserving surgery should be considered for young nulligravid women. Case. We present a case of a 24-year-old nulligravid female with bilateral adnexal masses, imaging findings of ovarian teratomas, and normal levels of tumor markers. A laparotomy revealed bilateral dermoid cysts, and solid tissue invaded most of the remaining ovarian parenchyma with no signs of malignancy in the uterus and peritoneum space. Consequently, a bilateral oophorectomy was performed to preserve her fertility. Histopathology examination showed mature cystic teratomas coexisting with granulosa cell tumors on both ovaries. Within six months, there were no signs of recurrence on ultrasonography and tumor makers. Combined oral contraceptive pills were prescribed as hormone replacement therapy. Conclusion. Fertility-preserving surgery can be performed in young women with an ovarian granulosa cell tumor coexisting with a teratoma. Long-term examination, hormone replacement therapy, and in vitro fertilization are required. [ABSTRACT FROM AUTHOR]

Background: Tumor-associated sarcoid reactions have been observed with various tumors; however, they have not been reported with uterine cancer. We present two cases of splenic sarcoid reactions that mimicked metastases a few years after uterine cancer surgery. Case presentation: Case 1 involved a 67-year-old female patient diagnosed with endometrial cancer (pT1aN0M0, pStage Ia, grade 1). The patient underwent open total abdominal hysterectomy and bilateral salpingo-oophorectomy with pelvic lymphadenectomy. Three years after the initial surgery, computed tomography (CT) and positron emission tomography CT showed multiple splenic masses with increasing numbers and sizes. Splenic metastases were diagnosed, and laparoscopic splenectomy was performed. The histopathological analysis revealed sarcoid reactions in the spleen. Case 2 involved a 47-year-old female patient diagnosed with endometrial cancer (pT1aN0M0, pStage Ia, grade 1). The patient underwent laparoscopic total abdominal hysterectomy and bilateral salpingo-oophorectomy with pelvic lymphadenectomy. Two years after the initial surgery, multiple splenic masses were observed. We performed laparoscopic splenectomy for the splenic metastases. Granuloma formations were identified in the splenic specimen and perisplenic lymph nodes that were removed simultaneously, resulting in a final diagnosis of sarcoid reaction. A review of the lymph nodes at the time of the previous uterine surgery revealed granuloma formation. Other than the presence of splenic masses, no findings suggestive of recurrence were observed in these cases. Uterine cancer and sarcoid reactions progressed without recurrence after splenectomy. Conclusions: To the best of our knowledge, this is the first report of the late development of splenic sarcoid reactions after uterine cancer surgery. Sarcoid reactions and metastases are difficult to diagnose based on preoperative imaging results. However, reviewing the specimen at the time of the initial resection, the number of lesions, and the clinical findings (other than imaging findings) may aid in the determination of the correct diagnosis. [ABSTRACT FROM AUTHOR]

Background: This study aimed to compare the feasibility and practicality of the ovariohysterectomy (OHE) technique in cats with or without a spay hook with respect to the incision size, surgical time, surgical variables, and intra- and postoperative pain. Twenty-nine female cats underwent OHE using a spay hook (spay hook group [SHG], n = 15) or without using a spay hook (control group [CG], n = 14) to achieve the ovaries and cervix. Physiological parameters were monitored during the intraoperative period, and postoperative pain was assessed using a multidimensional composite and visual analogue pain scales. Results: The SHG had a significantly shorter operative time than the CG. The variables in the intraoperative period showed no statistically significant difference between both groups, as well as the early postoperative pain. Conclusions: Less invasive OHE using a spay hook could potentially be a viable and feasible technique when performed by an inexperienced surgeon with appropriate training, especially in sterilisation campaigns, reducing the time to perform the procedure and increasing the number of animals spayed per time. [ABSTRACT FROM AUTHOR]

Objective: We aimed to compare the inflammatory response with alterations in hemogram parameters, in patients who underwent laparoscopic hysterectomy and bilateral salpingo-oophorectomy for benign gynecologic conditions with ligasure plus monopolar cautery or harmonic plus conventional bipolar cautery. Methods: Patients who underwent Laparoscopic hysterectomy with bilateral salpingo-oophorectomy between January 2017 and January 2022 for benign gynecologic pathology were identified. Patients were divided into two group, according to instruments used during surgery. Instruments were used according to surgeons preference. Preoperative and postoperative in the first 24 hours hematocrit (HCT), WBC, trombocyt, neutrophil- lymphocyte (NLR), plateletlymphocyte (PLR) ratio, mean platelet volume- lymphocyte ratio (MPVLR) and red cell distribution width- platelet ratio (RPR) values were compared. Results: During study period, a total of 462 patients underwent hysterectomy for benign gynecologic pathology. After exclusion, 212 patients were included in the study. İn the study group, 147 patients were operated with ligasure plus monopolar electrocauter and 65 with harmonic scalpel plus bipolar electrocautery. İn the postoperative period, regardless of the procedure, WBC and RPR count increase, hematocrit and trombocyt decrease in both group but the inflammatory markers lymphocyte count, neutrophyl, NLR, PLR and MPVLR count changed less in the harmonic plus bipolar cautery group which shows less inflamatuar response in this group. Conclusions: Ligasure plus monopolar cautery group compared with harmonic plus bipolar cautery group cause more inflammatory changes in complete blood count values. However, further studies are needed to show whether these changes in laboratory findings affect clinical situations. [ABSTRACT FROM AUTHOR]

Endometrial cancer (EC) stands as the most prevalent gynecologic malignancy. In the past, it was classified based on its hormone sensitivity. However, The Cancer Genome Atlas has categorized EC into four groups, which offers a more objective and reproducible classification and has been shown to have prognostic and therapeutic implications. Hormonally driven EC arises from a precursor lesion known as endometrial hyperplasia, resulting from unopposed estrogen. EC is usually diagnosed through biopsy, followed by surgical staging unless advanced disease is expected. The typical staging consists of a hysterectomy with bilateral salpingo-oophorectomy and sentinel lymph node biopsies, with a preference placed on a minimally invasive approach. The stage of the disease is the most significant prognostic marker. However, factors such as age, histology, grade, myometrial invasion, lymphovascular space invasion, tumor size, peritoneal cytology, hormone receptor status, ploidy and markers, body mass index, and the therapy received all contribute to the prognosis. Treatment is tailored based on the stage and the risk of recurrence. Radiotherapy is primarily used in the early stages, and chemotherapy can be added if high-grade histology or advanced-stage disease is present. The risk of EC recurrence increases with advances in stage. Among the recurrences, vaginal cases exhibit the most favorable response to treatment, typically for radiotherapy. Conversely, the treatment of widespread recurrence is currently palliative and is best managed with chemotherapy or hormonal agents. Most recently, immunotherapy has emerged as a promising treatment for advanced and recurrent EC. [ABSTRACT FROM AUTHOR]

Extraintestinal gastrointestinal stromal tumors (EGISTs) are rare stromal tumors involving mesentery, omentum, and retroperitoneum. EGISTs of the pelvic cavity are extremely uncommon, and till date, no case of pure epithelioid type arising from the pelvic cavity has been reported. They pose a diagnostic pitfall as they may mimic ovarian malignancy. We present a unique case of an epithelioid extraintestinal stromal tumor arising from the pelvic cavity. A 43-43-year-old woman presented with complaints of abdominal pain and menstrual irregularities. Ultrasound examination revealed a large well-defined hypoechoic mass in the right pelvic cavity with a possible site of origin from the right ovary. A total hysterectomy with bilateral salpingo-oophorectomy was done. Histopathological examination revealed an encapsulated tumor comprising predominantly of nests and lobules of epithelioid cells with round-to-oval nuclei, vesicular chromatin, and moderate amount of eosinophilic to clear cytoplasm. Mitotic activity was brisk along with focal areas of necrosis. On immunohistochemistry, tumor cells were diffusely and strongly positive for DOG1 and CD117. They were negative for smooth muscle actin, vimentin, S-100, and HMB-45. Based on these findings, a final diagnosis of the high-grade GIST epithelioid variant was made. It is crucial to make the correct preoperative diagnosis of GIST, since these patients may benefit from neoadjuvant imatinib, especially in case of large tumor size. [ABSTRACT FROM AUTHOR]

Endometrial stromal tumours are tumours of endometrial stromal origin and are classified into Endometrial Stromal Nodule (ESN), Low-Grade Endometrial Stromal Sarcoma (LG-ESS), and High-Grade Endometrial Stromal Sarcoma (HG-ESS). LG-ESS and HGESS are rare tumours, accounting for 1% of uterine malignancies and 10% of uterine sarcomas. These tumours commonly occur in perimenopausal women between the ages of 45 and 50 years. Their incidence is rare in younger women. Endometrial stromal tumours are usually confused with leiomyoma, uterine Leiomyosarcoma (LMS), or other sarcomas. The authors here present a case report of a 28-year-old nulligravid patient who presented with a history of heavy menstrual bleeding and dysmenorrhea for a duration of six months. Ultrasonography of the abdomen and pelvis suggested fibroid with degenerative changes, and Magnetic Resonance Imaging (MRI) indicated leiomyoma variants such as: i) Stromal Tumours of Uncertain Malignant Potential (STUMP)/ atypical/cellular leiomyoma; ii) myxoid degeneration of leiomyoma. To arrive at a definitive diagnosis, myomectomy was performed considering the woman's young age and nulliparity. Histopathology allowed for a differential diagnosis of LG-ESS, LMS, and cellular leiomyoma. Consequently, the patient underwent total abdominal hysterectomy with left salphingo opherectomy, right salpingectomy, and preservation of the right ovary. The definitive diagnosis is made by histopathological examination coupled with immunohistochemistry of the hysterectomy specimen. Hysterectomy is the definitive treatment of LG-ESS considering their ability to infiltrate and become malignant. [ABSTRACT FROM AUTHOR]

OBJECTIVE To evaluate the efficacy and safety of bromelain to control pain and inflammation in cats undergoing ovariohysterectomy. ANIMALS 30 client-owned cats undergoing ovariohysterectomy. PROCEDURES In a randomized, blinded clinical study, cats were assigned to receive either oral bromelain suspension (40 mg/kg [18 mg/lb]; BG, n = 15) or placebo solution (0.1 mL/kg [0.045 mL/lb]; PG, 15), which were administered 90 minutes before and 12 hours after surgery. The anesthetic protocol included acepromazine, meperidine, propofol, and isoflurane. Pain and sedation were assessed at various time points up to 24 hours post-extubation using the UNESP-Botucatu multidimensional composite pain scale, the Glasgow feline composite measure pain scale, and a descriptive numerical scale. Surgical wound inflammation was measured at the same time points, using a numeric rating scale. Morphine was administered as rescue analgesia. Laboratory data (urea, creatinine, gamma-glutamyl transferase, alkaline phosphatase,the prothrombin time, and the fecal occult blood) were analyzed preoperatively and 24 hours after surgery. RESULTS Pain/inflammation scores, and analgesic requirements did not differ between groups. Shorter recovery time and lower sedation scores were recorded during the first hour post-extubation in the BG than the PG. Postoperatively, serum creatinine and gamma-glutamyl transferase were lower in the BG compared to PG. Compared to baseline values, all biochemistry variables decreased at 24 hours in the BG. The prothrombin time and fecal occult blood did not differ between groups or over time. CLINICAL RELEVANCE Bromelain did not provide significant analgesic and anti-inflammatory benefits over placebo in cats undergoing ovariohysterectomy. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Radical gynecology oncology surgeries are feasible in patients refusing blood transfusion, when performed with careful preoperative (with hemoglobin optimization and patients' counseling), intraoperative (with hemostasis and stepwise devascularization, hemodilution, and autologous cell salvage) and postoperative (considering iron infusion or erythropoietin) planning with a multidisciplinary team involvement. We describe the case of a female Jehovah's Witness patient in her 60s undergoing pelvic exenteration, focusing on the preoperative, intraoperative, and postoperative measures that allowed an uncomplicated surgery without blood transfusion. Blood transfusions are common in the surgical management of gynecology oncology patients, up to 93% of patients undergoing pelvic exenteration may require blood products. However, increasingly more patients are cautious in receiving blood products, either for fear of potential risks or for religious believes. It is therefore vital to optimize the management of these patients in order to avoid blood transfusions. In this case, we summarize the management of a lady in her 60s who underwent laparotomy, pelvic exenteration, Bricker colicureterostomy, and end colostomy formation for recurrent endometrial carcinoma, despite previous total abdominal hysterectomy and bilateral salpingo‐oophorectomy followed by brachytherapy, chemotherapy, and external beam radiotherapy for high‐grade serous carcinoma. Preoperatively, an advance decision to refuse blood products was discussed to ascertain all the options that were suitable. As her preoperative hemoglobin was acceptable (127 g/L), no further intervention was required. Intraoperatively, blood loss was effectively minimized with meticulous hemostasis, stepwise pelvic devascularization, intraoperative hemodilution, and cell salvage. Despite these interventions, total blood loss was 1030 mL and postoperative hemoglobin was 113 g/L. Postoperative measures therefore included intravenous iron infusion, minimization of phlebotomy, and optimization of cardiopulmonary status. Erythropoietin was also considered, but was not necessary as patient responded to the previous measures well and was successfully discharged after an uncomplicated recovery. Only few cases of total pelvic exenteration have been described in the literature for Jehovah's Witness patients. However, our case shows that laparotomy and pelvic exenteration is feasible in patients refusing blood products, if performed under a multidisciplinary team and with careful preoperative, intraoperative, and postoperative planning, also in the setting of previous radical hysterectomy and co‐adjuvant therapy. [ABSTRACT FROM AUTHOR]

Objective: Pelvic access is a challenging matter in abdominal hysterectomy especially in obese patients and presence of pelvic adhesions. Uterus manipulators (UM) have been used in a number of studies on laparoscopic approach to improve surgical performance. This study aimed to assess the impact of UM application on the operation time and blood loss in total abdominal hysterectomy (TAH) for benign diseases. Materials and methods: Forty-one patients aged 34 to 56 years were enrolled for abdominal hysterectomy - 20 as the case group (hysterectomy with UM application) and 21 as the control group (conventional hysterectomy). In the case group, UM was used after uterus artery ligation during TAH. The control group underwent traditional TAH. Results: The mean operation time was significantly less in TAH with UM compared to traditional TAH (90.23 ± 10.54 minutes vs. 140.5 ± 16.61 minutes; p-value<0.001). The mean decline between preoperative and 12-hour postoperative hemoglobin was 0.74 ± 0.23 mg/dL in the TAH with UM group and 1.65± 1.02 mg/dL in the traditional TAH group (p-value<0.001). Also, no difference was detected in intra- and post-operative complications. Conclusion: The current study showed that, using UM is beneficial in total abdominal hysterectomy by decreasing the operative time and blood loss. [ABSTRACT FROM AUTHOR]

Struma ovarii is an infrequent type of teratoma arising from the ovary accounting for only 2% of all ovarian teratomas. These tumors have a benign biology with rare malignant transformation in about 3% of cases. The most common malignant transformation that arises from struma ovarii is papillary thyroid carcinoma. These neoplasms act in the same way as those arising from the thyroid gland, but due to the rarity of their occurrence there is still a debate over therapeutic options. We present a case of a 41-year-old Ethiopian Para IX woman presented with abdominal swelling for four years, accompanied by dull pain, satiety, and weight loss. Her vital signs were normal, and her abdominal examination revealed a large abdominopelvic mass. Her CA-125 was elevated, and her blood count, organ function tests, and serum electrolyte levels were normal. Abdominal ultrasound revealed a complex abdominopelvic mass with cystic and solid components, possibly ovarian teratoma. The patient underwent surgery, revealing a 14 by 10 cm right ovarian mass and a 3× 3 cm appendiceal mass. Subsequently, total abdominal hysterectomy, bilateral salpingo-oophorectomy, total omentectomy, and appendectomy was done. Histopathologic evaluation revealed follicular proliferation of enlarged cells, with no papillary growth pattern. The case was diagnosed as malignant struma ovarii, a follicular variant of papillary thyroid carcinoma (FVPTC) with secondary deposits on the appendix. A complete thyroidectomy was done after the histopathology diagnosis. Malignant struma ovarii is rare making it challenging to treat since there are no established prognosticating histopathologic or clinical characteristics. The tumor size and metastasis determine the surgical treatment scope. Large-scale investigations are essential for prognostication and treatment options considering pathologic traits. [ABSTRACT FROM AUTHOR]

Ovariohysterectomy (OHE) is one of the most common surgeries in veterinary medicine. Although this surgical method has several advantages, it can alter the function of various organs such as heart. The present study investigated the effect of OHE on cardiac functions using Mmode echocardiography. A total of 10 healthy adult domestic short-haired cats were enrolled in the current study. Fractional shortening (FS) and ejection fraction (EF) percentages along with cardiac output (CO) were measured through the right parasternal approach in papillary muscle level view. Moreover, the levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) were measured by enzyme-linked immunosorbent assay before OHE (D0) as well as 10 (D10), 20 (D20) and 30 (D30) days after OHE. The results of this study showed that the mean FS and EF decreased on all days of the study. The FS reduction was significant between D10 and D30 and EF changes were significant between D10 and D20. The means of CO increased significantly on D0 compared to the D10. After D20, CO reduced until the end of the study. Mean concentrations of LH and FSH increased on all research days; but, the changes were significant until D20. Despite the negative effects of OHE on myocardial function, there was no significant correlation between hormonal levels and echocardiographic findings after OHE in this study. [ABSTRACT FROM AUTHOR]

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The aim of this study is to compare vaginal cuff brachytherapy (VBT) and external pelvic radiotherapy (EPRT) in terms of oncological outcomes and toxicity in patients with stage IB (FIGO 2018) grade 3 endometroid type endometrial cancer. The records of 85 patients from two cancer centers, who received VBT or EPRT between 1994-2021, were evaluated retrospectively. The patients who received only EPRT and VBT after EPRT were examined in the same category due to small number of patients receiving only EPRT. The patient and tumor characteristics were analyzed with chi-square and Fisher's exact test. Survival estimates were calculated with Kaplan Meier and Log-rank tests. The median age was 62 years (range = 37-81 years). Total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed in 99% of the patients. Pelvic or pelvic + paraaortic lymph node dissection (LND) was performed in all cases except 1 patient (14% and 85%, respectively). The median number of dissected LNs was 37 (range = 12-110). Lymphovascular invasion (LVI) was observed in 41 (59%) patients. Only VBT, only EPRT, and EPRT+VBT was performed in 55 (65%), 6 (7%), and 24 (28%) patients, respectively. Tumor and treatment characteristics were similar between groups, but frequency of chemotherapy administration and only pelvic LND was higher in EPRT ± VBT group compared to VBT group (40% vs. 9%, p = 0.001 and 30% vs. 7%, p = 0.01, respectively). With a median follow-up of 92 months (range = 15-336 months), 5-y overall survival (OS), disease-free survival (DFS), locoregional recurrence-free survival (LRRFS), and distant metastasis-free survival (DMFS) rates were 84%, 70%, 73% and 82%, respectively. Five-y survival rates were similar between treatment groups (Tablo 1). LRR and DM was also similar (6% vs. 0%, p = 0.170 and 13% vs. 3%, p = 0.181, respectively). EPRT had no survival benefit in patients with LVI. In patients with LVI, LRR rates were 13% and 0% in VBT and EPRT groups, respectively (p = 0.283). In all cohort, there was no ³grade 3 acute or late genitourinary or gastrointestinal toxicity. Late vaginal toxicity was observed in 5 (6%) patients and higher in EPRT group than VBT group (10% vs. 4%, p = 0.340), although it did not reach statistical significance. The survival outcomes of VBT alone and EPRT ± VBT in patients with stage IB grade 3 endometroid type endometrial cancer were similar. However, in the presence of LVI, EPRT seems to be an accurate option in patients who had surgical staging due to high LRR rates of VBT alone. [ABSTRACT FROM AUTHOR]

The article discusses a case of a 46-year-old woman with iron deficiency anemia who underwent surgery for colorectal adenocarcinoma and multiple polyps. The patient received a total colectomy, hysterectomy, and double adnexectomy. The surgery involved laparoscopic techniques and a transanal transection with a single-stapled anastomosis. The patient experienced postoperative complications but is currently undergoing adjuvant chemotherapy. [Extracted from the article]

Colouterine fistula is a rare but recognizable complication of diverticulitis. This case illustrates the presence of a colouterine fistula in an elderly patient who had an atypical presentation for diverticulitis. She was initially treated with intravenous antibiotics for diverticulitis with a contained abscess. This gave her an opportunity to avoid surgery. However, her sepsis failed to respond to the initial treatment. Progress computerized tomography imaging demonstrated the presence of a colouterine fistula for which she required source control. Thus she underwent laparotomy, Hartmann's procedure, and total abdominal hysterectomy with bilateral salpingo-oophorectomy. The diagnosis of colouterine fistula was confirmed intraoperatively and on histopathology. Subsequently, the patient had an uneventful recovery following the operation. This case highlights the rarity but also the veracity of this clinical entity. [ABSTRACT FROM AUTHOR]

Foam cell vasculopathy is an obliterating type of vasculitis characterized by fibrinoid necrosis, sub‑intimal foam cell deposition, vessel wall hyalinosis, and lymphocytic infiltrate. Isolated intra‑tumoral foam cell vasculitis is rare and similar changes have been reported in a leiomyoma attributed to treatment with tranexamic acid and gonadotropin‑releasing hormone (GnRH) analogs. A 68‑year‑old hypertensive and diabetic female (P2L2) presented with vaginal spotting and vague abdominal pain. An ultrasound abdomen showed an anterior wall fibroid measuring 5 × 4 cm. She underwent a total abdominal hysterectomy with bilateral salpingo‑oophorectomy. Microscopic sections from the leiomyoma showed multiple foci of obliterating vasculitis, along with fibrinoid necrosis, sub‑intimal foam cell deposition, and hyalinosis. There was no involvement of the endometrium, cervix, or ovaries. There were no pulmonary, skin, or renal lesions, or history of systemic vasculitis, and treatment by tranexamic acid or GnRH analogs. This prompted a diagnosis of idiopathic intra‑tumoral foam cell vasculitis. This finding has been documented previously in three instances, namely, within a renal angiomyolipoma, cerebral Hodgkin’s lymphoma, and a gastrointestinal stromal tumor; the present case provides the first‑ever documentation of isolated intra‑tumoral acute atherosis‑like/foam cell vasculopathy in leiomyoma. [ABSTRACT FROM AUTHOR]

To our knowledge, this is the first reported case of synchronous ovarian and vulva (Bartholin gland) cancer. A postmenopausal woman presented with a complex multiloculated left adnexal mass and 2‐cm right Bartholin gland mass. CA 125 was 59 IU/mL. Computed tomography of chest, abdomen, and pelvis showed a very large (32 × 13.5 × 22.5 cm) complex mass arising from the pelvis and extending to the level of the T12/L1 disk space. A right Bartholin mass with suspicious right inguinal nodes was seen. Midline laparotomy, total abdominal hysterectomy, bilateral salpingo‐oophrectomy, infracolic omentectomy, pelvic peritoneal biopsies, and peritoneal washings were carried out. Wide local excision of the right Bartholin gland mass was carried out in the same setting. Histopathology came back as Stage 2B left ovarian clear‐cell carcinoma and synchronous right Bartholin gland adenoid cystic carcinoma with lymphovascular invasion, incompletely excised, staged at least FIGO Stage 1B. Following local multidisciplinary team discussion and positron emission tomography scan review, the local committee agreed to start three cycles of adjuvant chemotherapy then proceed with Bartholin gland scar re‐excision and bilateral groin lymph node dissection. After the three cycles, the groin lymph nodes came back as metastatic adenocarcinoma with overall morphologic and immunohistochemical features consistent with metastatic ovarian clear‐cell carcinoma. Postoperative adjuvant chemotherapy was given. Initial follow‐up period over 9 months was uneventful. Synopsis: A first report on the management of synchronous ovarian and Bartholin gland carcinomas. [ABSTRACT FROM AUTHOR]

Leydig cell hyperplasia (LCH) is a rare cause of hyperandrogenism that has been described only in case reports. The cases presented herein contrast the traditional presentation of LCH with an affected asymptomatic individual. The first case involves a 74-year-old woman presenting with symptomatic hyperandrogenism, whose symptoms resolved after bilateral salpingo-oophorectomy (BSO). The second patient presented with postmenopausal bleeding and an abdominal mass. Following total abdominal hysterectomy (TAH) and BSO, pathology showed ovarian LCH with concomitant endometrial cancer. The diagnosis of LCH is complex and requires careful investigation of many differential diagnoses. Incidentally discovered LCH may shed light on evolution and disease progression. Cases of LCH found in the setting of endometrial pathology may have implications on other states of testosterone excess. [ABSTRACT FROM AUTHOR]

OBJECTIVE To compare the analgesia provided by incisional (Incisional), transverse abdominis plane (TAP), and rectus sheath (RS) blocks in dogs submitted for ovariohysterectomy (OHE). ANIMALS 22 female mixed-breed dogs were allocated into 3 treatments of Incisional (n = 7), TAP (n = 7), and RS (n = 8) and underwent OHE from April 4 to December 6, 2022. PROCEDURES After premedication with acepromazine (0.05 mg/kg) and morphine (0.5 mg/kg), anesthesia was induced (6 mg/kg) and maintained (0.4 mg/kg/min) with propofol. Each dog randomly received either an incisional (blind technique), TAP, or RS (ultrasound-guided) block. Intraoperative analgesia was assessed using cardiorespiratory variables. Postoperative analgesia was evaluated up to 6 hours after the operation with a Short Form of Glasgow Pain Scale (SF-GCPS) and Visual Analog Scale (VAS). Fentanyl was administered as a rescue analgesic when needed. RESULT During surgery, all data remained within normal limits without any significant differences. Fentanyl was administered to 1 dog in the Incisional and 1 in the TAP. Post-operatively, a single dose of fentanyl was given to 1 dog in the TAP and 1 in the RS. Four dogs in the Incisional and 3 in the RS received both doses of fentanyl. There was no significant difference regarding postoperative rescue analgesia among treatments. CLINICAL RELEVANCE All 3 techniques demonstrated acceptable intra- and post-operative analgesia efficacy in dogs undergoing OHE. Further studies are warranted to confirm these findings. [ABSTRACT FROM AUTHOR]

Hysterectomy, most often performed because of bleeding disorders or uterine leiomyoma, is one of the most common major surgical procedures in women and is usually performed during the perimenopausal period on ages 45–55 years. Hysterectomy may be combined with bilateral salpingo-oophorectomy, as a risk-reducing procedure to minimize the risk of ovarian cancer. An open question is whether concomitant oophorectomy, with cessation of ovarian androgen secretion, has any long-term effects on sexual function. In the present prospective cohort study of women undergoing benign hysterectomy, the long-term (10–12 years) effects on sexual function and changes in sex hormone levels were investigated in women having undergone perimenopausal hysterectomy, with or without concomitant bilateral salpingo-oophorectomy. Originally, 491 women (mean age around 50 years) were operated with (patient preference) either only hysterectomy (HYST) or hysterectomy plus bilateral salpingo-oophorectomy (HYST + BSO), and 441 women (90%; HYST; n = 271 and HYST + BSO; n = 170) completed a one-year survey. In the present study, 185 women (42%) of the cohort with one-year follow up participated in the long-term follow up after 10–12 years. Follow-up was with the 10-item McCoy Female Sex Questionnaire and blood analysis of levels of testosterone, estradiol and sexual-hormone-binding globulin. The results showed that specific aspects of sexual function were lower after HYST + BSO compared to HYST 10–12 years after surgery. These lowered items were frequency of sexual fantasies, enjoyment of sexual activity, sexual arousal, and orgasmic frequency. No long-term differences in sex hormone levels were found between the two groups. In conclusion, some items related to sexual function were lower after HYST + BSO in a long-term perspective study, although the levels of testosterone were unaltered. This finding may have implications for clinical recommendations concerning prophylactic salpingo-oophorectomy or for hysterectomy during the perimenopausal age. [ABSTRACT FROM AUTHOR]

Malignant transformation in leiomyoma is rare, with a few documented cases of sarcomatous transformation in leiomyomas. However, carcinosarcomatous transformation in leiomyomas is extremely infrequent. A 45-year-old female presented with a mass sensation per abdomen for the last five months. An abdominal ultrasound revealed multiple uterine fibroids. Contrast-enhanced magnetic resonance imaging revealed a large multiloculated abdominopelvic mass arising from the fundus of the uterus, along with multiple smaller subserosal fibroids. A total abdominal hysterectomy with bilateral salpingectomy was performed. Grossly, the uterus was bosselated with multiple subserosal fibroids. The larger degenerated fibroid showed a smooth outer surface; however, the cut surface was predominantly cystic and filled with necrotic material. Microscopically and immunohistochemically, the larger mass showed a high-grade biphasic tumor comprising carcinomatous and sarcomatous components with the peripheral solid areas showing compressed smooth muscle bundles representing the residual leiomyomatous areas. A final diagnosis of carcinosarcomatous transformation in leiomyoma was rendered. The index report highlights the significance of systematic gross and microscopic examination of all the uterine masses in patients with multiple leiomyomata. [ABSTRACT FROM AUTHOR]

This review aims to provide a comprehensive description of surgical approaches for the management of uterine sarcomas. Uterine sarcomas are rare uterine neoplasms. Frequently, diagnosis is made after hysterectomy or myomectomy scheduled for presumed benign leiomyomas. The gold standard for surgical treatment of uterine sarcomas is hysterectomy with bilateral salpingo-oophorectomy. It is possible to adopt a fertility-sparing approach for those patients who wish to maintain their fertility. The role of pelvic lymphadenectomy is controversial; in fact, removal of lymph nodes is only recommended in the case of radiological suspicion of nodal involvement. Use of a morcellator is associated with increased risk of total recurrence, intra-abdominal recurrence and death. Advanced disease management should be customized based on the patient's performance status given the uncertain role of adjuvant chemotherapy. Treatment of advanced or recurrent disease remains a subject of debate, but surgery is the best approach in terms of morbidity and mortality. There are few options for management of these uterine tumours, and further studies are needed to clarify the diagnostic and therapeutic pathways of patients with a first diagnosis of uterine sarcoma and patients with relapse of uterine sarcoma. No specific evidence supports the adoption of adjuvant therapy in uterine-confined disease, and molecular/genomic profiling may be useful to identify patients at risk of recurrence. [ABSTRACT FROM AUTHOR]

Background and Objectives: The uterine smooth muscle tumors of uncertain malignant potential (STUMP) are tumors with pathological characteristics similar to leiomyosarcoma, but that do not satisfy histological criteria for leiomyoma. These are problematic lesions with intermediate morphologic features; thus, diagnosis and treatment are difficult. This narrative review aims to review data in the literature about STUMPs, particularly focusing on management and therapeutic options and strategies for women who desire to preserve fertility. Material and Methods: authors searched for "uterine smooth muscle tumor of uncertain malignant potential" in PubMed and Scopus databases, from 2000 to March 2023. Pertinent articles were obtained in full-text format and screened for additional references. Only articles in English language were included. Studies including full case description of patients with histopathological diagnosis of STUMP in accordance with Stanford criteria were included. Results: The median age was 43 years old. Symptoms are similar to those of leiomyomas, with a mean diameter of 8.0 cm. Total hysterectomy with or without bilateral salpingo-oophorectomy is the standard care for women if fertility desire is satisfied. Myomectomy alone can be considered for young patients. Although these tumors have not a high malignant potential, several studies described recurrence and metastases. Conclusions: STUMPs are complex uterine smooth muscle tumors, with a rare but reasoned clinical–diagnostic management. Considering the high clinical and histological complexity of these tumors, high level of expertise is mandatory. [ABSTRACT FROM AUTHOR]

Background: Uterine sarcomas are uncommon mesenchymal tumors of the uterus. The clinical problem is that the features of uterine sarcomas can sometimes mimic uterine fibroids. This study aims to investigate the clinical characteristics of patients with uterine sarcomas who were preoperative presenting mainly with uterine masses. Methods: A retrospective analysis of patients who underwent gynecological surgery for uterine sarcomas at the Obstetrics & Gynecology Hospital of Fudan University, between January 2016 and December 2021. Results: Over the 5-year period, 277 patients were final diagnosed of uterine sarcomas. A total of 162 patients were preoperatively diagnosed as uterine fibroids for surgical treatment, the majority of whom were diagnosed of uterine leiomyosarcoma (uLMS) (49/162) and low-grade endometrial stromal sarcoma (LG-ESS) (100/162). Ninety people underwent total hysterectomy and bilateral salpingo-oophorectomy (TH + BSO), while 72 underwent myomectomy followed by supplemental TH + BSO. The group with direct hysterectomy had a higher average age than the group with prior myomectomy (47.20 ± 8.94 vs. 40.86 ± 5.88, p < 0.001). Among patients preoperatively diagnosed as uterine fibroids, patients with uLMS had a higher proportion of previous myomectomy (26.53% vs. 5.00%, p < 0.001), a larger uterine mass diameter on ultrasound (8.38 ± 3.39 cm vs. 6.41 ± 1.92 cm, p < 0.001), and richer hypervascularity (34.69% vs. 18%, p = 0.024) compared with LG-ESS. Conclusions: Analysis of our data showed that a large proportion of uterine sarcomas, especially uLMS and LG-ESS, present mainly with uterine masses. Ultrasound features including a large uterine mass diameter and rich hypervascularity, and with a history of myomectomy may alert clinicians in suspicion of uLMS when compared with LG-ESS. [ABSTRACT FROM AUTHOR]

The aim of the study was to identify the bacterial profile and antimicrobial susceptibility from surgical site cultures in queens and bitches undergoing ovariohysterectomy via ventral midline and lateral flank approaches. Healthy 22 queens and 21 bitches were assigned randomly either ventral midline or lateral flank approach for routine ovariohysterectomy. Surgical site samples were collected before the surgery and on the 1st, 2 nd, and 3 rd days after the surgery for microbiological analysis. A total of 70 different strains were isolated from 50 (29%) of 172 samples. In both queens and bitches the total number of bacteria isolated from the midline approach (n = 50) was found to be higher than in the flank approach (n = 20). The most frequently isolated bacteria were Staphylococcus intermedius group (SIG) (38.5%), followed by Enterococcus faecium (10%) and Staphylococcus lentus (8.5%). Of the isolated Staphylococcus spp. strains were positive 64% for beta-lactam resistance while 52% of that strains were also methicillin-resistant. Multidrug resistance to methicillin, beta-lactamase, and clindamycin was determined in two Staphylococcus spp. isolates. A high level of streptomycin resistance was observed in three Enterococcus faecium isolates. Overall, this study revealed that choosing the surgical site for ovariohysterectomy affected the bacterial profile and more than half of the isolates were resistant to antimicrobials. Thus, the lateral flank approach might be better than the ventral midline approach to prevent possible complications such as a surgical site infection in queens and bitches undergoing ovariohysterectomy. [ABSTRACT FROM AUTHOR]

Brenner tumours of the ovary are typically discovered incidentally, and they are a rare occurrence primarily affecting women in their fifth to sixth decade of life. These tumours are classified as transitional cell tumours of the ovary, encompassing benign, borderline, and malignant Brenner tumours, as well as transitional cell carcinoma. Unfortunately, there is no dependable tumour marker for diagnosing Brenner tumours, and they cannot be accurately identified through imaging studies. In this case report, we present an unusual instance of a 50-year-old postmenopausal woman who experienced abdominal pain and detected a lump in her abdomen. As a result, she underwent a Total abdominal hysterectomy with bilateral salpingooopherectomy the postoperative histological analysis confirmed the presence of a tumour in the right ovary. [ABSTRACT FROM AUTHOR]

Anaphylaxis is a rapid-onset, life-threatening allergic reaction that needs immediate medical intervention. Typically, immunoglobulin E (IgE) mediated, these reactions necessitate skin testing for assessing drug hypersensitivity. A 31-year-old woman with cervical carcinoma, scheduled for a total hysterectomy with bilateral salpingo-oophorectomy under general anesthesia (GA), experienced preoperative urticaria and palpitations, during a blood transfusion. Administering intravenous (IV) pheniramine, ranitidine, and dexamethasone resolved symptoms, allowing surgery under GA. However, post atracurium injection, she developed generalized urticaria and mild hypotension. IV pheniramine and hydrocortisone stabilized her, prompting surgery deferral for an allergology workup. The skin testing was performed, and all drugs tested negative. To prevent non-IgE-mediated reactions, a preoperative regimen of pheniramine 25 mg, prednisolone 50 mg, and famotidine 20 mg was recommended. Subsequently, surgery was performed under GA, using propofol and rocuronium, with the whole perioperative period remaining uneventful. This case underscores the imperative role of skin testing in elucidating perioperative drug usage amid suspected or encountered drug allergies. [ABSTRACT FROM AUTHOR]

Endometrial stromal sarcoma (ESS) is a rare malignancy arising from the stromal cells of the endometrium. We present a case of a 38-year-old female who was admitted to the Emergency Room (ER) with heavy and foulsmelling vaginal bleeding. Further workup (examination) revealed a bulky uterus with a fibroid extending into the cervix. Ultrasound and MRI pelvis showed a large submucosal uterine fibroid with concerning features of possible rupture. The patient underwent total abdominal hysterectomy with bilateral salpingectomy. Intraoperatively, the fibroid was found to be necrotic and macerated, coming out of the cervical os. Histopathology examination revealed a low-grade ESS. The patient was discharged in stable condition. Follow-up imaging and clinical evaluations have shown no evidence of recurrence at three-months post-surgery. [ABSTRACT FROM AUTHOR]

Introduction: Primary ovarian carcinoids are extremely rare ovarian tumors, and there is limited data available on their clinical characteristics and survival outcomes. Material and methods: We conducted a historical cohort study of 56 patients to investigate their clinical characteristics. The overall survival, disease‐specific survival, recurrence‐free survival, and potential prognostic factors of these patients were also evaluated. Results: The median age of these patients was 42.0 years (range: 20–71). The average mass and carcinoid size was 7.3 and 0.4 cm, respectively. Elevated tumor marker levels and ascites were observed in 15 and 10 patients, respectively. In 98.2% of the patients, tumors were confined to the ovary, while only one had metastatic disease. Surgery was the mainstay therapy: 37.5% of the patients underwent unilateral salpingo‐oophorectomy, 25.0% underwent hysterectomy with bilateral salpingo‐oophorectomy, 21.4% underwent ovarian cystectomy, 10.7% underwent comprehensive staging surgery, and 5.4% underwent bilateral salpingo‐oophorectomy. Appendectomy and lymphadenectomy were performed in eight and five patients, respectively, but none showed tumor involvement. Chemotherapy was the only adjuvant treatment utilized, and was administered in four patients. Pathological analysis showed that strumal carcinoid was the most predominant subtype, occurring in 66.1% of the patients. The Ki‐67 index was reported in 39 patients, 30 of which had an index of no more than 3%, with a maximum of only 5%. Only one relapse occurred after the initial treatment, and that patient experienced recurrences on two occasions, maintaining stable disease after surgery and octreotide therapy. After a median follow‐up of 3.6 years, 96.4% of the patients achieved no evidence of disease, while 3.6% were alive with the disease. The 5‐year recurrence‐free survival rate was 97.9% and no death occurred. No risk factors for recurrence‐free survival, overall survival, or disease‐specific survival were identified. Conclusions: The Ki‐67 indices were extremely low and prognoses were excellent in patients with primary ovarian carcinoids. Conservative surgery, especially unilateral salpingo‐oophorectomy, is preferred. Individualized adjuvant therapy may be considered for patients with metastatic diseases. [ABSTRACT FROM AUTHOR]

Specific perioperative management decisions may reduce surgical morbidity and neoplasia risk in late-presenting complete molar pregnancy. BACKGROUND: Second-trimester complete molar pregnancies are rare. Due to a later presentation, means to reduce surgical and long-term morbidity from hemorrhage, hyperthyroidism, and gestational trophoblastic neoplasia risk should be considered. CASE: A 48-year-old woman presented at 17 6/7 weeks of gestation with vaginal bleeding, with a human chorionic gonadotropin (hCG) level of 483,906 milli-international units/mL, biochemical hyperthyroidism, and ultrasonographic suspicion for complete molar pregnancy. The patient received preoperative uterine artery embolization and antithyroid medication before undergoing total abdominal hysterectomy. Her thyroid function and hCG level normalized by 1 week and 69 days postoperatively, respectively. CONCLUSION: Uterine artery embolization and hysterectomy may reduce surgical blood loss and lower the risk of malignancy for patients at high risk for gestational trophoblastic neoplasia. Preoperative treatment of hyperthyroidism with gestational trophoblastic disease can reduce morbidity from thyrotoxicosis. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Veterinary Medicine / Arhiv Veterinarske Medicine is the property of Scientific Veterinary Institute Novi Sad and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Rare disease Background: Synchronous tumors occur when 2 separate primary tumors are diagnosed within 6 months. They can originate from the same site or different locations. For example, synchronous primary tumors of uterine and ovarian origin are a common type. Diagnosis can be challenging, however is critical to determine whether a patient has multiple primary tumors or a single tumor with metastasis to guide effective treatment. Compared with endometrial cancer that has spread to the ovary, synchronous primary tumors of the uterus and ovaries typically require less aggressive treatment. Case Report: A 45-year-old woman with nonspecific symptoms of headache and confusion had imaging studies that revealed a neoplasm in her brain, which was likely causing her symptoms. The masses were metastatic lesions, and the primary cancer was determined to be synchronous endometrial ovarian cancer (SEOC). She underwent bilateral frontal craniotomy for tumor resection and diagnostic tests. She had an exploratory laparotomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. She was stable during hospitalization but lost to follow-up after discharge. Conclusions: Regular gynecologic examinations, including bimanual palpation of the ovaries during cervical cancer screenings, are essential for detecting cancer early and improving chances of recovery. This case also highlights the indolent growth and high risk of metastasis associated with SEOC. Although this type of cancer is rare, patients with it can be at increased risk of developing metastatic lesions in other parts of their bodies. To manage synchronous tumors effectively, a multidisciplinary approach and close collaboration between medical professionals are necessary to ensure best patient outcomes. [ABSTRACT FROM AUTHOR]

One emerging problem for onco-gynecologists is the incidence of premenopausal patients under 40 years of age diagnosed with stage I Endometrial Cancer (EC) who want to preserve their fertility. Our review aims to define a primary risk assessment that can help fertility experts and onco-gynecologists tailor personalized treatment and fertility-preserving strategies for fertile patients wishing to have children. We confirm that risk factors such as myometrial invasion and The International Federation of Gynecology and Obstetrics (FIGO) staging should be integrated into the novel molecular classification provided by The Cancer Genome Atlas (TCGA). We also corroborate the influence of classical risk factors such as obesity, Polycystic ovarian syndrome (PCOS), and diabetes mellitus to assess fertility outcomes. The fertility preservation options are inadequately discussed with women with a diagnosis of gynecological cancer. A multidisciplinary team of gynecologists, oncologists, and fertility specialists could increase patient satisfaction and improve fertility outcomes. The incidence and death rates of endometrial cancer are rising globally. International guidelines recommend radical hysterectomy and bilateral salpingo-oophorectomy as the standard of care for this cancer; however, fertility-sparing alternatives should be tailored to motivated women of reproductive age, establishing an appropriate cost–benefit balance between childbearing desire and cancer risk. New molecular classifications such as that of TCGA provide a robust supplementary risk assessment tool that can tailor the treatment options to the patient's needs, curtail over- and under-treatment, and contribute to the spread of fertility-preserving strategies. [ABSTRACT FROM AUTHOR]

OBJECTIVE Ovariohysterectomy (OVH) is frequently recommended at the time of c-section in canines, yet prior literature suggests poor mothering ability and increased morbidity to the bitch with c-section with concurrent OVH (CSOVH). The study objective was to compare maternal survival, complications, and mothering ability between bitches that underwent c-section alone (CS) or CSOVH. ANIMALS 125 bitches. PROCEDURES Medical records from 2014 through 2021 were retrospectively reviewed; owners were surveyed for information up to weaning. RESULTS 80 bitches undergoing CS and 45 bitches undergoing CSOVH were identified. There was no difference in anesthesia duration, intraoperative complications, postoperative complications, mothering ability, puppy survival to weaning, or other variables compared between groups. CSOVH bitches had longer surgery times (P= .045; 54.4 + 20.7 min vs 46.9 + 16.6 min) and longer time from delivery to nursing (P = .028; 75.4 + 22.3 min vs 65.2 1 19.5 min). Ninety (72%) owners responded to the survey. All 90 bitches survived until puppy weaning. CSOVH bitches were more frequently perceived as painful postoperatively (P = .015). CLINICAL RELEVANCE Performing an OVH at the time of c-section does not pose a significant increase in risk of mortality, intraoperative complications, postoperative complications, or decreased mothering ability of the bitch. The increased duration of surgery and increased time from delivery to nursing in the CSOVH group were clinically insignificant. Appropriate postoperative pain management should be emphasized post-CSOVH. Based on these results, OVH should be performed concurrently with c-section if indicated. [ABSTRACT FROM AUTHOR]

A 1‐year‐old, female, spayed dog was referred for urinary incontinence, first noted after a complex dystocia and caesarean section with ovariohysterectomy. Transabdominal ultrasonography and computed tomography with intravenous contrast administration revealed a fluid‐filled tubular structure caudodorsal to the urinary bladder. Routine cystourethroscopy was unremarkable. A retrograde cystourethrogram revealed a 15 mm long connection between the urethra and a structure presumed to be a uterine body remnant. During exploratory laparotomy, the uterine remnant and urethra were separated, leaving oval defects approximately 15 mm long in both; these were then closed. A urinary catheter was left in place for 6 days. A urethrogram performed during catheter removal confirmed closure of the fistula, and the dog was subsequently continent. To the authors' knowledge, this is the first description of a urogenital fistula suspected to be associated with dystocia and emergency ovariohysterectomy in a dog. [ABSTRACT FROM AUTHOR]

Copyright of Indonesian Journal of Veterinary Science / Jurnal Kedokteran Hewan is the property of Universitas Syiah Kuala, Faculty of Veterinary Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The editorial discusses the importance of medical imaging in determining treatment strategies for endometrial cancer, particularly in assessing lymph node metastases and lymphovascular invasion. It highlights the debate over the necessity of lymphadenectomy and the potential benefits of automated imaging assessments using deep learning models. The article emphasizes the need for accurate preoperative imaging to guide treatment decisions and improve patient outcomes, especially in younger women with fertility-preserving considerations. Further research is recommended to evaluate the clinical impact of automated imaging in managing endometrial cancer effectively. [Extracted from the article]

Objective: Rare disease Background: Leiomyosarcoma is the most common uterine sarcoma. Leiomyosarcoma is classified into conventional leiomyosarcoma, epithelioid leiomyosarcoma, and myxoid leiomyosarcoma. Leiomyosarcomas with rhabdoid features have been rarely reported. Herein, we report a case of uterine leiomyosarcoma with rhabdoid features. Case Report: A 58-year-old Korean woman presented with acute abdominal pain. Computed tomography and magnetic resonance imaging of the pelvis revealed a large solid mass in the posterior wall of the uterus that extended to the uterine cervix. The patient underwent total hysterectomy with bilateral salpingo-oophorectomy and tumorectomy. Microscopic and immunohistochemical examination of the tumor revealed leiomyosarcoma with rhabdoid features and high proliferation rate. Next-generation sequencing showed PI3K amplification and ERBB2 amplification. Postoperative abdominal and pelvic computed tomography performed 3 weeks after the operation showed a mass at the vaginal stump that was attached to the urinary bladder and rectum. The patient underwent pelvic exenteration of remnant vaginal stump, rectum, and urinary bladder with loop ileostomy, and was diagnosed with recurrent leiomyosarcoma. One month later, after the second operation, a 13-cm recurrent mass was noted on the computed tomography. Chemotherapy was not done and the patient died during supportive treatment 7 months after diagnosis. Conclusions: This case, which is a uterine leiomyosarcoma with rhabdoid features and high proliferation rate, recurred very fast, within 1 month, and showed an aggressive clinical course. The molecular classification and postoperative therapy are not well established in uterine leiomyosarcomas. Further studies are required to clarify the clinical and pathological characteristics of leiomyosarcomas. [ABSTRACT FROM AUTHOR]

Background: Unusual ectopic growth of endometrial tissue in the umbilicus of a patient who has not undergone surgery is known as primary umbilical endometriosis. When a patient presents with an umbilical nodule, whether or not they have symptoms, it is critical to have a high index of suspicion. Case Summary: Here, we present a rare case of umbilical endometriosis with concurrent endometrial hyperplasia in a 40-year-old para II patient from Western Ethiopia. A total abdominal hysterectomy and umbilical nodule excision were performed under general anesthesia. After two months, she returned for a follow-up visit and was in good health. Conclusion: Primary umbilical endometriosis may coexist with endometrial hyperplasia. Hence, in order to provide suitable comprehensive management, a thorough gynecological evaluation is required. [ABSTRACT FROM AUTHOR]

Background Sexual function after hysterectomy can be a concern for patients, and research remains inconclusive about changes in sexual function associated with hysterectomy. Aim We meta-analyzed studies on change in sexual function from pre- to posthysterectomy and the role of total vs subtotal hysterectomy and concomitant bilateral salpingo-oophorectomy (BSO) in differences in such change. Methods We searched PubMed, Embase, and Cochrane databases from inception to January 2022. Two reviewers screened and included studies if they were published in a peer-reviewed journal and reported on sexual function pre- and posthysterectomy for benign nonprolapse indication. Methodological quality was assessed with the STROBE checklist. We used random effects multilevel models to meta-analyze standardized mean differences in pre- to postoperative sexual function and the posthysterectomy Female Sexual Function Index mean across study groups in R (RStudio). Outcomes Outcomes included overall sexual function, dyspareunia, desire, arousal, lubrication, and orgasm. Results Thirty-two articles were analyzed: 8 randomized controlled trials, 20 prospective studies, 2 retrospective studies, 1 cross-sectional study, and 1 secondary analysis, comprising a total of 4054 patients. Each study provided data for at least 1 outcome. Study quality was moderate, and effect sizes showed large between-study heterogeneity. Hysterectomy was not associated with significant change in overall sexual function irrespective of surgical route, with patients tending to report potentially remaining sexual dysfunction posthysterectomy. Cervix removal was not significantly associated with differences in magnitude of change. Hysterectomy without BSO was associated with significantly stronger improvement in lubrication and orgasm than hysterectomy with BSO, which was not the case for desire, arousal or overall sexual function. However, these significant differences were not replicated within studies that directly compared cases with and without BSO. Clinical Implications Clinicians should address remaining sexual dysfunction posthysterectomy, and BSO should not be considered if not medically required. Strengths and Limitations We analyzed a comprehensive number of trials and studied clinically relevant factors that might relate to differences in change in sexual function. Conclusions need to be interpreted with caution since many studies showed moderate methodological quality and large effect size heterogeneity. Conclusion Subtotal and total hysterectomy was not associated with significant change in overall sexual function irrespective of surgical route, with patients tending to report potentially remaining sexual dysfunction posthysterectomy. Hysterectomy without BSO was associated with significantly stronger improvement in lubrication and orgasm than hysterectomy with BSO. Future research on hysterectomy should analyze predictors of sexual function change trajectories, such as different indications. [ABSTRACT FROM AUTHOR]

Background: the uterus is the identity of any woman. Hence, apart from physical complications, there can be emotional and psychological disturbances as well after the hysterectomy. The experts opine that about 70% of the hysterectomy may not be appropriate for those women. All possible options for conservative therapy should be explored before planning for surgical approach. Objective: To study the Clinical profile and Complications associated with hysterectomy Methods: A hospital based prospective study was carried out among 405 women undergoing hysterectomy. Their age, parity, co-morbidities, presenting complaints, different approaches for hysterectomy and complications were noted. The data was described as percentages. Results: Majority (67.4%) were 41-50 years. Majority (83.6%) were multipara. Anemia was most common seen in 48.5%. Most common presenting complaint was abnormal uterine bleeding in 52%. Most common indication for hysterectomy was fibroid in 42.7%. Most common procedure performed for hysterectomy was Total abdominal hysterectomy (TAH) in 29.2% followed by TAH+ unilateral salpingo-oophorectomy in 15.3%. Only 28.3% had complications during surgery and in that most common was Hemorrhage requiring blood transfusion in 26.2%. Incidence of bladder injury was 0.7%. Pain was most common immediate post-operative complication in 20.7%. All cases were followed for one year after surgery. Nine had some complications in which vault prolapse was seen in 1.4% of cases. Conclusion: Hysterectomy is commonly performed in fourth decade of life among multipara. Correction for anemia is required before hysterectomy. Mostly they present with abnormal uterine bleeding and fibroid is the most common indication. TAH is commonly done procedure and overall, the complications are less. [ABSTRACT FROM AUTHOR]