The aim of this study was to analyze the clinical and reproductive outcomes of patients treated with myomectomy who were histologically diagnosed with uterine smooth muscle tumor of uncertain ...malignant potential (STUMP).
Patients who were diagnosed with STUMP and underwent a myomectomy at our institution between October 2003 and October 2019 were identified. Variables of interest obtained from the institution's database included patient age, relevant medical history, pre-operative appearance of the tumor on ultrasound, parameters of the surgical procedure, histopathological analysis of the tumor, post-operative clinical course, and course of follow-up, including reinterventions and fertility outcomes.
There were a total of 46 patients that fulfilled the criteria of STUMP. The median patient age was 36 years (range, 18-48 years) and the mean follow-up was 47.6 months (range, 7-149 months). Thirty-four patients underwent primary laparoscopic procedures. Power morcellation was used for specimen extraction in 19 cases (55.9% of laparoscopic procedures). Endobag retrieval was used in nine patients and six procedures were converted to an open approach due to the suspicious peri-operative appearance of the tumor. Five patients underwent elective laparotomy due to the size and/or number of tumors; three patients had vaginal myomectomy; two patients had the tumor removed during planned cesarean section; and two underwent hysteroscopic resection.There were 13 reinterventions (five myomectomies and eight hysterectomies) with benign histology in 11 cases and STUMP histology in two cases (4.3% of all patients). We did not observe any recurrence as leiomyosarcoma or other uterine malignancy. We did not observe any deaths related to the diagnosis. Twenty-two pregnancies were recorded among 17 women, which resulted in 18 uncomplicated deliveries (17 by cesarean section and one vaginal), two missed abortions, and two pregnancy terminations.
Our study found that uterus-saving procedures and fertility-preservation strategies in women with STUMP are feasible, safe, and seem to be associated with a low risk of malignant recurrence, even while maintaining the mini-invasive laparoscopic approach.
The aim of this study was to evaluate hysteroscopic findings after laparoscopic and laparotomic myomectomy with a focus on the presence of postoperative intrauterine adhesions in groups of patients ...with and without perioperative uterine cavity breach (UCB).
This is a historical cohort study. Our database was searched to identify patients with UCB during myomectomy and matched the same number of patients after myomectomy without UCB to create a control group. All relevant data were retrieved from our medical records. In both groups, the results of follow-up hysteroscopy were analyzed.
Low prevalence of intrauterine adhesions after myomectomy was observed in only 3.5% of the 170 patients in our samples. No significant difference in the occurrence of synechiae between the patients with and without UCB was found (2 vs. 4, RR 0.5, 95% CI 0.1-2.7, p = .341), nor was the difference in other hysteroscopic findings. Follow-up hysteroscopy was performed with slender optics and expandable casing system without need of any anesthesia in 87.1% of cases.
According to our findings, the prevalence of post-myomectomy intrauterine adhesions after myomectomy is low. Our study did not demonstrate that UCB during myomectomy is a risk factor for the formation of intrauterine synechiae.
This study was designed to evaluate the feasibility and effectiveness of hysteroscopy in the management of symptoms related to endometrial polyps and submucous leiomyomas in women using a ...levonorgestrel-releasing intrauterine system (LNG-IUS).
Twenty-three LNG-IUS users presenting with endometrial polyps and/or submucous leiomyomas and irregular uterine bleeding were recruited for hysteroscopic examination and surgery. Intrauterine pathology was investigated and treated by hysteroscopic resection with the LNG-IUS in situ, and the effect of the procedure on symptoms was evaluated after three to six months.
Intrauterine pathology was successfully resected by hysteroscopy in 23 (100.0%) out of 23 cases. Following hysteroscopy, 18 (78.3%) women reported amenorrhea, one (4.3%) regular spotting, three (13.0%) irregular spotting and one (4.3%) patient resumed normal menstrual cycle. We conclude that 19 (82.6%) patients were postoperatively asymptomatic. All procedures were uncomplicated and 4 (17.4%) were carried out without general anesthesia as office procedures.
Endometrial polyps and submucous leiomyomas can develop in LNG-IUS users, and this can cause irregular uterine bleeding. Hysteroscopic resection of these pathologies is a feasible method in the clinical management of symptoms.
Allopregnanolone and pregnenolone sulfate, which are neuroactive steroids that differentially modulate the sensitivity of GABA
A and NMDA receptors, were measured simultaneously in maternal and fetal ...sera and in amniotic fluid for the first time during the second trimester of gravidity. The study included 33 pregnant women, who underwent cordocentesis due to suspicion of fetal abnormality or alloimmunization. Allopregnanolone concentrations in maternal and fetal sera were similar and close to the previously found levels in healthy controls at 20 weeks of gestation The levels of pregnenolone sulfate in maternal serum were 2–3 times higher and in fetal serum, as much as 10–25 times higher than those found by others in the serum of healthy, non-pregnant women. A positive correlation between maternal and fetal allopregnanolone indicate similar 5α-reductase activities or the efficient transport of allopregnanolone between the two subjects. No correlation of pregnenolone sulfate levels between mother and fetus was found. This finding suggests the autonomous production of pregnenolone sulfate in mother and fetus.
The wear of slurry shield TBM excavation tools is a challenging topic that has been discussed over many years, Due to the complexity of the tribological system that defines the tool wear, no ...sufficient approach to determine the wear in a specific tunneling project has been developed up to now. The elementary step to display the application-oriented tribological system is one of the main issues regarding laboratory scale test methods. Therefore, the RUB Tunneling Device has been developed at the Ruhr-University Bochum (Germany). With this apparatus, several influencing factors regarding the tribological system of a TBM-tool can be analyzed. A unique feature of the device is the experimental simulation of a slurry shield excavation, including a realistic tunnel face support. This paper focuses on the experimental simulation of slurry shield excavation and the influence of face support on tool wear. Changes in the soil mechanical properties due to slurry penetration at the tunnel face are regarded and correlated with the tribological system of a slurry shield excavation. It is proven that the tribological system, and thus the tool wear, changes significantly due to slurry injection.
An empirical and a numerical calculation model were developed to predict the surface settlements due to EPB tunnelling in hard rock with heterogeneous face conditions. For this purpose, surface ...settlement and TBM driving data from Boßler Tunnel were considered. The TBM launching area characterised by a low overburden (z/D < 2) and a nature conservation area at surface was examined. The developed models were calibrated against the measured surface settlements of the first eastbound tube and were used to predict the surface settlements of the subsequent westbound tube. The prediction was then compared to the actual measured settlements during the excavation of the westbound tube. From this, findings for future settlement predictions in similar ground conditions were derived. It could be shown that both models are suitable for the application in the investigated subsoil conditions and can be used successfully in practice in different phases of the project development.
Zur Prognose der Oberflächensetzungen für EPB‐Vortriebe in Festgestein bei heterogenen Ortsbrustverhältnissen wurde am Beispiel des Boßlertunnels ein empirisches und ein numerisches Berechnungsmodell aufgestellt. Dazu wurden die Setzungsdaten, die aus dem Vortrieb der zuerst aufgefahrenen Oströhre des Boßlertunnels vorlagen, sowie die Vortriebsdaten der Maschine berücksichtigt. Untersucht wurde speziell der Anfahrtsbereich mit einer geringen Überdeckung (z/D < 2). Oberhalb des Tunnels befindet sich in diesem Bereich ein Naturschutzgebiet. Basierend auf den gemessenen Setzungen oberhalb der Oströhre wurden die Modelle kalibriert. Mit beiden Modellen wurden dann die Setzungen oberhalb der Weströhre, die nach der Oströhre aufgefahren wurde, prognostiziert. Die tatsächlichen Setzungen wurden anschließend ausgewertet und den prognostizierten gegenübergestellt. Daraus wurden Erkenntnisse für zukünftige Setzungsprognosen in ähnlichem Baugrund abgeleitet. Es konnte gezeigt werden, dass beide Modelle für die Anwendung in dem untersuchten Baugrund geeignet sind und in unterschiedlichen Phasen der Projektbearbeitung in der Praxis angewendet werden können.
In slurry shield tunnelling, a reliable face support is presumed if a sufficient support pressure is transferred and the slurry excess pressure provides efficient support pressure on the soil ...skeleton. The required support pressure is calculated in reference to the groundwater pressure and the earth pressure. In this paper, the sliding wedge mechanism is applied. To ensure face stability, the support pressure transfer needs to be provided within the theoretical sliding wedge at the tunnel face. Therefore, the penetration depth of the bentonite suspension as a support medium has to be kept within limits. Research shows that certain penetration is required.
The stagnation gradient defines the relation of the support pressure and the penetration depth of the suspension. The gradient has a described minimum, but also an undefined but existing maximum. The German standard DIN 4126 describes two cases for the minimum at each trench depth: Either the pressure losses due to the pressure acting outside the sliding wedge are less than 5 % or the stagnation gradient is at least 200 kN/m3. If the supporting pressure gradient is below 200 kN/m3, DIN 4126 defines rough reduction factors. For a more precise observation of the stagnation gradient, this paper presents a detailed supplement to the DIN 4126 approach taking the tunnel diameter and the angle of the sliding wedge into account. The aim is to determine the minimum recommended stagnation gradient for which no increase of the slurry excess pressure is necessary due to too deep penetration.
The levonorgestrel-releasing intrauterine system (LNG-IUS) is widely used and recommended as a reliable contraceptive. It also acts by opposing the effects of estrogen on the endometrium, thereby ...preventing development of endometrial hyperplasia and its possible malignant transformation. This case describes a 52-year-old multiparous amenorrhoeic patient who was seen in the gynecology outpatient department for a routine control 46 months after the insertion LNG-IUS as contraception. Hysteroscopy with a target biopsy following suspicious ultrasound scan confirmed well-differentiated endometrioid adenocarcinoma. Ultrasound scan prior to inserting LNG-IUS revealed normal 5 mm thin endometrium with the sharp edges. Uterine bleeding before the LNG-IUS insertion was regular and not excessive and the woman has remained amenorrhoeic after the LNG-IUS insertion. We present a case of the growth of a polyp-shaped endometrial carcinoma in a LNG-IUS asymptomatic user.
An entirely new method of optical microscopy in transmitted light "Relief Contrast after Hostounsky" or RCH, Lambda Ltd. Prague, Czech Republic, was used to study integument surface replicas of ...reptiles (microrelief adhesive method after Wolf) as well as reptilian sloughts. This equipment provides a three-dimensional image of high contrast and resolution. Compared to microscopy without phase or interference contrast, RCH-microscopy makes it possible to evaluate a three-dimensional organization of microrelief on reptilian scales. Results obtained from these microscopical observations can be used for both ecological and taxonomical studies on animals.
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