Results of extension of classic indications of vaginal hysterectomy for benign uterine conditions.

OBJECTIVE: to compare the results of two surgical approaches: one is to apply vaginal hysterectomy (VH) for non-prolapsed uterus respecting classic indications and contraindications and the other is to extend the indications of VH and decrease the contraindications by performing VH for large uterus, in nulliparous and in women with history of C section. STUDY DESIGN: 816 women with benign uterine pathology were included in this prospective study. In 465 were applied classic indications of VH and in 351 VH was applied as first choice, trying to overcome classic contraindications of VH. RESULTS: By extending classic indications of VH important benefits were obtained such as decreasing the operation time and shorter hospital stay. No differences were registered between the two arms of the study regarding intra and postoperative bleeding or major complications. CONCLUSIONS: extending classic indications of VH has important benefits without an increase in major complications occurrence.

Young woman with polyserositis, ovarian cystic mass and increased level of CA-125. Case report of peritoneal and pleural tuberculosis.

A 21-year-old woman was addressed to our department for progressive abdominal swelling, fatigue and fever. The clinical examination, the ultrasound examination and the computed tomography showed the presence of polyserositis (ascites and pleural effusion) and revealed a cystic mass at the level of right ovary. The laboratory work-up showed an increased level of CA-125, suggesting a malignancy. The thoracoscopy with visualization of the pleura revealed disseminated small white spots. The laparoscopic exploration of the pelvis and of the peritoneum also showed the same disseminated lesions and a cystic-like mass at the level of the right ovary which was excised and diagnosed as a benign cyst. At the analysis of the frozen and paraffin sections, the diagnostic of pleural and peritoneal tuberculosis was made and the specific quadruple treatment was started with a good evolution at two months and with the normalization of the CA-125 level. This case report underlines the importance of tuberculosis in the differential diagnosis of patients with polyserositis and increased levels of CA-125.