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Communications Medicine Oct 2023Precision prevention involves using the unique characteristics of a particular group to determine their responses to preventive interventions. This study aimed to...
BACKGROUND
Precision prevention involves using the unique characteristics of a particular group to determine their responses to preventive interventions. This study aimed to systematically evaluate the participant characteristics associated with responses to interventions in gestational diabetes mellitus (GDM) prevention.
METHODS
We searched MEDLINE, EMBASE, and Pubmed to identify lifestyle (diet, physical activity, or both), metformin, myoinositol/inositol and probiotics interventions of GDM prevention published up to May 24, 2022.
RESULTS
From 10347 studies, 116 studies (n = 40940 women) are included. Physical activity results in greater GDM reduction in participants with a normal body mass index (BMI) at baseline compared to obese BMI (risk ratio, 95% confidence interval: 0.06 [0.03, 0.14] vs 0.68 [0.26, 1.60]). Combined diet and physical activity interventions result in greater GDM reduction in participants without polycystic ovary syndrome (PCOS) than those with PCOS (0.62 [0.47, 0.82] vs 1.12 [0.78-1.61]) and in those without a history of GDM than those with unspecified GDM history (0.62 [0.47, 0.81] vs 0.85 [0.76, 0.95]). Metformin interventions are more effective in participants with PCOS than those with unspecified status (0.38 [0.19, 0.74] vs 0.59 [0.25, 1.43]), or when commenced preconception than during pregnancy (0.21 [0.11, 0.40] vs 1.15 [0.86-1.55]). Parity, history of having a large-for-gestational-age infant or family history of diabetes have no effect on intervention responses.
CONCLUSIONS
GDM prevention through metformin or lifestyle differs according to some individual characteristics. Future research should include trials commencing preconception and provide results disaggregated by a priori defined participant characteristics including social and environmental factors, clinical traits, and other novel risk factors to predict GDM prevention through interventions.
PubMed: 37794119
DOI: 10.1038/s43856-023-00366-x -
BMJ Case Reports Jan 2019The clinical scenario of a female patient with a pelvic mass, elevated CA125 tumour marker, pleural effusion and ascites is often associated with malignancy. However,... (Review)
Review
Hydropic leiomyoma presenting as a rare condition of pseudo-Meigs syndrome: literature review and a case of a pseudo-Meigs syndrome mimicking ovarian carcinoma with elevated CA125.
The clinical scenario of a female patient with a pelvic mass, elevated CA125 tumour marker, pleural effusion and ascites is often associated with malignancy. However, not all cases are malignant. Non-malignant diseases, such as Meigs syndrome and pseudo-Meigs syndrome, must be part of your differential. We present a 56-year-old woman with dyspnoea secondary to a right pleural effusion. After further investigations, a serum cancer antigen-125 was found to be elevated at 437.3 U/mL. CT of her abdomen and pelvis showed a large heterogeneous mass in the pelvis measuring 13.2×9.7×15.1 cm with mild ascites. She was initially thought to have ovarian carcinoma and underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy with omental biopsy. Pathology from the surgical specimen revealed a hydropic leiomyoma and after removal of pelvic mass her pleural effusion and ascites completely resolved. She was ultimately diagnosed with the rare pseudo-Meigs syndrome.
Topics: Ascites; CA-125 Antigen; Diagnosis, Differential; Dyspnea; Female; Humans; Hysterectomy; Leiomyoma; Meigs Syndrome; Middle Aged; Ovarian Neoplasms; Pleural Effusion; Rare Diseases; Salpingo-oophorectomy; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 30635302
DOI: 10.1136/bcr-2018-226454 -
World Journal of Clinical Cases Jun 2021Meigs' syndrome is regarded as a benign ovarian tumor accompanied by pleural effusion and ascites, both of which resolve after removal of the tumor. Patients often seek...
BACKGROUND
Meigs' syndrome is regarded as a benign ovarian tumor accompanied by pleural effusion and ascites, both of which resolve after removal of the tumor. Patients often seek treatment in the Department of Respiratory and Critical Care Medicine or other internal medicine departments due to symptoms caused by ascites or hydrothorax. Here, we report a rare case of Meigs' syndrome caused by granulosa cell tumor accompanied with intrathoracic lesions.
CASE SUMMARY
A 52-year-old women was admitted to the Department of Respiratory and Critical Care Medicine due to coughing and expectoration accompanied with shortness of breath. Chest X-ray and chest computed tomography showed a modest volume of pleural fluid with pleural thickening in the right lung. The carbohydrate antigen 125 (CA125) concentration was 150.8 U/mL (normal, 0-35 U/mL) and no tumor cells were observed in pleural fluid. Nodules and a neoplasm with a fish meat-like appearance in the parietal pleura and nodules with a 'string of beads'-like appearance in the diaphragm were found by thoracoscopic examination. Furthermore, pelvic magnetic resonance revealed a pelvic mass measuring about 11.6 cm × 10.0 cm × 12.4 cm with heterogeneous signal intensity and multiple hypointense separations. Total abdominal hysterectomy, bilateral adnexectomy, and separation of pelvic adhesion were performed under general anesthesia. The pathology results showed granulosa cell tumor. At the 2-mo follow-up after the surgery, the hydrothorax subsided, and the CA125 level returned to normal.
CONCLUSION
For postmenopausal women with unexplained hydrothorax and elevated CA125, in addition to being suspected of having gynecological malignancy, Meigs' syndrome should be considered.
PubMed: 34222440
DOI: 10.12998/wjcc.v9.i18.4734 -
Diagnostic Pathology Oct 2022Ovarian fibroma is the most common benign pure stromal tumor. It has no specific clinical manifestation, most of which are pelvic or adnexal masses. 10-15% of cases with... (Review)
Review
Ovarian fibroma is the most common benign pure stromal tumor. It has no specific clinical manifestation, most of which are pelvic or adnexal masses. 10-15% of cases with hydrothorax or ascites, after tumor resection, hydrothorax and ascites disappear, known as Meigs Syndrome. The elevated level of CA125 in a few patients was easily misdiagnosed as ovarian malignant tumor. A case of bilateral Ovarian fibroma associated with Meigs Syndrome is reported and the literature is reviewed in order to improve the understanding of the changes and avoid misdiagnosis.
Topics: Ascites; Female; Fibroma; Humans; Hydrothorax; Meigs Syndrome; Ovarian Neoplasms
PubMed: 36253781
DOI: 10.1186/s13000-022-01258-9 -
Oxford Medical Case Reports Jan 2019Here we report a case of a patient with systemic lupus erythematosus presenting with pseudo-pseudo Meigs' syndrome (PPMS): a triad of pleural effusion, ascites and...
Here we report a case of a patient with systemic lupus erythematosus presenting with pseudo-pseudo Meigs' syndrome (PPMS): a triad of pleural effusion, ascites and raised CA-125. There have only been nine other cases reported in the literature. To our knowledge, this is the first to have an oesophago-gastro-duodenoscopy and liver biopsy as part of the diagnostic work up. Its mechanism of action is not yet fully understood but PPMS is a treatable condition that is responsive to immunosuppression. It is therefore important to consider it in patients presenting like this, where alternative diagnoses, including malignancy, have been ruled out.
PubMed: 30740231
DOI: 10.1093/omcr/omy136 -
BMC Cardiovascular Disorders Oct 2020Meigs' syndrome is a rare disease characterized by a triad of presentations, including benign ovarian tumor, ascites, and pleural effusion. However, a clinical diagnosis...
BACKGROUND
Meigs' syndrome is a rare disease characterized by a triad of presentations, including benign ovarian tumor, ascites, and pleural effusion. However, a clinical diagnosis of Meigs' syndrome remains challenging because pleural and ascitic effusions can be common findings in a variety of underlying conditions. Furthermore, these findings can often be misdiagnosed as pleural and peritoneal dissemination caused by potentially malignant tumors, leading to the administration of improper treatment.
CASE PRESENTATION
We described a case of an 85-year-old postmenopausal female patient with atypical Meigs' syndrome presenting with right-sided pleural effusion, notable leg edema, and trivial ascites, which was initially mistaken as heart failure with preserved ejection fraction. However, pleural effusion was totally ineffective against diuretic therapy. Subsequently, thoracentesis yielded serosanguineous exudative effusion. Moreover, refractory pleural effusions and abdominal/pelvic computed tomography and magnetic resonance imaging findings strongly suggested bilateral malignant ovarian tumors with pleural dissemination. Repetitive negative cytological results allowed the patient to undergo bilateral salpingo-oophorectomy. Finally, a definitive diagnosis of Meigs' syndrome was made by confirming the presence of a benign mitotically active cellular fibroma of the ovary by pathology and that pleural effusion resolved following tumor resection.
CONCLUSIONS
Our case highlights the clinical importance of assessing Meigs' syndrome in the diagnostic workup of pleural effusion in postmenopausal female patients. Given the favorable prognosis of Meigs' syndrome, clinicians should consider surgical resection, even with potentially malignant ovarian tumors with accompanying pleural effusion, ascites, or both.
Topics: Aged, 80 and over; Diagnosis, Differential; Diagnostic Errors; Female; Heart Failure; Humans; Meigs Syndrome; Predictive Value of Tests; Salpingo-oophorectomy; Stroke Volume; Treatment Outcome; Ventricular Function, Left
PubMed: 33028203
DOI: 10.1186/s12872-020-01718-4 -
Journal of the Formosan Medical... Dec 2022Pseudo-pseudo Meigs' syndrome (PPMS) exhibits patients with ascites, pleural effusion, elevated CA-125, and diagnosed of systemic lupus erythematosus (SLE) eventually... (Review)
Review
Pseudo-pseudo Meigs' syndrome (PPMS) exhibits patients with ascites, pleural effusion, elevated CA-125, and diagnosed of systemic lupus erythematosus (SLE) eventually without evidence of ovarian or pelvic tumor. It's a rare diagnosis but it has a good response to treatment. We here present an 82-year-old female, who was found to have ascites, pleural effusion, and elevated CA-125. CT of abdomen revealed absence of pelvic tumor. However, a rapid decline in renal function and progressive proteinuria were also observed. We performed an autoimmune-associated investigation. A diagnosis of late-onset SLE was made due to meeting the criteria of serositis, hemolytic anemia, thrombocytopenia, renal disease, and positive anti-smith antibody. We gave this patient a regimen with steroids and hydroxychloroquine. Both ascites and pleural effusion resolved in one month. PPMS is an important differential diagnosis in female patients with ascites, pleural effusion, and elevated CA-125. A survey of the pelvic tumor should be done first to exclude Meigs' syndrome or pseudo-Meigs' syndrome. SLE flare-up should be kept in mind even in the elderly.
Topics: Aged; Humans; Female; Aged, 80 and over; Meigs Syndrome; Ascites; Pelvic Neoplasms; Taiwan; Pleural Effusion; Lupus Erythematosus, Systemic; Diagnosis, Differential
PubMed: 35459608
DOI: 10.1016/j.jfma.2022.03.020 -
Revue Medicale de Liege Dec 2018A 65-year old woman presents with a Demons-Meigs syndrome characterized by dyspnea resulting from a transsudative pleural effusion, an important unilateral right ovarian... (Review)
Review
A 65-year old woman presents with a Demons-Meigs syndrome characterized by dyspnea resulting from a transsudative pleural effusion, an important unilateral right ovarian mass and ascites. The diagnosis of a Brenner type histology was obtained after complete surgical removal of ovarian tumor. After discharge the patient entered in a sustained complete response and thus potential cure. Brenner tumor is a rare and often benign ovarian affection. The clinical signs aren't generally much specific: pelvic pain or heaviness, metrorrhagia and menstrual irregularity may be observed. Brenner tumor may exceptionally induce a Demons-Meigs's syndrome. This syndrome associates one or more benign tumors of the female reproductive tract with pleural and peritoneal effusions. This could depict a rich but disturbing clinical picture. The prognosis and the regression of the symptomatology are nevertheless excellent after tumor surgical resection.
Topics: Aged; Ascites; Brenner Tumor; Dyspnea; Female; Humans; Ovarian Neoplasms; Pleural Effusion, Malignant; Syndrome
PubMed: 30570232
DOI: No ID Found -
Cureus Jan 2024Demons-Meigs syndrome is a rare clinical presentation of benign ovarian mass with hydrothorax and ascites. As ascites can be present in any ovarian mass, hydrothorax is...
Demons-Meigs syndrome is a rare clinical presentation of benign ovarian mass with hydrothorax and ascites. As ascites can be present in any ovarian mass, hydrothorax is a salient feature of the syndrome. The syndrome is subtyped as atypical in the absence of ascites from the triad. Nevertheless, it is labeled as pseudo-Demons-Meigs syndrome if the ovarian tumor is neoplastic rather than benign. The management of Demons-Meigs syndrome is complex and could be misleading due to pleural effusion and ascites, so an understanding of the syndrome is important. This case report is unique as it has two rare findings of neoplastic tumor and absence of ascites. Furthermore, this case is distinct as both ovaries are involved in malignant granulosa theca cell tumor with right-sided pleural effusion without ascites.
PubMed: 38384615
DOI: 10.7759/cureus.52689 -
Asian Journal of Surgery Mar 2024
PubMed: 38522982
DOI: 10.1016/j.asjsur.2024.03.064