Transvaginal uterine artery ligation: a possible alternative treatment modality for the symptomatic fibroids

To determine the efficacy of Transvaginal Uterine Artery Ligationfor the management of symptomatic fibroids. 19 women, aged from 33 to 46 years, with symptomatic, single uterine fibroid, not exceeding 14 weeks, were recruited. Objective measurement of menstrual blood loss [MBL] by the alkaline hematin technique [Hallberg, et al, 1966], and ultrasonographic measurement of the fibroid volumes were determined preoperatively and at 3, 6 and 12 month post operative follow up. Improvement of the presenting symptoms -was observed during follow up. There was a significant decrease in the sonographic myoma volume at 3 month [P> 0.05], 6 months [P> 0.01], and 12 month [P> 0.01] postoperatively. The MBL was significantly lower in the postoperative follow up, when compared with the preoperative levels; at 3 month [P< 0.05], 6 month [P< 0.01], and 12 month [P< 0.01]. Rise in hemoglobin concentration was observed at 3 month postoperative [P>0.05]. Statistically significant higher hemoglobin concentrations were observed at 6 and 12 month postoperatively [P< 0.05]. There were no cases of ureteric injury, and none needed a second procedure. Transvaginal uterine artery ligation could be considered a possible, simple, alternative treatment modality for the symptomatic fibroids

effect of hysterectomy on psychiatric morbidity [anxiety and depression]

To evaluate the psychiatric morbidity [anxiety and depression] in women underwent an abdominal and vaginal hysterectomy of a benign indication. This is a prospective observational study which was done in the Obstetric and Gynecology and Neuropsychiatry Departments, Sohag University Hospital. One hundred and two women were scheduled for undergoing hysterectomy after fulfilling the inclusion criteria. All women underwent a thorough history taking, clinical examination and complete psychiatric history. General health questionnaire [GHQ-28] was used to assess women with psychiatric co-morbidity before and after the operation. All women with psychiatric co-morbidity were re-evaluated by Beck depression inventory [BDI] and Hamilton anxiety scale [HAMA] before and after hysterectomy. On screening for psychiatric co-morbidity using the GHQ-28 for the 96 women who completed the follow up protocol of the study 35 [36.46%] scored >/= 4 [Group I] with psychiatric co-morbidity, and 61 [63.54%] scored <4 [Group II] without psychiatric co-morbidity. GHQ-28 was reapplied to all women in group II [post-operatively] where 48 [78.69%] scored >/= 4 [group IIa] and 13 [21.31%] scored <4 [group IIb. Severe anxiety and depressive symptomes were the most common presentation after the operation and represented 8 [40%] and 8 [53.3%], of patients of group I, respectively. In patient, of group II [without psychiatric morbidity] after hysterectomy, depressive and anxiety symptoms was the most common presentation in nulliparous women and was found in 7 [63.64%] and 3 [27.27%], respectively. However, the least depressive and anxiety symptoms was observed in women with parity >/= 5 and was found in 12 [38.7%] and 9 [29.03%], respectively. It is not worthy that the majority of women free from psychiatric co-morbidity was observed in women with parity >/= 5 and represented 10 [32.5%] of patients. It was clear that there was a definite significant relation between hysterectomized women and psychiatric morbidity of a depressive and anxiety nature. So we recommend that before hysterectomy in benign conditions, gynecologists should exhaust great effort of using the available recent less invasive modalities of treatment as first option