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International Urogynecology Journal Jun 2024The Manchester procedure (MP) and sacrospinous ligament hysteropexy (SSHP) have long been established as effective conservative surgeries for treating uterine prolapse....
INTRODUCTION
The Manchester procedure (MP) and sacrospinous ligament hysteropexy (SSHP) have long been established as effective conservative surgeries for treating uterine prolapse. However, there have been limited studies on outcomes comparing these two techniques.
METHODOLOGY
This was a prospective cohort study of the British Society of Urogynaecology database between February 2007 and 2023 of MP and SSHP outcomes from 90 centres in the UK. The primary outcome was the Patient Global Impression of Improvement (PGI-I). The other outcomes compared were the absence of pelvic organ prolapse beyond the hymen in any compartment evaluated by the Pelvic Organ Prolapse Quantification (POP-Q), complications, and the incidence of reported symptomatic prolapse within 1 year after the operation.
RESULTS
There were 718 women who underwent MP and 2,384 who had SSHP. The PGI-I score was significantly better in the MP group (p value <0.001). The rates of symptomatic prolapse within 1 year (odds ratio [OR] 0.36, 95% confidence interval [CI] 0.18-0.69; p value 0.001), recurrence of prolapse beyond the hymen (OR 0.13, 95% CI 0.03-0.53; p value 0.001) and apical recurrence (OR 0.09, 95% CI 0.01-0.65; p value 0.003) during follow-up examination were lower in the MP group. The combined peri-operative and post-operative complications reported in both groups were comparatively similar.
CONCLUSION
The symptom improvement was better and recurrence was lower with the MP than with SSHP at short-term follow-up.
PubMed: 38847822
DOI: 10.1007/s00192-024-05826-z -
Annals of Medicine and Surgery (2012) Jun 2024The presentation of a strangulated obturator hernia is rare, with it accounting for less than 0.04% of all hernias. Delay in presentation and diagnosis results in...
INTRODUCTION
The presentation of a strangulated obturator hernia is rare, with it accounting for less than 0.04% of all hernias. Delay in presentation and diagnosis results in complications like bowel ischemia, necrosis, perforation, and peritonitis, thereby increasing morbidity and mortality.
CASE PRESENTATION
The authors report the case of an 85-year-old multiparous woman who presented with a 3-day history of abdominal pain and vomiting. Upon examination, she exhibited hypotension, altered sensorium, and a distended abdomen with visible peristalsis. An abdominal pelvic computed tomography scan confirmed the diagnosis of 'intestinal obstruction secondary to an incarcerated obturator hernia'. Subsequently, a lower midline laparotomy was performed, successfully reducing the bowel and repairing the hernial orifice. The patient was discharged on the fourth postoperative day, and there has been no hernia recurrence as of her 3-month follow-up.
DISCUSSION
The presentation of a strangulated obturator hernia can be elusive. During clinical examination, both the Howship-Romberg sign and the Hannington-Kiffs sign tests may be negative. Laparoscopic obturator hernia repair has been shown to reduce hospital stay and morbidity. A midline laparotomy has the advantage of easy manual reduction, minimizing bowel trauma, accurately accessing the bowel, and facilitating bowel resection.
CONCLUSION
Obturator hernias constitute rare subtypes of abdominal hernias. They typically occur in older women, and patients often present with poor functional status and multiple comorbidities. The clinical diagnostic tests are uncertain, even in patients with a high index of suspicion. Timely diagnosis and appropriate surgical management are crucial for a favorable outcome.
PubMed: 38846839
DOI: 10.1097/MS9.0000000000002073 -
Alternative Therapies in Health and... Jun 2024This study aims to evaluate the clinical significance of using real-time three-dimensional transperineal ultrasound in conjunction with a combined magnetic and...
The Clinical Significance of Real-Time 3-D Transperineal Ultrasound in the Treatment of Postpartum Pelvic Floor Dysfunction Using a Combined Magnetic and Electrical Repair Approach.
OBJECTIVE
This study aims to evaluate the clinical significance of using real-time three-dimensional transperineal ultrasound in conjunction with a combined magnetic and electrical repair approach for the treatment of postpartum pelvic floor dysfunction.
METHODS
Ninety patients with postpartum pelvic floor dysfunction were included and randomly assigned to the control or the observation group. The control group received Kegel pelvic floor rehabilitation training, while the observation group underwent real-time three-dimensional transperineal ultrasound examination, along with the training. Following assessment tools were used: Modified Oxford Scale (MOS) assessed pelvic floor muscle (PFM) strength and function; Pelvic Floor Distress Inventory (PFDI-20) questionnaire assessed the distress and discomfort reported by patients concerning symptoms of genital prolapse, anal colorectal symptoms, and urinary symptoms; Pelvic Floor Impact Questionnaire (PFIQ-7) measured the impact of urinary, colorectal-anal, and genital prolapse symptoms on patients' activities, relationships, and feeling; and International Consultation on Incontinence Questionnaire (ICIQ) was utilized to assess urinary incontinence (UI) symptoms and their impact on an individual's quality of life (QoL). It was developed by an international committee of experts in the field of incontinence research and is available in multiple languages. ICIQ-UI Short Form focuses on the symptoms of urinary incontinence. It assesses the type, frequency, and amount of urine leakage, as well as the impact of UI on daily activities, such as work, social interactions, and emotional well-being. It also includes questions about the use of protective pads or aids.
RESULTS
The results showed significant improvements in pelvic floor muscle strength, symptom distress, and impact on activities, relationships, and feelings in the observation group compared to the control group. The MOS scores significantly increased in the observation group (P < .001), indicating improved PFM strength. The PFDI-20 scores significantly decreased in the observation group (P < .001), indicating reduced distress related to pelvic floor dysfunction symptoms. The PFIQ-7 scores also showed significant improvements in the observation group, indicating reduced impact on activities, relationships, and feelings. The ICIQ scores significantly decreased in the observation group, indicating reduced severity of UI symptoms and improved QoL.
CONCLUSION
The findings of the study suggest that this innovative therapeutic strategy can be a potentially effective therapeutic option for postpartum pelvic floor dysfunction and has prospects for clinical implementation.
PubMed: 38843412
DOI: No ID Found -
Fertility and Sterility Jun 2024To determine whether obstetric outcomes differ between women with endometriosis and those without, where all women undergo first-trimester screening for endometriosis.
OBJECTIVE
To determine whether obstetric outcomes differ between women with endometriosis and those without, where all women undergo first-trimester screening for endometriosis.
DESIGN
A prospective observational cohort study.
SETTING
The Early Pregnancy Unit at University College London Hospital, United Kingdom.
PATIENTS
Women with a live pregnancy progressing beyond 12 weeks' gestation and concurrent endometriosis (n = 110) or no endometriosis (n = 393).
INTERVENTION
All women underwent a pelvic ultrasound examination in early pregnancy to examine for the presence of endometriosis and uterine abnormalities.
MAIN OUTCOME MEASURES
The primary outcome of interest was preterm birth, defined as delivery before 37 completed weeks' gestation. Secondary outcomes included late miscarriage, antepartum hemorrhage, placental site disorders, gestational diabetes, hypertensive disorders of pregnancy, neonates small for gestational age, mode of delivery, intrapartum sepsis, postpartum hemorrhage, and admission to the neonatal unit.
RESULTS
Women with a diagnosis of endometriosis did not have statistically significantly higher odds of preterm delivery (adjusted odds ratio [aOR] 1.85 [95% confidence interval {CI} 0.50-6.90]), but they did have higher odds of postpartum hemorrhage during cesarean section (aOR 3.64 [95% CI 2.07-6.35]) and admission of their newborn infant to the neonatal unit (aOR 3.24 [95% CI 1.08-9.73]). Women with persistent or recurrent deep endometriosis after surgery also had higher odds of placental site disorders (aOR 8.65 [95% CI 1.17-63.71]) and intrapartum sepsis (aOR 3.47 [95% CI 1.02-11.75]).
CONCLUSION
We observed that women with endometriosis do not have higher odds of preterm delivery, irrespective of their disease subtype. However, they do have higher odds of postpartum hemorrhage during the cesarean section and newborn admission to the neonatal unit.
PubMed: 38838806
DOI: 10.1016/j.fertnstert.2024.05.162 -
Journal of Cellular and Molecular... Jun 2024Chimeric antigen receptor- (CAR-)modified T cells have been successfully used to treat blood cancer. With the improved research on anti-tumour adoptive cell therapy,... (Review)
Review
Chimeric antigen receptor- (CAR-)modified T cells have been successfully used to treat blood cancer. With the improved research on anti-tumour adoptive cell therapy, researchers have focused on immune cells other than T lymphocytes. Natural killer (NK) cells have received widespread attention as barriers to natural immunity. Compared to T lymphocyte-related adoptive cell therapy, the use of NK cells to treat tumours does not cause graft-versus-host disease, significantly improving immunity. Moreover, NK cells have more sources than T cells, and the related modified cells are less expensive. NK cells function through several pathways in anti-tumour mechanisms. Currently, many anti-tumour clinical trials have used NK cell-related adoptive cell therapies. In this review, we have summarized the recent progress in NK cell-related adoptive cellular immunotherapy for tumour treatment and propose the current challenges faced by CAR-NK cell therapy.
Topics: Humans; Immunotherapy, Adoptive; Killer Cells, Natural; Neoplasms; Receptors, Chimeric Antigen; Animals
PubMed: 38837666
DOI: 10.1111/jcmm.18362 -
International Journal of Surgery Case... Jul 2024Fallopian tube cancer is a rare tumor, representing between 0.3 and 1.8 % of all malignant tumors in the gynecological sphere. Due to the proximity of the uterus and...
INTRODUCTION
Fallopian tube cancer is a rare tumor, representing between 0.3 and 1.8 % of all malignant tumors in the gynecological sphere. Due to the proximity of the uterus and ovary, the diagnosis of primary fallopian tube cancer is very difficult to establish and relies on very strict criteria. The endometrioid form is exceptional and of controversial etiopathogenesis. Only a few cases have been previously reported. Diagnosis most often occurs incidentally during histological examination. This case presents a distinctive aspect with the rare occurrence of endometrioid-type fallopian tube cancer, notably associated with endometriosis, and initially misdiagnosed as an infected endometrioma. It underscores the diagnostic complexities encountered in identifying primary fallopian tube cancer.
CASE REPORT
We present the case of a 49-year-old patient, followed for chronic pelvic pain associated with menorrhagia. Imaging revealed a myomatous and adenomyotic uterus, a right ovarian endometrioma, and a left multicystic ovarian formation with thick walls, measuring 135 mm, requiring histological verification. She underwent an exploratory laparotomy. During the procedure, extensive retro- and supravaginal adhesive tissue involving the uterus, both adnexa, and the digestive tract was found. Careful adhesiolysis was performed. The left adnexa harbored a formation suggestive of an infected endometrioma. A total hysterectomy with bilateral adnexectomy and peritoneal washing was performed. The postoperative course was uneventful. Histopathological examination revealed an endometrioid carcinoma of the left fallopian tube, classified as pT1a according to FIGO guidelines.
DISCUSSION
Tubal cancer is a rare cancer of unknown etiology, underestimated, and sometimes confused with ovarian pathology. Preoperative diagnosis is difficult because the clinical presentation is polymorphic and imaging is nonspecific. The endometrioid form is exceptional and of controversial etiopathogenesis. Treatment mirrors that of malignant epithelial ovarian tumors, with prognosis depending on FIGO stage and histological type.
CONCLUSION
Due to its unpredictable nature, fallopian tube cancer should not be overlooked as a differential diagnosis for any adnexal mass.
PubMed: 38833903
DOI: 10.1016/j.ijscr.2024.109796 -
European Journal of Obstetrics,... May 2024To compare the female sexual function between cervical cancer survivors and healthy women or with benign gynecological diseases.
OBJECTIVE
To compare the female sexual function between cervical cancer survivors and healthy women or with benign gynecological diseases.
STUDY DESIGN
From January 1, 2010 to January 31, 2019, a case-control study was conducted to compare the female sexual function of 106 cervical cancer survivors from a tertiary hospital and 185 women admitted to a gynecological outpatient clinic from the same health area for a routine gynecological examination (n=46) or for a benign gynecological disorder (symptomatic, n=113; asymptomatic, n=26). We prospectively assessed the female sexual function using the Female Sexual Function Index (FSFI). For the contrastive analysis hypothesis, we employed R statistical software.
RESULTS
Cervical cancer survivors reported lower sexual activity rates than controls, in general, did (47.12% vs. 88.65%, p=0.0001), and, particularly, compared with healthy and symptomatic controls (47.12% vs. 82.61%, p=0.003; 47.12% vs. 87.61%, p=0.0001, respectively). Sixty and fifty-eight hundredths percent of the cervical cancer survivors experienced female sexual dysfunction, mainly due to hypoactive sexual desire (93.27%). Female sexual dysfunction was diagnosed in 64.32% of the controls, with sexual arousal disorders being the most common diagnosis (44.86%). Compared with controls, cervical cancer survivors exhibited considerably lower FSFI total scores and in sexual desire and lubrication domains (p <0.000; p <0.0001; p=0.023).
CONCLUSIONS
Cervical cancer survivors had worse female sexual function and less sexual activity than controls did, although scores in both groups were in range of FSD. Rates of female sexual dysfunction were similar across cervical cancer survivors and controls, with hypoactive sexual desire and sexual arousal disorders as the most common diagnoses, respectively.
PubMed: 38833773
DOI: 10.1016/j.ejogrb.2024.05.027 -
Leukemia Research Reports 2024Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematological malignancy characterized by the proliferation of plasmacytoid dendritic cells with a...
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare hematological malignancy characterized by the proliferation of plasmacytoid dendritic cells with a blast-like appearance. It usually presents in elderly people, and clinical manifestations include nodular blue-violet skin lesions, bone marrow infiltration and, less frequently, extramedullary involvement. Gynecological manifestation (breast mass and exocervical lesion) is an unusual and rare presentation. Herein, we report the case of a 51-year-old woman patient who presented with a history of a rapidly growing and bleeding breast mass, along with a decline in general health. Notably, the disease had multifocal involvement, affecting the breast, uterine cervix, and cervical lymphadenopathy. Biopsies were performed on the breast mass and cervical lesion. Histopathological examination showed a diffuse lymphoid proliferation. The neoplastic cells show immunoreactivity for CD45 and CD56. The myelogram showed a 50 % excess of blasts with a heterogeneous appearance with the presence of cells that could suggest dendritic plasmacytoid cells. Bone marrow immunophenotyping showed the presence of blast-like cells that were positive for CD4, CD56, CD123, which supported the diagnosis of BPDCN. Despite initiating chemotherapy, the patient's condition rapidly deteriorated, highlighting the aggressive nature of BDCP. This case underscores the importance of early detection and the need for further research to improve outcomes for this rare condition.
PubMed: 38831790
DOI: 10.1016/j.lrr.2024.100462