Is myomectomy always the best choice for infertile women with symptomatic uterine fibroids?

Uterine artery embolization (UAE) is still regarded by most gynaecologists as contraindicated for women with symptomatic fibroids and otherwise unexplained infertility. For such patients, myomectomy is the usual option. We performed UAE as treatment of menorrhagia in an infertile woman with multiple subserosal and intramural fibroids who had previously failed multiple myomectomy. UAE resulted in durable symptom relief and substantial reduction of the uterine and fibroid size. The patient conceived spontaneously 20 months after UAE and progressed through pregnancy uneventfully. At 38 weeks of gestation, she underwent elective cesarean section and delivered a normal, healthy, 3180-g fetus without complications. The present case demonstrates that in symptomatic women with multiple subserosal and intramural fibroids and otherwise unexplained infertility, UAE may have symptomatic and reproductive outcomes superior to those of myomectomy.     

Glucose level is a major determinant of carotid intima-media thickness in patients with hypertension and hyperglycemia

BACKGROUND: A causal relationship has been established between hyperglycemia and cardiovascular diseases, but no threshold has been retained to determine a 'glycemia-associated' cardiovascular risk. Carotid intima-media thickness (CIMT) is an independent predictor for cardiovascular events. High blood pressure is a major determinant of CIMT. OBJECTIVES: To determine the influence of fasting glycemia on CIMT in hypertensive patients with either normal fasting glucose, impaired fasting glucose (IFG) or type 2 diabetes (DM-2). METHODS: We included 158 essential hypertensive patients with either normal fasting glucose (n=74), IFG (n=24) or DM-2 (n=60) in a cross-sectional study. Common carotid IMT was measured with a high resolution echotracking system. RESULTS: CIMT of DM-2 patients was significantly higher than that of IFG and normal fasting glucose patients (809 +/- 180, 697 +/- 151 and 689 +/- 134 microm, respectively; analysis of variance (ANOVA) P <0.0001). In multivariate analysis in normal fasting glucose patients, local pulse pressure and age were the major determinants of CIMT, whereas glycemia was not. In IFG and DM-2 patients, fasting glycemia was strongly associated with CIMT, explaining 21 and 18% of its variance, respectively. Particularly, in IFG patients, an increase in 1 mmol/l glycemia was associated with a 165 microm increase in CIMT. In hyperglycemic patients, with either IFG or DM-2, age was an important determinant of CIMT, whereas local pulse pressure was not. CONCLUSION: These data suggest that glycemia is a major independent determinant of CIMT in hypertensive hyperglycemic patients, not only in DM-2 patients but also at the earlier stage of IFG, offsetting the mechanical role of local pulse pressure.     

Review of the Naval Health Research Center's development of medical information systems for far-forward echelons of care, 1983 to 1997

Medical treatment information must be gathered quickly and accurately to ensure continuity of care at far-forward echelons. The manual documentation methods in use during the Vietnam War revealed the need for considerable improvements in medical information documentation, patient tracking, and effective transfer of data throughout each of the first three echelons of care. The U.S. military determined that automation would result in the greatest enhancement of documentation techniques. The Naval Health Research Center (NHRC) has been an integral part of the development of medical information systems for the Navy's far-forward echelons of care. The prototypes designed by NHRC for echelons I and II can successfully raise the standard of treatment while simultaneously reducing the number of individuals needed for administrative duties and increasing the number of medical staff available for patient care. An overview of NHRC's work in medical information systems from 1983 to 1997 is presented.     

Surgical complications of oncological treatments: A narrative review

Gastrointestinal complications are common in patients undergoing various forms of cancer treatments, including chemotherapy, radiation therapy, and molecular-targeted therapies. Surgical complications of oncologic therapies can occur in the upper gastrointestinal tract, small bowel, colon, and rectum. The mechanisms of action of these therapies are different. Chemotherapy includes cytotoxic drugs, which block the activity of cancer cells by targeting intracellular DNA, RNA, or proteins. Gastrointestinal symptoms are very common during chemotherapy, due to a direct effect on the intestinal mucosa resulting in edema, inflammation, ulceration, and stricture. Serious adverse events have been described as complications of molecular targeted therapies, including bowel perforation, bleeding, and pneumatosis intestinalis, which may require surgical evaluation. Radiotherapy is a local anti-cancer therapy, which uses ionizing radiation to cause inhibition of cell division and ultimately lead to cell death. Complications related to radiotherapy can be both acute and chronic. Ablative therapies, including radiofrequency, laser, microwave, cryoablation, and chemical ablation with acetic acid or ethanol, can cause thermal or chemical injuries to the nearby structures. Treatment of the different gastrointestinal complications should be tailored to the individual patient and based on the underlying pathophysiology of the complication. Furthermore, it is important to know the stage and prognosis of the disease, and a multidisciplinary approach is necessary to personalize the surgical treatment. The purpose of this narrative review is to describe complications related to different oncologic therapies that may require surgical interventions.