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Biomedical subjects

George A Vilos

Publications and source records attributed to George A Vilos.

At least 19 recordsLinked to original sources
PubMed2006

Administration of goserelin acetate after uterine artery embolization does not change the reduction rate and volume of uterine myomas.

OBJECTIVE: To determine if goserelin immediately after uterine artery embolization (UAE) affected myoma reduction. DESIGN: Randomized pilot study (level 1). SETTING: Teaching hospital. PATIENT(S): Twenty-six women. INTERVENTION(S): All patients underwent UAE, and then 12 patients received 10.8 mg of goserelin 24 hours later. The treatment group was 5 years older: 43 versus 37.7 years. Uterine and myoma volumes were measured by ultrasound 2 weeks before UAE and at 3, 6, and 12 months. MAIN OUTCOME MEASURE(S): Uterine and fibroid volumes. RESULT(S): Pretreatment uterine volume was 477 versus 556 cm3, and dominant fibroid volume was 257 versus 225 cm3 in the control versus goserelin groups. Analysis of variance measurements indicated that the change over time did not significantly differ between the two groups. By 12 months, the control group had a mean uterine volume reduction of 58%, while the goserelin group had a reduction of 45%. Dominant fibroid changes over time did not differ between the two groups. At 12 months, the mean fibroid volume had decreased by 86% and 58% in the control and goserelin groups, respectively. CONCLUSION(S): The addition of goserelin therapy to UAE did not alter the reduction rate or volume of uterine myomas.

Adult↗
PubMed2006

Fertility and pregnancy outcomes following hysteroscopic septum division.

OBJECTIVES: We sought to evaluate retrospectively the efficacy of hysteroscopic metroplasty in a population of women with a history of recurrent pregnancy loss or infertility who were also known to have a uterine septum. METHODS: Hysteroscopic metroplasty was performed on 26 women with a uterine septum and a history of either recurrent pregnancy loss or infertility. The metroplasty was performed using a Versapoint bipolar needle device (in 23% of cases) or a resectoscopic knife electrode with cutting current (in 77% of cases). The main outcome measures were rates of clinical pregnancy and live birth. RESULTS: Nineteen women had a hysteroscopic metroplasty because of recurrent pregnancy loss. Postoperatively, the pregnancy rate was 95%, and the live birth rate was 72%. The seven infertile patients had pregnancy and live birth rates of 43% and 29%, respectively. CONCLUSION: Hysteroscopic metroplasty using either the Versapoint bipolar needle device or a knife electrode is both safe and effective. In women with recurrent pregnancy loss, future fertility is not impaired, and live birth rates are significantly improved.

Abortion, Habitual↗
PubMed2006

Uterine artery occlusion: what is the evidence?

Symptomatic uterine fibroids are a relatively common gynecologic condition. In the past, fibroids were exclusively treated by myomectomy and/or hysterectomy. With the advent of uterine artery embolization or uterine artery occlusion, there now exist minimally invasive approaches to fibroid therapy especially for women in whom surgery is contraindicated or for those who wish to retain their uterus and possibly fertility. Fertility and pregnancy outcomes after these minimally invasive therapies are currently being evaluated.

Arteries↗
PubMed2005

New developments in ambulatory hysteroscopic surgery.

In the last decade, advancements have been made in hysteroscopic techniques, instrumentation and indications. Vaginoscopic hysteroscopy is performed without medication, cervical dilation and use of vaginal speculum or cervical tenaculum. To prevent complications during uterine access, both misoprostol and laminaria are equally effective for cervical priming. The use of normal saline to distend the uterus prevents hyponatraemia, but hypervolaemia may still be a major problem. Irrigant fluid deficit is best monitored by automated devices. Bipolar electrosurgical systems do not require dispersive return electrodes and do not generate stray currents, thus minimizing the risk of electrical burns. Tissue debulking and extraction are facilitated by vaporizing electrodes or morcellators. Hysteroscopic indications have expanded to include diagnosis and treatment of missed abortion, and cervical and interstitial pregnancies. The most important advancement of hysteroscopy has been proximal tubal access for sterilization.

Ambulatory Surgical Procedures↗
PubMed2005

Adenoid cystic carcinoma of the head and neck. Clinicopathological analysis of 23 patients and review of the literature.

Adenoid cystic carcinoma (ACC) is a rare epithelial tumor with a distinct natural history characterized by an indolent but persistent growth, late onset of distant metastases and eventual death of patients. Between 1991 and 2003, 23 patients with ACC were treated in our Department. Surgery with a curative intent followed by radiotherapy (RT) was applied in 22 patients. Complete resection was achieved in 72.73% of patients. Local recurrence occurred in 26% of patients. Positive margins emerged as the only statistically significant parameter (p < 0.0001) influencing the development of local recurrence. Distant metastasis (DM) occurred in 47.8% of patients. In 54.5% of the patients developing DM, this occurred between 5 and 10 years after the initial treatment. DM was influenced by perineural invasion (p = 0.04) and was disassociated from local control of the tumor. The mean overall survival of our patients was 70.58 months and the mean disease free survival 61.85 months. Perineural invasion (p = 0.048) and DM (p = 0.001) had a statistically significant impact on final patients' outcome. The most important factor influencing survival was DM. Its late onset, irrespectively of local control, supports the hypothesis that ACC has a potential to develop DM in the very early phases of tumor growth.

Adult↗
PubMed2005

Improving quality of care for patients undergoing arterial embolization for uterine fibroids: case report and review.

BACKGROUND: Uterine artery embolization (UAE) is an effective and accepted management option for symptomatic uterine fibroids. This case report presents a complication following UAE and is followed by a review outlining the need to monitor quality of care for women who undergo this procedure. CASE: A 37-year-old woman presented with fever and general malaise refractory to medical treatment 16 days after UAE was performed to treat a symptomatic fibroid. At hysterectomy, 20 days after UAE, a 10 cm necrotic and infected submucosal fibroid with cervicitis was identified. CONCLUSION: Complications of UAE for treatment of fibroids will be minimized if patients are selected appropriately, if the procedure is performed correctly, and if outcomes, efficacy, and complication rates are monitored.

Adult↗
PubMed2005

Consensus guidelines for the management of chronic pelvic pain.

OBJECTIVE: To improve the understanding of chronic pelvic pain (CPP) and to provide evidence-based guidelines of value to primary care health professionals, general obstetricians and gynaecologists, and those who specialize in chronic pain. BURDEN OF SUFFERING: CPP is a common, debilitating condition affecting women. It accounts for substantial personal suffering and health care expenditure for interventions, including multiple consultations and medical and surgical therapies. Because the underlying pathophysiology of this complex condition is poorly understood, these treatments have met with variable success rates. OUTCOMES: Effectiveness of diagnostic and therapeutic options, including assessment of myofascial dysfunction, multidisciplinary care, a rehabilitation model that emphasizes achieving higher function with some pain rather than a cure, and appropriate use of opiates for the chronic pain state. EVIDENCE: Medline and the Cochrane Database from 1982 to 2004 were searched for articles in English on subjects related to CPP, including acute care management, myofascial dysfunction, and medical and surgical therapeutic options. The committee reviewed the literature and available data from a needs assessment of subjects with CPP, using a consensus approach to develop recommendations. VALUES: The quality of the evidence was rated using the criteria described in the Report of the Canadian Task Force on the Periodic Health Examination. Recommendations for practice were ranked according to the method described in that report (Table 1). RECOMMENDATIONS: The recommendations are directed to the following areas: (a) an understanding of the needs of women with CPP; (b) general clinical assessment; (c) practical assessment of pain levels; (d) myofascial pain; (e) medications and surgical procedures; (d) principles of opiate management; (f) increased use of magnetic resonance imaging (MRI); (g) documentation of the surgically observed extent of disease; (h) alternative therapies; (i) access to multidisciplinary care models that have components of physical therapy (such as exercise and posture) and psychology (such as cognitive-behavioural therapy), along with other medical disciplines, such as gynaecology and anesthesia; (j) increased attention to CPP in the training of health care professionals; and (k) increased attention to CPP in formal, high-calibre research. The committee recommends that provincial ministries of health pursue the creation of multidisciplinary teams to manage the condition.

Canada↗
PubMed2004

Hysteroscopic and nonhysteroscopic endometrial ablation.

Endometrial ablation is defined as the elimination of the endometrium by thermal energy or resection. It was introduced in the 1980s as an alternative to hysterectomy to those patients with abnormal uterine bleeding and benign pathology who are unable or unwilling to tolerate traditional therapies. This article explores various endometrial ablation techniques.

Catheter Ablation↗
PubMed2003

Weighted speculum buttock burn during gynecologic surgery.

Genital tract and perineal electrical burns during resectoscopic surgery are occasionally encountered. However, perineal or buttock burns from other causes have not been reported.A 44-year-old overweight woman with a history of menometrorrhagia underwent endometrial ablation with a thermal balloon device uneventfully under general anesthesia. Upon removal of the weighted speculum it was noted that the buttocks had sustained two oval burns under the speculum ball. Experiments demonstrated that the weighted speculum cools off differentially, with the ball temperature remaining at higher than 45C in room air for at least 30 minutes after autoclaving.The use of the weighted speculum within 30 minutes of autoclaving may result in buttock burns. The speculum cools to lower than 40C within 1 minute when rinsed or bathed with at least 1 L of saline solution.

Adult↗
PubMed2003

Frequency and laparoscopic management of ovarian remnant syndrome.

STUDY OBJECTIVE: To report the frequency and outcome of laparoscopy in women with chronic pelvic pain and/or pelvic mass who were found to have ovarian remnants. DESIGN: Cohort study. (Canadian Task Force classification II-2). SETTING: University-affiliated hospital. PATIENTS: One hundred nineteen women who had had hysterectomy and oophorectomy. INTERVENTION: Laparoscopic surgery. MEASUREMENTS AND MAIN RESULTS: Ovarian remnants were known in 5 and were found intraoperatively in 21 patients (18%). These 26 women had undergone at least one laparoscopy in an attempt to remove the remnants. After the ureter was identified, ovarian remnants were dissected and removed from the retroperitoneum laparoscopically with minimal risk of vessel or visceral injury. There were no intraoperative or postoperative complications and no conversions to laparotomy. In addition to ovarian remnants, adhesions were found in 19 women, endometriosis in 4, and no other pathology in 3. Twenty women had complete relief of symptoms. At follow-up of 1 to 8 years (mean 5 yrs), six underwent repeat laparoscopy for persistent pain; one had recurrent ovarian remnant. CONCLUSIONS: Ovarian remnant syndrome is not an infrequent complication after hysterectomy and oophorectomy in women with endometriosis.

Adult↗
PubMed2003

Minimal-deviation adenocarcinoma of the cervix encountered during hysteroscopic endometrial ablation.

A 43-year-old, para 2, gravida 2 woman experienced menorrhagia. She had no risk factors for endometrial neoplasia, and five annual Papanicolaou smears, the last one 3 months earlier, were satisfactory for evaluation and within normal limits. During hysteroscopic endometrial ablation the endometrium appeared normal. The uterine-cervical cavity was normal other than a 1-cm, prominent, vascular, erythematous lesion in the posterior cervical canal, which was resected together with the entire endometrium. Pathology was reported as highly suggestive of a minimal-deviation adenocarcinoma of the cervix, and the patient underwent radical hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy. No residual cancer was found in the surgical specimen and the patient was alive and well 1 year later. Preablation evaluation is not adequate to detect all gynecologic malignancies. Routine resection of all unrecognizable lesions may identify rare tumors such as the one discovered in this woman.

Adenocarcinoma↗
PubMed2003

Midgut carcinoid tumor identified from a metastasis in the uterosacral ligament.

Chronic pelvic pain is common in women of reproductive age and accounts for more than 40% of all laparoscopic procedures. In up to 40% of these patients laparoscopic findings are negative. As a result, many gynecologists frequently excise portions of the uterosacral ligaments and biopsy inconspicuous pelvic lesions in an effort to perform uterosacral nerve ablation and also to identify subclinical endometriosis. During diagnostic laparoscopy for chronic intermittent pelvic and abdominal pain, a 37-year-old woman was noted to have an incidental, 5-mm, pink-white nodule in the right uterosacral ligament. Pathologic examination reported features typical of a carcinoid tumor. Further evaluation by computerized tomographic scan and indium-III octreotide scan identified a 1.6-cm lesion in the mesentery. At laparotomy a 2-cm primary mucosal tumor in the terminal ileum and a 2-cm nodule in the adjacent mesentery were present. Carcinoid tumor was confirmed in 2 nodules and in 7 of 17 mesenteric lymph nodes. Liver and lung metastases were not seen.

Abdominal Pain↗
PubMed2003

Laparoscopic mobilization of the rectosigmoid and excision of the obliterated cul-de-sac.

STUDY OBJECTIVE: To evaluate the feasibility and surgical and clinical outcomes of laparoscopic excision of anterior recto-sigmoid wall endometriosis and en bloc dissection of the obliterated cul-de-sac. DESIGN: Retrospective cohort (Canadian Task Force classification II-2). SETTING: University-affiliated teaching hospital. PATIENTS: Eighty-one women with infertility and/or chronic pelvic pain. Intervention. Laparoscopic excision of all endometrial implants and uterosacral ligaments, and dissection of the cul-de-sac using a horseshoe-shaped approach to mobilize, but not resect, the rectosigmoid. MEASUREMENTS AND MAIN OUTCOMES: Eleven women (24%) had endometriomas. Cumulative pregnancy rates in 34 women with primary infertility and 12 with secondary infertility were 62% and 42%, respectively. Eighty-eight percent of 61 women with pain reported significant improvement of symptoms. CONCLUSION: Laparoscopic excision of cul-de-sac and rectovaginal endometriosis by this approach is feasible and safe when performed by an experienced surgeon, and results in high rates of cumulative pregnancy and relief of pain. Some patient variables may give higher rates of success for pregnancy than others.

Adolescent↗
PubMed2003

Atypical polypoid adenomyoma and hysteroscopic endometrial ablation.

A 49-year-old woman presenting with menometrorrhagia underwent an office endometrial biopsy that indicated features suspicious for atypical polypoid adenomyoma (APA) but was inconclusive. The woman requested further evaluation prior to consenting to a hysterectomy and bilateral salpingo-oophorectomy. Hysteroscopy demonstrated a fleshy 2 cm to 3 cm sessile polypoid tumour, which was resected with the entire endometrium. The histology confirmed APA. Although amenorrhea was achieved, the gynaecological oncologist recommended the woman undergo hysterectomy, which she did 4 months later. Pathologic examination of the uterus revealed no residual endometrium or APA. As this tumour generally occurs in premenopausal women, and as conserving fertility potential may be an important consideration, hysteroscopic resection of such tumours may be a therapeutic option in women who wish to retain their uterus or who would be at high medical risk for hysterectomy. However, close, intermittent postoperative surveillance is recommended.

Adenomyoma↗
PubMed2003

Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure.

Laparoscopy was performed in 259 women. Under general anesthesia, after administering muscle relaxants, and with the patient in stirrups and horizontal position, a nondisposable Veress needle was inserted at the umbilicus or left upper quadrant site with carbon dioxide (CO2) flowing at 1 L/minute. We measured initial intraabdominal pressure in the first 52 women (group 1), pneumoperitoneum pressure (up to 15 mm Hg) at 1-L intervals in the next 102 women (group 2), and CO2 volume required for pressures of 10, 15, 20, and 25 mm Hg in the final 102 women (group 3). In three patients the procedure was abandoned. The primary trocar and laparoscope were introduced at pressure of 25 mm Hg and the entry site and abdominal contents were inspected before desufflation to 15 mm Hg and Trendelenburg position. Medians and means of initial intraabdominal pressure were 4 and 4.09 mm Hg (SD 1.34 mm Hg, range 2-8 mm Hg). This was always below interstitial pressures measured in the abdominal wall and during inadvertent insertion into omentum (5) and colon (2). Correlation between initial intraperitoneal pressure and patients' parity, weight, and body mass index was minimal. Mean CO2 volumes at 10, 15, 20, and 25 mm Hg were 3.7, 5.1, 5.9, and 6.5 L, respectively. No major complications were encountered. An initial intraabdominal pressure of 8 mm Hg or below always indicates correct placement of the Veress needle regardless of the patient's body habitus. Pressures greater than 8 mm Hg indicate interstitial placement including colon. Adequate pneumoperitoneum is determined by CO2 insufflation to a pressure of 25 mm Hg and not by a preconceived volume of CO2.

Abdominal Wall↗
PubMed2002

Endometrial adenocarcinoma encountered at the time of hysteroscopic endometrial ablation.

STUDY OBJECTIVE: To determine the diagnostic accuracy and possible role of treatment of hysteroscopic endometrial resection in women with abnormal uterine bleeding (AUB) diagnosed with endometrial adenocarcinoma. DESIGN: Retrospective analysis (Canadian Task Force classification II-2). SETTING: University-affiliated center. PATIENTS: Thirteen women with AUB and eight with postmenopausal bleeding. INTERVENTION: Preablation endometrial office biopsy and hysteroscopic evaluation. MEASUREMENTS AND MAIN RESULTS: Preablation endometrial biopsy was inadequate, inconclusive, or difficult to obtain in these women, and endometrial cancer was found at the time of resectoscopic surgery. Total endomyometrial resection including the tubal ostia was completed in eight women (group 1) and partial resection in five (group 2). Endometrial adenocarcinoma was confirmed histologically in all patients. A small focus of cancer was found in only two women in group 1 after total resection; in one the procedure was performed 9 years earlier and in the other it was completed hastily after absorption of 800 ml of 1.5% glycine irrigation solution. In women in group 2 malignancy was highly suspected and total resection was considered unwise. CONCLUSION: All patients were alive and well 0.5 to 9 years after hysterectomy, with no evidence of recurrent cancer.

Adenocarcinoma↗
PubMed2002

Atypical complex endometrial hyperplasia treated with the GyneLase system.

A 47-year-old premenopausal, para 1, gravida 1 woman complained of menometrorrhagia. She had no risk factors for endometrial hyperplasia or cancer, and office endometrial biopsy indicated focal, nonatypical endometrial hyperplasia. Seven months later the patient was scheduled for hysteroscopic endometrial resection. Instead she was treated by hysteroscopy, curettage, and the GyneLase system. The curetting indicated atypical, complex endometrial hyperplasia. The woman refused hysterectomy and salpingo-oophorectomy and adjunctive therapy with progesterone. She agreed to close surveillance and further treatment if she had any vaginal bleeding. At 13 months she remains amenorrheic, the endometrial echo is 2 mm, and follicle-stimulating hormone level is 63 IU/L. Based on the patient's amenorrhea and ultrasound uterine measurement, it is tempting to assume that GyneLase treatment may have cured her atypical hyperplasia. However, at this time, we have no evidence to substantiate this assumption.

Curettage↗