Objective: Unicornuate uterus with rudimentary cavity is anextremely rare Mullerian duct anomaly. It is frequently misdiagnosedor under treated, since women who suffer from thiscondition tend to be asymptomatic. We aimed to report thisinteresting case and review the available background literature.Methods: Case report.Case: A thirty two-year-old nulligravid woman was presentedwith severe abdominal pain. Laparoscopic surgery demonstratedunicornuate uterus with arudimentary cavity and hematometra.Partial hysterectomy was conducted to the right rudimentaryuterus.Conclusion: Thorough diagnosis is essential to prevent thecomplications of unicornuate uterus. Unicornuate uterus withrudimentary cavity is associated with increased rate of pregnancycomplications such as preterm labor and fetal malpresentation.Pregnancy can also occurred on the rudimentary cavity and leadsto recurrent pregnancy loss. Laparoscopy is essential for confirmatorydiagnosis. Surgical intervention should be considered asthe first line therapy to avoid associated morbidity.[Indones J Obstet Gynecol 2017; 5-4: 246-249]Keywords: hematometra, hysterectomy, unicornuate uterus
Objective: to highlight the needs of awareness on recognizing, prevent and address complications in laparoscopic gynecologic surgery.Method: Literature reviewDiscussion: The complications of laparoscopic gynecologic surgery mainly can be classified as complications related to anesthesia, entry technique, electrosurgical, postoperative and visceral due to surgical procedure itself. Lam proposed a 6 phase-based classification of laparoscopic surgery complications; patient identification, anesthesia and positioning, abdominal entry and port placement, surgery, postoperative recovery and counselling. The aim of this classification is to promote a culture risk management to improve patient safety and outcome. Each and every phase above should be able to assessed, analyzed and executed properly to prevent complications. Conclusion: Complication in operative laparoscopy is generally minor and can be handled successfully. However, although very rare, major complications are detrimental to the patient. It also becomes heavy burden for the surgeons. Preventive measures should be implemented not only by the operator but also the anesthesiologist, and theatre practitioners. Systematic drills, which regularly re rehearsed is important in order to maintain team proficiencies. Keywords: complications, gynecologic laparoscopy, operative Laparoscopy Abstrak Tujuan: Untuk menekankan pentingnya mengenali, mencegah dan mengatasi secara dini komplikasi operasi laparoskopi ginekologi. Metode: Kajian pustaka Diskusi : Komplikasi operasi ginekologi laparoskopi dapat diklasifikasikan menjadi komplikasi yang berhubungan dengan anestesi, teknik masuknya trokar utama, terkait elektro surgikal, komplikasi pascaoperasi dan komplikasi visera (pembuluh darah, usus, cedera traktus urinarius) terkait tindakan operasi itu sendiri. Lam mengusulkan suatu klasifikasi berbasis fase, antara lain, identifikasi pasien, anestesi dan posisi pasien, akses masuk abdomen dan penempatan trokar, terkait operasi, pemulihan pascaoperasi dan konseling. Tujuan dari klasifikasi ini adalah untuk meningkatkan budaya sadar risiko,guna meningkatkan keselamatan pasien. Setiap tahap harus dapat dilaksanakan, dinilai dan dianalisis dengan baik untuk mencegah terjadinya komplikasi. Kesimpulan: Komplikasi pada operasi ginekologi laparoskopi umumnya ringan dan dapat ditangani dengan baik. Walaupun jarang terjadi, komplikasi berat umumnya sangat merugikan pasien dan menjadi beban operator. Langkah-langkah pencegahan ini harus dilaksanakan oleh operator, tim anestesi serta seluruh tim kamar operasi. Simulasi harus dilaksanakan, guna mempertahankan kecakapan tim Kata kunci : komplikasi, laparoskopi ginekologi, laparoskopi operatif
Objective: To investigate the role of CC-highly purified Human Menopausal Gonadotropin (hpHMG) and Growth Hormone (GH) in mini-stimulation protocol to improve outcome in poor ovarian responders (POR). Method: All patients were given clomiphene citrate 150 mg from day 3 to day 7 of menstrual cycle followed by 150 IU hpHMG daily from day 8 until ovulation trigger. Two groups were observed where one group received GH and the other arm did not. In the GH group, 8 IU of GH were given from day 1 of stimulation until stimulation was stopped. GnRH antagonist was used to suppress ovulation. Result: Among 51 eligible women, 29 patients with GH and 22 patients without GH, no difference was observed in the number of oocytes retrieved (2.21 versus 2.64) and the number of embryos transferred (1.24 versus 1.68) in the GH group versus the group without GH, respectively. Total clinical pregnancy rate was 17.6%. No significant difference in pregnancy and ongoing pregnancy rate in both groups (17.2% versus 18.2%) and (13.8% versus 13.6%), respectively. In patients older than 40 years old, GH showed a 4-fold likelihood in producing top quality embryos (44.8% vs 13.6%, OR=3.6, p=0.05). Conclusion: CC-HMG regimen in mini-stimulation protocol is an effective option in poor responders. Additional GH in ministimulation program provided a higher number of top quality embryos in women older than 40 years old, although there were no difference in clinical or ongoing pregnancy rate. Keywords: CC-HMG, growth hormone, IVF, mini-stimulation protocol, poor ovarian responders
Introduction: The E6 and E7 oncoproteins of high-risk Human Papillomavirus (HPV) have crucial roles in cervical cancer pathogenesis by inhibiting p53 and retinoblastoma protein (pRb) which are tumor suppressor genes. Genetic sequence mutations of E6 and E7 oncogenes can affect E6/E7 protein functions that will change E7-pRB interaction. Furthermore, this condition will influence progression cervical cancer progression in several intratypic variants of high-risk HPV type 16. Methods: A cross-sectional study was conducted from September 2020-September 2021, at the Obstetrics and Gynecology Outpatient Clinic, Prof Dr I. G. N. G. Ngoerah General Hospital. Consecutive sampling was taken by collecting cervical cancer tissue followed by isolation, amplification, and gene sequencing to assess E6 and E7 mutations. The expression of pRb was measured by immunohistochemical staining (IHC). Results: From 100 cervical cancer subjects, 31 subjects were found HPV16 positive (19 wildtype and 12 mutants). The proportion of E6 and E7 mutants was 25.8% and 12.9% respectively. This study shows that T27C/F9F; A360G/E120E and G371A/R124K variants were found on E6 oncogene mutations, meanwhile, A86C/N29T; A86G/N29S; C229T/R77C and T285C/S95S variants were detected on E7 oncogene mutations. The types of E6 mutations were T27C (16.1%), A360G (6.4%) and G371A (1 subject; 3.2%). In addition, pRb expression was stronger in mutant group than wild-type group 60.5% vs. 53%. There was no correlation between retinoblastoma protein expression and mutations E6/E7 oncogene HPV Type 16 (PR 0.22; 95% CI 0.03-1.6; p value 0.10). Conclusions: In cervical cancer, there is no significant difference between the expression of retinoblastoma protein in mutant vs wildtype E6 and E7 oncogene HPV16.
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