ABSTRACT
Post-hysterectomy fallopian tube prolapse is a rare complication with only 80 cases described since 1902. Symptoms are non-specific and often of delayed onset. Final diagnosis is confirmed by vaginal biopsy with salpingectomy being the treatment of choice, preferably performed laparoscopically. Following surgery, complete symptom resolution is usually observed and no recurrence has been reported.
Subject(s)
Fallopian Tube Diseases/etiology , Hysterectomy/adverse effects , Fallopian Tube Diseases/surgery , Female , Humans , Laparoscopy , ProlapseABSTRACT
The case of a young primiparous woman with defibrillator-assisted familial hypertrophic cardiomyopathy (HCM) has led us to review the literature on this pathology, which is exceptional because of its scarcity and the originality of the problems encountered. To our knowledge, this is the first observation ever reported of defibrillator-assisted activation during pregnancy in a woman with HCM. Several questions raised from this particular case, e.g. what are the risks caused by pregnancy in these patients, what is the impact of therapeutics, does the activation of an internal defibrillator involve particular risks, what is the best disposition for delivery and what are the risks for fetuses? We have tried to ask all of these questions, using as exhaustive a literature review as possible.
Subject(s)
Cardiomyopathy, Hypertrophic , Pregnancy Complications, Cardiovascular , Adult , Cardiomyopathy, Hypertrophic/diagnosis , Defibrillators, Implantable , Delivery, Obstetric , Female , Humans , Labor, Obstetric , Postpartum Period , Pregnancy , PrognosisABSTRACT
OBJECTIVE: To compare sonohysterography (SH), in the exploration of the uterine cavity, with classical transvaginal sonography (TVS), hysterography (HSG), and hysteroscopy. STUDY DESIGN: 104 consecutive patients evaluated for uterine disorders underwent both TVS and SH. SH was obtained by distension of the uterine cavity with the instillation of an isotonic saline solution; 36 patients also underwent HSG; 82 women underwent surgery. Histologic findings were considered as gold standard. The criteria used to compare these methods were sensitivity, specificity, and negative and positive predictive values (NPV, PPV) for identifying pathology. RESULTS: 3 instillation failures occurred. SH was found to be more effective (sensitivity 94%, specificity 98%) than HSG (sensitivity 67%, specificity 94%). The difference between TVS and SH was less marked, SH showing some superiority (sensitivity 88%, specificity 98%) to TVS (sensitivity 77%, specificity 93%). CONCLUSION: SH represents an improvement over conventional TVS and is fully capable of replacing HSG for the study of the uterine cavity.
Subject(s)
Ultrasonography, Interventional , Uterine Diseases/diagnostic imaging , Adult , Female , Humans , Hysterosalpingography , Hysteroscopy , Middle Aged , Sensitivity and Specificity , Ultrasonography, Interventional/instrumentation , Ultrasonography, Interventional/methods , Uterine Diseases/diagnosis , Uterine Diseases/pathology , Uterus/diagnostic imaging , Uterus/pathologyABSTRACT
OBJECTIVE: Evaluate the reliability, safety and performance of hysterosonographic assessment of the uterine cavity. MATERIALS AND METHODS: Hysterosonography was performed in 220 patients with injection of sterile saline into the uterine with a novel catheter. Among these patients, 132 patients then underwent a hysteroscopy or hysterectomy with a histology examination. RESULTS: There were 8 failures: 2 synechiae, 3 atresias of the cervix, and massive reflux in 3 cases. No other complication occurring. Hysterosonography appeared to give more information on the uterine cavity than standard vaginal sonography. In cases with metrorrhage before menopause, the diagnosis was correct in 75.4% of the cases. Errors were related to confusion between polyp and hyperplasia. In post-menopausal metrorrhagia, there was 92% agreement between sonography and histological results. Agreement was 86.3% in cases of infertility. CONCLUSION: Hysterosonography using saline solution injected with a novel catheter can be an excellent means of evaluating the uterine cavity and can completely replace classical hysterography, thus avoiding many exploratory hysterocopies.
Subject(s)
Hysteroscopy/methods , Ultrasonography, Interventional/methods , Uterine Diseases/diagnostic imaging , Bias , Diagnosis, Differential , Feasibility Studies , Female , Humans , Hysterectomy , Hysteroscopes , Injections , Reproducibility of Results , Sodium Chloride/administration & dosage , Ultrasonography, Interventional/instrumentation , Uterine Diseases/pathology , Uterine Diseases/surgeryABSTRACT
The intrauterine death of one fetus in the case of multiple pregnancies can have an impact on the development of the surviving twin. Based on a single-centre retrospective personal study of 248 multiple pregnancies, 10 of which presented a monofetal intrauterine death, the authors observed the type of placentation, the age and cause of the death, the way in which pregnancy continued and the outcome of the surviving twin. This investigation also includes a review of published documents. Monochorial pregnancies were more frequently encountered in the case of monofetal death in utero. The etiology of the death was not always found and one surviving twin presented lesions as microcephaly convulsions and was retarded on a psychomotor level. In this series these complications did not exist when the pregnancy was bichorial. The authors conclude by demonstrating the major risk of fetal contamination for a live twin coexisting with a dead twin in the case on monochorial pregnancy. Other parameters (cause of death, gestational age at death, delay and duration of cohabitation), do not seem to be significant. It would appear to be of fundamental importance to establish an accurate diagnosis of placentation and to implement specific surveillance of monochorial pregnancies. A decision tree is suggested for use in the case of monofetal death.
