Background
Vaginal metastasis should be kept in mind when evaluating the staging tests of all cancers, especially endometrial cancer.
Case presentation
We present four patients with vaginal recurrence who recently applied to our clinic. Three cases were of endometrial cancer and one case of rectal cancer. All patients presented with vaginal bleeding.
Conclusion
Standard treatment for vaginal metastasis has not yet been established. Therapeutic options for vaginal metastasis—separately or in combination—are surgical resection, radiotherapy, and chemotherapy.
ABSTRACT
A 46-year-old woman was referred to gynecology for the assessment and treatment of an anterior vaginal wall cyst. The preoperative physical examination and transvaginal USG of the pelvis were most consistent with the presence of a bladder cyst. Following the excision of the cyst wall, the patient was diagnosed with an endometrioma in the anterior part of the vagina. This case emphasizes difficulties in the identification of endometriosis in the vagina and other uncommon places, potential processes of disease progression, and recommended therapies.
Objective: Laparoscopic surgery has become more popular than traditional open surgery because it is less invasive, provides faster recovery, and provides better cosmetic success. This procedure requires insufflation of an inert gas into the peritoneal cavity. This may be an increase in arterial CO2, changes in cerebral blood flow, an increase in intra-abdominal pressure (IAP), a decrease in cardiac output. The primary outcome of this study is to show the effect of IAP levels on cerebral oxygen saturation (COS) in patients who underwent laparoscopic total abdominal hysterectomy, and the secondary outcome is to reveal the relationship between IAP and COS and the recovery of postoperative cognitive functions.
Material and Method: Demographic data of the cases were recorded and mini-mental test (MMT) was applied to evaluate the preoperative cognitive functions of the cases before surgery. COS monitoring were performed with standard anesthesia procedure for all patients. The MMT was repeated after the surgery.
Results: A total of 40 female patients were included in the study. Those with IAP level 12 and below were defined as Group Low-Pressure, and those above 12 were defined as Group High-Pressure. There was no statistical difference between the anesthesia times and recovery times of the two groups. While there was no statistical difference in the preoperative MMT evaluation, it was found to be significantly lower in Group H in the postoperative MMT evaluation.
Conclusion: In this study, we evaluated the effect of intraoperative IAP levels on intraoperative COS. It is seen that high IAP level does not have a negative effect on COS. In addition, this study has evidence that high IAP affects postoperative cognitive functions. In intraoperative management for TLH surgery, we recommend maintaining the IAP level at the lowest appropriate pressure that does not impair surgical comfort.
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