Histopathological findings of abdominal hysterectomies in patients presenting with heavy menstrual bleeding [HMB]

To determine the frequency of different histopathological findings in hysterectomy specimens in patients with heavy menstrual bleeding. Cross-sectional study This study was carried out in Gynae Unit III [Sandemen Provincial Teaching Hospital Quetta] from January 2009- December 2009. Two hundred abdominal Hysterectomy cases done for the treatment of heavy menstrual bleeding [HMB] were included in this study. An exclusion criteria was vaginal hysterectomies, abdominal hysterectomies done for complaints other than manorrhagia and malignancies. After hysterectomy specimen of uterus sent for histopathology. The age ranged from 30-55 years with maximum number [62.5%] of cases in 41-50 years of age group. The main presenting complaint of patients was heavy cyclical menstrual flow. Total abdominal Hysterectomies with bilateral salpingoophoroctomy done in 120patients, in 80 patients both ovaries conserved. There was no intra-operative complication. Mild post operative complications occurred in 15% of cases. There was no death. On histopathology leiomyoma was most common pathlogy found in 55% cases. No malignancy was detected on histopathology of the uterus. The study confirmed that benign diseases were more common in hysterectomy specimen performed for HMB. Uterine fibroids and adenomyosis are the most common benign conditions found in hysterectomy specimens on histopathological examination

Ablación endometrial por histeroscopia: resultados, prevención y manejo de complicaciones / Endometrial ablation by hysteroscopy: outcome, prevention and management of complications

A mediados de la década de los 80, se introdujeron procedimientos que eliminan el espesor completo del endometrio como tratamiento del sangrado menstrual profuso. A pesar de que en el mundo, el número y la popularidad de estas técnicas, conocida como ablación endometrial, se ha incrementado ostensiblemente, en nuestro país continúa siendo una herramienta poco difundida y subutilizada. Este artículo aborda de manera crítica la racionalidad, indicaciones y complicaciones, de la ablación endometrial en el manejo del sangrado menstrual profuso, considerando su utilidad clínica frente a otras alternativas de tratamiento.

In the mid 80's, procedures were introduced to eliminate the entire thickness of the endometrium as treatment of heavy menstrual bleeding. Although in the world, the number and popularity of these techniques, known as endometrial ablation has increased considerably, in our country remains a little known and underutilized tool. This article critically discusses the rationale, indications and complications of the endometrial ablation in the management of heavy menstrual bleeding, considering their clinical utility over other alternative treatments.

[Second generation endometrial ablation: surgical treatment of choice for menorrhagia]

Menorrhagia is a very common problem affecting over 20% of women in the reproductive age group. Until 30 years ago hysterectomy was the only surgical treatment available. Although it is 100% effective, it is associated with surgical complications and is more costly both financially and recovery time. The first generation endometrial ablation technique was introduces in the early 1980 as alternative to hysterectomy in suitable cases. This was followed few years later with second generation ablation techniques. These second generation devices avoid the need for hysteroscopic surgery, therefore are quick, easy to perform and can be carried out in out patient setting. Their safety and efficacy is primarily dependent on the devices rather than the operator

Case report leech infestation presenting as metromenorrhagia

This case s presented to show that leech infestation is still not uncommon in Iraq especially of the genital tract. Leech infestation, could cause menorrhagia in women. A 45 years old multiparous woman from Sinjar's rural areas in Mosul province, attending the out patient department with severe vaginal bleeding, and a history of moderate, continuous vaginal bleeding for four months. She underwent diagnostic curettage three months before, which revealed normal secretory endometrium. The infected woman was pale and hypotensive with features of chronic iron deficiency anemia. Speculum and gynecological examinations demonstrated no abnormalities. Total abdominal hysterectomy as an emergency was done with preservation of both ovaries; bleeding persisted postoperatively; re-assessment by speculum pelvic examination revealed leech infestation of the vagina. The Leech belongs to Phyllum Annelida, class Hirudinea, and order Rhychobdellida. An infestation with leeches should be considered in patients who present with menorrhagia and history of immersion in fresh water lakes or streams in tropical infested areas. Leech infestation is not common in gynecological practice, and is rare nowadays as water supplied to all cities and villages is passing through filtration and disinfection process. Leech infestation should be remembered, as a cause of menorrhagea, in areas where using river water and sitting at riverside is habitual for women in infested rural areas

Utilización de eritropoyetina en un paciente con anemia hemolítica autoinmune con aloinmunización múltiple para la obtención de sangre autóloga prequirúrgica. Caso reportado en sangre, actualización / The use of recombinant erytropoietin in autologous blood donation in a patient with autoimmune hemolytic anemia and multiple red cells alloantibodies. Case report

Se presenta el caso de una mujer de 44 años con hipermenorrea por una hiperplasia uterina que no cede con tratamiento hormonal y que debe ser sometida, en primer lugar, a un legrado biópsico y luego a una histerectomía con diagnóstico de anemia hemolítica autoinmune y la presencia de 2 aloanticuerpos (anti c y anti Fya). Se le realizó tratamiento con corticoides a dosis inmunosupresoras y cuando se estabilizó su hematocrito se le realizó tratamiento con EPOrHu (6 dosis) con ferroterapia parenteral y se le extrajeron 2 unidades de sangre autólogas que fueron transfundidas durante la cirugía. La paciente logró un buen hematocrito prequirúrgico y postquirúrgico.

Clinicopathological study of hysterectomies.

A randomised study of 100 cases undergoing hysterectomy in the age group of 20-70 years was carried out and clinicopathological correlation was done. Maximum number of women who underwent hysterectomy were in the age group of 31-50 years. Abnormal menstrual flow was the most common complaint (66%). Clinically main indications for hysterectomy were fibroid (34%), dysfunctional uterine bleeding (DUB) (26%) and uterine prolapse (24%). Abdominal hysterectomy was the procedure of choice in conditions other than uterovaginal prolapse. Out of 34 cases, clinically diagnosed as fibroid uterus, leiomyoma was found on histopathology in 25 cases and adenomyosis in 3 cases. In 3 cases, both leiomyoma and adenomyosis were present. Out of 26 cases, clinically diagnosed as DUB, histopathological examination revealed leiomyoma in 6 cases, adenomyosis in 9 cases, endometrial polyp in 3 cases. Hence, after exclusion of organic pathology, DUB was confirmed in 8 cases.

case notes analysis of hysterectomy performed for non-neoplastic indications at liaquat national hospital, Karachi

To determine the indications, associated morbidity, mortality and histopathological findings in women who underwent hysterectomy for non-neoplastic indications at Liaquat National Hospital Karachi. This is a five year retrospective case note study of 143 women who underwent hysterectomy, excluding all those performed for benign or malignant pelvic neoplasms [excluding fibroids] and hysterectomy following childbirth for postpartum haemorrhage. Menorrhagia was the commonest indication for performing hysterectomy. The majority of the patients were in their forties; the commonest post operative complications were pyrexia, urinary tract and wound infections in 16% of the patients. There was no mortality associated with the procedure. The histopathology of the specimens revealed adenomyosis followed by leiomyoma to be the commonest pathology. It appears that adenomyosis is a common pathology in women from various ethnic and social backgrounds in Karachi, who are suffering from menorrhagia. Early diagnosis with high-resolution ultrasound is possible and hysterectomy may be offered earlier to these women, as they do not usually respond to medical treatment

Ablación endometrial histeroscópica: experiencia en Antofagasta / Hysteroscopic endometrial ablation: experience at Antofagasta

Se analizan 52 casos de ablación endometrial histeroscópica, realizadas entre marzo de 1992 a diciembre de 1995, procedimientos que se efectuaron con resectoscopio y asa diatérmica. El signo común de estas pacientes era genitorragia refractaria a tratamientos médicos. El seguimiento postcirugía es de 20,3 meses promedio, el 76,9 por ciento de ella están sin problemas, el 19,2 por ciento (10 casos), requirieron otra cirugía por recurrencia de sus síntomas, 8 histeroctomías

Ablaçäo histeroscópica do endométrio: análise preliminar de 21 casos / Histeroscopic ablation of the endometrium: preliminary analysis of 21 cases

Foram realizadas, em abril de 1991 a agosto de 1992, 21 ablaüoes de endom,trio, com o uso do ressectoscopio, em 21 paciente do Hospital do Servidor Publico Estadual de Sao Paulo e da clinica privada dos autores. Estas pacientes apresentavam sangramento uterino anormal, de etiologia benigna, dificultando o controle clinico. Nao houve complicacoes, exeto um caso que presentou sobrecarga hidrica. Apos seguimento de três a dezenove meses, foi constatado que 20/21 pacientes (95,2 por cento) ficaram satisfeitas com o procedimento, devido _ grande reducao do sangramento menstrual - ou amenorreia - que se seguiu ao tratamento.