ABSTRACT
Here, we present a novel surgical technique to repair an obturator hernia with a uterine flap. The description is both written and in video format.
Subject(s)
Hernia, Obturator/surgery , Surgical Flaps , Aged , Female , Humans , Recurrence , Surgical Procedures, Operative/methods , Uterus/surgeryABSTRACT
OBJECTIVES: Cervical cancer is common in resource-poor settings with high prevalence of tuberculosis, pelvic inflammatory disease, and human immunodeficiency virus (HIV) infection. There are no data regarding the sentinel lymph node (SLN) algorithm in these high-risk cancer populations. Our objectives were to establish the sensitivity, specificity, positive predictive value, and negative predictive value of the SLN algorithm in cervical cancer and to compare the detection rate of indocyanine green (ICG) versus blue dye versus technetium Tc 99m nanocolloid (Tc). METHODS: This prospective study was conducted at the University of Pretoria. Tc-nanocolloid tracer, ICG dye, and methylene blue (MB) were used to detect SLNs. Pathological ultrastaging was performed on hematoxylin-eosin- negative nodes. RESULTS: Results of 72 women were analyzed. The mean age was 47.2 years, 5.5% had a history of tuberculosis, 18.1% had pelvic inflammatory disease, and 65.3% were HIV positive. The SLN detection rate was 65.3%. Detection rate of MB was 56.9%; Tc, 69.4%; ICG, 87.5%; and the combination of MB and Tc, 91.7%. Pelvic nodal metastases occurred in 26.4%. The sensitivity, specificity, negative predictive value, and positive predictive value of SLN biopsy were 85.7%, 100%, 100%, and 98.33%, respectively. The false-negative rate was 14.3%, and it was 0% if the algorithm was applied. CONCLUSIONS: The SLN algorithm is a feasible option for use in cervical cancer women with a high prevalence of HIV infection. The detection rate is generally lower, but in select subgroups of women, it was comparable to that reported elsewhere. This is the first report of the use of SLN biopsy in a substantial group of HIV-infected women.
Subject(s)
Algorithms , HIV Infections/physiopathology , Sentinel Lymph Node Biopsy/methods , Uterine Cervical Neoplasms/diagnostic imaging , Uterine Cervical Neoplasms/virology , Adult , Aged , Female , HIV Infections/epidemiology , Humans , Indocyanine Green , Lymph Node Excision , Lymphatic Metastasis , Middle Aged , Predictive Value of Tests , Prospective Studies , Sentinel Lymph Node/diagnostic imaging , Sentinel Lymph Node/pathology , Sentinel Lymph Node/surgery , South Africa/epidemiology , Technetium Tc 99m Aggregated Albumin , Uterine Cervical Neoplasms/epidemiology , Uterine Cervical Neoplasms/surgeryABSTRACT
Rare cervical cancers are responsible for a minority of cases encountered by a clinician. However, behavioral patterns, management, and prognosis of certain rare cervical cancers differ from either squamous carcinomas or adenocarcinomas. Here we present a case of a locally advanced cervical tumor as a presentation of an extranodal cervical non-Hodgkin lymphoma (NHL), with a review of the current literature.
