-
BMJ Case Reports Jun 2024Malakoplakia is a rare granulomatous, chronic inflammatory disease generally affecting the urogenital organs, though it can arise in other organs. The clinical...
Malakoplakia is a rare granulomatous, chronic inflammatory disease generally affecting the urogenital organs, though it can arise in other organs. The clinical manifestations of malakoplakia vary depending on the affected organ. The final diagnosis is confirmed by the presence of Michaelis-Gutmann bodies on pathology. This report describes a case of pelvic malakoplakia accompanied by an ovarian tumour-cutaneous fistula, initially misdiagnosed as advanced ovarian cancer invading the anterior abdominal wall with left pleural effusion based on imaging studies and increased serum carbohydrate antigen 19-9. The patient underwent left thoracentesis and fluid collection from the fistula tract for cytology, which showed no malignancy. She underwent primary debulking surgery, including removal of the fistula tract from anterior abdominal wall. Histopathological examination revealed malakoplakia coexisting with mucinous cystadenoma of the left ovary. For postoperative management, she received prolonged oral antibiotics for 6 months. There was no evidence of disease recurrence at the 24-month follow-up.
Topics: Humans; Female; Ovarian Neoplasms; Malacoplakia; Diagnosis, Differential; Cutaneous Fistula; Cystadenoma, Mucinous; Middle Aged; Pelvis
PubMed: 38914526
DOI: 10.1136/bcr-2024-260990 -
Gynecologic Oncology Reports Aug 2024This report describes a unique case of IgG4-related disease in a 36-year-old woman who presented with a pelvic mass. Although CT and MR imaging initially suggested a...
This report describes a unique case of IgG4-related disease in a 36-year-old woman who presented with a pelvic mass. Although CT and MR imaging initially suggested a malignant process, further work-up including sigmoidoscopy and surgical exploration revealed no evidence of malignancy. The final pathology indicated an inflammatory process, leading to the diagnosis of IgG4-related disease. After receiving appropriate systemic treatment, the patient's symptoms significantly improved. This case underscores the limitations of current imaging studies and emphasizes the importance of considering a wide range of potential diagnoses when dealing with pelvic masses of uncertain etiology.
PubMed: 38912387
DOI: 10.1016/j.gore.2024.101428 -
American Family Physician Jun 2024Gender-affirming surgery includes a range of procedures that help align a transgender or gender diverse person's body with their gender identity. As rates of...
Gender-affirming surgery includes a range of procedures that help align a transgender or gender diverse person's body with their gender identity. As rates of gender-affirming surgery increase, family physicians will need to have the knowledge and skills to provide lifelong health care to this population. Physicians should conduct an anatomic survey or organ inventory with patients to determine what health screenings are applicable. Health care maintenance should follow accepted guidelines for the body parts that are present. Patients do not require routine breast cancer screening after mastectomy; however, because there is residual breast tissue, symptoms of breast cancer warrant workup. After masculinizing genital surgery, patients should have lifelong follow-up with a urologist familiar with gender-affirming surgery. If a prostate examination is indicated after vaginoplasty, it should be performed vaginally. If a pelvic examination is indicated after vaginoplasty, it should be performed with a Pederson speculum or anoscope. After gonadectomy, patients require hormone therapy to prevent long-term morbidity associated with hypogonadism, including osteoporosis. The risk of sexually transmitted infections may change after genital surgery depending on the tissue used for the procedure. Patients should be offered the same testing and treatment for sexually transmitted infections as cisgender populations, with site-specific testing based on sexual history. If bowel tissue is used in vaginoplasty, vaginal bleeding may be caused by adenocarcinoma or inflammatory bowel disease. (Am Fam Physician. 2024;109(6):560-565.
Topics: Humans; Female; Sex Reassignment Surgery; Male; Transgender Persons; Sexually Transmitted Diseases
PubMed: 38905554
DOI: No ID Found -
Surgical Endoscopy Jun 2024Endometriosis is a chronic, inflammatory, and hormone-dependent disease that affects approximately 10% of women in reproductive age. Endometriosis is categorized into...
BACKGROUND
Endometriosis is a chronic, inflammatory, and hormone-dependent disease that affects approximately 10% of women in reproductive age. Endometriosis is categorized into different types, as superficial, deep, and ovarian endometriosis. When deep endometriosis occurs, the sigmoid and rectum are often affected (Becker et al. in Hum Reprod Open, 2022, https://doi.org/10.1093/hropen/hoac009 ). In the following article, we aim to demonstrate stepwise surgery for stage IV endometriosis involving the anterior rectosigmoid.
METHODS
We present the case of a 26-year-old obese (BMI 35.87) woman with severe posterior pelvic compartment endometriosis, persistent abdominal pain, and constipation. On preoperative MRI of the pelvis, a 13 cm conglomerate incorporating both ovaries (kissing ovaries), uterine serosa, and the anterior rectosigmoid was observed (Fig. 1). Accordingly, interdisciplinary laparoscopic surgery with a gynecologist and colorectal surgeon was planned.
RESULTS
The total laparoscopic approach is demonstrated step by step in the video.
CONCLUSIONS
Deep endometriosis is a rare condition. When involvement of other organs (e.g., the bowel) is suspected, preoperative endometriosis-specific imaging should be performed for optimal surgical planning. Experienced endometriosis multidisciplinary surgical teams can provide specialized and high-quality care for patients suffering from this debilitating disease (Luna Russo et al. in Minerva Ginecol, 2020, https://doi.org/10.23736/S0026-4784.20.04544-X ).
PubMed: 38898342
DOI: 10.1007/s00464-024-10969-7 -
Immunity, Inflammation and Disease Jun 2024The sequelae of pelvic inflammatory disease (SPID) are major causes of secondary infertility. Modified Hongteng Baijiang decoction (MHTBD) has produced positive results...
OBJECTIVE
The sequelae of pelvic inflammatory disease (SPID) are major causes of secondary infertility. Modified Hongteng Baijiang decoction (MHTBD) has produced positive results in the treatment of patients with chronic pelvic inflammatory disease; however, its role in SPID remains elusive. Therefore, this study clarified the role of MHTBD in SPID pathogenesis.
METHODS
The main components in MHTBD were analyzed by using liquid chromatography‒mass spectrometry (LC/MS). An SPID rat model was established, and the rats were treated with different doses of MHTBD (0.504 g of raw drug/kg, 1.008 g of raw drug/kg, and 2.016 g of raw drug/kg). Endometrial pinopodes were observed via scanning electron microscopy, endometrial thickness and inflammatory cell infiltration were assessed via HE staining, and the expression of estrogen receptor (ER), progesterone receptor (PR), integrin β3 (ITGB3), and CD31 in the endometrium was detected by using immunohistochemistry. Western blot analysis was used to detect the protein expression of LIF, JAK2, p-JAK2, STAT3, and p-STAT3 in the endometrium. Moreover, the changes in the gut microbiota were analyzed via 16S rRNA sequencing.
RESULTS
MHTBD improved endometrial receptivity, attenuated endometrial pathologic damage, reduced inflammatory cell infiltration, decreased ER and PR expression in the endometrium, and promoted the expression of LIF, p-JAK2, and p-STAT3 in the endometrium (p < .05) in SPID rats. Additionally, MHTBD treatment affected the composition of the gut microbiota in SPID rats. Furthermore, MHTBD attenuated endometrial receptivity and pathological damage in SPID rats by promoting the LIF/JAK2/STAT3 pathway.
CONCLUSION
MHTBD attenuates SPID in rats by promoting the LIF/JAK2/STAT3 pathway and improving the composition of the gut microbiota. MHTBD may be a valuable drug for SPID therapy.
Topics: Animals; Female; Rats; Disease Models, Animal; Drugs, Chinese Herbal; Endometrium; Gastrointestinal Microbiome; Janus Kinase 2; Pelvic Inflammatory Disease; Rats, Sprague-Dawley; Signal Transduction; STAT3 Transcription Factor; Male
PubMed: 38896093
DOI: 10.1002/iid3.1300 -
International Journal of Molecular... May 2024Endometriosis is one of the most common causes of chronic pelvic pain and infertility, affecting 10% of women of reproductive age. A delay of up to 9 years is estimated... (Review)
Review
Endometriosis is one of the most common causes of chronic pelvic pain and infertility, affecting 10% of women of reproductive age. A delay of up to 9 years is estimated between the onset of symptoms and the diagnosis of endometriosis. Endometriosis is currently defined as the presence of endometrial epithelial and stromal cells at ectopic sites; however, advances in research on endometriosis have some authors believing that endometriosis should be re-defined as "a fibrotic condition in which endometrial stroma and epithelium can be identified". There are several theories on the etiology of the disease, but the origin of endometriosis remains unclear. This review addresses the role of microRNAs (miRNAs), which are naturally occurring post-transcriptional regulatory molecules, in endometriotic lesion development, the inflammatory environment within the peritoneal cavity, including the role that cytokines play during the development of the disease, and how animal models have helped in our understanding of the pathology of this enigmatic disease.
Topics: Endometriosis; Humans; Female; MicroRNAs; Animals; Endometrium; Cytokines; Disease Models, Animal
PubMed: 38892003
DOI: 10.3390/ijms25115815 -
Pathogens and Disease Jun 2024Chlamydia trachomatis (Ct) is the most common sexually transmitted bacterial infection worldwide, potentially leading to severe pathologies including pelvic inflammatory...
Chlamydia trachomatis (Ct) is the most common sexually transmitted bacterial infection worldwide, potentially leading to severe pathologies including pelvic inflammatory disease, ectopic pregnancy, and tubal infertility if left untreated. Current strategies, including screening and antibiotics, have limited effectiveness due to high rates of asymptomatic cases and logistical challenges. A multi-epitope prophylactic vaccine could afford long-term protection against infection. Immunoinformatic analyses were employed to design a multi-epitope Chlamydia vaccine antigen. B- and T-cell epitopes from five highly conserved and immunogenic Ct antigens were predicted and selected for the vaccine design. The final construct, adjuvanted with cholera toxin A1 subunit (CTA1), was further screened for immunogenicity. CTA1-MECA was identified as antigenic and non-allergenic. A tertiary structure was predicted, refined, and validated as a good quality model. Molecular docking exhibited strong interactions between the vaccine and toll-like receptor 4 (TLR4). Additionally, immune responses consistent with protection including IFN-γ, IgG + IgM antibodies, and T- and B-cell responses were predicted following vaccination in an immune simulation. Expression of the construct in an E. coli expression vector proved efficient. To further validate the vaccine efficacy, we assessed its immunogenicity in mice. Immunization with CTA1-MECA elicited high levels of Chlamydia-specific antibodies in mucosal and systemic compartments.
PubMed: 38889932
DOI: 10.1093/femspd/ftae015 -
Expert Opinion on Investigational Drugs Jun 2024Polymyalgia rheumatica (PMR) is an inflammatory rheumatic disorder characterized by pain and stiffness in the shoulder and pelvic girdles, constitutional symptoms, and...
INTRODUCTION
Polymyalgia rheumatica (PMR) is an inflammatory rheumatic disorder characterized by pain and stiffness in the shoulder and pelvic girdles, constitutional symptoms, and elevated acute-phase reactants. Glucocorticoids (GCs) remain the first-choice treatment for PMR, but relapses are common. Identification of steroid-sparing agents is therefore of utmost importance.
AREAS COVERED
The efficacy of conventional immunosuppressive drugs is controversial. The use of interleukin (IL)-6 receptor inhibitors proved to be effective and safe in treating PMR patients. Currently, there are 12 ongoing clinical trials exploring potential treatments such as leflunomide, low-dose IL-2, rituximab, abatacept, secukinumab, Janus kinase inhibitors, and selective inhibitors like SPI-62 and ABBV 154.
EXPERT OPINION
The high efficacy of IL-6 R receptor inhibitors as well as the numerous drug trials currently recruiting suggest that several therapeutic options will be available in the near future. Accurate diagnosis and early stratification of PMR patients according to the giant cell arteritis-PMR Spectrum Disease 'GPSD' and potential risk factors for relapsing disease or GC-related adverse events are crucial to identify patients who would benefit most from GC-sparing agents. The development of internationally accepted definitions for remission and relapse is urgently needed. Early referral strategies to specialist settings would improve disease stratification and personalized treatment.
PubMed: 38879822
DOI: 10.1080/13543784.2024.2366847 -
Case Reports in Women's Health Jun 2024A tubo-ovarian abscess is a potential life-threatening condition. In postmenopausal women, it is rarely seen and it has fewer typical symptoms, making it difficult to...
A tubo-ovarian abscess is a potential life-threatening condition. In postmenopausal women, it is rarely seen and it has fewer typical symptoms, making it difficult to diagnose. This report concerns a postmenopausal patient who was admitted with general health decline, weight loss and ascites. At first, a malignancy of the right ovary was suspected because of the sonographic and laboratory findings. On diagnostic laparoscopy, the diagnosis of pelvic inflammatory disease was made, most likely caused by a Mirena intrauterine device that had been in place for 20 years. In a postmenopausal woman a tubo-ovarian abscess should be included in differential diagnoses especially if she has an intrauterine device. Conservative treatment with antibiotics is preferred. If surgery is required, diagnostic laparoscopy is advised.
PubMed: 38873434
DOI: 10.1016/j.crwh.2024.e00618 -
Sexually Transmitted Infections Jun 2024Most people who have experienced sexual violence (SV) will disclose the event(s) to someone. Key recipients of disclosure are those working in healthcare. Telling...
Making sexual and reproductive healthcare environments safe and supportive for disclosure of sexual violence: interview findings from patients and healthcare professionals using a realist approach.
OBJECTIVES
Most people who have experienced sexual violence (SV) will disclose the event(s) to someone. Key recipients of disclosure are those working in healthcare. Telling someone in healthcare about experiences of SV can be an important step in accessing necessary medical care and being signposted to other services. While recognising healthcare settings are a key place for people to seek support, evidence is lacking about how best to create a safe environment for disclosure to take place, how services can make changes to better facilitate this experience and what changes matter most.
DESIGN
This study used a realist approach to identify mechanisms that facilitate safe and supported disclosure. Data were generated through three focus groups with Sexual and Reproductive Health Services healthcare professionals in the UK, and one-to-one interviews with survivors of SV who attended healthcare settings (n=18).
RESULTS
The analysis found that service users needed to feel empowered and recognised as appropriate candidates for care in the material used to promote sexual healthcare services after SV. This promotional material needs to address rape myths, stereotypes and silence surrounding SV, to ensure that all individuals and especially those from diverse groups are empowered to access care. Three fundamental mechanisms for safe and supported disclosure were identified: being listened to, being validated and having choice. Trauma-informed care was identified as being essential for implementing these mechanisms. Healthcare professionals who were confident and competent regarding enquiry about SV and response to disclosures of SV were key.
CONCLUSIONS
The development of services that are conducive to the disclosure of SV is needed to provide better support for those who have experienced SV and are ready to seek support. Use of appropriate promotional material, specific staff training and a trauma-informed approach are key elements to improve services.
PubMed: 38871453
DOI: 10.1136/sextrans-2024-056140