scholarly journals Developing a Preoperative Algorithm for the Diagnosis of Uterine Leiomyosarcoma

Diagnostics ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. 735
Author(s):  
Hannah Lawlor ◽  
Alexandra Ward ◽  
Alison Maclean ◽  
Steven Lane ◽  
Meera Adishesh ◽  
...  
Keyword(s):  
Endometrial Biopsy ◽  
Uterine Leiomyosarcoma ◽  
Postmenopausal Bleeding ◽  
Prompt Treatment ◽  
Cellular Atypia ◽  
Postmenopausal Status ◽  
Benign Leiomyoma ◽  
Life Threatening ◽  
Mass Size ◽  
Postoperative Diagnosis

Early diagnosis of the rare and life-threatening uterine leiomyosarcoma (LMS) is essential for prompt treatment, to improve survival. Preoperative distinction of LMS from benign leiomyoma remains a challenge, and thus LMS is often diagnosed post-operatively. This retrospective observational study evaluated the predictive diagnostic utility of 32 preoperative variables in 190 women who underwent a hysterectomy, with a postoperative diagnosis of leiomyoma (n = 159) or LMS (n = 31), at the Liverpool Women’s National Health Service (NHS) Foundation Trust, between 2010 and 2019. A total of 7 preoperative variables were associated with increased odds of LMS, including postmenopausal status (p < 0.001, OR 3.08), symptoms of pressure (p = 0.002, OR 2.7), postmenopausal bleeding (p = 0.001, OR 5.01), neutrophil count ≥7.5 × 109/L (p < 0.001, OR 5.72), haemoglobin level <118 g/L (p = 0.037, OR 2.22), endometrial biopsy results of cellular atypia or neoplasia (p = 0.001, OR 9.6), and a mass size of ≥10 cm on radiological imaging (p < 0.0001, OR 8.52). This study has identified readily available and easily identifiable preoperative clinical variables that can be implemented into clinical practice to discern those with high risk of LMS, for further specialist investigations in women presenting with symptoms of leiomyoma.

scholarly journals Role of Ultrasound in the Assessment of Postmenopausal Bleeding

2012 ◽  
Vol 6 (2) ◽  
pp. 197-206 ◽  
Author(s):  
Kallie Appleton
Keyword(s):  
Doppler Ultrasound ◽  
Color Doppler ◽  
Power Doppler ◽  
Endometrial Biopsy ◽  
Common Symptom ◽  
Uterine Leiomyosarcoma ◽  
Postmenopausal Bleeding ◽  
3D Power Doppler ◽  
Case Based

ABSTRACT Uterine bleeding is a symptom seen by gynecologists in approximately 70% of their visits with women of peri and postmenopausal age. A common symptom, postmenopausal bleeding sometimes can be indicative of malignant pathology. While traditional diagnosis took place via endometrial biopsy, diagnosis is trending toward the use of ultrasound. Benefits of ultrasound include its noninvasive nature, decreased cost, and increased accuracy in diagnosis of postmenopausal bleeding. We present a case-based approach to the usage of various ultrasonography techniques including 2D and color Doppler ultrasound, saline infusion sonography (SIS), 3D and 3D power Doppler ultrasound, as complements to traditional diagnosis of endometrial biopsy. In each of the cases, ultrasonography reveals the diagnosis of postmenopausal pathologies, including atrophic endometrium, endometrial polyps, endometrial hyperplasia, and the malignant pathology, such as endometrial carcinoma, uterine leiomyosarcoma and cervical carcinoma. By the end of our case-based discussion, learners are encouraged to test their knowledge in self-assessment quiz. How to cite this article Appleton K, Plavsic SK. Role of Ultrasound in the Assessment of Postmenopausal Bleeding. Donald School J Ultrasound Obstet Gynecol 2012;6(2):197-206.

Pharmacology Update: School Nurse Role and Emergency Medications for Treatment of Anaphylaxis

2021 ◽  
pp. 1942602X2110219
Author(s):  
Theresa A. Bingemann ◽  
Anil Nanda ◽  
Anne F. Russell
Keyword(s):  
Side Effects ◽  
School Personnel ◽  
Local Environment ◽  
School Nurses ◽  
First Line ◽  
Onset Of Action ◽  
Epinephrine Administration ◽  
Prompt Treatment ◽  
Nurse Role ◽  
Life Threatening

Anaphylaxis is a rapidly occurring allergic reaction that is potentially life threatening. Recognition of the early signs and prompt treatment of anaphylaxis is critical. School nurses are tasked with educating nonmedical school personnel on the recognition and treatment of anaphylaxis and emphasizing that epinephrine is the first line of treatment for anaphylaxis. Fortunately, there is now availability of multiple epinephrine administration devices. However, this also means that there are more devices that school nurses and nonmedical assistive personnel need to learn about to be able to administer in an emergency. Once epinephrine is administered, emergency medical services must be activated. Education regarding what to expect after the administration of epinephrine with respect to side effects and onset of action is also necessary. Though adjunctive medicines, such as antihistamines and inhalers, may also be administered after the injection of epinephrine, they should not be solely relied on in anaphylaxis. School nurses are uniquely situated for this role, as they understand the local environment in a school and can assess and reassess the needs of the faculty and staff.

Postpartum ovarian vein thrombosis

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Kelly Ribeiro ◽  
Samir Mahboobani ◽  
Katherine Van Ree ◽  
Katy Clifford ◽  
TG Teoh
Keyword(s):  
Abdominal Pain ◽  
Complete Resolution ◽  
Early Recognition ◽  
Ovarian Vein ◽  
Transabdominal Ultrasound ◽  
Case Presentation ◽  
Vein Thrombosis ◽  
Prompt Treatment ◽  
Life Threatening ◽  
Ovarian Vein Thrombosis

Abstract Objectives Postpartum ovarian vein thrombosis (POVT) is a rare pathology that can lead to severe complications such as sepsis, extension of the thrombus leading to organ failure, and pulmonary embolism. It therefore requires early recognition and prompt treatment. Case presentation A patient with right POVT presented four days after delivery with acute right-sided abdominal pain and fever. Appendicitis was initially considered, before an abdominal-pelvic computed tomography raised the suspicion of POVT, subsequently confirmed through transabdominal ultrasound. Antibiotics and anticoagulation were initiated, with rapid clinical improvement and complete resolution of the thrombus three months later. Conclusions Diagnosing POVT is challenging as it clinically mimics other more frequent conditions. It is rare but life-threatening and should be considered in all females presenting with abdominal pain and fever in the postpartum period.

POTT’S PUFFY TUMOR: A CASE REPORT

2020 ◽  
Vol 18 (Suppl.1) ◽  
pp. 93-96
Author(s):  
V. Stoyanov ◽  
D. Petkov ◽  
P. Bozdukova
Keyword(s):  
Case Report ◽  
Early Diagnosis ◽  
Rare Complication ◽  
Frontal Bone ◽  
Frontal Sinusitis ◽  
Subperiosteal Abscess ◽  
Prompt Treatment ◽  
Pott’S Puffy Tumor ◽  
Intracranial Complications ◽  
Life Threatening

Pott’s puffy tumor (PPT) is a rare complication of sinusitis characterized by osteomyelitis of the frontal bone with subperiosteal abscess presenting as frontal swelling. It was first described by Sir Percival Pott in 1768 in relation to frontal head trauma. Later, it was established that this entity is more common in relation to frontal sinusitis (1). In this article we report a case of PPT in a 17-year-old boy. CT scan confirmed subperiosteal abscess. At surgery, the subperiosteal abscess was drained and sequestrectomy of the affected frontal bone was done. Broad-spectrum antibiotics were given for 4 weeks. The patient recovered without residual problems and has remained well. PPT is now relatively uncommon and early diagnosis and prompt treatment is necessary to avoid further intracranial complications, which can be life-threatening.

scholarly journals Thromboembolic complications of thyroid storm

2014 ◽  
Vol 2014 ◽  
Author(s):  
T Min ◽  
S Benjamin ◽  
L Cozma
Keyword(s):  
Atrial Fibrillation ◽  
Early Recognition ◽  
Massive Pulmonary Embolism ◽  
Clinical Findings ◽  
Favourable Outcome ◽  
Thyroid Storm ◽  
List Type ◽  
Chads2 Score ◽  
Prompt Treatment ◽  
Life Threatening

Summary Thyroid storm is a rare but potentially life-threatening complication of hyperthyroidism. Early recognition and prompt treatment are essential. Atrial fibrillation can occur in up to 40% of patients with thyroid storm. Studies have shown that hyperthyroidism increases the risk of thromboembolic events. There is no consensus with regard to the initiation of anticoagulation for atrial fibrillation in severe thyrotoxicosis. Anticoagulation is not routinely initiated if the risk is low on a CHADS2 score; however, this should be considered in patients with thyroid storm or severe thyrotoxicosis with impending storm irrespective of the CHADS2 risk, as it appears to increase the risk of thromboembolic episodes. Herein, we describe a case of thyroid storm complicated by massive pulmonary embolism. Learning points Diagnosis of thyroid storm is based on clinical findings. Early recognition and prompt treatment could lead to a favourable outcome. Hypercoagulable state is a recognised complication of thyrotoxicosis. Atrial fibrillation is strongly associated with hyperthyroidism and thyroid storm. Anticoagulation should be considered for patients with severe thyrotoxicosis and atrial fibrillation irrespective of the CHADS2 score. Patients with severe thyrotoxicosis and clinical evidence of thrombosis should be immediately anticoagulated until hyperthyroidism is under control.

scholarly journals Epithelioid leiomyosarcoma: a rare uterine cancer

2018 ◽  
Vol 7 (4) ◽  
pp. 1663
Author(s):  
Upadhya Rekha ◽  
Vidyashree G. Poojari ◽  
Muralidhar V. Pai ◽  
Jayaraman Nambiar
Keyword(s):  
Tumour Growth ◽  
Uterine Cancer ◽  
Malignant Tumour ◽  
Uterine Sarcoma ◽  
Uterine Leiomyosarcoma ◽  
Postmenopausal Bleeding ◽  
Palpable Mass ◽  
Menopausal Women ◽  
Operative Findings ◽  
Mass Lesions

A uterine epithelioid leiomyosarcoma is a rare malignant tumour that arises from the smooth muscle lining the walls of the uterus. The exact cause of leiomyosarcoma, including uterine leiomyosarcoma accounting for 5 to 10% is unknown. Leiomyosarcoma is the most common subtype of uterine sarcoma, accounts for 1-2% of uterine malignancies. Malignancy should be suspected in menopausal women with tumour growth who are not on hormonal replacement therapy. A 64-year-old female had attained menopause 16 year back and developed postmenopausal bleeding since 2 months, with palpable mass, of 16 weeks size. Ultrasonography showed whorled mass lesions, endometrium and myometrium could not be seen separately. Uterus with both ovaries removed. Intra-operative findings showed 16 weeks uterine mass with size 15×10.5×10cm and weight 1kg with intramural fibroid. Necrotic and haemorrhagic areas with degenerative changes seen on cut section suggestive of malignancy. Histopathology and immunohistochemistry reported epithelioid leiomyosarcoma.

scholarly journals The role of hysteroscopy in diagnosis and treatment of postmenopausal bleeding

2013 ◽  
Vol 70 (8) ◽  
pp. 747-750 ◽  
Author(s):  
Sonja Pop-Trajkovic-Dinic ◽  
Aleksandar Ljubic ◽  
Vesna Kopitovic ◽  
Vladimir Antic ◽  
Snezana Stamenovic ◽  
...  
Keyword(s):  
Histological Examination ◽  
Predictive Value ◽  
Surgical Procedure ◽  
Diagnostic Procedure ◽  
Pathological Finding ◽  
Endometrial Biopsy ◽  
Postmenopausal Bleeding ◽  
Histological Findings ◽  
Minimally Invasive Surgical Procedure ◽  
Gynecology And Obstetrics

Background/Aim. Abnormal uterine bleeding is the most common problem which brings woman to the gynecologist during the postmenopausal period. The aim of this study was to define the significance of hysteroscopy as a diagnostic procedure for the evaluation of patients with postmenopausal bleeding, as well as to define it as a surgical procedure by which the cause of bleeding can be treated in most cases in the same sitting. Methods. The study involved 148 female patients referred to the Clinic for Gynecology and Obstetrics in Nis for postmenopausal bleeding in the period of 12 months. Hysteroscopy with endometrial biopsy were performed in all the patients. Biopsy materials were directed to histological examination, and the hysteroscopic and histological findings were compared afterwards. Polyps and submucous miomas were hysteroscopically removed in the same sitting and also directed to histological examination. Results. The success rate of the method was 95.1%, while complications occurred in 1.37% of the cases. The hysteroscopic findings were normal in almost 30% of the cases, and the most common pathological finding was endometrial polyp. The sensitivity of hysteroscopy in the detection of intrauterine pathology was 100%, the specificity 81%, the positive predictive value 92% and the negative predictive value 100%. In 69.7% of the patients the cause of bleeding was hysteroscopically removed. Hysteroscopy was performed in 58.1% of the patients in the same sitting, and in 11.6% of the patients after obtaining histological findings. Conclusion. Hysteroscopy is a safe, highly sensitive diagnostic procedure, thus being an ideal method for evaluation of patients with postmenopausal bleeding. The application of hysteroscopy with endometrial biopsy leads to accurate diagnosis. An adequate diagnosis is crucial for the selection of relevant treatment of postmenopausal bleeding and avoidance of unnecessary major surgical procedures. Except for being a diagnostic method hysteroscopy, is also an outpatient minimally invasive surgical procedure for treating the cause of bleeding in the majority of cases in the same sitting.

The role of endometrial biopsy in the preoperative detection of uterine leiomyosarcoma

2015 ◽  
Vol 137 ◽  
pp. 164
Author(s):  
E.M. Hinchcliff ◽  
K.M. Esselen ◽  
J. Watkins ◽  
J.A. Rauh-Hain ◽  
T. Oduyebo ◽  
...  
Keyword(s):  
Endometrial Biopsy ◽  
Uterine Leiomyosarcoma

scholarly journals Adult Onset Henoch-Schonlein Purpura and Intussusception: A Rare Presentation

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Mridula Krishnan ◽  
Joseph Nahas
Keyword(s):  
Unusual Case ◽  
Surgical Intervention ◽  
Gastrointestinal Symptoms ◽  
Adult Onset ◽  
Henoch Schonlein Purpura ◽  
Rare Presentation ◽  
Prompt Treatment ◽  
Life Threatening ◽  
Schonlein Purpura ◽  
Henoch Schönlein Purpura

We present an unusual case of a young 26-year-old male who was diagnosed with Henoch-Schonlein Purpura (HSP). Initial presentation was primarily mild gastrointestinal symptoms, which progressed to a life threatening intussusception and subsequently resolved with prompt glucocorticoid use rather than typical surgical intervention. Of importance, the patient’s initial gastrointestinal symptoms without associated skin manifestations made the diagnosis difficult. In conclusion, it is important to recognize uncommon presentations of HSP as it may lead to life threatening complications and surgical intervention may be avoided with prompt treatment.

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