ABSTRACT
Ganglioneuromas are rare, benign, well-differentiated, slowgrowing tumors of the sympathetic nervous system, composed of large, mature neurons in a stroma composed of Schwann cells. Ganglioneuromas are derived from the neural crest cells and can arise anywhere from the base of the skull to the pelvis. The pre-sacral area is a very rare location for ganglioneuromas to develop. We describe the case of a 31 year old woman, who was incidentally found to have an abnormal pre-sacral mass. The following work-up, revealed the mass to be growing on imagery (computed tomography and magnetic resonance imagery) and fluorine-18 fluorodeoxiglucose avid. The mass was removed by assisted laparoscopy and was found to be a benign ganglioneuroma. This is the first described case of fluorine-18 fluorodeoxiglucose avid, pre-sacral, benign ganglioneuroma.
Subject(s)
Fluorodeoxyglucose F18 , Ganglioneuroma/diagnosis , Magnetic Resonance Imaging/methods , Peripheral Nervous System Neoplasms/diagnosis , Positron-Emission Tomography/methods , Adult , Diagnosis, Differential , Female , Fluorodeoxyglucose F18/pharmacokinetics , Ganglioneuroma/metabolism , Humans , Laparoscopy , Lumbosacral Plexus , Neoplasm Staging , Peripheral Nervous System Neoplasms/metabolism , Radiopharmaceuticals/pharmacokineticsABSTRACT
PURPOSE: To compare the postoperative evolution and the long-term efficacy after stapled haemorrhoidopexy (PPH) and Milligan-Morgan haemorrhoidectomy (MM). METHODS: In a prospective randomized study, 40 patients requiring surgical treatment for prolapsing haemorrhoids grade II or III were assigned to either MM or PPH (20 each). Postoperative pain, wound healing were evaluated, as well as anal pressures and sphincter anatomy. Mean follow-up is 46 months. RESULTS: Postoperative pain at rest and during defecation was less important after PPH if no resection of external piles or skin tags was associated (P < 0.0001). Healing time was shorter after PPH (P < 0.0001). Endoanal ultrasound remained unchanged postoperatively. Resting and squeeze pressures decreased after MM, but not after PPH (P < 0.01). After a mean follow-up of 46 months (12-56), persistent or recurrent symptoms, mostly mild and temporary, were observed after both MM and PPH, in 7 and 11 patients respectively (NS). After PPH, five patients (25%) complained of recurrent external swelling and/or prolapse (P = 0.047 vs. MM) requiring redo surgery in four of them, after 10, 13, 14 and 21 months. No redo-surgery was required after MM. Long term patient satisfaction after PPH was not better than after MM. CONCLUSIONS: Postoperative pain is less important after PPH. This advantage disappears if any resection is associated with the stapling. At medium to long-term follow-up, PPH seems to carry a higher risk of symptomatic external haemorrhoidal disease, needing further surgery.
Subject(s)
Hemorrhoids/surgery , Rectal Prolapse/surgery , Surgical Stapling , Adult , Aged , Belgium , Digestive System Surgical Procedures/methods , Female , Follow-Up Studies , Hemorrhoids/complications , Humans , Male , Middle Aged , Prospective Studies , Rectal Prolapse/etiology , Time FactorsABSTRACT
Three cases of lymphangiosarcoma have been followed recently. All were finally treated by amputation. Only one is actually disease-free. The other two developed local recurrence at the thoracic cage. An extensive review of the literature follows the case presentation.
Subject(s)
Lymphangiosarcoma , Combined Modality Therapy , Diagnosis, Differential , Female , Humans , Lymphangiosarcoma/diagnosis , Lymphangiosarcoma/epidemiology , Lymphangiosarcoma/therapy , Male , Middle Aged , PrognosisABSTRACT
The aim of this study was to determine whether the presence of a hydrosalpinx influences in-vitro fertilization (IVF) prognosis. Comparisons were made between 69 IVF cycles in 37 patients carrying hydrosalpinges (hydrosalpinx group) and 67 IVF cycles in 41 patients without tubes or surgically sterilized (control group). Twenty-two patients carrying hydrosalpinges underwent salpingectomy or salpingoplasty (operated group); they then underwent 42 IVF trials which were compared with the two former groups. In the hydrosalpinx group, pregnancy rates by oocyte retrieval were 10.1% for clinical and ongoing pregnancies. In the control group, the corresponding pregnancy rates were 23.0 and 21.3% respectively. The implantation rate per embryo was 4.2% for clinical and ongoing pregnancies in the hydrosalpinx group and 11.0 and 10.4% respectively in the control group. The operated group had pregnancy rates of 38.1% for clinical pregnancies and 31.0% for ongoing pregnancies, with implantation rates of 17.4 (clinical) and 14.8% (ongoing) respectively. Pregnancy and implantation rates were statistically lower in the hydrosalpinx group as compared with controls and with the operated group. The differences between control and operated groups were not significant. In conclusion, the presence of a hydrosalpinx is thus associated with poor prognosis in IVF treatment. Surgical correction of such lesions appears to restore high success rates.
