INTRODUCTION

Hysteroscopy is the gold standard procedure for the evaluation and diagnosis of intrauterine pathologies. The optimal time to do hysteroscopy is during the proliferative phase. However, for women with irregular bleeding, the optimal time is unpredictable. Besides pharmacological means, mechanical endometrial preparation could be done.

OBJECTIVE

The objective of this study was to determine the effect of suction curettage on visualization, operative time, fluid deficit, and histopathologic diagnosis among perimenopausal women with abnormal uterine bleeding (AUB) and unprepared endometrium prior to operative hysteroscopy.

METHODOLOGY

Thirty-four (34) perimenopausal women admitted for AUB with unprepared endometrium for operative hysteroscopy who consented to participate were recruited and randomly divided into two groups: 18 women had suction curettage done prior to operative hysteroscopy and 16 women had operative hysteroscopy done alone. The following data were obtained for each group: (1) improvement in clarity (i.e., visualization of fundus and both tubal ostia), (2) operative time from entry to withdrawal of the resectoscope (measured in minutes), (3) fluid deficit, and (4) final histopathological diagnosis. P 

RESULTS

Women who underwent suction curettage prior to operative hysteroscopy had improved visualization (72.2%, P < 0.001), shorter operative time (29.06 ± 7.06 min vs. 35.5 ± 7.2 min, P = 0.013), no difference in fluid deficit (P = 0.276), and the histopathologic diagnosis (P = 0.470).

CONCLUSION

Suction curettage prior to operative hysteroscopy among perimenopausal women with AUB and unprepared endometrium improved visualization and shortened operative time without affecting fluid deficit and histopathologic diagnosis.

Hysteroscopy ; Suction Curettage ; Vacuum Curettage

High gravidity hydatidiform mole (HM) without normal pregnancy is very rare. The challenge of managing such cases will dwell on the concern of having normal conception versus having another molar gestation and its neoplastic sequelae.

Presented in this paper is a case of a 32-year-old, gravida 5 para 0 (0040) who was admitted for the management of her fifth molar pregnancy. She underwent suction curettage and administration of methotrexate chemoprophylaxis. Genetic testing was done, which revealed a homozygous mutation in NLRP7, the gene implicated in recurrent molar gestations. This paper discusses the proper approach to determine the cause of recurrent molar pregnancies, as well as the management and prognosis of such cases.

Human ; Female ; Adult ; Gravidity ; Methotrexate ; Vacuum Curettage ; Hydatidiform Mole ; Homozygote ; Genetic Testing ; Mutation ; Prognosis ; Chemoprevention ; Molar

High gravidity hydatidiform mole (HM) without normal pregnancy is very rare. The challenge of managing such cases will dwell on the concern of having normal conception versus having another molar gestation and its neoplastic sequelae.

Presented in this paper is a case of a 32-year-old, gravida 5 para 0 (0040) who was admitted for the management of her fifth molar pregnancy. She underwent suction curettage and administration of methotrexate chemoprophylaxis. Genetic testing was done, which revealed a homozygous mutation in NLRP7, the gene implicated in recurrent molar gestations. This paper discusses the proper approach to determine the cause of recurrent molar pregnancies, as well as the management and prognosis of such cases.

Human ; Female ; Adult ; Gravidity ; Methotrexate ; Vacuum Curettage ; Hydatidiform Mole ; Homozygote ; Genetic Testing ; Mutation ; Prognosis ; Chemoprevention ; Molar

This study aimed to determine the utility of post-evacuation transvaginal ultrasound as an adjunct to serum ß-hCG monitoring of patients diagnosed with hydatidiform mole. It is a prospective cohort analysis of 13 patients diagnosed with hydatidiform mole who underwent suction curettage from December 1, 2010 to February 28, 2011 at the Philippine General Hospital. Transvaginal ultrasound immediately post-evacuation of hydatidiform mole and then monthly thereafter were performed. The morphologic characteristics of the uterus and ovaries were observed and recorded during each examination. The usual monitoring protocol of hydatidiform mole after evacuation of molar products which is serial serum ß-hCG was observed. The serum ß-hCGlevels and the results of the transvaginal ultrasound scans were correlated during data analysis.
Data were analyzed using STATCALC version 2000.Traditional calculations for the sensitivity, specificity, positive and negative predictive values for each sonographic descriptor was conduced with their 95% confidence intervals derived. All P-values less than .05 were considered statistically significant.
Two of the 13 (15.4%) patients with complete hydatidiform mole progressed to gestational trophoblastic neoplasia (GTN).In this study, the presence of uterine mass with increased vascularity and low resistance indices on color Doppler studies was the most accurate in predicting the progression of hydatidiform mole to GTN with a high specificity (90.9%)and sensitivity (100%).Interestingly, the uterine mass was noted even before the rise in the serum ß-hCG levels. The other sonographic features observed post-evacuation of hydatidiform mole include: dilated arcuate vessels, theca lutein cysts and hematometra.
This study demonstrated that transvaginal ultrasound is essential in the diagnosis of hydatidiform mole as well as as in the follow-up of patients post-evacuation of molar tissues and in predicting the degeneration of hydatidiform mole to GTN. Clinical use of its predictive value permits individualization of follow-up and a timely and appropriate management or referral of patients for treatment prior to the onset of advanced stage of disease.

Human ; Female ; Adult ; Hematometra ; Lutein ; Vacuum Curettage ; Ovary ; Hospitals, General ; Philippines ; Hydatidiform Mole ; Gestational Trophoblastic Disease ; Molar ; Cysts

OBJECTIVETo observe the clinical efficacy of artificial skin combined with vacuum sealing drainage (VSD) in treating large-area skin defects.

METHODSTotally 18 patients with skin defects, treated with artificial skin combined with VSD from September 2008 to May 2009 in our hospital, were retrospectively analyzed in this study. There were 15 males and 3 females, aged 7-66 years, 34.3 years on average. Among them, 10 cases had skin laceration caused by traffic accidents (7 with open fractures), 1 mangled injury, 1 blast injury, 1 stump infection combined with skin defects after amputation and 5 heel ulcers.

RESULTSAll skin grafts in 16 cases survived after being controlled by VSD for one time. For the rest 2 patients, one with skin avulsion on the left foot was given median thickness skin grafts after three times of VSD, the other with open fractures in the left tibia and fibula caused by a traffic accident was given free flap transplantation. Skin grafts of both patients survived, with normal color and rich blood supply.

CONCLUSIONSkin grafting in conjunction with artificial skin and VSD is much more effective than traditional dressing treatment and worth wide application in clinic.

Adolescent ; Adult ; Aged ; Child ; Drainage ; methods ; Female ; Humans ; Lacerations ; surgery ; Male ; Middle Aged ; Postoperative Care ; Retrospective Studies ; Skin Transplantation ; Skin, Artificial ; Vacuum Curettage ; Wounds and Injuries ; surgery

Acute Disease ; Child ; Child, Preschool ; Empyema, Pleural ; therapy ; Female ; Humans ; Infant ; Male ; Therapeutic Irrigation ; Vacuum Curettage

Implantation of a pregnancy within the scar of previous cesarean section is the rarest form of ectopic pregnancy. Delayed diagnosis and treatment can lead to uterine rupture, hemorrhage and maternal morbidity. But diagnosed early by transvaginal sonography, treatment options are capable of preserving the uterus and subsequent fertility. Suction curettage, exploratory laparotomy, laparoscopic surgery, systemic or local injection of methotrexate is the treatment method currently performed. In this report, we treated a case of this patient by transvaginal hysterotomy. This is the first case report in the recent literature. By this surgery, we could successfully remove gestational sac from the implantation site and repair the defect by primary suture and preserve uterus.
Cesarean Section ; Cicatrix ; Delayed Diagnosis ; Female ; Fertility ; Gestational Sac ; Hemorrhage ; Humans ; Hysterotomy ; Laparoscopy ; Laparotomy ; Methotrexate ; Pregnancy ; Pregnancy, Ectopic ; Sutures ; Uterine Rupture ; Uterus ; Vacuum Curettage

PURPOSE: To evaluate the role of performing ultrasound (US)-guided vacuum-assisted breast biopsies for the treatment (mammotome excision) of gynecomastia. MATERIALS AND METHODS: Between November 2005 and December 2006, nine male patients underwent US-guided mammotome excision for eleven cases of true gynecomastia. The patient ages ranged from 14 to 55 years (mean age, 32.3 years). US-guided mammotome excision was performed with an 11-gauge needle in seven cases and an 8-gauge needle in four cases. After the procedure, the cigarette method using gauze packing was performed. The number of samples, procedure time and presence of complications were evaluated. Scheduled follow-up physical and US examinations were performed after three and six months. RESULTS: For 11 cases of US-guided mammotome excision of gynecomastia, the number of samples ranged from 12-126 (mean, 66) and the procedure time ranged from 10-42 minutes (mean time, 25.1 minutes). Clinical significant complications did not occur immediately after the procedure and complications were not seen after a follow-up examination in any of the cases. At the 3- and 6-month follow up examinations, all of the patients showed a normal male physical appearance on a physical examination and there was no evidence of hypoechoic glandular tissues as seen on ultrasonograms. CONCLUSION: US-guided mammotome excision is effective for the treatment of small, glandular true gynecomastia and is suggested as a new modality to replace the need for surgery or liposuction.
Biopsy ; Breast ; Follow-Up Studies ; Gynecomastia ; Humans ; Lipectomy ; Male ; Mammography ; Needles ; Physical Examination ; Tobacco Products ; Vacuum Curettage

Cervical pregnancy is an uncommon life threatening form of ectopic pregnancy. It is associated with the unexpected occurrence of uncontrollable hemorrhage from the cervix. This condition is usually treated with hysterectomy. And thus the patient loses her fertility potential. To avoid hysterectomy and to maintain fertility, several conservative methods of termination have been used. We report a case of cervical pregnancy treated conservatively without hysterectomy. Hemorrhage from the implantation site was controlled with an inflated Foley catheter balloon positioned within the cervical canal. Foley catheter ballooning after endocervical suction curettage seems to be a simple and effective treatment of cervical pregnancy as conservative treatment to maintain fertility.
Catheters ; Cervix Uteri ; Female ; Fertility ; Hemorrhage ; Humans ; Hysterectomy ; Pregnancy* ; Pregnancy, Ectopic ; Vacuum Curettage

Objective: To be able to determine whether prophylactic doxycycline at completion curettage or manual vacuum aspiration for incomplete, spontaneous, non-septic abortion decreases the rate of postoperative pelvic infection. Study Design: This is a prospective randomized controlled trial (no blinding, prophylaxis versus no prophylaxis), between March 1,2005 to June 15,2005. Patients presenting with nonseptic, spontaneous, incomplete abortion were recruited. Those who will fulfilled the following criteria were included in the study: pregnancy less than 12 weeks, no clinical signs of genital infection, hemodynamically stable, no antibiotic treatment during the three weeks before the abortion, and no suspected allergic reactions to tetracyclines. Participants were allocated randomly to two groups: 1) antibiotic or treatment group (4 tablets of 100mg doxycycline, 400mg, 30minsto1 hour before the procedure, 2) no treatment or control group. All patients received aseptic curettage and manual vacuum aspiration procedures. At follow-up, a diagnosis of infectious morbidity would be recorded if any two or more of the following signs or symptoms were found: 1) pelvic inflammatory disease, 2) uterine, adnexal or cervical tenderness, and 3) leukocytosis >15,000/cu mm. Statistical analysis usedttestand chi-square test to note for differences between the two groups. Results: Two hundred forty patients were randomized. The differences in age distribution, parity, gestational age, anaesthetic method and method of uterine evacuation were insignificant between the two groups. Forty six out of the 240 patients presented with signs and symptoms of pelvic inflammatory disease after the uterine evacuation, giving a postoperative pelvic inflammatory disease rate of 19.1 percent. Majority of the patients belonging to the control group (42/123=34.1 percent) developed more infectious morbidity (lower abdominal pain, fever, leucorrhea, adnexal mass, elevated ESR, and leukocytosis) as compared to the doxycycline group (4/117=3.4 percent). Disregarding treatment, an infection rate of 10.55 percent was recorded in the group with previous pelvic inflammatory disease, as compared with 8.18 percent in the group without previous infection (RR=1.29). Conclusion: In our population of patients with incomplete, nonseptic, spontaneous abortion, prophylactic doxycycline prior to curettage or manual vacuum aspiration decreased the rate of postoperative pelvic infection. Prophylactic antibiotics proved to be a protective factor, reducing the rate of complications, most especially noted amongst the group of patients who had previous history of pelvic inflammatory disease and those who had multiple sexual partners.
Doxycycline ; Dilatation And Curettage ; Spontaneous Abortion ; Incomplete Abortion ; Vacuum Curettage ; Antibiotic Prophylaxis ; Pelvic Inflammatory Disease