A case of septic expulsion of a leiomyoma is reported 18 weeks after uterine artery embolisation (UAE). The patient underwent UAE for a symptomatic sub- mucous leiomyoma (type 2) of 5 cm. She was feverish and presente...A case of septic expulsion of a leiomyoma is reported 18 weeks after uterine artery embolisation (UAE). The patient underwent UAE for a symptomatic sub- mucous leiomyoma (type 2) of 5 cm. She was feverish and presented pelvic pain and purulent vaginal discharges. Vaginal examination revealed a necrotic mass prolapsed through the cervix that was carefully twisted out. Histopathologic examination showed extensive necrosis of the myomatous tissue. Microbiologic cultures showed heavy growth of Escherichia coli. Such findings challenge the interest and the safety of UAE for submucous fibroids. Our case report stresses that uterine artery embolisation for submucous fibroids does not constitute, because of its risks, an alternative to conventional surgical treatment represented mainly by hysteroscopic resection.展开更多
Background/Purpose: The management of exomphalos is controversial with many centers in the United Kingdom and elsewhere advocating a conservative nonsurgical approach for the larger examples. Nevertheless, this approa...Background/Purpose: The management of exomphalos is controversial with many centers in the United Kingdom and elsewhere advocating a conservative nonsurgical approach for the larger examples. Nevertheless, this approach is not without pr oblems or complication. The aim of the study was to ascertain the outcome of all infants with an antenatally diagnosed exomphalos treated recently at our instit ution using a policy of aggressive abdominal wall closure. Methods: This is a re trospective review of all infants with exomphalos treated from January 1995 to S eptember 2002. Results: There were 35 infants, all of whom underwent surgery. Th ese were separated into 3 groups: group A (all exomphalos minor) underwent primary closure (n = 11), group B (exomphalos maj or) underwent primary closure (n = 13), and group C (exomphalos major)- underwe nt staged closure involving a silo (n = 11). Infants in group C had a lower birt h weight (P = .05) and were less mature (P = .06). They required longer periods of ventilation (P<.001), a longer hospital stay (P =. 001), and a longer period to achieve full enteral feeds (P < .001). Overall survival was 34 (97% ) of 35 infants. One premature infant who was born with a ruptured exomphalos sac (birth weight, 862 g) died of nonsurgical complications (sepsis and respiratory failur e) early after the creation of a silo. Conclusions: An aggressive surgical appro ach in infants with exomphalos is a safe option resulting in effective abdominal wall closure. This requires a skilled multidisciplinary approach and possibly g reater resources than other options.展开更多
文摘A case of septic expulsion of a leiomyoma is reported 18 weeks after uterine artery embolisation (UAE). The patient underwent UAE for a symptomatic sub- mucous leiomyoma (type 2) of 5 cm. She was feverish and presented pelvic pain and purulent vaginal discharges. Vaginal examination revealed a necrotic mass prolapsed through the cervix that was carefully twisted out. Histopathologic examination showed extensive necrosis of the myomatous tissue. Microbiologic cultures showed heavy growth of Escherichia coli. Such findings challenge the interest and the safety of UAE for submucous fibroids. Our case report stresses that uterine artery embolisation for submucous fibroids does not constitute, because of its risks, an alternative to conventional surgical treatment represented mainly by hysteroscopic resection.
文摘Background/Purpose: The management of exomphalos is controversial with many centers in the United Kingdom and elsewhere advocating a conservative nonsurgical approach for the larger examples. Nevertheless, this approach is not without pr oblems or complication. The aim of the study was to ascertain the outcome of all infants with an antenatally diagnosed exomphalos treated recently at our instit ution using a policy of aggressive abdominal wall closure. Methods: This is a re trospective review of all infants with exomphalos treated from January 1995 to S eptember 2002. Results: There were 35 infants, all of whom underwent surgery. Th ese were separated into 3 groups: group A (all exomphalos minor) underwent primary closure (n = 11), group B (exomphalos maj or) underwent primary closure (n = 13), and group C (exomphalos major)- underwe nt staged closure involving a silo (n = 11). Infants in group C had a lower birt h weight (P = .05) and were less mature (P = .06). They required longer periods of ventilation (P<.001), a longer hospital stay (P =. 001), and a longer period to achieve full enteral feeds (P < .001). Overall survival was 34 (97% ) of 35 infants. One premature infant who was born with a ruptured exomphalos sac (birth weight, 862 g) died of nonsurgical complications (sepsis and respiratory failur e) early after the creation of a silo. Conclusions: An aggressive surgical appro ach in infants with exomphalos is a safe option resulting in effective abdominal wall closure. This requires a skilled multidisciplinary approach and possibly g reater resources than other options.