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Przeglad Menopauzalny = Menopause Review Mar 2023A possible cause for acute abdomen is haemoperitoneum resulting from the rupture of an ovarian tumour. Here we discuss a case of spontaneous haemoperitoneum caused by... (Review)
Review
INTRODUCTION
A possible cause for acute abdomen is haemoperitoneum resulting from the rupture of an ovarian tumour. Here we discuss a case of spontaneous haemoperitoneum caused by granulosa cell tumour (GCT) rupture in a postmenopausal woman.
MATERIAL AND METHODS
We present a systematic review of the current literature to draw attention to this rare gynaecological complication and provide guidance about the most appropriate management.
RESULTS
Eight case reports and one retrospective study were identified. A total of 11 patients were analysed in this review including the present case report. The first case was described in 1948, while the last one was in 2019. The mean age of the patients was 60.8 years. All cases were treated with primary surgery. The mean diameter of the masses was 10.1 cm.
DISCUSSION
We found endometrial pathology in 45% of the cases, of which 4 (36%) were associated with postmenopausal bleeding. The presentation of GCT is not always in the form of overt endocrine disturbance but can onset (10-15%) with acute abdomen.
CONCLUSIONS
Granulosa cell tumour should remain in the differential diagnosis of all patients presenting with acute abdomen and imaging suspicious for gynaecological malignancy originating from the ovary.
PubMed: 37206680
DOI: 10.5114/pm.2023.126399 -
The Cochrane Database of Systematic... Jul 2022Ovarian cancer (OC) has the highest case fatality rate of all gynaecological cancers. Diagnostic delays are caused by non-specific symptoms. Existing systematic reviews... (Review)
Review
BACKGROUND
Ovarian cancer (OC) has the highest case fatality rate of all gynaecological cancers. Diagnostic delays are caused by non-specific symptoms. Existing systematic reviews have not comprehensively covered tests in current practice, not estimated accuracy separately in pre- and postmenopausal women, or used inappropriate meta-analytic methods.
OBJECTIVES
To establish the accuracy of combinations of menopausal status, ultrasound scan (USS) and biomarkers for the diagnosis of ovarian cancer in pre- and postmenopausal women and compare the accuracy of different test combinations.
SEARCH METHODS
We searched CENTRAL, MEDLINE (Ovid), Embase (Ovid), five other databases and three trial registries from 1991 to 2015 and MEDLINE (Ovid) and Embase (Ovid) form June 2015 to June 2019. We also searched conference proceedings from the European Society of Gynaecological Oncology, International Gynecologic Cancer Society, American Society of Clinical Oncology and Society of Gynecologic Oncology, ZETOC and Conference Proceedings Citation Index (Web of Knowledge). We searched reference lists of included studies and published systematic reviews.
SELECTION CRITERIA
We included cross-sectional diagnostic test accuracy studies evaluating single tests or comparing two or more tests, randomised trials comparing two or more tests, and studies validating multivariable models for the diagnosis of OC investigating test combinations, compared with a reference standard of histological confirmation or clinical follow-up in women with a pelvic mass (detected clinically or through USS) suspicious for OC.
DATA COLLECTION AND ANALYSIS
Two review authors independently extracted data and assessed quality using QUADAS-2. We used the bivariate hierarchical model to indirectly compare tests at commonly reported thresholds in pre- and postmenopausal women separately. We indirectly compared tests across all thresholds and estimated sensitivity at fixed specificities of 80% and 90% by fitting hierarchical summary receiver operating characteristic (HSROC) models in pre- and postmenopausal women separately.
MAIN RESULTS
We included 59 studies (32,059 women, 9545 cases of OC). Two tests evaluated the accuracy of a combination of menopausal status and USS findings (IOTA Logistic Regression Model 2 (LR2) and the Assessment of Different NEoplasias in the adneXa model (ADNEX)); one test evaluated the accuracy of a combination of menopausal status, USS findings and serum biomarker CA125 (Risk of Malignancy Index (RMI)); and one test evaluated the accuracy of a combination of menopausal status and two serum biomarkers (CA125 and HE4) (Risk of Ovarian Malignancy Algorithm (ROMA)). Most studies were at high or unclear risk of bias in participant, reference standard, and flow and timing domains. All studies were in hospital settings. Prevalence was 16% (RMI, ROMA), 22% (LR2) and 27% (ADNEX) in premenopausal women and 38% (RMI), 45% (ROMA), 52% (LR2) and 55% (ADNEX) in postmenopausal women. The prevalence of OC in the studies was considerably higher than would be expected in symptomatic women presenting in community-based settings, or in women referred from the community to hospital with a suspicion of OC. Studies were at high or unclear applicability because presenting features were not reported, or USS was performed by experienced ultrasonographers for RMI, LR2 and ADNEX. The higher sensitivity and lower specificity observed in postmenopausal compared to premenopausal women across all index tests and at all thresholds may reflect highly selected patient cohorts in the included studies. In premenopausal women, ROMA at a threshold of 13.1 (± 2), LR2 at a threshold to achieve a post-test probability of OC of 10% and ADNEX (post-test probability 10%) demonstrated a higher sensitivity (ROMA: 77.4%, 95% CI 72.7% to 81.5%; LR2: 83.3%, 95% CI 74.7% to 89.5%; ADNEX: 95.5%, 95% CI 91.0% to 97.8%) compared to RMI (57.2%, 95% CI 50.3% to 63.8%). The specificity of ROMA and ADNEX were lower in premenopausal women (ROMA: 84.3%, 95% CI 81.2% to 87.0%; ADNEX: 77.8%, 95% CI 67.4% to 85.5%) compared to RMI 92.5% (95% CI 90.3% to 94.2%). The specificity of LR2 was comparable to RMI (90.4%, 95% CI 84.6% to 94.1%). In postmenopausal women, ROMA at a threshold of 27.7 (± 2), LR2 (post-test probability 10%) and ADNEX (post-test probability 10%) demonstrated a higher sensitivity (ROMA: 90.3%, 95% CI 87.5% to 92.6%; LR2: 94.8%, 95% CI 92.3% to 96.6%; ADNEX: 97.6%, 95% CI 95.6% to 98.7%) compared to RMI (78.4%, 95% CI 74.6% to 81.7%). Specificity of ROMA at a threshold of 27.7 (± 2) (81.5, 95% CI 76.5% to 85.5%) was comparable to RMI (85.4%, 95% CI 82.0% to 88.2%), whereas for LR2 (post-test probability 10%) and ADNEX (post-test probability 10%) specificity was lower (LR2: 60.6%, 95% CI 50.5% to 69.9%; ADNEX: 55.0%, 95% CI 42.8% to 66.6%).
AUTHORS' CONCLUSIONS
In specialist healthcare settings in both premenopausal and postmenopausal women, RMI has poor sensitivity. In premenopausal women, ROMA, LR2 and ADNEX offer better sensitivity (fewer missed cancers), but for ROMA and ADNEX this is off-set by a decrease in specificity and increase in false positives. In postmenopausal women, ROMA demonstrates a higher sensitivity and comparable specificity to RMI. ADNEX has the highest sensitivity in postmenopausal women, but reduced specificity. The prevalence of OC in included studies is representative of a highly selected referred population, rather than a population in whom referral is being considered. The comparative accuracy of tests observed here may not be transferable to non-specialist settings. Ultimately health systems need to balance accuracy and resource implications to identify the most suitable test.
Topics: Biomarkers; Carcinoma, Ovarian Epithelial; Cross-Sectional Studies; Female; Humans; Menopause; Ovarian Neoplasms; Sensitivity and Specificity
PubMed: 35879201
DOI: 10.1002/14651858.CD011964.pub2 -
Cureus Dec 2022Epithelioid sarcoma is a rare entity that shows a predilection for the young and middle-aged population. There are two subtypes, i.e., the distal or conventional type,...
Epithelioid sarcoma is a rare entity that shows a predilection for the young and middle-aged population. There are two subtypes, i.e., the distal or conventional type, which is located in distal extremities, and the proximal type, located in proximal areas of the extremities, pelvis, perineal, and genital region. The latter is characterized by more aggressive behavior, a higher recurrence rate, and poor prognosis. Histopathological and immunohistochemical diagnoses are key to correct and timely treatment and a higher survival rate. We report a case of a 41-year-old man who presented a palpable progressive growth mass in the hypogastrium. The disease time was of nine months, and the tumor was resected, but it recurred a few months later in the same location. Computed tomography (CT) scans showed images suggestive of lung metastasis and the patient had to undergo a second surgery. He received eight cycles of chemotherapy and a subsequent CT scan control showed the progression of the disease, so a new chemotherapy regimen was established. The patient received three cycles of chemotherapy without improvement, so he decided to discontinue treatment. His last outpatient medical consultation was in January 2022. A systematic review of the studies published in PubMed and Google Scholar was performed. We identified 291 articles, but only 41 reports and case series were included, with a total of 55 patients. It is important to include this type of tumor in the differential diagnosis of epithelial tumors due to its aggressive behavior. Correct and timely diagnosis is crucial to obtain lower recurrence rates, lower mortality, and higher survival rates in these patients.
PubMed: 36712724
DOI: 10.7759/cureus.32962 -
Sports Medicine (Auckland, N.Z.) Oct 2021If interplanetary travel is to be successful over the coming decades, it is essential that countermeasures to minimize deterioration of the musculoskeletal system are as... (Meta-Analysis)
Meta-Analysis
BACKGROUND
If interplanetary travel is to be successful over the coming decades, it is essential that countermeasures to minimize deterioration of the musculoskeletal system are as effective as possible, given the increased duration of spaceflight associated with such missions. The aim of this review, therefore, is to determine the magnitude of deconditioning of the musculoskeletal system during prolonged spaceflight and recommend possible methods to enhance the existing countermeasures.
METHODS
A literature search was conducted using PubMed, Ovid and Scopus databases. 5541 studies were identified prior to the removal of duplicates and the application of the following inclusion criteria: (1) group means and standard deviations for pre- and post-spaceflight for measures of strength, muscle mass or bone density were reported (or provided by the corresponding author when requested via e-mail), (2) exercise-based countermeasures were included, (3) the population of the studies were human, (4) muscle function was assessed and (5) spaceflight rather than simulated spaceflight was used. The methodological quality of the included studies was evaluated using a modified Physiotherapy Evidence Database (PEDro) scale for quality, with publication bias assessed using a failsafe N (Rosenthal method), and consistency of studies analysed using I as a test of heterogeneity. Secondary analysis of studies included Hedges' g effect sizes, and between-study differences were estimated using a random-effects model.
RESULTS
A total of 11 studies were included in the meta-analyses. Heterogeneity of the completed meta-analyses was conducted revealing homogeneity for bone mineral density (BMD) and spinal muscle size (Tau < 0.001; I = 0.00%, p > 0.05), although a high level of heterogeneity was noted for lower body force production (Tau = 1.546; I = 76.03%, p < 0.001) and lower body muscle mass (Tau = 1.386; I = 74.38%, p < 0.001). The estimated variance (≤ -0.306) for each of the meta-analyses was significant (p ≤ 0.033), for BMD (- 0.48 to - 0.53, p < 0.001), lower body force production (- 1.75, p < 0.001) and lower body muscle size (- 1.98, p < 0.001). Spaceflight results in small reductions in BMD of the femur (Hedges g = - 0.49 [- 0.69 to - 0.28]), trochanter (Hedges g = - 0.53 [- 0.77 to - 0.29]), and lumbo-pelvic region (Hedges g = - 0.48 [- 0.73 to - 0.23]), but large decreases in lower limb force production (Hedges g = - 1.75 [- 2.50 to - 0.99]) and lower limb muscle size (Hedges g = - 1.98 [- 2.72 to - 1.23]).
CONCLUSIONS
Current exercise countermeasures result in small reductions in BMD during long-duration spaceflight. In contrast, such exercise protocols do not alleviate the reductions in muscle function or muscle size, which may be attributable to the low to moderate loads reported by crewmembers and the interference effect associated with concurrent training. It is recommended that higher-load resistance exercise and the use of high-intensity interval training should be investigated, to determine if such modifications to the reported training practices result in more effective countermeasures to the deleterious effect of long-duration spaceflight on the muscular system.
Topics: Bone Density; Exercise; Humans; Muscle Strength; Space Flight; Time Factors
PubMed: 34115344
DOI: 10.1007/s40279-021-01496-9 -
Neurospine Sep 2021The aim of study is to investigate the features and risk factors of rod fracture (RF) following adult spinal deformity (ASD) surgery.
OBJECTIVE
The aim of study is to investigate the features and risk factors of rod fracture (RF) following adult spinal deformity (ASD) surgery.
METHODS
We searched the PubMed, Embase, Web of Science, and Cochrane Library databases to identify relevant studies. Patient's data including age, sex, body mass index (BMI), previous spine surgery, pedicle subtraction osteotomy (PSO), interbody fusion, fusion to the pelvis, smoking history, preoperative sagittal vertical axis (SVA), preoperative pelvic tilt (PT), preoperative pelvic incidence minus lumbar lordosis, preoperative thoracic kyphosis (TK), and change in the SVA were documented. Comparable factors were evaluated using odds ratio (OR) and weighted mean difference (WMD) with 95% confidence interval (CI).
RESULTS
Seven studies were included. The overall incidence of RF following ASD surgery was 12%. Advanced age (WMD, 2.8; 95% CI, 1.01-4.59; p < 0.002), higher BMI (WMD, 1.98; 95% CI, 0.65-3.31; p = 0.004), previous spine surgery (OR, 1.47; 95% CI, 1.05-2.04; p = 0.02), PSO (OR, 2.28; 95% CI, 1.62-3.19; p < 0.0001), a larger preoperative PT (WMD, 6.17; 95% CI, 3.55-8.97; p < 0.00001), and a larger preoperative TK (WMD, 5.19; 95% CI, 1.41-8.98; p = 0.007) were identified as risk factors for incidence of RF.
CONCLUSION
The incidence of RF in patients following ASD surgery was 12%. Advanced age, higher BMI, previous spine surgery, and PSO were significantly associated with an increased occurrence of RF. A larger preoperative PT and TK were also identified as risk factors for occurrence of RF following ASD surgery.
PubMed: 34610673
DOI: 10.14245/ns.2040832.416 -
Acta Orthopaedica Et Traumatologica... May 2022This study aimed to conduct a systematic review and meta-analysis to assess the risk factors for proximal junctional kyphosis after the correction surgery of adult... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This study aimed to conduct a systematic review and meta-analysis to assess the risk factors for proximal junctional kyphosis after the correction surgery of adult spinal deformity.
METHODS
Relevant studies were systematically retrieved from databases including Cochrane Library, PubMed, and Embase. Based on inclusion and exclusion criteria, literature screening, quality evaluation, and data extraction were conducted. Analysis was performed with Revman 5.3 software.
RESULTS
Sixteen studies with 2388 patients, covering 905 cases with proximal junctional kyphosis and 1483 cases without proximal junctional kyphosis, were included in the study. The high-risk factors for the development of proximal junctional kyphosis were found to be high body mass index, osteoporosis, severe fatty infiltration of paravertebral muscles, small functional area of paravertebral muscles, lumbar lordosis over-correction, lack of ligament reinforcement device at the proximal vertebrae and upper instrumented vertebra at the thoracolumbar segment, and pelvic fixation. The results were statistically significant.
CONCLUSION
Evidence from this study has revealed that the independent risk factors for proximal junctional kyphosis complications after correction surgery of adult spinal deformity are high body mass index, osteoporosis, severe degeneration of paravertebral muscles, lumbar lordosis overcorrection, fixed fusion to the pelvis, and lack of ligament reinforcement device at the proximal vertebrae and upper instrumented vertebra at the thoracolumbar segment.
LEVEL OF EVIDENCE
Level IV, Therapeutic Study.
Topics: Adult; Humans; Kyphosis; Lordosis; Lumbar Vertebrae; Osteoporosis; Postoperative Complications; Retrospective Studies; Risk Factors; Spinal Fusion; Thoracic Vertebrae
PubMed: 35703502
DOI: 10.5152/j.aott.2022.21255 -
Annals of Hepatology 2020Endometriosis is characterized by the presence of endometrial-like tissue and stroma in extra-uterine locations. Hepatic endometriosis (HE) is one of the rarest forms of...
Endometriosis is characterized by the presence of endometrial-like tissue and stroma in extra-uterine locations. Hepatic endometriosis (HE) is one of the rarest forms of extrapelvic endometriosis. We aimed to summarize the existing evidence on HE with special consideration to natural history, diagnosis and surgical treatment. Three electronic databases were systematically searched for articles published up to March 2019. All appropriate observational studies and case reports addressing cases of women with HE were considered eligible for inclusion. A total of 27 studies which comprised 32 patients with HE were included. Mean age of patients was 39.7 years. Ten (62.5%) were nulliparous and 24 (75%) were women of reproductive age. Eleven patients (36.7%) had a history of pelvic endometriosis of various sites. Abdominal pain was the primary symptom in 28 patients (87.5%). Preoperative diagnosis of endometriosis was available for 5 patients and 6 underwent a preoperative diagnostic procedure. Cyst resection, minor and major liver resections were performed in 14/31, 9/31 and 8/31 patients, respectively. Preoperative diagnosis of HE is challenging due to variable radiologic features and clinical symptomatology. Nonetheless, it should be considered in the differential diagnosis of a liver mass especially in premenopausal women with a history of endometriosis. The type of resection of the endometriotic lesion is based on the extent and the location of the disease and presented with favourable outcomes concerning morbidity, symptom relief and recurrence.
Topics: Abdominal Pain; Ascites; Endometriosis; Female; Hepatectomy; Humans; Jaundice; Liver Diseases; Magnetic Resonance Imaging; Treatment Outcome; Ultrasonography
PubMed: 31630985
DOI: 10.1016/j.aohep.2019.08.006 -
Sexually Transmitted Infections Feb 2022The UK National Chlamydia Screening Programme uses an opportunistic approach. Many programmes use campaigns to raise awareness of chlamydia screening in young people....
What is the effectiveness of community-based health promotion campaigns on chlamydia screening uptake in young people and what barriers and facilitators have been identified? A mixed-methods systematic review.
BACKGROUND
The UK National Chlamydia Screening Programme uses an opportunistic approach. Many programmes use campaigns to raise awareness of chlamydia screening in young people. This review aimed to assess the effectiveness of campaigns on uptake of chlamydia screening in young people.
METHODS
We conducted a mixed-methods systematic review of articles assessing the outcomes of community-based health-promotion campaigns to increase chlamydia screening in young people, their experiences of the campaigns and other facilitators and barriers to the conduct of the campaigns. We searched four databases for quantitative and qualitative studies with no language restrictions.
MAIN RESULTS
From 10 329 records identified, 19 studies (20 articles) were included in the review: 14 quantitative, 2 qualitative and 3 mixed methods. All studies with quantitative outcomes were before-after study designs or interrupted time series. The prediction interval for relative change (RC) in test counts ranged from 0.95 to 1.56, with a summary pooled estimate of RC 1.22 (95% CI 1.14 to 1.30, 13 studies, I=97%). For test positivity rate, 95% prediction interval was 0.59 to 1.48, with a summary pooled estimate of RC 0.93 (95% CI 0.81 to 1.07, 8 studies, I=91.8%). Large variation in characteristics between studies precluded exploring outcomes by type of campaign components. Seven major qualitative themes to improve screening were identified: targeting of campaigns; quality of materials and message; language; anonymity; use of technology; relevance; and variety of testing options.
CONCLUSIONS
Health promotion campaigns aiming to increase chlamydia testing in those aged 15-24 years may show some effectiveness in increasing overall numbers of tests, however numbers of positive tests do not follow the same trend. Qualitative findings indicate that campaigns require clear, relevant messaging that displays the full range of testing options and assures anonymity in order to be effective.
Topics: Adolescent; Chlamydia Infections; Health Promotion; Humans; Interrupted Time Series Analysis; Mass Screening; Public Health; Qualitative Research; United Kingdom; Young Adult
PubMed: 34446545
DOI: 10.1136/sextrans-2021-055142 -
Journal of Clinical Medicine Apr 2024Malignant-associated abdominal wall endometriosis (AWE) is a rare pathology, likely to occur in 1% of scar endometriosis. The objectives of this study were to update... (Review)
Review
Malignant-associated abdominal wall endometriosis (AWE) is a rare pathology, likely to occur in 1% of scar endometriosis. The objectives of this study were to update the evidence on tumor degeneration arising from AWE to notify about the clinical characteristics, the different treatments offered to patients and their outcomes. A comprehensive systematic review of the literature was conducted. PubMed, Embase and Cochrane Library databases were used. Prospero (ID number: CRD42024505274). Out of the 152 studies identified, 63 were included, which involved 73 patients. The main signs and symptoms were a palpable abdominal mass (85.2%) and cyclic pelvic pain (60.6%). The size of the mass varied between 3 and 25 cm. Mean time interval from the first operation to onset of malignant transformation was 20 years. Most common cancerous histological types were clear cell and endometrioid subtypes. Most widely accepted treatment is the surgical resection of local lesions with wide margins combined with adjuvant chemotherapy. The prognosis for endometriosis-associated malignancy in abdominal wall scars is poor, with a five-year survival rate of around 40%. High rates of relapse have been reported. Endometrial implants in the abdominal wall should be considered as preventable complications of gynecological surgeries. Special attention should be paid to women with a history of cesarean section or uterine surgery.
PubMed: 38673556
DOI: 10.3390/jcm13082282 -
Frontiers in Oncology 2019Newer technologies such as near-infrared (NIR) imaging of the fluorescent dye indocyanine green (ICG) and daVinci Xi Surgical System have become promising tools for...
Newer technologies such as near-infrared (NIR) imaging of the fluorescent dye indocyanine green (ICG) and daVinci Xi Surgical System have become promising tools for sentinel lymph node (SLN) mapping. This meta-analysis was conducted to comprehensively evaluate the diagnostic value of SLN in assessing lymph nodal metastasis in pelvic malignancies, using ICG with NIR imaging in robotic-assisted surgery. A literature search was conducted using PubMed for studies in English before April 2019. The detection rate, sensitivity of SLN detection of metastatic disease, and factors associated with successful mapping (sample size, study design, mean age, mean body mass index, type of cancer) were synthesized for meta-analysis. A total of 17 articles including 1,059 patients were finally included. The reported detection rates of SLN ranged from 76 to 100%, with a pooled average rate of 95% (95% CI: 93-97; 17 studies). The sensitivity of SLN detection of metastatic disease ranged from 50 to 100% and the pooled sensitivity was 86% (95% CI: 75-94; 8 studies). There were no complications related to ICG administration reported. NIR imaging system using ICG in robotic-assisted surgery is a feasible and safe method for SLN mapping. Due to its promising performance, it is considered to be an alternative to a complete pelvic lymph node dissection.
PubMed: 31312614
DOI: 10.3389/fonc.2019.00585