Cervical and broad ligament fibroids are rare; with incidence of only 2% and 1% respectively.
Cervical fibroid often present with pressure symptoms and often pose surgical difficulties due to its proximity to bladder and rectum.
Broad ligament fibroid though rare , but have the propensity of growing into large adnexal masses and may mimic ovarian malignancy.
Uterine Fibroids (Leiomyomata): Investigations and Treatment Michelle Fynes
Uterine fibroids (UF) are the most common benign neoplastic threat to women's health, costing hundreds of billions of health care dollars worldwide. The objective of this presentation is to review risk factors, aetiology, classification and clinical presentation of Uterine fibroids.
Uterine Fibroids (Leiomyomata): Investigations and Treatment Michelle Fynes
Uterine fibroids (UF) are the most common benign neoplastic threat to women's health, costing hundreds of billions of health care dollars worldwide. The objective of this presentation is to review risk factors, aetiology, classification and clinical presentation of Uterine fibroids.
Benign growths in the uterus that can develop during a woman's childbearing years.Highest incidence was seen in Pakistani women 78%, then rural Indian women 37.65%, urban India 24% and Nigerian women 30%. Arobosoba from Nigeria has reported prevalence of uterine fibroids in black women was more (26%), in comparison to Caucasian women (17.9%).
Case Report on Invasive Mole. Gestational Trophoblastic Neoplasia (GTN) encom...Niranjan Chavan
Gestational Trophoblastic Neoplasia (GTN) encompasses a suite of rare but significant gynecological malignancies arising from aberrant placental trophoblast cells. As medical professionals and researchers, our comprehension of GTN's complexities is crucial for accurate diagnosis and effective treatment. This introduction serves to illuminate the key features, diagnostic procedures, and treatment protocols associated with GTN, helping to navigate the intricate landscape of this disease.
Peripartum cardiomyopathy (PPCM) is a rare form of heart failure that occurs during the last month of pregnancy or within the first five months postpartum. It presents significant challenges in diagnosis and treatment due to its overlap with symptoms of normal pregnancy and postpartum changes. This condition varies in incidence across different racial groups and geographical locations, with a notable occurrence in the United States and southern India.
DR. NNC LAPAROSCOPY IN PREGNANCY IAGE VARANASI, 17TH MARCH 2024.pptxNiranjan Chavan
Our journey will navigate the evolution of laparoscopy in the context of pregnancy, detailing key milestones, breakthroughs, and advancements in technology and techniques. The presentation highlights how laparoscopy has revolutionized the diagnosis and treatment of conditions such as ectopic pregnancy, ovarian cysts and other gynecological disorders during pregnancy.
Optimising Delivery Of 1kg Fetus - Special Considerations.pptxNiranjan Chavan
After an uncomplicated vaginal birth in a health facility, healthy mothers and newborns should receive care in the facility for at least 24 hours after birth.
VACCINE IN WOMEN TOWARDS SDG 2030 DR.N N CHAVAN 10012024 AICOG HYDERABAD.pptxNiranjan Chavan
In our presentation today, we will unravel the transformative power of vaccines in women, aligning with the Sustainable Development Goals (SDGs) for 2030. By exploring the pivotal role of vaccinations, we aim to elucidate how they contribute to women's health, empowerment, and overall well-being. Through this lens, we envision a future where widespread vaccine access propels us closer to achieving the SDGs and ensures a healthier, more equitable world for women globally.
RRRR IN OBSTETRIC HEMORRHAGE 09012024 AICOG 2024 HEYDERABAD.pptxNiranjan Chavan
This presentation focuses on a critical aspect of maternal care: "Reducing Maternal Mortality through Rapid Response in Obstetric Haemorrhage" (RRRR). As we navigate through this presentation, let us collectively work towards advancing our understanding and application of RRRR in obstetric care to safeguard the well-being of mothers during childbirth.
Anemia is a condition in which the number of red blood cells and/OR their oxy...Niranjan Chavan
Anemia is a condition in which the number of red blood cells and/OR their
oxygen-carrying capacity is insufficient to meet the body’s physiological needs.
HELLP syndrome is a pregnancy complication. It is a type of preeclampsia. It ...Niranjan Chavan
HELLP syndrome is a pregnancy complication. It is a type of preeclampsia. It usually occurs during the third trimester of pregnancy. But it also can develop in the first week after childbirth
Guidelines & Identification of Early Sepsis DR. NN CHAVAN 02122023.pptxNiranjan Chavan
Here is a highly informative session on guidelines and identification of early sepsis as it is critical for timely intervention and improved patient outcomes.
PAST, PRESENT AND FUTURE IN OBGYN INFECTIONS 01102023.pptxNiranjan Chavan
Today, we face new infectious threats; but also benefit from advanced diagnostics and treatments. Looking ahead, it’s crucial to continue
adapting to emerging pathogens, implement stringent preventive measures, and
leverage cutting-edge technologies to ensure the safety and well-being of our patients in the ever-evolving landscape of obstetrics and gynecology.
Vaccination during pregnancy is crucial to protect both the mother and the developing baby. It helps prevent serious complications and ensures a healthier start in life. #VaccinateForTwo 🤰💉
Explore a comprehensive presentation on Invasive Cervical Carcinoma, shedding light on its causes, symptoms, diagnosis, treatment options, and preventive measures.
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
2. Dr. Niranjan Chavan
MD, FCPS, DGO, DFP, MICOG, DICOG, FICOG
Professor and Unit Chief, L.T.M.M.C & L.T.M.G.H
Chairperson, FOGSI Oncology and TT Committee (2012-2014)
Treasurer, MOGS (2017- 2018)
Chair and Convener, FOGSI Cell- Violence against Doctors (2015-2016)
Chief Editor, AFG Times (2015-2017)
Editorial Board, European Journal of Gynecologic Oncology
Editor of FOGSI FOCUS, MOGS, AFG & IAGE Newsletters
Member, Managing Committee, IAGE (2013-2017)
Member , Oncology Committee, AOFOG (2013 -2015)
Recipient of 6 National & International Awards
Author of 15 Research Papers and 19 Scientific Chapters
Course Co-Ordinator, of 11 batches, of MUHS recognized Certificate Course of
Basic Infertility Management Including Endoscopy (BIMIE) at LTMGH
3. INTRODUCTION
• Fibroids(Myoma, Leiomyoma, Fibromyoma)
• Most common Monoclonal Benign tumors of
uterus arising in the smooth muscle cells of
myometrium.
• Contain large aggregation of extracellular
matrix consisting of collagen, elastin,
fibronectin and proteoglycan.
• Each fibroid is derived from smooth muscle
cells rests, either from vessel wall or uterine
musculature.
4. INCIDENCE
• Incidence of cervical fibroid is 2-3% and broad ligament fibroid is < 1%.
• 5-20% women in their reproductive age are reported to have fibroids.
• Most common----77% specimen of hysterectomy were having Fibroids
invariable number ,size (micro-macro) and site.
7. ETIOLOGY
GENETIC FACTORS
• Monoclonal
• 40% have chromosomal
abnormalities
• Translocation between
chromosome 12 and 14,
deletion of 7q, Trisomy of 12
HORMONAL FACTORS
• Both estrogen and progesterone
stimulates growth
• De novo production of estrogen in
fibroids
• Increased progesterone receptors
GROWTH FACTORS
They increase smooth muscle cell
proliferation, DNA synthesis and
angiogenesis
8. RISK FACTORS
• Age – incidence increases with age till on set of
menopause.
• Endogenous Hormonal factors
1. Early menarche
2. Late menopause
3. Hyper-estrogenic states
4. Increased expression and responsiveness of
progesterone receptors A & B.
• Family History—1st degree relatives are having 3.5 times
more risk of developing fibroids.
9. • Body weight
• Diet—diet rich in red meat, ham, beef
• Exercise – women doing regular exercise low risk
• OCS --- no definite relationship.
• ERT—variable reports
• Pregnancy
• Smoking
11. BROAD LIGAMENT FIBROID
• Extremely rare (< 1%).
• Broad ligament fibroids are divisible into two
types:
• True broad ligament fibroids: These spring
from the muscle fibers normally found in the
mesometrium. Such tumors may be found in at
least three situations, (1) In the round ligament, (2)
In the utero-ovarian ligament, and (3) In the
connective tissue surrounding the ovarian and the
uterine vessels.
• False broad ligament fibroids: These originate
mostly from the lateral walls of the uterus or cervix
12.
13. BROAD LIGAMENT FIBROID
True Broad Ligament False Broad Ligament
Originates from the muscle fibres
normally found in the mesometrium
(in the round ligament, ovario-
uterine ligament, and the connective
tissue around the uterine and
ovarian vessels)
Arises from the lateral wall of the
uterine corpus or of the cervix, and
bulges outward between the layers
of the broad ligament.
Ureter is medial to mass Ureter is lateral to mass
No groove felt between mass and
uterus
Groove felt between mass and
uterus
14. BROAD LIGAMENT FIBROID:
SYMPTOMS
• Often symptomatic
• Abdominal distension
• Menstrual irregularities
• Dysmenorrhoea
• Dyspareunia
• Broad ligament fibroids may extent laterally
and compress the ureter , causing pressure
symptoms like retention , increased
frequency etc.
15. BROAD LIGAMENT FIBROID:
DIAGNOSIS
• Transvaginal ultrasound : a typical leiomyoma
usually has a whorled appearance is seen.
“Bridging vessel sign” confirms uterine
origin.
• Ultrasound-guided percutaneous biopsy of the
tumour may be helpful for determining its exact
histologic composition before surgery.
16. BROAD LIGAMENT FIBROID:
DIAGNOSIS
• Magnetic resonance imaging (MRI),
with its multiplanar imaging
capabilities, may be extremely useful
for differentiating broad ligament
fibroids from masses of ovarian or tubal
origin and from broad ligament cysts.
17. BROAD LIGAMENT FIBROID :
DIFFERENTIAL DIAGNOSIS
• Parasitic leiomyoma involving the broad
ligament
• Pedunculated subserosal
leiomyoma projecting towards the broad
ligament
• Tubo - ovarian mass
• Hydrosalphinx
• Ectopic Pregnancy
18. • Solid ovarian neoplasms: particularly those
with dominant fibrous components
• Ovarian fibroma: fibrothecoma: tend to
inseparable from the ovary
• Brenner tumour: tend to be inseparable
from the ovary
• Malignant ovarian tumour
• Other ligamentous mesenchymal tumours
• Neurofibroma in the pelvis
19. BROAD LIGAMENT FIBROID:
COMPLICATIONS
• Torsion
• Psuedo meg syndrome
• Cystic degeneration mimicking ovarian
malignancy
• As broad ligament fibroids grow very
big in size, necrosis can occur in fibroid
causing symptoms of acute abdomen
• Huge broad ligament fibroid may cause
hydroureter and hydronephrosis.
21. Broad ligament myomectomy may be
preferred:
1. Large fibroids, or produce symptoms of
oppression.
2. Broad ligament fibroids are not associated
with uterine fibroids,
3. Suspected degeneration particularly
suspect.
4. Young patients, who need to preserve
fertility.
BROAD LIGAMENT FIBROID:
MANAGEMENT
22. BROAD LIGAMENT FIBROID:
MANAGEMENT
Hysterectomy is preferred in
following cases :
1. Family complete
2. Large no of fibroids in uteri along
with broad ligament fibroid
3. Suspected malignant fibroids.
4. Associated with endometrial
lesions.
5. Severe cervical lesions.
23. CASE REPORT
• A 45yr old P2L2 presented with complaints of heaviness in abdomen,
irregular heavy menses and dysmenorrhea , since 2 – 3 months
• On Examination:
P/A – soft, non tender
P/S - cervix , vagina healthy
P/V – uterus bulky firm mobile, AV, soft to cystic mass 10X 8 cm in left and
posterior fornix separate from uterus. Right fornix free and non tender.
P/R – bogginess felt anteriorly, rectal mucosa and parametrium free.
• Tumor Marker - WNL
24. CASE REPORT
• USG Pelvis: solid, hypoechoic, well-circumscribed right adnexal
mass of size 11.2 X 9 cm
25. CASE REPORT
• Intra-operatively, an abdomino-pelvic mass of
size approximately 11cm × 8 cm × 5cm was
seen with variable consistency and increased
vascularity, arising from the left side of the
uterus pushing the ureter laterally.
• Left fallopian tube, ovarian ligament, and
round ligament stretched over the mass. Left
ovary was normal.
• Right tube and ovary were normal.
• The mass was loosely adherent to the small
bowel loops.
28. CERVICAL FIBROID
• Cervical myomas accounts for 2% of all
uterine fibroids .
• They are classified depending on the location
into anterior , posterior, lateral and central
cervical myomas.
• Supravaginal cervical fibroid may be
interstitial or sub-peritoneal variety and
rarely polypoidal.
• Vaginal cervical fibroid is usually
pedunculated and rarely sessile.
29. CERVICAL FIBROID : SYMPTOMS
• Chronic pelvic pain
• Menstrual irregularities
• Dyspareunia
• Pressure symptoms
1. Anterior cervical fibroid produces symptoms like frequency or even
retention of urine. Retention is more due to pressure than the
elongation of the urethra.
2. Rectal symptoms are more common with posterior cervical fibroid
in the form of constipation
3. Lateral cervical fibroid causes vascular obstruction which may lead
to hemorrhoids and edema of legs (rare).
• Maternal dystocia, though rare during pregnancy
30. CERVICAL FIBROID: DIAGNOSIS
ULTRASONOGRAPHY
• Most readily available and is least costly
• It is reasonably reliable for evaluation of uterine volume less than
375 cc and containing four or fewer fibroids.
• Transvaginal sonography (sensitivity 83%, specificity 90%)
• Saline infusion sonography (sensitivity 90%, specificity 89%)
MRI
• Submucous fibroids are bets identifies with MRI.
• It can also evaluate the proximity of fibroid to the bladder, rectum
and endometrial cavity, thus giving a fair idea what can be
expected in surgery.
CT SCAN
31. CERVICAL FIBROID :DIFFERENTIAL
DIAGNOSIS
• Cervical polyp
• Pedunculated submucous fibroid
• Cervical cancer
• Lymphoma of the cervix: extremely rare
• Melanoma of the cervix: rare; usually involves
the vagina with invasion into the cervix
32. CERVICAL FIBROID : MANAGEMNT
• Treatment of cervical fibroid depends on the size , location and
the desire for fertility of patients.
• Preoperative GnRH analogues administration for 3 months
facilitate surgery and improve the haemoglobin status .
• In vaginal part fibroids if the tumour is sessile, myomectomy and
if pedunculated ,polypectomy is done.
33. CERVICAL FIBROID : MANAGEMNT
• For lateral fibroids if patient is desirous of fertility,
myomectomy may be attempted .
• For central fibroids, hysterectomy is required which may be
done laparoscopically or by open surgery or by vaginal route if
the size of the fibroid is small.
34. Victor Bonney was born in West London in
1872: both his father and his paternal
grandfather were family doctors.
He was on the Council of the Royal College
of Surgeons of England for a long time.
Bonney's professional achievements and his
fame among colleagues were firstly for his
extraordinary performance of 500
Wertheim radical extended hysterectomy
operations for cancer of the cervix and,
secondly, for his development of the
conservative operations of myomectomy
and ovarian cystectomy.
40. • A 55 year old female P3 L3 presented in
September, 2010 in Dr N N Chavan Unit with
complaints of mass coming out of vagina with
acute retention of urine .
• Case was suspected to a case of chronic uterine
inversion.
• The mass was ulcerated for which Acriflavine –
glycerine packing was done daily for a week.
• Patient was prepared for vaginal hysterectomy.
CASE REPORT 1
43. CONCLUSION
• Cervical and broad ligament fibroids are rare; with incidence of only
2% and 1% respectively.
• Cervical fibroid often present with pressure symptoms and often pose
surgical difficulties due to its proximity to bladder and rectum.
• Broad ligament fibroid though rare , but have the propensity of
growing into large adnexal masses and may mimic ovarian
malignancy.
44. • The choice of operation depends on the size , location and the family
status of the concerned patient.
• Both cervical and broad ligament can be managed by myomectomy or
hysterectomy either by laparoscopy or by open surgery .
45.
46. REFERENCES
1. Uterine leiomyomata. American College of Obstetricians and Gynecologists (ACOG) Technical
Bulletin. Number 192, May 1994
2. Monaghan JM, Lopes AB, Naik R. Total hysterectomy for cervical and broad ligament fibroids.
In: Huxley R, Taylor S, Chandler K, editors. Bonney's Gynaecological Surgery, 10th ed. Maiden,
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