Background Reflectance confocal microscopy (RCM) images skin at cellular resolution and has shown utility for the diagnosis of nonmelanoma skin cancer in-vivo. Topical application of Aluminum Chloride (AlCl3) enhances contrast in RCM images by brightening nuclei. Objective To investigate feasibility of RCM imaging of shave biopsy wounds using AlCl3 as a contrast agent. Methods AlCl3 staining was optimized, in terms of concentration versus immersion time, on excised tissue ex-vivo. RCM imaging protocol was tested in patients undergoing shave biopsies. The RCM images were retrospectively analyzed and compared to the corresponding histopathology. Results For 35% AlCl3, routinely used for hemostasis in clinic, minimum immersion time was determined to be 1 minute. We identified 3 consistent patterns of margins on RCM mosaic images by varying depths: epidermal margins, peripheral dermal margins, and deep dermal margins. Tumour islands of basal cell carcinoma were identified at peripheral or deep dermal margins, correlating on histopathology with aggregates of neoplastic basaloid cells. Atypical cobblestone or honeycomb pattern were identified at the epidermal margins, correlating with a proliferation of atypical keratinocytes extending to biopsy margins. Conclusions RCM imaging of shave biopsy wounds is feasible and demonstrates the future possibility of intra-operative mapping in surgical wounds.
Introduction Granulosa cell tumour (GCT) comprises 2-5% of ovarian malignancies. They are hormonally active tumours and may present with menstrual complaints, abdominal distension or infertility. Prognosis is generally favourable because of the early stage at diagnosis and less aggressive behaviour. Materials and Methods Medical records of 32 cases presenting from January 2008 to December 2014 were retrospectively analysed for the patient characteristics, tumour characteristics and the treatment received. ResultsThe mean age was 42.75 ± 10.25 years (range: 22 to 70 years). The most common presenting symptom was abdominal distension (50.00%) followed by menstrual complaints. The mean tumour diameter was 15.24 cm (range: 4-25 cm). Endometrial pathology was found in 4 patients (12.50%), and all had simple hyperplasia without atypia. Twenty-four patients underwent primary staging surgery; one patient underwent interval debulking surgery after neo-adjuvant chemotherapy. Seven patients had undergone surgery elsewhere of which 4 underwent re-staging and three were given chemotherapy. All patients had the final histopathology of adult granulosa cell tumour except one patient with juvenile granulosa cell tumour. Most patients had stage I disease (81.25%). Post-operative chemotherapy was administered to 22 patients. The most commonly used regimen was paclitaxel and carboplatin. The overall 5-year survival rate was 90%. The mean overall survival was 36.95 ± 34.08 months (range: 0.50 to 112.00 months). Two patients had recurrence at 38 and 44 months, respectively. Conclusion GCT of the ovary is a rare tumour with a tendency for late relapse. Survival is generally excellent as majority of the patients present in early stages.
Postpartum hemorrhage (PPH) is associated with considerable morbidity and mortality, particularly when relaparotomy is necessary. The etiology of spontaneous intractable PPH in a hemodynamically stable patient is poorly understood and remains open to speculation. Secondary, or delayed, PPH is usually defined as the excessive bleeding from the genital tract, with a loss of 500 ml or more of blood occurring after the first 24 hours after delivery until the sixth week of puerperium. In this report, we present three cases of severe, diffuse postpartum bleeding unresponsive to conventional hemostatic measures, which were successfully managed laparoscopically at our center. In all three cases, hemostasis was accomplished by using a laparoscopic procedure: with the excision of cervical stump bleeding in the first case, bilateral uterine artery ligation accompanied by laparoscopic hysterectomy in the second case, and bilateral internal iliac artery ligation in the third case.
Objective: To evaluate the efficacy of laparoscopic surgery in the treatment of cesarean scar ectopic pregnancy compared with other modalities. Design: Case report. MP4 video clip, 5.10 minutes in length. Settings: A hospital. Patients: A 38 year old, gravid 2, para 1, with history of previous cesarean section in 2013 was admitted to the emergency department with vaginal bleeding and a positive pregnancy test. Transvaginal ultrasonography revealed a vascularized amorphous 4 cm in diameter mass surrounding a gestational sac at 10 -12 weeks located to the scar of the previous cesarean section. Ultrasound guided dilation and curettage was indicated, followed by Foley catheter insertion. After that, the pregnancy mass increased to 7 cm in diameter and the thickness of the uterine wall between the bladder and the gestational sac was thinner. Laparoscopic treatment was considered. Interventions: Laparoscopic bilateral uterine artery ligation was performed, followed by a sharp dissection of the vesicouterine peritoneal fold and removal of the ectopic pregnancy located in the dehiscent scar. Then, bipolar coagulation and suturing of the defect in two layers were done, followed by peritonealization. Measurements/Results: The total operative time was 120 minutes. Intraoperative blood loss was 50 mL. No immediate complications were noticed. The patient was discharged on postoperative day 2 with the decrease in serum β-hCG levels. At 1 month after the intervention, ultrasound was normal. Conclusions: Surgical management of caesarean scar pregnancy and repair of scar defect can be performed safely and efficiently with laparoscopy.
Patients: Women with high risk endometrial adenocarcinoma who underwent laparoscopic pelvic and para aortic lymph node dissection as a part of the staging procedure. Interventions: Laparoscopic surgical staging of endometrial adenocarcinoma. Measurements/Results: A total of 42 patients with high risk (tumour size >2 cm, more than 50% myometrial invasion, grade 3, LVSI positive) endometrial adenocarcinoma who underwent laparoscopic staging surgery were retrospectively analysed to determine the impact of body mass index (BMI) on pelvic and para aortic lymph node count. Patients were divided into four groups, non obese (BMI <25), overweight (BMI 25-29.99), obese (BMI 30-39.99) and morbidly obese (BMI >40). All patients underwent laparoscopic systematic pelvic and para aortic lymphadenectomy as a part of the staging procedure. Nodal count was assessed in respective groups. Although mean pelvic and para aortic nodal count in each subgroup was at par with that mentioned in current literature, there was no significant difference in pelvic and para aortic nodal yield in between the four groups (p = .274, 0.131 respectively). Conclusions: Studies mentioned in literature suggest an inverse relationship of increasing BMI and decreasing lymph node harvest. Our study negates this correlation and proves the feasibility and efficiency of laparoscopic pelvic and para aortic lymphadenectomy in endometrial adenocarcinoma even in morbidly obese women.
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