A New Anatomic and Staging-Oriented Classification Of
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Factors Associated with Parametrial Involvement
Original Article Obstet Gynecol Sci 2018;61(1):88-94 https://doi.org/10.5468/ogs.2018.61.1.88 pISSN 2287-8572 · eISSN 2287-8580 Factors associated with parametrial involvement in patients with stage IB1 cervical cancer: who is suitable for less radical surgery? Seung-Ho Lee1, Kyoung-Joo Cho1, Mi-Hyang Ko1, Hyun-Yee Cho2, Kwang-Beom Lee1, Soyi Lim1 1Departments of Obstetrics and Gynecology, 2Pathology, Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea Objective To detect the possible clinicopathologic factors associated with parametrial involvement in patients with stage IB1 cervical cancer and to identify a cohort of patients who may benefit from less radical surgery. Methods We retrospectively reviewed 120 patients who underwent radical hysterectomy and pelvic lymphadenectomy as treatment for stage IB1 cervical cancer. Results Overall, 18 (15.0%) patients had parametrial tumor involvement. Tumor size larger than 2 cm, invasion depth greater than 1 cm, presence of lymphovascular space involvement (LVSI), corpus involvement, and positive lymph nodes were statistically associated with parametrial involvement. Multivariate analysis for other factors showed invasion depth >1 cm (P=0.029), and corpus involvement (P=0.022) were significantly associated with parametrial involvement. A subgroup with tumor size smaller than 2 cm showed no parametrial involvement, regardless of invasion depth or presence of LVSI. Conclusion Tumor size smaller than 2 cm showed no parametrial involvement, regardless of invasion depth or presence of LVSI. Invasion depth >1 cm and corpus involvement were significantly associated with parametrial involvement in multivariate analysis. These finding may suggest that tumor size may a strong predictor of parametrial involvement in International Federation of Gynecology and Obstetrics stage IB1 cervical cancer, which can be used to select a subgroup population for less radical surgery. -
Female Pelvic Relaxation
FEMALE PELVIC RELAXATION A Primer for Women with Pelvic Organ Prolapse Written by: ANDREW SIEGEL, M.D. An educational service provided by: BERGEN UROLOGICAL ASSOCIATES N.J. CENTER FOR PROSTATE CANCER & UROLOGY Andrew Siegel, M.D. • Martin Goldstein, M.D. Vincent Lanteri, M.D. • Michael Esposito, M.D. • Mutahar Ahmed, M.D. Gregory Lovallo, M.D. • Thomas Christiano, M.D. 255 Spring Valley Avenue Maywood, N.J. 07607 www.bergenurological.com www.roboticurology.com Table of Contents INTRODUCTION .................................................................1 WHY A UROLOGIST? ..........................................................2 PELVIC ANATOMY ..............................................................4 PROLAPSE URETHRA ....................................................................7 BLADDER .....................................................................7 RECTUM ......................................................................8 PERINEUM ..................................................................9 SMALL INTESTINE .....................................................9 VAGINAL VAULT .......................................................10 UTERUS .....................................................................11 EVALUATION OF PROLAPSE ............................................11 SURGICAL REPAIR OF PELVIC PROLAPSE .....................15 STRESS INCONTINENCE .........................................16 CYSTOCELE ..............................................................18 RECTOCELE/PERINEAL LAXITY .............................19 -
Vessels and Circulation
CARDIOVASCULAR SYSTEM OUTLINE 23.1 Anatomy of Blood Vessels 684 23.1a Blood Vessel Tunics 684 23.1b Arteries 685 23.1c Capillaries 688 23 23.1d Veins 689 23.2 Blood Pressure 691 23.3 Systemic Circulation 692 Vessels and 23.3a General Arterial Flow Out of the Heart 693 23.3b General Venous Return to the Heart 693 23.3c Blood Flow Through the Head and Neck 693 23.3d Blood Flow Through the Thoracic and Abdominal Walls 697 23.3e Blood Flow Through the Thoracic Organs 700 Circulation 23.3f Blood Flow Through the Gastrointestinal Tract 701 23.3g Blood Flow Through the Posterior Abdominal Organs, Pelvis, and Perineum 705 23.3h Blood Flow Through the Upper Limb 705 23.3i Blood Flow Through the Lower Limb 709 23.4 Pulmonary Circulation 712 23.5 Review of Heart, Systemic, and Pulmonary Circulation 714 23.6 Aging and the Cardiovascular System 715 23.7 Blood Vessel Development 716 23.7a Artery Development 716 23.7b Vein Development 717 23.7c Comparison of Fetal and Postnatal Circulation 718 MODULE 9: CARDIOVASCULAR SYSTEM mck78097_ch23_683-723.indd 683 2/14/11 4:31 PM 684 Chapter Twenty-Three Vessels and Circulation lood vessels are analogous to highways—they are an efficient larger as they merge and come closer to the heart. The site where B mode of transport for oxygen, carbon dioxide, nutrients, hor- two or more arteries (or two or more veins) converge to supply the mones, and waste products to and from body tissues. The heart is same body region is called an anastomosis (ă-nas ′tō -mō′ sis; pl., the mechanical pump that propels the blood through the vessels. -
Normal Imaging Findings of the Uterus 3
Normal Image Findings of the Uterus 37 Normal Imaging Findings of the Uterus 3 Claudia Klüner and Bernd Hamm CONTENTS the strong muscle coat forming the mass of the organ. The myometrium is mostly comprised of spindle- 3.1 Embryonic Development and shaped smooth muscle cells and additionally con- Normal Anatomy of the Uterus 37 tains reserve connective tissue cells, which give rise 3.2 Imaging Findings: Uterine Corpus 40 to additional myometrial cells in pregnancy through 3.3 Imaging Findings: Uterine Cervix 44 hyperplasia. The uterine cavity is only a thin cleft and References 47 is lined by endometrium (Fig. 3.2). Functionally, the endometrium consists of basal and functional layers. The isthmus of uterus (lower uterine segment), 3.1 together with the internal os, forms the junction be- Embryonic Development and tween the corpus and cervix. In nonpregnant wom- Normal Anatomy of the Uterus en the isthmus is only about 5 mm high and is less muscular than the corpus. Unlike the uterine cervix, During embryonal life, fusion of the two Müllerian the isthmus becomes overproportionally large in the ducts gives rise to the uterine corpus, isthmus, cervix, course of pregnancy and serves as a kind of reserve and the upper third of the vagina. The Müllerian ducts for fetal development in addition to the uterine cor- are of mesodermal origin and arise in the 4th week pus. The endometrium of the isthmus consists of a of gestation. They course on both sides lateral to the single layer of columnar epithelium and only under- ducts of the mesonephros (Wolffi an ducts). -
Clinical Pelvic Anatomy
SECTION ONE • Fundamentals 1 Clinical pelvic anatomy Introduction 1 Anatomical points for obstetric analgesia 3 Obstetric anatomy 1 Gynaecological anatomy 5 The pelvic organs during pregnancy 1 Anatomy of the lower urinary tract 13 the necks of the femora tends to compress the pelvis Introduction from the sides, reducing the transverse diameters of this part of the pelvis (Fig. 1.1). At an intermediate level, opposite A thorough understanding of pelvic anatomy is essential for the third segment of the sacrum, the canal retains a circular clinical practice. Not only does it facilitate an understanding cross-section. With this picture in mind, the ‘average’ of the process of labour, it also allows an appreciation of diameters of the pelvis at brim, cavity, and outlet levels can the mechanisms of sexual function and reproduction, and be readily understood (Table 1.1). establishes a background to the understanding of gynae- The distortions from a circular cross-section, however, cological pathology. Congenital abnormalities are discussed are very modest. If, in circumstances of malnutrition or in Chapter 3. metabolic bone disease, the consolidation of bone is impaired, more gross distortion of the pelvic shape is liable to occur, and labour is likely to involve mechanical difficulty. Obstetric anatomy This is termed cephalopelvic disproportion. The changing cross-sectional shape of the true pelvis at different levels The bony pelvis – transverse oval at the brim and anteroposterior oval at the outlet – usually determines a fundamental feature of The girdle of bones formed by the sacrum and the two labour, i.e. that the ovoid fetal head enters the brim with its innominate bones has several important functions (Fig. -
Post-Hysterectomy Fallopian Tube Prolapse: Elementary Yet Enigmatic
BRIEF COMMUNICATION Post-hysterectomy Fallopian Tube Prolapse: Elementary Yet Enigmatic Vijay ZUTSHI, Pakhee AGGARWAL, Swaraj BATRA Lok Nayak Hospital, Department of Obstetrics and Gynecology, New Delhi, India Received 09 July 2007; received in revised form 19 September 2008; accepted 26 November 2008; published online 12 June 2008 Abstract Fallopian tube prolapse following hysterectomy should be kept in mind when a patient presents with pain, discharge, dys- pareunia or an obvious lesion at the vault. Combined laparoscopic and vaginal approach should become the standard of care in management of such cases. Keywords: fallopian tube prolapse, post-hysterectomy tubal prolapse, laparoscopic salpingectomy Özet Histerektomi Sonras› Fallop Tüpü Prolapsusu Histerektomi sonras›nda a¤r›, ak›nt›, disparoni veya vajina kubbesinde belirgin bir lezyon ile baflvuran kad›nlarda fallop tüpü prolapsusu ak›lda tutulmal›d›r. Bu vakalar›n yönetiminde laparoskopik ve vajinal yaklafl›m, birlikte kullan›lacak standart yaklafl›m olmal›d›r. Anahtar sözcükler: fallop tüpü prolapsusu, histerektomi sonras› tuba prolapsusu, laparoskopik salpenjektomi Introduction postoperative period and standard operating technique, thus lending credence to the fact that there may be other Fallopian tube prolapse after hysterectomy is a rare predisposing factors that are yet to be identified. occurrence, but also one that is often under-reported. To date, some 100-odd cases have been reported in literature, since the Mrs. A, a 35 year old, para 2, presented eight months after first such report by Pozzi in 1902, just over a hundred years hysterectomy symptomatic of blood stained discharge per ago (1). Almost two third of these cases have been reported to vaginum for the past six months. -
Intra and Retroperitoneal Anatomy – Landmarks and Pearls of Dissection (Didactic)
Intra and Retroperitoneal Anatomy – Landmarks and Pearls of Dissection (Didactic) PROGRAM CHAIR Vadim Morozov, MD PROGRAM CO-CHAIR Maurizio Rosati, MD E. Cristian Campian, MD Cristina C. Enzmann, MD Nucelio Lemos, MD S. Sony Singh, MD Pamela T. Soliman, MD Sponsored by AAGL Advancing Minimally Invasive Gynecology Worldwide Professional Education Information Target Audience This educational activity is developed to meet the needs of residents, fellows and new minimally invasive specialists in the field of gynecology. Accreditation AAGL is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AAGL designates this live activity for a maximum of 3.75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS As a provider accredited by the Accreditation Council for Continuing Medical Education, AAGL must ensure balance, independence, and objectivity in all CME activities to promote improvements in health care and not proprietary interests of a commercial interest. The provider controls all decisions related to identification of CME needs, determination of educational objectives, selection and presentation of content, selection of all persons and organizations that will be in a position to control the content, selection of educational methods, and evaluation of the activity. Course chairs, planning committee members, presenters, authors, moderators, panel members, and others in a position to control the content of this activity are required to disclose relevant financial relationships with commercial interests related to the subject matter of this educational activity. Learners are able to assess the potential for commercial bias in information when complete disclosure, resolution of conflicts of interest, and acknowledgment of commercial support are provided prior to the activity. -
Differential Diagnosis of Endometriosis by Ultrasound
diagnostics Review Differential Diagnosis of Endometriosis by Ultrasound: A Rising Challenge Marco Scioscia 1 , Bruna A. Virgilio 1, Antonio Simone Laganà 2,* , Tommaso Bernardini 1, Nicola Fattizzi 1, Manuela Neri 3,4 and Stefano Guerriero 3,4 1 Department of Obstetrics and Gynecology, Policlinico Hospital, 35031 Abano Terme, PD, Italy; [email protected] (M.S.); [email protected] (B.A.V.); [email protected] (T.B.); [email protected] (N.F.) 2 Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, 21100 Varese, VA, Italy 3 Obstetrics and Gynecology, University of Cagliari, 09124 Cagliari, CA, Italy; [email protected] (M.N.); [email protected] (S.G.) 4 Department of Obstetrics and Gynecology, Azienda Ospedaliero Universitaria, Policlinico Universitario Duilio Casula, 09045 Monserrato, CA, Italy * Correspondence: [email protected] Received: 6 October 2020; Accepted: 15 October 2020; Published: 20 October 2020 Abstract: Ultrasound is an effective tool to detect and characterize endometriosis lesions. Variances in endometriosis lesions’ appearance and distorted anatomy secondary to adhesions and fibrosis present as major difficulties during the complete sonographic evaluation of pelvic endometriosis. Currently, differential diagnosis of endometriosis to distinguish it from other diseases represents the hardest challenge and affects subsequent treatment. Several gynecological and non-gynecological conditions can mimic deep-infiltrating endometriosis. For example, abdominopelvic endometriosis may present as atypical lesions by ultrasound. Here, we present an overview of benign and malignant diseases that may resemble endometriosis of the internal genitalia, bowels, bladder, ureter, peritoneum, retroperitoneum, as well as less common locations. An accurate diagnosis of endometriosis has significant clinical impact and is important for appropriate treatment. -
Considering Surgery for Vaginal Or Uterine Prolapse?
Considering Surgery for Vaginal or Uterine The Condition(s): Your doctor is one of a growing Vaginal Prolapse, Uterine Prolapse number of surgeons offering Prolapse? Vaginal prolapse occurs when the network of muscles, ligaments and skin that hold Learn why da Vinci® Surgery da Vinci Surgery for the vagina in its correct anatomical position may be your best treatment option. Vaginal and Uterine Prolapse. weaken. This causes the vagina to prolapse (slip or fall) from its normal position. Uterine prolapse occurs when pelvic floor muscles and ligaments stretch and weaken, reducing support for the uterus. The uterus then slips or falls into the vaginal canal. Prolapse can cause the following symptoms: a feeling of heaviness or pulling in your pelvis, tissue protruding from your vagina, painful intercourse, pelvic pain and difficulties with urination and bowel movements. For more information about da Vinci for About 200,000 women have prolapse Vaginal and Uterine Prolapse and to find surgery each year in the United States.1 a da Vinci Surgeon near you, visit: Risk factors for prolapse include multiple www.daVinciSurgery.com vaginal deliveries, age, obesity, hysterectomy, collagen quality and smoking. One in nine women who undergo hysterectomy will experience vaginal prolapse and 10% of these women may need surgical repair of a major vaginal prolapse.2 Uterus Bladder Vagina Normal Anatomy Uterine Prolapse Vaginal Prolapse 1Boyles SH, Weber AM, Meyn L. Procedures for pelvic organ prolapse in the United States, 1979-1997. Am J Obstet Gynecol. 2003 Jan;188(1):108-15. Abstract. 2Marchionni M, Bracco GL, Checcucci V, Carabaneanu A, Coccia EM, Mecacci F, Scarselli G. -
Vaginal Reconstruction/Sling Urethropexy)
Patient Name: _ Date: _ New Jersey Urologic Institute Dr Betsy Greenleaf DO, FACOOG Pelvic Medicine and Reconstructive Surgery 10Industrial Way East, Suite 101, Eatontown, New Jersey 07724 732-963-9091 Fax: 732-963-9092 Findings: _ Post Operative Instructions (Vaginal Reconstruction/Sling Urethropexy) 1. Activity: May do as much as you feel up to. Your body will let you know when you are doing too much. Don't push yourself, however. Walking is ok and encouraged. If you sit too long you will become stiff and it will make it more difficult to move. Lying around can promote the formation of blood clots that can be life threatening. It is therefore important to move around. If you don't feel like walking, at least move your legs around in bed from time to time. Stairs are ok, just be careful of standing up too quickly and becoming light headed. Sitting still can also increase your risk of pneumonia. In addition to moving around, practice taking deep breaths ( 10 times each every hour or so) to keep your lungs properly aerated. Limitations: Avoid lifting or pushing/pulling any objects heavier than 1Olbs for at least 3 months. For patients with pelvic hernia or prolapse repairs it is recommended not to lift objects heavier than 25 Ibs for life. This may seem unrealistic. Try to put off lifting as long as possible. If you must lift, do not hold your breathe. Blow out as you lift to decrease abdominal and pelvic pressure. Also be aware that if you choose to lift objects heavier than recommended you risk forming another hernia 2. -
MRI Anatomy of Parametrial Extension to Better Identify Local Pathways of Disease Spread in Cervical Cancer
Diagn Interv Radiol 2016; 22:319–325 ABDOMINAL IMAGING © Turkish Society of Radiology 2016 PICTORIAL ESSAY MRI anatomy of parametrial extension to better identify local pathways of disease spread in cervical cancer Anna Lia Valentini ABSTRACT Benedetta Gui This paper highlights an updated anatomy of parametrial extension with emphasis on magnetic Maura Miccò resonance imaging (MRI) assessment of disease spread in the parametrium in patients with locally advanced cervical cancer. Pelvic landmarks were identified to assess the anterior and posterior ex- Michela Giuliani tensions of the parametria, besides the lateral extension, as defined in a previous anatomical study. Elena Rodolfino A series of schematic drawings and MRI images are shown to document the anatomical delineation of disease on MRI, which is crucial not only for correct image-based three-dimensional radiotherapy Valeria Ninivaggi but also for the surgical oncologist, since neoadjuvant chemoradiotherapy followed by radical sur- Marta Iacobucci gery is emerging in Europe as a valid alternative to standard chemoradiation. Marzia Marino Maria Antonietta Gambacorta Antonia Carla Testa here are two main treatment options in patients with cervical cancer: radical sur- Gian Franco Zannoni gery, including trachelectomy or radical hysterectomy, which is usually performed T in early stage disease as suggested by the International Federation of Gynecology Lorenzo Bonomo and Obstetrics (FIGO stages IA, IB1, and IIA), or primary radiotherapy with concurrent ad- ministration of platinum-based chemotherapy (CRT) for patients with bulky FIGO stage IB2/ IIA2 tumors (> 4 cm) or locally advanced disease (FIGO stage IIB or greater). Some authors suggested the use of CRT followed by surgery for bulky tumors or locally advanced disease (1). -
Anatomy and Histology of Apical Support: a Literature Review Concerning Cardinal and Uterosacral Ligaments
Int Urogynecol J DOI 10.1007/s00192-012-1819-7 REVIEW ARTICLE Anatomy and histology of apical support: a literature review concerning cardinal and uterosacral ligaments Rajeev Ramanah & Mitchell B. Berger & Bernard M. Parratte & John O. L. DeLancey Received: 10 February 2012 /Accepted: 24 April 2012 # The International Urogynecological Association 2012 Abstract The objective of this work was to collect and Autonomous nerve fibers are a major constituent of the deep summarize relevant literature on the anatomy, histology, USL. CL is defined as a perivascular sheath with a proximal and imaging of apical support of the upper vagina and the insertion around the origin of the internal iliac artery and a uterus provided by the cardinal (CL) and uterosacral (USL) distal insertion on the cervix and/or vagina. It is divided into ligaments. A literature search in English, French, and Ger- a cranial (vascular) and a caudal (neural) portions. Histolog- man languages was carried out with the keywords apical ically, it contains mainly vessels, with no distinct band of support, cardinal ligament, transverse cervical ligament, connective tissue. Both the deep USL and the caudal CL are Mackenrodt ligament, parametrium, paracervix, retinaculum closely related to the inferior hypogastric plexus. USL and uteri, web, uterosacral ligament, and sacrouterine ligament CL are visceral ligaments, with mesentery-like structures in the PubMed database. Other relevant journal and text- containing vessels, nerves, connective tissue, and adipose book articles were sought by retrieving references cited in tissue. previous PubMed articles. Fifty references were examined in peer-reviewed journals and textbooks. The USL extends Keywords Apical supports .