Choosing a treatment option for uterine fibroids is today one of the most relevant problems in gynecological practice. Thanks to the success of modern medicine and the increased level of the population’s culture, female patients seek medical help without waiting for the tumor to acquire significant sizes. However, in practice, there are cases when fibroids reach gigantic sizes. Hysterectomy is a traditional approach to treating uterine fibroids of these sizes according to the current clinical guidelines. The introduction of new high-tech treatments, such as uterine artery embolization, has led to a revision of radical surgery, by giving preference to alternative approaches especially in cases where the patient desires to preserve the reproductive organ. The paper describes a clinical case that confirms an individual approach to choosing a treatment option towards organ-sparing surgery for giant uterine fibroids. The use of endovascular embolization of the uterine arteries as a treatment for giant uterine fibroids is shown to be justified as an organ-sparing surgery if the patient desires to preserve reproductive function.
Among the numerous changes in a woman's body during pregnancy, childbirth and puerperium, changes in the pubic joint occupy a specific place. M.F. Eisenberg pointed out that "by changes in the pubic joint, which is like an indicator of the pelvis, one can judge about changes occurring in the whole pelvic ring". Under the general name "changes and damages of the pubic joint" there are up to 16 components: loosening, softening, edema impregnation, stretching, dilation, divergence, rupture, inflammatory process, aseptic necrosis, a sterile form of osteomalacia of pregnant women, a special form of pregnant women toxicity, a special form of hypovitaminosis, symphysiopathy, osteopathy, symphyseitis.
Inflammatory complications are relatively frequent in the hierarchy of complications of hysteroscopy. The article describes two clinical case scenarios of hysteroscopic procedures complicated by pelvioperitonitis. The analysis of contemporary local and international literature is presented, and shows different attitude towards the antibiotic prophylaxis of inflammatory complications related to hysteroscopy. Taking into account that potential spread of infected material from the uterine cavity through the tubes into Douglas space plays role in the pathogenesis of inflammatory complications, it is advisable to consider the value of intra-uterine pressure as one of the main factors responsible for the development of inflammatory complications. It is also prudent to use the technique and values of in-office hysteroscopy to prevent tubal reflux and thus reduce the chance of infectious complications. The possibility of complete abandonment of antibiotic prophylaxis requires additional research and confirmation with clinical studies.
A tumor of the uterus, consisting of smooth muscles, is called myoma and fibroids, and in practice, the terms are used synonymously. Myoma of the uterus is a common disease in women of childbearing age. The frequency of its detection without regard to age is 2.45%. With age, its prevalence increases and reaches 8.31% by the age of 50. The estimate of the final probability of contracting uterine fibroids in the population throughout life is 9.7%. According to sectional data, uterine fibroids, including small nodes, occur in 20% of women. In 50% of cases, these tumors are manifested by clinically pronounced disorders that lead a woman to a doctor.
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