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1.
BMC Womens Health ; 23(1): 558, 2023 10 27.
Article in English | MEDLINE | ID: mdl-37891612

ABSTRACT

BACKGROUND: A cesarean scar defect (CSD) is incomplete healing of the myometrium at the site of a prior cesarean section (CS), complicating more than half of all cesarean sections. While transvaginal ultrasound (TVU) is the most common modality for diagnosing this defect, hysteroscopy remains the gold standard. We aimed to develop an efficient diagnostic tool for CSD among women with abnormal uterine bleeding (AUB) by integrating TVU findings and participants' demographic features. METHODS: A single-center cross-sectional study was conducted on 100 premenopausal and non-pregnant women with a history of CS complaining of AUB without a known systemic or structural etiology. Each participant underwent a hysteroscopy followed by a TVU the next day. The defect dimensions in TVU, patients' age, and the number of previous CSs were integrated into a binary logistic regression model to evaluate their predictive ability for a hysteroscopy-confirmed CSD. RESULTS: Hysteroscopy identified 74 (74%) participants with CSD. The variables age, the number of CSs, defect length, and defect width significantly contributed to the logistic regression model to diagnose CSD with odds ratios of 9.7, 0.7, 2.6, and 1.7, respectively. The developed model exhibited accuracy, sensitivity, and specificity of 88.00%, 91.89%, and 76.92%, respectively. The area under the receiver operating curve was 0.955 (P-value < 0.001). CONCLUSION: Among non-pregnant women suspected of CSD due to AUB, looking at age, the number of previous CSs, and TVU-based defect width and length can efficiently rule CSD out.


Subject(s)
Cicatrix , Uterine Diseases , Humans , Female , Pregnancy , Cicatrix/etiology , Cicatrix/complications , Cesarean Section/adverse effects , Cross-Sectional Studies , Uterus/diagnostic imaging , Hysteroscopy/adverse effects
2.
Asian Cardiovasc Thorac Ann ; 31(5): 421-425, 2023 Jun.
Article in English | MEDLINE | ID: mdl-37259504

ABSTRACT

BACKGROUND: The only beneficial treatment option for the management of inferior vena cava (IVC) tumor thrombus is complete tumor removal. The aim of this study was to report our experience in surgical and clinical outcomes in patients with tumor thrombosis in IVC. METHODS: A retrospective chart review of patients who underwent surgical resection of IVC tumor at our institution over the past 10 years was performed. The patients were identified using a prospectively maintained database. RESULTS: We identified 51 patients, the mean age was 53.4 ± 16.8 years, and 25.4% were female. They were divided into three groups based on tumor thrombosis level. Twenty patients (39.2%) required sternotomy, and cardiopulmonary bypass (CPB) was used in 19 (37.2%) patients, and 2 (3.9%) cases underwent coronary artery bypass graft. The perioperative complications were severe bleeding (3 patients), pulmonary embolism (2 patients), and duodenal perforation (1 patient). Three (5.8%) in-hospital deaths occurred, and all were due to severe abdominal bleeding. After a mean follow-up time of 46.5 ± 42.0 months, 29 (56.9%) patients were alive. The mean survival time was 75.2 ± 8.4 months. In multivariate analysis, higher age (p = 0.033) and male gender (p = 0.033) proved to be independent prognostic factors. CONCLUSIONS: Tumor thrombus extending to the IVC is a rare and challenging event. Although using CPB may be safe and result in long-term survival with acceptable function, excessive bleeding during surgery may limit the use of this method.


Subject(s)
Carcinoma, Renal Cell , Kidney Neoplasms , Thrombosis , Venous Thrombosis , Humans , Male , Female , Adult , Middle Aged , Aged , Carcinoma, Renal Cell/pathology , Carcinoma, Renal Cell/surgery , Kidney Neoplasms/pathology , Retrospective Studies , Thrombectomy/adverse effects , Thrombectomy/methods , Vena Cava, Inferior/diagnostic imaging , Vena Cava, Inferior/surgery , Thrombosis/etiology , Venous Thrombosis/etiology , Nephrectomy/adverse effects , Nephrectomy/methods
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