MyMedR

Manchester - Fothergill procedure for treatment of recurrence procidentia in young nulliparous woman: A case report

Ab Latip N, Ng PY, Jaili S, Mohd Noordin N

Med J Malaysia, 2018 02;73(1):41-43.

Procidentia is uncommon condition altering quality of life of young and nulliparous women. Its management poses significant dilemma and challenges as its associated body image, fertility and sexuality issues. Uterine preservation surgery described by Archibald Donald in 1888 known as Manchester -Fothergill procedure seems best option as alternative to vaginal hysterectomy. Despite its increasing popularity among surgeons and patients, robust clinical evidence is needed. We report a case of recurrent procidentia in a young nulliparous woman who had Manchester repair following vaginal sacrospinous hysteropexy. We concluded that Manchester repair is a useful and safe alternative for uterine-preserving technique.

Matched MeSH terms: Hysterectomy, Vaginal

Ovotesticular Disorders of Sex Development: Improvement in Spermatogonia after Removal of Ovary and Müllerian Structures

Abd Wahab AV, Lim LM, Mohamed Tarmizi MH

J Pediatr Adolesc Gynecol, 2019 Feb;32(1):74-77.

PMID: 30248506 DOI: 10.1016/j.jpag.2018.09.006

BACKGROUND: Ovotesticular disorders of sex development is a condition defined as the presence of ovarian tissue containing ovarian follicles and testicular tissue containing seminiferous tubules in the same individual.

CASE: We report on a 19-year-old who is phenotypically male, with a 46,XX/46,XY mosaicism karyotype, who presented later in life with cyclical abdominal pain that resembled menstrual cramps and unilateral undescended testes.

SUMMARY AND CONCLUSION: He underwent laparoscopic hysterectomy and right salpingo-oophorectomy, resulting in cessation of his symptoms and improved sperm count.

Matched MeSH terms: Hysterectomy/methods*

Fulltext Magnetic resonance-guided focused ultrasound surgery (MRgFUS) treatment for uterine fibroids

Abdullah B, Subramaniam R, Omar S, Wragg P, Ramli N, Wui A, et al.

Biomed Imaging Interv J, 2010 Apr-Jun;6(2):e15.

PMID: 21611036 MyJurnal DOI: 10.2349/biij.6.2.e15

Magnetic Resonance-guided focused Ultrasound Surgery (MRgFUS) is gaining popularity as an alternative to medical and surgical interventions in the management of symptomatic uterine fibroids. Studies have shown that it is an effective non-invasive treatment with minimal associated risks as compared to myomectomy and hysterectomy. MRgFUS can be offered to a majority of patients suffering from symptomatic uterine fibroids. It has been suggested that the use of broader inclusion criteria as well as the mitigation techniques makes it possible to offer MRgFUS to a much larger subset of patients than previously believed. This paper will describe how MRgFUS treatment for uterine fibroids is performed at the University of Malaya Medical Centre, Kuala Lumpur, Malaysia.

Matched MeSH terms: Hysterectomy

Fulltext Determinants of Pap smear screening among urbanite older female in North Klang Valley. [Abstract]

Abdullah NN, Ahmad Saman MS

Malaysian Journal of Medicine and Health Sciences, 2019;15(104):85-85.

MyJurnal

ABSTRACTS FOR INTERNATIONAL FAMILY HEALTH CONFERENCE 2019 (I-FaH 2019)
Introduction: As cervical cancer is the third most common cancer among women and ten percent of cervical cancer incidence among those 65 years and above, Pap smear is still relevant to be performed among older women. The aim of this study was to determine the determinants of Pap smear screening among older women in an urban setting.
Methods: This cross-sectional study was conducted among 515 women aged 50 and above in two urban health centres in Gombak, Selangor. The sampling technique conducted was random systematic sampling. The indepen-dent variables were age, marital status, employment status, gynaecological history (family history of cervical cancer, menopause, hysterectomy), obstetric history (number of live births, ever had contraception), presence of chronic diseases (hypertension, Diabetes Mellitus, heart disease). Results: Only 202 (39.2%) out of 515 undergone Pap smear screening. An estimated 80.7% of them had their last Pap smear a year ago. The mean age of the respondents was 58.83± 7.05 years old and 77.3% had one and more comorbidities. The respondents preferred health care person-nel as the source for the pap smear information compared to reading materials and internet. Married vs divorced (aOR=1.89,p=0.02); those with heart disease (aOR=0.32,p value=0.01; those with Diabetes Mellitus (aOR=0.57,p value=0.01; those who had hysterectomy (OR=2.89, p value=0.04) and those who had contraception (aOR=3.72, p value =

Matched MeSH terms: Hysterectomy

Case report: torsion of a gravid horn of a didelphic uterus

Achanna S, Monga D, Hassan MS

J Obstet Gynaecol Res, 1996 Apr;22(2):107-9.

PMID: 8697337

Acute abdominal pain during pregnancy presents a dilemma as signs and symptoms are often modified. Abdominal massage by traditional birth attendants (TBAs') during early labour is a common practice in the rural population, as it is perceived to give a soothening effect to the labouring mother. Many instances of abruptio placentae were reported in the past by this procedure, and in this case, the clinical picture presented as an abruptio placenta. Malpresentation and failure to progress were the indications for caesarean section despite the fetal demise. Severe post partum haemorrhage and failure to contract despite massive oxytocics resulted in the hysterectomy of the gravid horn, leaving the other horn intact.

Matched MeSH terms: Hysterectomy

Fulltext An Unusual Presentation and Behaviour of Endometrial Stromal Sarcoma

Adibah, I., Wan Abu Bakar, W.Y., Nik Mohamed Zaki, N.M., Nik Hazlina, N.H., Venkatesh, R.N.

International Medical Journal Malaysia, 2006;5(2):1-4.

MyJurnal

Endometrial stromal sarcoma is a rare tumour of the uterus. We reported a case of a young lady with endometrial stromal sarcoma. She became pregnant while having the disease and delivered a healthy baby, her sixth, without any complication. A total abdominal hysterectomy with bilateral oopherectomy was performed subsequently. She refused any added treatment after the operation. To date, she is free of any recurrence.

Matched MeSH terms: Hysterectomy

Fulltext Large perineal and gluteal angiomyxoma: the role of diagnostic imaging and literature review

Alhabshi SM, Abd Rashid M

BMJ Case Rep, 2013;2013.

PMID: 23429032 DOI: 10.1136/bcr-2013-008680

Aggressive angiomyxoma is a benign soft tissue tumour usually affecting the pelvis and perineum predominantly in women. Because of its variable presentation, this tumour is often clinically misdiagnosed as liposarcoma. We describe a case of a 38-year-old woman who presented with a large perineal and gluteal mass which increased in size in one year. Ultrasound showed hypoechoic mixed solid and cystic mass. Contrasted CT and MRI examinations showed typical appearance of swirling and layering pattern. She had undergone TAHBSO as the mass was difficult to dissect intra-operatively. The post-operative specimen confirmed to be an aggressive angiomyxoma.

Matched MeSH terms: Hysterectomy

Fulltext Factors affecting decision for hysterectomy: experience in a tertiary teaching hospital in Malaysia: a cross-sectional study

Alzergany, Maha Makluf, Noor Azmi Mat Adenan, Aizura Syafinaz Ahmad Adlan

Malaysian Journal of Public Health Medicine, 2014;14(3):0-0.

MyJurnal

Hysterectomy is one of the most common non-obstetric surgical procedures performed on women. Little is known about the factors affecting decision making process regarding hysterectomy in Malaysia. The study aimed to explore factors affecting women decision regarding hysterectomy among Malaysian women. This study has enrolled 100 women eligible for hysterectomy in the department of general gynecology ward in the university of Malaya hospital, Malaysia. A structured questionnaire was administered by interview. Descriptive analysis was used to obtain the frequencies. Chi square test and simple logistic regression test were performed to assess the association between variables. The majority of participants aged 41-50 years (52%) and married (74%). Twenty seven out of 100 participants made their decision on the operation within one month while 73 women decided after one month. Some complications were only known by the minority of patients such as injury to ureter (47%), injury to nerve (8%), incision hernia (18%), vault prolapse (21 %), and deep vein thrombosis (43%). Most of women delay their decision on the surgery (73%). Factors associated significantly with decision were ethnicity, religion, knowledge on complication, discussion with spouse and doctor.. Cultural factors, opinion of husband and doctors and knowledge of the complication play an important role in the decision of women. It is important to provide suitable information and social support for patients to help them in their decision-making. Participation and support from spouses and doctors should also be encouraged.

Matched MeSH terms: Hysterectomy

Hysterectomy in a phenotypic male with congenital adrenal hyperplasia (CAH)

Aziz NA, Mohd Ali MH, Ramli R

BMJ Case Rep, 2022 Feb 08;15(2).

PMID: 35135794 DOI: 10.1136/bcr-2021-246603

A young adult patient with 46XX congenital adrenal hyperplasia (CAH) presented with recurrent painful haematuria. CAH was diagnosed at birth following ambiguous genitalia. Hormonal treatment was started, female gender was assigned and feminising genitoplasty was planned, however the patient was lost to follow-up. Gender dysphoria started to occur during childhood which prompted the family to raise the patient as a boy. He eventually identified himself as a male. Examination revealed a male phenotype with severely virilised genitalia. Imaging studies confirmed the presence of uterus with low confluent urogenital sinus. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed, and the troublesome symptoms were cured.

Matched MeSH terms: Hysterectomy

Innate Immune and Neuronal Genetic Markers Are Highly Predictive of Postoperative Pain and Morphine Patient-Controlled Analgesia Requirements in Indian but Not Chinese or Malay Hysterectomy Patients

Barratt DT, Sia AT, Tan EC, Somogyi AA

Pain Med, 2021 Nov 26;22(11):2648-2660.

PMID: 34015137 DOI: 10.1093/pm/pnab172

OBJECTIVE: Pain severity and opioid requirements in the postoperative period show substantial and clinically significant inter-patient variation due mainly to factors such as age, surgery type, and duration. Genetic factors have not been adequately assessed except for the neuronal OPRM1 rs1799971 and COMT rs4680, whereas the contribution of innate immune signaling pathway genetics has seldom been investigated.

SETTING: Hospital surgical ward.

SUBJECTS: Women (107 Indian, 184 Malay, and 750 Han Chinese) undergoing total hysterectomy surgery.

METHODS: Morphine consumption, preoperative pain, and postoperative pain were evaluated in relation to genetic variability comprising 19 single-nucleotide polymorphisms (SNPs) in 14 genes involved in glial activation, inflammatory signaling, and neuronal regulation, plus OPRM1 (1 SNP) and COMT (3 SNPs).

RESULTS: Pre- and postoperative pain and age were associated with increased and decreased morphine consumption, respectively. In Chinese patients, only 8% of the variability in consumption could be explained by these nongenetic and genetic (BDNF, IL1B, IL6R, CRP, OPRM1, COMT, MYD88) factors. However, in Indian patients, 41% of morphine consumption variability could be explained by age (explaining <3%) and variants in OPRM1 rs1799971, CRP rs2794521, TLR4 rs4986790, IL2 rs2069762, COMT rs4818, TGFB1 rs1800469, and IL6R rs8192284 without controlling for postoperative pain.

CONCLUSIONS: This is the highest known value reported for genetic contributions (38%) to morphine use in the acute postoperative pain setting. Our findings highlight the need to incorporate both genetic and nongenetic factors and consider ethnicity-dependent and nonadditive genotypic models in the assessment of factors that contribute to variability in opioid use.

Matched MeSH terms: Hysterectomy

Fulltext Subcutaneous administration of tramadol after elective surgery is as effective as intravenous administration in relieving acute pain and inflammation in dogs

Buhari S, Hashim K, Yong Meng G, Mustapha NM, Gan SH

ScientificWorldJournal, 2012;2012:564939.

PMID: 22778699 DOI: 10.1100/2012/564939

Subcutaneous (SC) administration of tramadol was compared with intravenous (IV) administration to evaluate analgesia following canine ovariohysterectomy (OHE). Healthy female dogs (n = 12) between 1 and 3 years of age (1.95 ± 0.65 years), weighing between 10.5 and 17.1 kg (13.12 ± 1.95 kg), were used. Pain was assessed at baseline before surgery and then hourly for 8 hr after surgery. Tramadol was administered both SC and IV at a dose of 3 mg/kg and provided significant postoperative analgesia, as indicated by analgesiometry, β-endorphin levels, and interleukin 6 (IL-6) levels. The respiratory rates and rectal temperatures remained normal and were not significantly different between or within the groups. A significant increase in heart rate was observed at 4 hr for dogs in both groups relative to the baseline, but there was no significant difference in heart rates between the groups at any time point. A significant decrease in mechanical pain threshold was observed within each group after surgery, but both groups responded similarly, suggesting that SC administration of tramadol is as effective as IV administration. Increased serum levels of both IL-6 and β-endorphin 3 hr postoperatively further indicate that both routes of administration achieve similar pain control. Thus, the relative analgesic efficacy of SC tramadol is comparable to that of IV administration and can be used to achieve similar effects for postsurgical pain management in dogs undergoing OHE.

Matched MeSH terms: Hysterectomy/adverse effects*; Hysterectomy/veterinary*

A plea against abdominal hysterotomy in the treatment of hydatidiform mole

Chan DP

Med J Malaya, 1965 Sep;20(1):36-8.

PMID: 4221409

Matched MeSH terms: Hysterectomy*

Metastatic leiomyosarcoma of the thyroid: A rare entity

Che Jalil NA, Rama Chandran P, Samsudin AHZ, Yahya MM, Wan Abdul Rahman WF

Malays J Pathol, 2021 Apr;43(1):69-73.

PMID: 33903308

Cancer metastasis to the thyroid gland from non-thyroid sites is a rare presentation in clinical practice. The most frequent primary cancers that metastasise to the thyroid are renal cell carcinoma, followed by colorectal, lung and breast. We report a case of a 64-year-old Malay lady who presented with anterior neck swelling 4 years after an initial diagnosis of uterine leiomyosarcoma. She had undergone a hysterectomy procedure four years ago. Fine needle aspiration cytology of the thyroid mass suggested undifferentiated thyroid carcinoma. After multi-disciplinary discussion, the patient underwent thyroidectomy and the final histopathological diagnosis was metastatic leiomyosarcoma of the thyroid. The diagnosis was aided by an immunohistochemistry panel of positive myogenic markers, negative epithelial markers as well as the previous medical history of uterine leiomyosarcoma. Metastatic leiomyosarcoma of the thyroid may mimic primary undifferentiated (anaplastic) thyroid carcinoma (UTC) with a sarcomatoid pattern, medullary thyroid carcinoma (MTC) with spindle cells morphology and spindle cell tumour with thymus-like differentiation (SETTLE). Hence, a multidisciplinary approach must be practised by pathologists, surgeons and radiologists to consider metastatic lesions of the thyroid gland, especially when a previous history of cancer exists or is suspected.

Matched MeSH terms: Hysterectomy

An evaluation of the vaginal hysterectomy-repair operation for utero-vaginal prolapse

Cheng M

Med J Malaya, 1971 Sep;26(1):56-8.

PMID: 4258577

Matched MeSH terms: Hysterectomy*

Prospective follow-up of changes in menopausal complaints and hormone status after surgical menopause in a Malaysian population

Collaris R, Sidhu K, Chan JM

Menopause, 2010 Mar;17(2):351-8.

PMID: 19890223 DOI: 10.1097/gme.0b013e3181bcd6f8

Surgical menopause, in comparison with natural menopause, has traditionally been claimed to lead to faster onset of more severe menopausal symptoms. There is little prospective research to support this view. We aimed to evaluate the speed of onset and magnitude of climacteric symptoms after oophorectomy and whether they relate to serum hormone changes. This would aide in counseling women before surgery.

Matched MeSH terms: Hysterectomy

Fulltext A retrospective review of 25 cases of lethal fetal anomalies

Dalia, F.A., Hamizah, I., Zalina, N., Yong, S.L., Mokhtar, A.

International Medical Journal Malaysia, 2016;15(1):19-23.

MyJurnal

Introduction: To review the gestational age at diagnosis, method of diagnosis, pregnancy outcome and
maternal complications of prenatally diagnosed lethal foetal anomalies. Methods: Retrospective review of 25
women who had aborted or delivered foetuses with lethal anomalies in a tertiary hospital in 2011 based on
patient medical records. Results: There were a total of 10,088 deliveries, in which 25 (0.24%) women were
found to have conceived foetuses with lethal anomalies. All of them were diagnosed by prenatal ultrasound
and only 7 (28.0%) had both prenatal ultrasound and genetic study done. The women’s mean age was 29.9
years old. The mean gestational age at diagnosis of lethal foetal anomalies was 25.5 weeks (SD=12.5) and
mean gestational age at termination of pregnancy (TOP) or delivery was 28.5 weeks (SD=12.5). Seven (28%)
women had early counseling and TOP at the gestation of < 22 weeks. Beyond 22 weeks of gestation, eight
(32%) women had TOP and ten (40%) women had spontaneous delivery. Twenty (80%) women delivered or
aborted vaginally, three (12%) women with assisted breech delivery and two (8%) women with abdominal
delivery which were performed due to transverse foetal lie in labour and a failed induction, leading to
emergency hysterotomy complicated by hysterectomy due to intraoperative finding of ruptured uterus.
Overall, the associated post-partum adverse events included post-partum haemorrhage (12%), retained
placenta (12%), blood transfusion (8%), uterine rupture (4%) and endometritis (4%). Mean duration of hospital
stay was 6.6 days (SD 3.7 days). Conclusion: Late diagnosis of lethal foetal anomalies leads to various
maternal morbidities, in this case series , which could have been prevented if they were diagnosed and
terminated at early trimester. A new direction is needed in our local practice.

Matched MeSH terms: Hysterectomy

Uterine arteriovenous malformation - Possible association to uterine fibroids?

Gan F, Vikneswaran V, Yu KK

Med J Malaysia, 2021 03;76(2):273-274.

PMID: 33742646

A 32-year-old, gravida 2 para 0+1, was managed in Selayang Hospital, Selangor for uterine fibroids in pregnancy and placenta previa major. The lady went into preterm labour at 33 weeks, requiring emergency Caesarean section. Intraoperatively, we found a thinned-out bulge between the intramural uterine fibroids at the posterior uterine wall, which then perforated and was repaired. Persistent bleeding post operatively led to relaparotomy and hysterectomy. Histology of the uterus reported arteriovenous malformation (AVM). We postulate the possibility of these lesions coexisting with uterine fibroids. Screening for uterine AVMs in patients with fibroids may lead to early detection with option of embolization; deferring the need for hysterectomy.

Matched MeSH terms: Hysterectomy

Fulltext Villoglandular papillary adenocarcinoma of the uterine cervix with lymph node metastasis - a case report and review of the literature

Geok, Chin Tan, Mohd Sidik Shiran, Manickam Swaminathan, Ali Siti Aishah, M.D., Poo, Ling Ong, Mohd Dali Ahmad Zailani Hatta

Medicine & Health, 2006;1(1):85-90.

MyJurnal

Villoglandular papillary adenocarcinoma was first described by Young and Scully in 1989 as a distinct entity with the histological features of exophytic growth proliferation, villous and papillary architecture and mild to moderate nuclear atypia. We report one case of villoglandular papillary adenocarcinoma (VGPA) of the uterine cervix with lymph node metastasis and reviewed the clinicopathological features of six other cases reported in the literature. Our patient is the seventh similar reported cases. They ranged in age from 29 to 54 (mean, 41) years. Five had lymphovascular invasion. All except our patient were treated with radical hysterectomy and radiotherapy. She was followed-up for 7 months and unfortunately died due to chest infection.

Matched MeSH terms: Hysterectomy

Uterine bleeding with an IUD requiring emergency hysterectomy

Glew S, Singh A

Adv Contracept, 1989 Mar;5(1):51-3.

PMID: 2782134

A case is described of profuse uterine bleeding with a dislodged Multiload Cu 250 intrauterine device (IUD). Multiple blood transfusions were necessary, and ultimately, an emergency hysterectomy was performed.

Matched MeSH terms: Hysterectomy*

Uterine leiomyomata in pregnancy

Hasan F, Arumugam K, Sivanesaratnam V

Int J Gynaecol Obstet, 1991 Jan;34(1):45-8.

PMID: 1671020

Sixty cases with uterine leiomyomata in pregnancy are presented. The incidence was 1 in 1033 deliveries. The median age of the patients was 33.4 years. The majority were primigravidae (60%). A significant number of patients gave a history of infertility (43%) and spontaneous abortions (25%). The commonest antenatal complication was malpresentation and in all these patients the myomata were larger than 6 cm. Typical features of red degeneration occurred in 10% of cases. The cesarean section rate was 73%, the commonest indication being obstructed labor. Severe hemorrhage was encountered at cesarean section in 10 patients, 3 of whom needed hysterectomy. There were no perinatal deaths.

Matched MeSH terms: Hysterectomy

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