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      Lantern on Dome of St. Paul's Cathedral – An Apt Metaphor for a Challenging Leiomyoma

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Fibroids are ubiquitous in women of the reproductive age group more so in midlife. The cervical fibroids are challenging to operating surgeons because it distorts the surgical anatomy of the pelvis and urogenital system. The metaphor given historically to this condition is apt as the uterus appears like a lantern sitting on the dome of cervical fibroid similar to the dome of the cathedral. Here, we report two cases of cervical fibroid in perimenopausal age group of different sizes managed by following specific steps.

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          Uterine myomas: an overview of development, clinical features, and management.

          Edward E Wallach, Nikos Vlahos (2004)
          To review the biology and the pathophysiology of uterine myomas, focus on options for management, and emphasize principles that will render the decision-making process as logical as possible. Literature review and synthesis of the authors' experience and philosophy. Uterine myomas are the most common solid pelvic tumors in women. There is increasing evidence that they have a genetic basis and that their growth is related to genetic predisposition, hormonal influences, and various growth factors. Treatment choices are wide and include pharmacologic, surgical, and radiographically directed intervention. Most myomas can be followed serially with surveillance for development of symptoms or progressive growth. The past century has witnessed development of highly sophisticated diagnostic and therapeutic technology for myomas. The tools currently at our disposal permit greater management flexibility with safe options, which must be tailored to the individual clinical situation.
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            Efficacy of pre-operative gonadotrophin hormone releasing analogues for women with uterine fibroids undergoing hysterectomy or myomectomy: a systematic review.

            A Lethaby, H Sowter, Beverley Vollenhoven (2002)
            To evaluate the role of pretreatment with gonadotrophin releasing hormone (GnRH) analogues (GnRHa) prior to surgery for women with uterine fibroids. A systematic review was undertaken of all randomised controlled trials assessing the efficacy of GnRHa treatment prior to surgery (myomectomy or hysterectomy) in women with fibroids. Secondary care. Sample Premenopausal women with fibroids awaiting surgery attending hospitals or clinics. Electronic searches of Medline, EmBase, Current Contents, the Cochrane Library, National Research Register, NLM's Clinical Trials Register and the Cochrane group's Trials Register were performed, between 1980 and 2000. Twenty-six randomised controlled trials were identified that compared GnRHa with no treatment, placebo or other medical treatment. The quality of the trials was assessed and data were extracted independently by two of the reviewers. Statistical analysis was performed in Revman according to Cochrane guidelines and where possible outcomes were pooled in a meta-analysis. Pre-operative assessment (reduction in uterine and fibroid volume, change in haemoglobin and haematocrit, change in patient's symptoms), intra-operative assessment (duration of operation, blood loss, proportion with vertical incision, proportion undergoing vaginal rather than abdominal procedure, frequency of blood transfusions), post-operative assessment (complications, duration of hospital stay, recurrence of fibroids). Pre- and post-operative haemoglobin and haematocrit were significantly improved by GnRHa therapy prior to surgery, and uterine volume, uterine gestational size and fibroid volume were all reduced. Pelvic symptoms were also reduced but some adverse events were more likely during GnRHa therapy. Hysterectomy appeared to be easier after pretreatment with GnRHa therapy; there was reduced operating time and a greater proportion of hysterectomy patients was able to have a vaginal rather than an abdominal procedure. Duration of hospital stay was also reduced. Blood loss and rate of vertical incisions were reduced for both myomectomy and hysterectomy. Evidence of increased risk of fibroid recurrence after GnRHa pretreatment in myomectomy patients was equivocal and few data were available to assess change in postoperative fertility. The use of GnRHa for three to four months prior to fibroid surgery reduces both uterine volume and fibroid size. They are beneficial in the correction of pre-operative iron deficiency anaemia, if present, and reduce intra-operative blood loss. If uterine size is such that a midline incision is planned, this can be avoided in many women with the use of GnRHa. For women undergoing hysterectomy, a vaginal procedure is more likely following the use of these agents.
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              Urologic Complications Following Obstetric and Gynecologic Surgery

              Joong Shik Lee, Jin Choe, Hyo Lee … (2012)
              Purpose Urologic injuries occur frequently during surgery in the pelvic cavity. Inadequate diagnosis and treatment may lead to severe complications and side effects. This investigation examined the clinical features of urologic complications following obstetric and gynecologic surgery. Materials and Methods We accumulated 47,318 obstetric and gynecologic surgery cases from 2007 to 2011. Ninety-seven patients with urological complications were enrolled. This study assessed the causative disease and surgical approach, type, and treatment method of the urologic injury. Results Of these 97 patients, 69 had bladder injury, 23 had ureteral injury, 2 had vesicovaginal fistula, 2 had ureterovaginal fistula, and 1 had renal injury. With respect to injury rate by specific surgery, laparoscopic-assisted radical vaginal hysterectomy was the highest with 3 of 98 cases, followed by radical abdominal hysterectomy with 15 of 539 cases. All 69 cases of bladder injury underwent primary suturing during surgery without complications. Of 14 cases with an early diagnosis of ureteral injury, 7 had a ureteral catheter inserted, 5 underwent ureteroureterostomy, and 2 underwent ureteroneocystostomy. Of nine cases with a delayed diagnosis of ureteral injury, ureteral catheter insertion was carried out in three cases, four cases underwent ureteroureterostomy, and two cases underwent ureteroneocystostomy. Conclusions Bladder injury was the most common urological injury during obstetric and gynecologic surgery, followed by ureteral injury. The variety of injured states, difficulty of diagnosis, and time to complete cure were much greater among patients with ureteral injuries. Early diagnosis and urologic intervention is important for better outcomes.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Midlife Health
                Journal ID (iso-abbrev): J Midlife Health
                Journal ID (publisher-id): JMH
                Title: Journal of Mid-Life Health
                Publisher: Wolters Kluwer - Medknow (India )
                ISSN (Print): 0976-7800
                ISSN (Electronic): 0976-7819
                Publication date (Print): Jul-Sep 2020
                Publication date (Electronic): 29 September 2020
                Volume: 11
                Issue: 3
                Pages: 181-184
                Affiliations
                [1]Department of Obstetrics and Gynaecology, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
                Author notes
                Address for correspondence: Dr. Sonakshi Singhal, AF 5 Doctors Quarters, AVBR Hospital Campus, Datta Meghe Institute of Medical Sciences DU, Wardha, Maharashtra, India. E-mail: sonmodkmc@ 123456gmail.com
                Article
                Publisher ID: JMH-11-181
                DOI: 10.4103/jmh.JMH_143_19
                PMC ID: 7718941
                PubMed ID: 33384545
                SO-VID: 5d3558ef-68ef-4be0-8af8-202dd2aaa5d6
                Copyright © Copyright: © 2020 Journal of Mid-life Health
                License:

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Date received : 16 October 2019
                Date revision received : 28 February 2020
                Date accepted : 03 March 2020
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Medicine
                Keywords: cervical fibroid,leiomyoma,st. paul's cathedral lantern
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: cervical fibroid, leiomyoma, st. paul's cathedral lantern

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