Antenatal care is the routine health control of presumed healthy pregnant women without symptoms (screening), in order to diagnose diseases or complicating obstetric conditions without symptoms and to provide information about lifestyle, pregnancy and delivery.
tubal factor is almost 30% of all female infertility causes.Hence evaluation of tubes is usulally the first of the testings.
this presentation evaluates all the methods for evaluation of fallopian tubes
Ovulation was initially monitored by conventional methods like BBT, mid luteal serum progesterone and urinary LH.
Nowadays, USG is used for follicular monitoring for both natural and stimulated cycles.
accurate assessment of gestational age by certain mensrtual data and clinical examination may have dating discrepancy with the ultrasound. this ppt critically addresses such issues
Fetal growth restriction (FGR), formerly called intrauterine growth restriction (IUGR), refers to a condition in which an unborn baby is smaller than it should be because it is not growing at a normal rate inside the womb.
Mild FGR usually doesn't cause long-term problems. In fact, most babies who have it catch up in height and weight by age 2. But severe FGR can seriously harm a baby before and after birth. The extent of the problems depends on the cause and how severe the growth restriction is. It also depends on what point in the pregnancy it starts.
In this presentation we will discuss role of Doppler US in Infertility, fertilization and assisted fertilization.
we will discuss the favorable and unfavorable RI and PI.
We will discuss role of doppler us in various gynecological malignancies.
Antenatal care is the routine health control of presumed healthy pregnant women without symptoms (screening), in order to diagnose diseases or complicating obstetric conditions without symptoms and to provide information about lifestyle, pregnancy and delivery.
tubal factor is almost 30% of all female infertility causes.Hence evaluation of tubes is usulally the first of the testings.
this presentation evaluates all the methods for evaluation of fallopian tubes
Ovulation was initially monitored by conventional methods like BBT, mid luteal serum progesterone and urinary LH.
Nowadays, USG is used for follicular monitoring for both natural and stimulated cycles.
accurate assessment of gestational age by certain mensrtual data and clinical examination may have dating discrepancy with the ultrasound. this ppt critically addresses such issues
Fetal growth restriction (FGR), formerly called intrauterine growth restriction (IUGR), refers to a condition in which an unborn baby is smaller than it should be because it is not growing at a normal rate inside the womb.
Mild FGR usually doesn't cause long-term problems. In fact, most babies who have it catch up in height and weight by age 2. But severe FGR can seriously harm a baby before and after birth. The extent of the problems depends on the cause and how severe the growth restriction is. It also depends on what point in the pregnancy it starts.
In this presentation we will discuss role of Doppler US in Infertility, fertilization and assisted fertilization.
we will discuss the favorable and unfavorable RI and PI.
We will discuss role of doppler us in various gynecological malignancies.
Women with benign heavy menstrual bleeding have the choice of a number of medical treatment options to reduce their blood loss and improve quality of life.
Platelet-rich plasma (PRP) has become popular as a non operative treatment option for a broad spectrum of medical disorders. There are reasonable amount of data which warrant continued research in PRP but currently its role in clinical practice is not completely defined. Prior to its use, special consent is required after an honest and open discussion with the patient as well controlled human studies are lacking
Fertility Management: Synergy between Endoscopists and Fertility SpecialistsSujoy Dasgupta
Dr Sujoy Dasgupta was invited to moderate a panel discussion on "Fertility Management: Synergy between Endoscopists and Fertility Specialists " in a CME by Torrent held on 27 May 2023.
AGAINST the Motion- “Surgery is the ONLY treatment of Endometriosis with Infe...Sujoy Dasgupta
Dr Sujoy Dasgupta participated in an invited debate through a webinar organized by Dr B. N. Chakraborty School of Fertility Management and research, held in July, 2020
Recurrence of endometriosis is fairly common; some studies suggest the rate of recurrence to be as high as 40%. Most common cause of recurrence is incomplete resection in primary surgery and microscopic foci which escapes detection.
Uterus (womb) as an organ is pivotal not only to giving birth, but also to the overall well-being of women and their physical, emotional, and sexual health.
Similar to management of ovarian cysts other than endometriomas in infertility (20)
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
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.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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.
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.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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
management of ovarian cysts other than endometriomas in infertility
1. • The young, enthusiastic and energetic chief
consultant at Rupal Hospital For Women,
Surat, India for last 18 years
• Medical director and IVF consultant at
Blossom IVF Centre,Surat,India
• Diploma in Reproductive Medicine from Kiel,
Germany
• Intense training in Advanced infertility
treatment at numerous workshops and
conferences in USA and Europe.
• Specialized in all kind of gynec endoscopic
surgeries.
• Invited as a faculty in various state,national and
international conferences.
• Promotes health awareness by conducting
Seminars and writing articles and specialty
related books
• In addition of being techno-savvy person, she
loves making friends, and keenly interested in
music and Guajarati literature. She is actively
associated with the leading cultural club of
Surat-Tarbatar.
Dr Rupal N Shah
M.D.(OBGYN)
Diploma in Reproductive Medicine
(Germany)
04/30/17 Dr Rupal Shah-ISAR 2017 1
2. Managing cysts other than
endometriomas
Dr Rupal N Shah
M.D;D.G.O
Diploma in Reproductive Medicine,Germany
Rupal Hospital For Women &
Blossom Fertility and IVF Centre
Surat, Gujarat
3. The relationship
between ovarian
cysts and infertility is
a subject of debate,
mainly because it is
difficult to
determine the real
impact of the cyst
and its treatment on
later fertility.04/30/17 Dr Rupal Shah-ISAR 2017 3
4. The management of ovarian cysts in an
infertile woman raises two questions:
1. Do these cysts impair
the prognosis of
assisted reproductive
technologies (ART)?
2. How does treatment
of a cyst affect these
results?
These two questions
obviously depend on
various factors,
including the size,
number, and
histologic type of
cysts.
04/30/17 Dr Rupal Shah-ISAR 2017 4
5. Ovarian Cysts in Reproductive Age
● Functional cysts
○ follicular cysts
○ cysts following GnRH agonist treatment 24%
○ corpus luteum cysts
○ theca lutein cysts
•Hemorrhagic cysts
● Benign cystic teratoma (Dermoid)
● Endometrioma 70%
•Cystadenomas-Serous /mucinous
● Malignant cyst 6%
04/30/17 Dr Rupal Shah-ISAR 2017 5
7. Ultrasonography
Transvaginal US, with
transabdominal US as
needed, remains the
primary, and in most cases
the preferred, imaging
modality to evaluate ovarian
cysts.
Society of Radiologists in
Ultrasound Consensus
Conference Statement1,201004/30/17 Dr Rupal Shah-ISAR 2017 7
8. Doppler Ultrasound
Doppler ultrasound assessment of cyst wall
blood flow does not always appear to
differentiate between benign and malignant
ovarian cysts. This is probably because of the
presence of neo-angiogenesis in both malignant
and functional tumors.
04/30/17
Malignant Benign
Dr Rupal Shah-ISAR 2017 8
9. Other Imaging Modalities
Computed tomography (CT) scan and magnetic
resonance imaging (MRI) is reserved for cases with
suspicion for malignancy.
Routine use of computed tomography and MRI for
assessment of ovarian masses does not improve the
sensitivity or specificity obtained by transvaginal
ultrasonography in the detection of ovarian
malignancy.
RCOG Green-top Guideline No. 62,2011
04/30/17 Dr Rupal Shah-ISAR 2017 9
10. Evaluation of ovarian reserve
When evaluating a patient with an ovarian cyst
undergoing ART treatment, we should assess
her ovarian reserve.
It helps us to tailor the best treatment option
for the specific patient.
04/30/17 Dr Rupal Shah-ISAR 2017 10
11. AMH
• Reduced ovarian reserve as measured by
serum levels of AMH may contraindicate
surgical management in the specific patient.
• Pre-operative and post-operative AMH levels
may be used as a tool for evaluating ovarian
damage after surgery.
Gnoth, C., et al. (2008)
04/30/17 Dr Rupal Shah-ISAR 2017 11
12. Tumour Markers
• Serum CA-125 does not need to be undertaken
in all infertile women with USG diagnosis of a
simple ovarian cyst of < 5 cms.
• CA-125 in the reproductive age rises in
fibroids, endometriosis, adenomyosis and
pelvic infections.
So, it is an unreliable marker for differentiating
benign from malignant masses and not
helpful at all in D/D of benign cysts
04/30/17 Dr Rupal Shah-ISAR 2017 12
13. Tumour Markers
Lactate dehydrogenase
(LDH), α-FP and hCG
should be measured in all
women under age 40 with a
complex ovarian mass
because of the possibility of
germ cell tumours.
RCOG Green-top Guideline
No. 62,2011
04/30/17 Dr Rupal Shah-ISAR 2017 13
14. Management and follow up of cysts
other than endometrioma
04/30/17 Dr Rupal Shah-ISAR 2017 14
15. Functional Cysts
Round or oval anechoic space with smooth thin
walls, posterior acoustic enhancement, no solid
component or septation, and no internal flow at
color Doppler US.
04/30/17 Post acoustic enhancementDr Rupal Shah-ISAR 2017 15
16. Functional cysts
• Benign and usually asymptomatic
• Do not require any treatment.
• Follow-up and repeated scans will usually
confirm spontaneous resolution of the cysts.
• This is not the case when the cyst is large and
may interfere with fertility treatments and in
vitro fertilization (IVF).
• Simple cysts up to 10 cm are highly likely to be
benign, with malignancy rates of less than 1%
04/30/17 Dr Rupal Shah-ISAR 2017 16
17. Functinal Cysts-Follow Up
• Cysts </= 5 cms: Do not need follow-up.
• Cysts >5 and </=7 cms: Yearly follow-up
with US recommended.
• Cysts >7 cms: Further imaging with magnetic
resonance (MR) or surgical evaluation
Levine, D., et al. (2010) Society of Radiologists in Ultrasound
Consensus Conference Statement1
04/30/17 Dr Rupal Shah-ISAR 2017 17
18. Cysts following GnRH agonist treatment
• may be of no clinical significance or may
negatively influence its outcome
Qublan, H.S., et al. (2006)
Mechanism
• primary flare-up caused by the GnRHa
affecting gonadotropins;
• the persistence of a follicular or corpus
luteum cyst formed in the preceding cycle
(Rizk 2009)
04/30/17 Dr Rupal Shah-ISAR 2017 18
19. Management in relation to ART
Transvaginal cyst aspiration
safe and straightforward approach
04/30/17 Dr Rupal Shah-ISAR 2017 19
20. Insufficient evidence to determine whether
drainage of functional ovarian cysts prior to COH
influences live birth rate, clinical pregnancy rate,
number of follicles recruited, or oocytes
collected.
04/30/17 Dr Rupal Shah-ISAR 2017 20
21. 04/30/17 Dr Rupal Shah-ISAR 2017 21
Despite of this proven insufficient advantages
,trans-vaginal Ultrasonography guided cyst
aspiration is often performed in cysts more
than 2 cms ,before starting ovarian
stimulation.
Cycle cancellation rate of 2.2% in the cyst
aspiration group and 14.9% in the
conservatively managed group
Firouzabadi et al,2010
22. Medical Management
• The use of the combined oral
contraceptive pill does not promote the
resolution of functional ovarian cysts.
• Combined oral contraceptives may be
used to prevent the reccurrence of these
cysts.
RCOG Green-top Guideline No. 62,2011
04/30/17 Dr Rupal Shah-ISAR 2017 22
23. • Ovarian surgery for benign cysts significantly
reduces folliculogenesis.
• Adverse effect on ovarian response to
stimulation with gonadotrophins and on the
results of fertility therapy
04/30/17 Dr Rupal Shah-ISAR 2017 23
24. Hemorrhagic ovarian cyst.
• Complex cystic mass with a
reticular pattern of internal
echoes (also known as fishnet,
cobweb, spiderweb, or lacy
appearance) and/or a solid-
appearing area with concave
margins.
• No internal flow at color
Doppler US, and usually
circumferential flow in the
wall of the cyst
04/30/17 Dr Rupal Shah-ISAR 2017 24
25. Hemorrhagic ovarian cyst
Follow up
Formed because of occurrence of bleeding into
a follicular or corpus luteum cyst.
•Cysts </=5 cms: Do not need follow-up.
•Cysts >5 cms: Short-interval follow-up (6–12
weeks) with US recommended to ensure
resolution.
Typically resolve within 8 weeks
•.04/30/17 Dr Rupal Shah-ISAR 2017 25
26. Hemorrhagic Ovarian cyst
Surgical Intervention
• Large persistant cysts greater than 5
cm
• Severe persistent abdominal pain
• Occurrence of complications such as
rupture and ovarian torsion
• High WBC count and low
hemoglobin level.04/30/17 Dr Rupal Shah-ISAR 2017 26
27. Benign cystic teratoma (Dermoid)
• fat-fluid level
• intra-cystic floating balls
• focal or diffuse hyperechoic
components
• hyperechoic lines and dots,
• area of acoustic shadowing,
• tip of the iceberg sign ,with no
internal flow at color Doppler
US04/30/17 Dr Rupal Shah-ISAR 2017 27
28. Benign cystic teratoma (dermoid cyst)
Management
• Dermoid cyst, especially smaller than 6 cm,
can be followed conservatively.
O’Neill, K.E. and Cooper, A.R. (2011)
• Followed with US at an initial interval of
between 6 months and 1 year, regardless of
age, if they are not removed.
• No medical treatment
04/30/17 Dr Rupal Shah-ISAR 2017 28
29. 04/30/17
Ovarian dermoid cyst excision could significantly reduce ovarian
reserve to a similar extent as the cyst itself. The presence or
resection of dermoid cysts will not affect the main IVF outcomes.
Dr Rupal Shah-ISAR 2017 29
30. Benign epithelial cysts
• Cystadenomas may not always lead to
infertility. However, they do present the risk
of turning cancerous and hence, treating them
is a wise approach.
• A growing cystadenoma can lead to adhesions
or septations in the ovarian tissues that can
impair the ovulation cycle and disrupt the
secretion of ovarian hormones.
04/30/17 Dr Rupal Shah-ISAR 2017 30
31. Serous cystadenoma
Ultrasound
•Usually seen as a unilocular
cystic lesion,ocassionally with
septations
•Papillary projections are absent
MRI
•Unilocular thin walled adnexal
cyst. MRI may show a beak sign
which may suggest an ovarian
origin
•
04/30/17 Dr Rupal Shah-ISAR 2017 31
32. Mucinous cystadenoma
Ultrasound
• Large cystic adnexal
mass,multilocular with numerous thin
septations
•loculations may contain low-level
internal echogenicity due to increased
mucin content
MRI
• large multilocular cysts containing
fluid of various viscosity- “stained
glass” appearance.
04/30/17 Dr Rupal Shah-ISAR 2017 32
33. Benign Cystadenoma-Management
• Conservative approach of ovarian cystectomy
to retain functioning ovarian tissue ,for future
conception.
• Complete excision is must to minimize
recurrence
• Laparoscopic fertility sparing ovarian
cystectomy is safe and effective.
04/30/17 Dr Rupal Shah-ISAR 2017 33
34. Malignant ovarian cysts
• Incidence:
0.4–8.9/100 000(reproductive age group)
Germ cell tumours most common,followed by
epithelial cells and metastatic
• Symptoms:
abdominal bloating, abdominal and pelvic
pain, and early satiety and appetite changes
• Physical examination
an irregular, solid, fixed and nodular mass or a
bilateral finding. The presence of ascites04/30/17 Dr Rupal Shah-ISAR 2017 34
35. Malignant ovarian cyst
• Thick septations (3 mm) & solid elements
• flow at Doppler US, and focal areas of wall
thickening (3 mm)
• Omental or peritoneal masses,
• ascitic fluid in the pelvis
• A cyst with a nodule that has internal
blood flow
No follow-up imaging but , should be
considered for surgical evaluation.
Society of Radiologists in Ultrasound Consensus
Conference Statement1,201104/30/17 Dr Rupal Shah-ISAR 2017 35
36. • Usually, in reproductive age group ovarian tumors
are low-stage and low-grade.
• Borderline tumours can be operated conservatively
at all stages.
• Conservative surgical approaches for ovarian
tumours after surgical staging includes,
cystectomy, unilateral salpingo-oophorectomy and
unilateral salpingo-oophorectomy plus contralateral
cystectomy.
04/30/17 Dr Rupal Shah-ISAR 2017 36
37. • fertility saving surgery can be performed
safely in germ cell, borderline and early stage
epithelial ovarian tumours in selected cases.
• Spontaneous pregnancy rates following
fertility saving surgery has been reported as
60-88%. Because of this ,over-treatment of
these patients for fertility should be
avoided.
04/30/17 Dr Rupal Shah-ISAR 2017 37
39. Surgical Management
Only when tissue diagnosis is necessary
or when the ovarian cyst interferes with
oocyte retrieval or ovarian stimulation.
04/30/17 Dr Rupal Shah-ISAR 2017 39
40. Which surgical method?
• When surgical management is indicated, the
laparoscopic approach should be
undertaken.
• Laparotomy occasionally be necessary in
women with a large cyst, if there is suspicion
of malignancy or if the patient is unfit for
laparoscopy because of obesity or extensive
abdominal scarring following previous
surgery.
04/30/17 Dr Rupal Shah-ISAR 2017 40
41. SURGICAL TECHNIQUES OF
CYSTECTOMY (EXCISION)
• Laparoscopy Gold standard .
• Bipolar energy should be
preferred to monopolar.
• coagulation of the cyst walls
should be avoided.
• No differences in benefits for
fertility between bipolar
coagulation and hemostatic
suture of the ovary.(Ferrero S,
Venturini PL,J. Minim Invasive
Gynecol 2012;19:722–30.)
04/30/17 Dr Rupal Shah-ISAR 2017 41
42. single-center retrospective study of 17 excisions of non-
endometriotic cysts that averaged 37 mm (one serous and
seven dermoid cysts) found that after excision, compared
with a healthy ovary, ovarian reserve decreased in volume by
40%; the number of dominant follicles also decreased
The ovarian reserve should be assessed prior to
the procedure and if severely reduced,
surgery may be deferred in order to decide for
further treatment options.
04/30/17 Dr Rupal Shah-ISAR 2017 42
43. Significantly greater decrease in the AMH rate
after cystectomy for the seven
nonendometriotic cysts (one mucinous and six
dermoid)
04/30/17 Dr Rupal Shah-ISAR 2017 43
44. •A recent randomized trial compared two
different techniques (mesial incision vs.
antimesial incision) for the risk of a dermoid cyst
rupture.
•The authors sought as a secondary objective to
analyze the impact on fertility of these two
techniques and reported that ,
FSH levels decreased less at 3 months and 12
months when the incision was mesial.04/30/17 Dr Rupal Shah-ISAR 2017 45
45. • After the surgical removal of an ovarian cyst,
the resulting defect in the ovarian surface
may either be closed with sutures, treated
with bipolar cautery or left open to heal.
• No method has been clearly shown to be
superior in terms of healing and postoperative
adhesion formation.
04/30/17 Dr Rupal Shah-ISAR 2017 46
46. Straightforward messages…
● Conservative management ,where possible.
● Use of laparoscopic techniques where
appropriate, thus avoiding laparotomy where
possible
● Referral to a gynaecological oncologist where
appropriate.
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