Case report of rhabdomyosarcoma in the maternity hospital-Damascus university

Rhabdomyosarcoma is the commonest soft tissue cancer of childhood accounting for 5% of all childhood malignancies. The tumor arises from embryonic mesenchymal tissue in any of various sites, the most frequent being head and neck [40%], GU tract [20%], and extremities [18%], the trunk [7%], retroperitoneum [7%] and perineum and other sites [8%]. Rhabdomyosarcomas have many presentations with widely different prognoses and the classification is controversial. Multivariate analysis of prognostic factors agree that the presence or absence of metastasis is the most important prognostic factor. The addition of chemotherapy to radiation therapy and surgery has dramatically improved survival in rhabdomyosarcoma in the last 20 years. R. Kh., a 15 - year old patient, referred to the Maternity Hospital with huge mass in perineum that extended to the left pelvic wall and metastasized to left paraortic lymph nodes compressing left ureter. There was also lung metastasis. Under general anaesthesia the huge mass was removed. Biopsies were taken from left paraortic lymph nodes and left pelvic mass. Left ureter was freed and reinserted in the urinary bladder and colostomy was done. The patient received 6 courses of [VAC], chemotherapy [3] weeks after surgery. At the end of chemotherapy, the rest of perineal mass, pelvic mass and left paraortic nodes disappeared. Only lung metastasis remained stationary. After 4 months a new lung metastasis appeared. The patient was put on Etopside and Ifosfamide chemotherapy

Urinary tract injuries of gynecologic surgery

Urinary tract injuries occur more often in gynecologic surgery than in any other surgery. 75% of urinary fistulas are due to gynecological surgeries, and the incidence of urinary tract injuries related to gynecologic surgery is about 1-3%. The early detection of the urinary injury during surgery gives more chance for correction without any postoperative complications. In the Maternity Hospital a study, covering 5 years [1992-1996], was conducted. It aimed at being a statistical research on the urinary tract injuries, the value of their early detection, the methods of avoiding them and the best ways of management. Ureter Injury: 24 cases were studied. Ureteral ligation was the most common injury; and cesarean section was the leading causative surgery in this type of injury [50%], after it comes the postpartum hysterectomy [20.8%] and the least causative surgery was the vaginal hysterectomy [4.1%] The study showed that the rate of ureteral damage was 0.1% of all cesarean sections, 5.37% all postpartum hysterectomies, 2% of all radical hysterectomies and 0.18% of all vaginal hysterectomies. Therefore 0.14% of ureteral injuries were due to obstetric operations and 0.35% to gynecologic operations. The obstetric causes constituted 71% of all injuries, and the gynecologic causes constituted 29% of all injuries. The rate of recognized injuries during operations was 62.5% and they were all repaired. Bladder injury: 70 cases were studied [0.45% of all surgeries.]. The obstetric causes [cesarean section. postpartum hysterectomy] were the leading causes [71.4%], specially due to recurrent cesarean sections. The rate of bladder injury during cesarean sections was 0.34% all cesarean sections, 10.7% of all postpartum hysterectomies [relatively it is considered an elevated rate], 0.6% of all abdominal hysterectomies, 1.57% of all vaginal hysterectomies. 95.7% of the injuries were recognized during operations and the surgical success rate was 94%. We reached the following considerations: 1- Enhancement the obstetric management. 2- Enhancement of surgical techniques and following all surgical recommendations and adequate sterilization. 3- Pre - and post - operative IVP if necessary. 4- The early and direct detection of the tract injury and its suitable management and treatment

Reproductive morbidity in damascus city

Reproductive Morbidity in the fertile period is defined as the medical disorders that occur during pregnancy, delivery and postpartum, and have an impact upon fetal, neonatal, and child morbidity and mortality; as well as maternal health during pregnancy, delivery, perpeurium and gynecological diseases, that may result from pregnancy an d delivery like infectious diseases, uterine prolapse, infertility and cytological changes. The study included 150 women in Miedan area at Damascus City. The study showed the following: 68.6% of the patients were married before the age of 19 [early marriage]. The analphabetic women were 28.6%. The analphabetic wives were more than husbands. Genital tract infection was found in 36%, 20% was with Monilial infection. Utero-Cervical diseases were found in 57.3%. Cervical ectopia was found in 40% of the women. Urinary tract infection was found in 10% of the women. Uterine prolapse in 6.6%. Hypertension was found in 9.3%. Diabetes Mellitus was found in 5.7%. 18% of the patients have anemia. Perineal lacerations were found in 1.2%. More than one complication were found in the same woman

Cervix cancer

A study of cervical cancer took place at the Maternity Hospital of Damascus University from 1990 to 1995. A total of 102 patients were treated, the mean age was 46.6 years, 55% of patients were 40-59 years old. 30.4% were less than 40 years old and 14.6% were older than 60 years old. Vaginal bleeding was the main symptom especially post menopausal bleeding 31.4% and postcoital bleeding 27.5%. 85.2% of the cases were stage I and stage II of cancer cervix. 88.2% of all cases of cancer cervix were squamous cell carcinoma and 10.2% were adenocarcinoma. The most common among squamous cell carcinoma was large cell non keratinizing 54.7, then large cell keratinzing 26.6%, and at the end small cell 18.8%. The incidence of pelivc nodes metastases were high in small cell squamous cell carcinoma 75%, while it was 31.4% in non keratinzing large cell and 17.6% in large cell keratinizing. The dominating treatment modality for cervix carcinoma in our hospital was surgery 78.5% alone or combined with radiotherapy. Surgery alone was adequate in 41.2% of cases. During follow up of 83 patients with cancer cervix, there were 26.5% deaths of cancer, 19.3% patients were lost, and survival rate 53%. The survival rate after surgery was the highest among all other kinds of treatment. The stage of cervical cancer has been shown to be an important prognostic indication, the incidence of nodal metastases for stage I, II were 20% and 35.7% respectively. The incidence of positive vaginal margins was 6.7% for stage I and l6.7% for stage II