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Rhinology Jun 2016Management of rhinosinusitis during pregnancy requires special considerations. (Review)
Review
BACKGROUND
Management of rhinosinusitis during pregnancy requires special considerations.
OBJECTIVES
1. Conduct a systematic literature review for acute and chronic rhinosinusitis (CRS) management during pregnancy. 2. Make evidence-based recommendations.
METHODS
The systematic review was conducted using MEDLINE and EMBASE databases and relevant search terms. Title, abstract and full manuscript review were conducted by two authors independently. A multispecialty panel with expertise in management of Rhinological disorders, Allergy-Immunology, and Obstetrics-Gynecology was invited to review the systematic review. Recommendations were sought on use of following for CRS management during pregnancy: oral corticosteroids; antibiotics; leukotrienes; topical corticosteroid spray/irrigations/drops; aspirin desensitization; elective surgery for CRS with polyps prior to planned pregnancy; vaginal birth versus planned Caesarian for skull base erosions/ prior CSF rhinorrhea.
RESULTS
Eighty-eight manuscripts underwent full review after screening 3052 abstracts. No relevant level 1, 2, or 3 studies were found. Expert panel recommendations for rhinosinusitis management during pregnancy included continuing nasal corticosteroid sprays for CRS maintenance, using pregnancy-safe antibiotics for acute rhinosinusitis and CRS exacerbations, and discontinuing aspirin desensitization for aspirin exacerbated respiratory disease. The manuscript presents detailed recommendations.
CONCLUSIONS
The lack of evidence pertinent to managing rhinosinusitis during pregnancy warrants future trials. Expert recommendations constitute the current best available evidence.
Topics: Administration, Intranasal; Adrenal Cortex Hormones; Anti-Bacterial Agents; Cerebrospinal Fluid Rhinorrhea; Cesarean Section; Chronic Disease; Delivery, Obstetric; Disease Management; Female; Humans; Leukotriene Antagonists; Nasal Polyps; Otorhinolaryngologic Surgical Procedures; Paranasal Sinuses; Practice Guidelines as Topic; Preconception Care; Pregnancy; Pregnancy Complications, Infectious; Rhinitis; Sinusitis
PubMed: 26800862
DOI: 10.4193/Rhino15.228 -
American Journal of Obstetrics and... Apr 2002Endometrial polyps are relatively common in all groups of women. More polyps are being diagnosed with the widespread use of transvaginal ultrasound scanning and...
OBJECTIVE
Endometrial polyps are relatively common in all groups of women. More polyps are being diagnosed with the widespread use of transvaginal ultrasound scanning and sonohysterography. The reported incidence of malignancy is low. The potential benefit of a noninvasive technique to distinguish benign from malignant polyps is obvious. This study was undertaken to evaluate endometrial polyps by color flow Doppler ultrasound scanning and histopathologic examination.
STUDY DESIGN
This was an observational study of patients with an endometrial polyp on sonohysterography who underwent interrogation of their polyp with color Doppler ultrasound scanning and subsequently polypectomy. Polyp volume, resistive index, pulsatility index, indication for scan (bleeding vs incidental), and patient age were correlated with histopathologic type of the polyp (nonfunctional, proliferative, secretory, hyperplastic, or malignant).
RESULTS
Of 61 patients studied, 42 patients (68.9%) were scanned for abnormal bleeding, and 19 patients (31.1%) had their polyps discovered incidentally. There were no statistically significant differences between histologic categories and the resistive index, pulsatility index, or size of the polyp. The age of patients with nonfunctional polyps was significantly greater than any other group (P <.001). Ninety-four percent of the functional polyps were discovered because of abnormal bleeding; 38% of the nonfunctional polyps were discovered incidentally (P <.001).
CONCLUSION
The data suggest that the objective assessment of blood flow impedance (resistive index, pulsatility index) in endometrial polyps and the size of these polyps cannot replace surgical removal and pathologic evaluation to predict histologic type. Patients with nonfunctional polyps were older and less likely to have vaginal bleeding.
Topics: Adult; Endometrial Neoplasms; Female; Humans; Polyps; Pulsatile Flow; Ultrasonography, Doppler, Color; Uterine Hemorrhage; Vascular Resistance
PubMed: 11967489
DOI: 10.1067/mob.2002.122128 -
Haemophilia : the Official Journal of... Jul 2005In women, menorrhagia may be the most common manifestation of a bleeding disorder, but it is not the only reproductive tract abnormality that women with bleeding... (Review)
Review
In women, menorrhagia may be the most common manifestation of a bleeding disorder, but it is not the only reproductive tract abnormality that women with bleeding disorders experience. Women with bleeding disorders appear to be at an increased risk of developing haemorrhagic ovarian cysts and possibly endometriosis. As they grow older, they may be more likely to manifest conditions, which present with bleeding such as fibroids, endometrial hyperplasia and polyps. Women with bleeding disorders are more likely to undergo a hysterectomy and are more likely to have the operation at a younger age. During pregnancy, they may be at greater risk of miscarriage and bleeding complications. At the time of childbirth, women with bleeding disorders appear to be more likely to experience postpartum haemorrhage, particularly delayed or secondary postpartum haemorrhage. Vaginal or vulvar haematomas, extremely rare in women without bleeding disorders, are not uncommon. While women with bleeding disorders are at risk for the same obstetrical and gynaecological problems that affect all women, they appear to be disproportionately affected by conditions that manifest with bleeding.
Topics: Abortion, Spontaneous; Anovulation; Blood Coagulation Disorders; Endometrial Hyperplasia; Endometriosis; Female; Genital Diseases, Female; Humans; Hysterectomy; Ovarian Cysts; Polyps; Postpartum Hemorrhage; Pregnancy; Pregnancy Complications; Uterine Diseases
PubMed: 16011580
DOI: 10.1111/j.1365-2516.2005.01108.x -
The Journal of Obstetrics and... Feb 2023Previous studies have shown an association between chronic endometritis and endometrial polyps, and only one study in infertile women reported an association between...
AIMS
Previous studies have shown an association between chronic endometritis and endometrial polyps, and only one study in infertile women reported an association between tubal obstruction and polyps. This study aimed to compare the prevalence of endometrial polyps in two groups of women with tubal factor infertility and male factor infertility to assess if is there any association between tubal factor infertility and endometrial polyps.
METHODS
This case-control study was performed on infertile women. The case group included women with tubal factor infertility and the control group included all women with male factor infertility. In all patients, vaginal ultrasound was performed between days 8 and 12 of the menstrual cycle to diagnose endometrial polyp, its size, and number. Demographic and obstetrics variables were recorded. Patients underwent hysteroscopy and polypectomy and the diagnosis of the polyp was confirmed by pathology report.
RESULT
In the present study, 245 people participated in two groups. There was a statistically significant difference between the two groups in terms of demographic and obstetric characteristics like type of infertility, duration of infertility, and gravidity. The prevalence of polyps in the tubal factor group was higher than in the male factor group (63 [60%] vs. 12 [9.8%]), and this difference was statistically significant (p = 0.0001). In addition, the prevalence of chronic endometritis in the tubal factor group was higher than in the male factor group (19 [18.8%] vs. 4 [3.3%]), and this difference was statistically significant (p = 0.001).
CONCLUSIONS
In the present study, a strong association was observed between endometrial polyps and tubal obstruction, and considering that the most common cause of tubal obstruction is pelvic and genital infections, after confirmation with more studies, it may be possible to consider antibiotic treatment in these patients, especially in patients with recurrent polyps.
Topics: Pregnancy; Humans; Female; Male; Infertility, Female; Endometritis; Case-Control Studies; Prevalence; Hysteroscopy; Fallopian Tube Diseases; Polyps
PubMed: 36448572
DOI: 10.1111/jog.15485 -
Diagnostic Pathology Jun 2016Enteric-type glandular lesions are extremely rare in the vagina. Their histological origin remains a matter of speculation at present.
BACKGROUND
Enteric-type glandular lesions are extremely rare in the vagina. Their histological origin remains a matter of speculation at present.
METHOD
We review two rectal mucosal prolapse-like polyps and one intestinal-type adenosis in the vagina.
RESULTS
Case 1, a 64-year-old woman, presented with a vaginal polypoid lesion with a size of 4 × 3 × 3 cm. Case 2, an 8-year-old girl, had a 1.5 × 1.5 × 0.8-cm pedunculated polyp in the vaginal navicular fossa and a clinically suspected rectovaginal fistula. Case 1 and 3 had an obsolete severe perineal laceration. On histopathological examination, cases 1 and 2 resembled rectal mucosal prolapse or inflammatory cloacogenic polyp (rectal mucosal prolapse-like polyp). Case 3 had an incidental intestinal-type adenosis in the removed vaginal wall. Immunohistochemistry confirmed the intestinal differentiation in all 3 lesions by showing diffuse CDX2-positive, CK20-positive, and scattered chromogranin A-positive neuroendocrinal cells in the lower compartment of the crypt.
CONCLUSIONS
In summary, we report herein three unusual cases of benign intestinal-type glandular lesions in the vagina including two rectal mucosal prolapse-like polyps and one case of intestinal-type adenosis, and discuss possibilities for their histogenetic basis.
Topics: Biomarkers, Tumor; CDX2 Transcription Factor; Cell Differentiation; Child; Chromogranin A; Female; Humans; Immunohistochemistry; Intestinal Mucosa; Keratin-20; Middle Aged; Neoplasms, Glandular and Epithelial; Polyps; Rectal Prolapse; Treatment Outcome; Vagina; Vaginal Neoplasms
PubMed: 27315791
DOI: 10.1186/s13000-016-0503-5 -
International Journal of Gynecological... Jul 2009Polyps are the most common benign lesions in the endometrium. Metastasis to the endometrial polyp from a distant primary tumor is rare. Breast carcinoma is the most... (Review)
Review
Polyps are the most common benign lesions in the endometrium. Metastasis to the endometrial polyp from a distant primary tumor is rare. Breast carcinoma is the most frequent extragenital cancer that metastasizes to the endometrial polyp. We report the case of a 63-year-old with metastatic gall bladder adenocarcinoma involving endometrial polyps detected by endometrial curetting. It was the first sign of her metastatic disease. After this diagnosis, bone metastases were detected during radiologic screening. Gastrointestinal tumor metastasis to an endometrial polyp is a very rare event, but if a patient with a known primary extragenital tumor has abnormal vaginal bleeding, the possibility of metastasis should be included in the differential diagnosis.
Topics: Adenocarcinoma; Aged; Dilatation and Curettage; Endometrial Neoplasms; Female; Gallbladder Neoplasms; Humans; Immunohistochemistry; Neoplasm Staging; Polyps
PubMed: 19483630
DOI: 10.1097/PGP.0b013e318192927d -
Cancer Mar 1983Seven cases of vaginal polyps with atypical stromal cells were investigated. Three of the cases were classified as vaginal rhabdomyoma and four as fibroepithelial polyps... (Comparative Study)
Comparative Study
Seven cases of vaginal polyps with atypical stromal cells were investigated. Three of the cases were classified as vaginal rhabdomyoma and four as fibroepithelial polyps with atypical stromal cells. All of the patients were adult women with minor or no symptoms. None of the tumor recurred or metastasized. The recognition of the vaginal polyps with bizarre stromal cells is important in order to avoid misdiagnosis of sarcoma, particularly botryoid rhabdomyosarcoma.
Topics: Adolescent; Adult; Aged; Cytoskeleton; Endoplasmic Reticulum; Female; Finland; Follow-Up Studies; Humans; Microscopy, Electron; Middle Aged; Myofibrils; Polyps; Registries; Rhabdomyoma; Vaginal Neoplasms
PubMed: 6681596
DOI: 10.1002/1097-0142(19830315)51:6<1148::aid-cncr2820510629>3.0.co;2-7 -
American Journal of Obstetrics and... Dec 1993Our objective was to determine the presence of intrauterine lesions in patients with a cervical polyp.
OBJECTIVE
Our objective was to determine the presence of intrauterine lesions in patients with a cervical polyp.
STUDY DESIGN
We performed a retrospective analysis to determine the influence of hormonal treatment and age on 165 patients with a cervical polyp and bleeding on admission. All 165 patients underwent a diagnostic hysteroscopy to rule out intrauterine lesions, including polyps, fibroids, hyperplasia, and adenocarcinoma.
RESULTS
Endometrial polyps were found in up to 26.7% of patients who had a cervical polyp. In patients undergoing a combined pill treatment this incidence was much lower (8.3%). Menopausal patients had a 56.8% incidence of cervix-related endometrial polyps, and hormone replacement therapy did not significantly increase (45.7% vs 28.6%) the incidence of coexisting polyps. All cervical polyps present during tamoxifen treatment were associated with endometrial polyps. Abnormal vaginal bleeding was of no clinical significance in excluding concomitant endometrial polyps.
CONCLUSIONS
All menopausal patients with a cervical polyp could benefit from a diagnostic hysteroscopy. Premenopausal patients receiving a combined pill treatment are the least likely to have coexistent endometrial polyps.
Topics: Adult; Aged; Contraceptives, Oral, Combined; Endometrial Hyperplasia; Endometrial Neoplasms; Estrogen Replacement Therapy; Female; Humans; Hysteroscopy; Menopause; Middle Aged; Polyps; Uterine Cervical Neoplasms
PubMed: 8267062
DOI: 10.1016/0002-9378(93)90437-n -
International Journal of Gynaecology... Mar 2011To determine the pre-malignant and malignant potential of endometrial polyps and to assess whether different clinical parameters are associated with malignancy in the...
OBJECTIVE
To determine the pre-malignant and malignant potential of endometrial polyps and to assess whether different clinical parameters are associated with malignancy in the polyps of premenopausal women.
METHODS
The clinical records of operative office hysteroscopic and resectoscopic procedures for endometrial polyps in 417 premenopausal women who attended Baskent University were examined over a retrospective period of 30 months. Only premenopausal patients were included in the study.
RESULTS
In 97.8% of women, histology showed benign endometrial pathology. In 2.2% of women, pre-malignant or malignant conditions were found in the polyp. Polycystic ovary syndrome (PCOS) and the presence of 2 or more polyps were associated with significant pre-malignant or malignant changes.
CONCLUSION
The presence of irregular vaginal bleeding was not a predictor of malignancy in the polyp. Premenopausal women with PCOS and those with 2 or more polyps had an increased prevalence of polyp malignancy. These groups of patients, whether symptomatic or not, should be evaluated by hysteroscopic resection of the polyps.
Topics: Adenocarcinoma; Adenomyoma; Adult; Cell Transformation, Neoplastic; Endometrial Neoplasms; Female; Gynecologic Surgical Procedures; Humans; Polycystic Ovary Syndrome; Polyps; Precancerous Conditions; Premenopause; Prevalence; Retrospective Studies; Risk Factors
PubMed: 21247566
DOI: 10.1016/j.ijgo.2010.10.014 -
European Journal of Gynaecological... 2003Tamoxifen is commonly used in the management of patients with breast cancer because of its anti-oestrogenic effects to the breasts. However, tamoxifen acts as an... (Review)
Review
Tamoxifen is commonly used in the management of patients with breast cancer because of its anti-oestrogenic effects to the breasts. However, tamoxifen acts as an oestrogen agonist on the endometrium increasing the incidence of endometrial polyps, hyperplasia and cancer. In addition, it may be possible that tamoxifen increases the occurrence of uterine body tumours. We describe a rare case of a large endometrial polyp with sarcomatous stromal components in a 73-year-old breast cancer patient treated daily with 20 mg of tamoxifen for four years. The glands of the polyp were lined by benign appearing epithelium. The polyp was twisted and protruded from a dilated cervix at the entrance of the vagina. The patient was treated by removal of the polyp and dilatation and curretage. A postoperative computed tomography scan showed many focal hypodense lesions in the hepatic lobes with a well-defined profile suggestive of metastatic disease and the patient was referred for combined chemotherapy. In conclusion, a case of a mesenchymal malignant neoplasm arising in the uterus of a breast cancer patient treated with tamoxifen is reported and its clinical, histological and immunohistochemical features are discussed. Also, the international literature is reviewed.
Topics: Aged; Breast Neoplasms; Endometrial Neoplasms; Female; Humans; Immunohistochemistry; Mixed Tumor, Mullerian; Polyps; Selective Estrogen Receptor Modulators; Survivors; Tamoxifen
PubMed: 14658606
DOI: No ID Found