Circulating tumor DNA as a prognostic factor.
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Ascitic Fluid↗
Biomedical subjects
Arash Rafii
Publications and source records attributed to Arash Rafii.
Obturator abscess after transobturator tape for stress urinary incontinence.
BACKGROUND: A transobturator tape is a nonwoven, thermally bonded polypropylene tape recently approved in Europe for minimally invasive treatment of stress urinary incontinence. CASE: Three cases of obturator abscess after transobturator tape procedures are reported. Patients presented with groin pain and vaginal discharge, and physical examination showed vaginal erosions. Magnetic resonance imaging confirmed the obturator abscess. All patients had complete sling removal and were treated with antibiotics. The organism responsible for the obturator abscess was Bacteroides fragilis in all three cases, suggesting that the infection occurred through a vaginal erosion. CONCLUSION: Persistent painful or irritating symptoms after suburethral tape procedures may be due to a vaginal erosion that can be associated with an obturator abscess. Appropriate evaluation and treatment result in marked symptomatic improvement, although stress incontinence may recur.
Abscess↗
Objective and subjective cure rates after trans-obturator tape (OBTAPE) treatment of female urinary incontinence.
OBJECTIVE(S): To evaluate the safety and efficacy of a thermally bonded nonwoven polypropylene mesh in a transobturator suburethral tape procedure (OBTAPE), Mentor-Porges, Le Plessis Robinson, France) for women with stress urinary incontinence. METHODS: Between January 2003 and January 2005, 129 consecutive women (mean age 57.2 years) underwent OBTAPE) in two academic centers. All the patients had stress urinary incontinence preoperatively. Detrusor instability was ruled out by cystometry. The women were evaluated 1, 6 and 12 months postoperatively. The objective cure rate was evaluated by clinical examination and the subjective cure rate was assessed using the KHQ and BFLUTS questionnaire. RESULTS: Mean follow-up was 17.2+/-4.7 months (range 4 to 28 months). The objective and subjective cure rates were respectively 89.9% and 77.5%. Most of the patients received general anesthesia (85.3%). Urinary retention was observed in two women (1.5%), necessitating tape adjustment. Voiding difficulties were observed in 7 cases (5.4%) necessitating intermittent self-catheterization for 4.2+/-2.4 days (range 1 to 7 days). Seven patients developed vaginal erosion (one with vaginal extrusion, and two with an obturator abscess). Complete mesh removal was necessary in 6 patients, four of whom had recurrent stress urinary incontinence. CONCLUSIONS: Our results suggest that the OBTAPE) is an effective treatment for women with stress urinary incontinence. However, vaginal mesh erosion occurred in 6.2% of women, and this implies the need for careful follow-up.
Adult↗
Previous abdominal surgery and closed entry for gynaecological laparoscopy: a prospective study.
OBJECTIVES: To assess the morbidity from closed laparoscopic access and define the role of previous surgery on the occurrence of these complications. DESIGN AND METHODS: We prospectively recorded data on all laparoscopic procedures between January 2000 and January 2001. We compared results from patients without previous abdominal surgery (group I) with patients with prior abdominal surgery (group II). The insertion site for the Verres needle was trans-umbilical for patients in group I and in the left upper quadrant for patients in group II. SETTING: Gynaecology department of a University Hospital. POPULATION: All laparoscopic procedures between January 2000 and January 2001. MAIN OUTCOME MEASURES: We compared results from patients without previous abdominal surgery (group I) with patients with prior abdominal surgery (group II). The insertion site for the Verres needle was trans-umbilical for patients in group I and the left upper quadrant for patients in group II. RESULTS: Four hundred and seventy-seven laparoscopies were carried out during the study period, 368 women without previous surgery were included in group I, and 109 women were included in group II. We recorded 1 complication (overall complication rate of 0.2% and 31 incidents (6.4%). One complication (small bowel injury) was related to the insertion of the Verres needle (0.2%). The incidents and complications occurred only in group II (P < 0.05). All the complications were treated by laparoscopy. CONCLUSION: The complication rate of the entry step is low in gynaecological laparoscopy. A previous history of laparotomy increases the risk of these complications and incidents. Safety rules and other access method should be investigated for these patients.
Abdomen↗
Vaginal hysterectomy for benign disorders in obese women: a prospective study.
OBJECTIVE: To compare the morbidity of vaginal hysterectomy in obese and non-obese women in a single institution. DESIGN: Obese and non-obese women with benign uterine disorders matched for age, parity and race underwent vaginal hysterectomy without laparoscopic assistance. Peri-operative outcome complications were compared. Thirty-eight women had a BMI over 30 kg/m(2) (study group) and 178 women had a BMI below 30 kg/m(2) (control group). SETTING: Gynaecologic department of a university hospital. POPULATION: Women who were referred to our department with an indication of vaginal hysterectomy for benign disorders. METHODS: Case control study. MAIN OUTCOME MEASURES: Peri-operative complications, the fall in the haemoglobin concentration, the duration of the procedure, the length of the hospital stay and uterine weight were analysed. RESULTS: Mean BMI was 33.2 and 23.7 kg/m(2) in the study and control groups, respectively. None of the obese women had severe co-morbidity contraindicating surgery. There were no significant differences in surgical or anaesthetic risk factors, including parity, hormonal status, pre-existing disease and estimated mean uterine weight. The overall complication rates were 14% and 16% in the obese and non-obese groups, respectively (P= 0.7). Obesity did not increase the duration of the procedure (48 [7] minutes vs 50 [10] minutes, P= 0.1) or the length of hospitalisation (5.8 [1.4] days vs 5.5 [1.2] days, P= 0.2). CONCLUSION: Vaginal hysterectomy can be successfully performed, with acceptable morbidity, in obese women.
Adult↗
Sonography in prenatal diagnosis of congenital adrenal hyperplasia.
Congenital adrenal hyperplasia (CAH) is an autosomal recessive disorder with an incidence of 1/15 000. More than 90% of CAH cases result from mutations of CYP21, leading to 21-hydroxylase deficiency. In its classical form, CAH is severe and consists of the virilizing (increase of androgens) and salt-wasting (lack of aldosterone) phenotype. When a proband exists, early prenatal diagnosis for CAH can be performed by direct molecular analysis in the first trimester. We describe herein two cases suggesting that the prenatal diagnosis of CAH can be initiated by the sonographic appearance of the adrenal gland at the second-trimester scan in the absence of a family history.
Adrenal Glands↗
Tension-free vaginal tape and associated procedures: a case control study.
OBJECTIVES: We compare objective and subjective cure rates after tension-free vaginal tape procedures performed alone or in conjunction with vaginal procedures. METHODS: One hundred eighty-six women underwent a tension-free vaginal tape procedure for stress or mixed urinary incontinence. One hundred women treated with tension-free vaginal tape alone (group 1) were compared with 40 women treated with tension-free vaginal tape and concomitant vaginal hysterectomy (group 2), and 46 patients treated with tension-free vaginal tape and pelvic floor reconstruction (group 3). Patient outcomes, surgical difficulties and complications are reported. Postoperative voiding diaries, standing stress-test results, and patient satisfaction were compared. RESULTS: There were no significant differences among the three groups in terms of age, menopausal status, BMI, previous incontinence surgery, or the type and degree of incontinence. Parity was significantly higher in the group treated with tension-free vaginal tape and pelvic floor reconstruction ( p=0.04 ). The overall perioperative complication rate was 15.6%. Women treated with tension-free vaginal tape and hysterectomy (group 2), and those treated with tension-free vaginal tape and pelvic floor reconstruction (group 3) had a significantly higher incidence of bladder injury (17.9% and 13%, respectively, versus 5% in group 1; p=0.05 ). Estimated blood loss and the frequencies of postoperative urgency and voiding disorders did differ significantly between women treated with tension-free vaginal tape alone and those who underwent associated procedures. The mean follow-up time was 24.5+/-2.6 months. No difference in the objective cure rate was found between the tension-free vaginal tape group and the other two groups (93% versus 97.5% and 91.1%; p=0.3 ). No difference in the subjective cure rate was found between the tension-free vaginal tape group and the groups undergoing associated procedures (72% versus 72.5% and 68.8%; p=0.4). CONCLUSION: Pelvic floor defects, benign uterine disorders and stress urinary incontinence can be safely treated with tension-free vaginal tape and vaginal procedures during the same surgical procedure.
Case-Control Studies↗
Body mass index and outcome of tension-free vaginal tape.
OBJECTIVES: To assess the effectiveness of tension-free vaginal tape (TVT) in women with high body mass indices (BMIs). METHODS: Thirty-eight consecutive patients with BMIs exceeding 30 who underwent tension-free vaginal tape were compared with 149 consecutive patients with BMIs of 30 or less who underwent the same procedure. Body mass index was calculated pre-operatively and at follow-up. Women were classified as being of normal weight (BMI 20-25), overweight (BMI 26-30), or obese (BMI >30). Patient characteristics, operative and post-operative complications, reported continence rates were analyzed according to BMI. RESULTS: There were no significant differences between groups in terms of age, parity, menopausal status, previous surgery, type and degree of incontinence. Estimated blood loss, operative times, bladder injuries, post-operative urgency and voiding disorders did not differ significantly between women with high BMIs and those with low BMIs. Women with BMIs exceeding 30 had a significantly higher incidence of post-operative urge urinary incontinence (17.9 versus 3.4 and 6.4% p = 0.02) without any effects on the objective and subjective cure rates (82 versus 88.7 and 93% p = 0.1, 71.7 versus 72.1 and 74% p = 0.9). CONCLUSION: We did not find pre-operative obesity to be a risk factor for failure of tension-free vaginal tape.
Aged↗
A French multicenter clinical trial of SPARC for stress urinary incontinence.
OBJECTIVE: To evaluate the safety and efficacy of the SPARC procedure in women with genuine stress urinary incontinence. METHODS: We conducted a prospective multicenter trial of a suprapubic approach to suburethral polypropylene (SPARC) taping for the treatment of genuine stress urinary incontinence. Between June 2001 and June 2002, 104 consecutive women (mean age 58.7 years) underwent SPARC in three centers. All the women had urethral hypermobility preoperatively. Detrusor instability was ruled out by cystometry. The women were evaluated 1, 3, 6 and 12 months postoperatively. The objective cure rate was evaluated by clinical and urodynamic examination, and the subjective cure rate was assessed using the Kings and Bristol questionnaire. RESULTS: The mean follow-up time was 11.9+/-1.9 months (range 8 to 20 months). The mean operating time was 30 min (25-50 min). Most of the patients received general anesthesia (48%). The overall complication rate was 44.2% (46/104). The perioperative complication rate was 10.5%, including 11 bladder injuries. A significant difference in the bladder injury rate was observed between women with and without previous incontinence surgery (respectively 4/11, 36.3% versus 7/93, 7.5%; p<0.001). No hemorrhaging occurred. The early postoperative complication rate was 22.1%. The main complication was voiding disorders (11 patients), which necessitated intermittent self-catheterization for less than 15 days (1.3+/-1.1 days, range 1 to 10 days). The late postoperative complication rate was 11.5%, including de novo urge symptoms in 12 women. The objective cure rate was 90.4%. No difference was found between patients with genuine stress incontinence and those with mixed incontinence. The subjective cure rate was 72%. The objective and subjective cure rates differed significantly (p<0.05). The subjective cure rate among patients with de novo urge symptoms was 58%. CONCLUSION: The SPARC procedure is a safe and effective treatment for women with stress urinary incontinence, despite a high incidence of de novo urge symptoms.
Adult↗
Vaginal mesh erosion 7 years after a sacral colpopexy.
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Diagnosis, Differential↗
Morbidity of vaginal hysterectomy for benign tumors as a function of uterine weight.
OBJECTIVE: To evaluate the relationship between uterine weight and morbidity in women undergoing vaginal hysterectomy. STUDY DESIGN: A prospective study of vaginal hysterectomy was carried out in women with benign uterine tumors. The only exclusion criteria were a suspected adnexal mass, a very narrow vagina and an immobile uterus. The women were stratified into 3 groups according to uterine weight. The groups were compared as regards indications, operative time, complication rates, analgesia requirements and postoperative recovery. RESULTS: A total of 214 women underwent vaginal hysterectomy: group 1, n = 114, uteri < 180 g; group 2, n = 73, uteri 180-500 g; group 3, n = 27, uteri > 500 g (maximum 1,350 g). The groups differed with respect to mean age (P = .003) and menopausal status (P = .002) but not gravidity, parity, previous pelvic surgery or preoperative hemoglobin levels. Concerning the indications for hysterectomy, only the incidence of pelvic compression differed between the groups (P = .04). There was no difference in the frequency of concomitant surgical procedures (e.g., adnexectomy) between the groups. Morcellation rate was 30% in group 1, 73% in group 2 and 100% in group 3. The overall complication rate was not significantly different between the groups: 20.1%, 15.0% and 22.2%, respectively. The only major complication was an injury to the in-fundibulopelvic ligament in a group 1 patient. Operative time increased significantly with uterine weight (82 +/- 35.4, 91.8 +/- 35.4 and 94.8 +/- 36.5 minutes, respectively; P = .01). There were no significant differences between the groups as regards perioperative hemoglobin loss, analgesia requirements, time to flatus and stool return or length of hospital stay. CONCLUSION: Vaginal hysterectomy can be performed successfully even in the case of greatly enlarged uteri; nulliparity and a history of pelvic surgery are not absolute contraindications.
Adult↗
Sigmoid endometriosis in a postmenopausal woman.
Bowel obstruction resulting from endometriosis is an infrequently observed phenomenon in postmenopausal women. A 69-year-old woman without hormone replacement had clinical and radiologic findings consistent with a pelvic tumor invasive into the wall of the sigmoid colon. The patient underwent resection of the sigmoid colon and total hysterectomy. Histologic examination revealed endometrioma. This case documents the possible occurrence of symptomatic bowel endometriosis after years of a hormonally castrated state.
Aged↗
Inherited interleukin-12 deficiency: IL12B genotype and clinical phenotype of 13 patients from six kindreds.
Interleukin-12 (IL12) is a cytokine that is secreted by activated phagocytes and dendritic cells and that induces interferon-gamma production by natural-killer and T lymphocytes. It consists of two subunits, p35 and p40, which are encoded by IL12A and IL12B, respectively. The first reported patient with a genetic cytokine disorder was a Pakistani child, who was homozygous for a large loss-of-function deletion (g.482+82_856-854del) in IL12B. This IL12-deficient child suffered from infections caused by bacille Calmette-Guérin (BCG) and Salmonella enteritidis. We herein report 12 additional patients from five other kindreds. In one kindred from India, the same large deletion that was described elsewhere (g.482+82_856-854del) was identified. In four kindreds from Saudi Arabia, a recessive loss-of-function frameshift insertion (g.315_316insA) was found. A conserved haplotype encompassing the IL12B gene suggested that a founder effect accounted for the recurrence of each mutation. The two founder mutational events-g.482+82_856-854del and g.315_316insA-were estimated to have occurred approximately 700 and approximately 1,100 years ago, respectively. Among a total of 13 patients with IL12 deficiency, 1 child had salmonellosis only and 12 suffered from clinical disease due to BCG or environmental nontuberculous mycobacteria. One patient also had clinical disease caused by virulent Mycobacterium tuberculosis, five patients had clinical disease caused by Salmonella serotypes, and one patient had clinical disease caused by Nocardia asteroides. The clinical outcome varies from case to case, since five patients (aged 2-11 years) died of overwhelming infection, whereas eight patients (aged 3-12 years) are still in good health and are not currently taking antibiotics. In conclusion, IL12 deficiency is not limited to a single kindred, shows significant variability of outcome, and should be considered in the genetic diagnosis of patients with mycobacteriosis and/or salmonellosis. To date, two founder IL12B mutations have been identified, accounting for the recurrence of a large deletion and a small insertion within populations from the Indian subcontinent and from the Arabian Peninsula, respectively.
Adolescent↗
Laparoscopic obturator nerve neurolysis after pelvic lymphadenectomy.
Postoperative neuropathy is a known complication of major pelvic oncologic surgery. Obturator nerve injury complicating pelvic lymph node dissection has been reported in the literature. Severity and duration of symptoms are determined by the severity of the initial nerve lesion. Different management options have been described in the literature. We report here on a patient who developed right obturator neuropathy after pelvic lymphadenectomy. Initial management by physical therapy was unsuccessful, and the patient underwent a successful laparoscopic surgical neurolysis. Whereas preventive measures remain essential to avoid any nerve injury, this case illustrates the use of laparoscopy to perform neurolysis with a favorable outcome; therefore, persistent pain or motor loss should motivate at least surgical exploration that can be done with low morbidity by laparoscopy.
Carcinoma, Squamous Cell↗