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Obstetrics and Gynecology Oct 2018The pelvic examination has long been considered a fundamental component of the well-woman visit, and many women and gynecologic care providers view this visit as an...
The pelvic examination has long been considered a fundamental component of the well-woman visit, and many women and gynecologic care providers view this visit as an opportunity to discuss sexual and reproductive health issues. Traditionally, a pelvic examination is performed for asymptomatic women as a screening tool for gynecologic cancer, infection, and asymptomatic pelvic inflammatory disease; some obstetrician-gynecologists and patients consider it important in detecting subclinical disease, despite evidence to the contrary. Given changes in screening recommendations and the ability to screen for sexually transmitted infections using less-invasive methods, reevaluation of the role of the pelvic examination for asymptomatic, nonpregnant women is warranted. A limited number of studies have evaluated the benefits and harms of a screening pelvic examination for detection of ovarian cancer, bacterial vaginosis, trichomoniasis, and genital herpes. Data from these studies are inadequate to support a recommendation for or against performing a routine screening pelvic examination among asymptomatic, nonpregnant women who are not at increased risk of any specific gynecologic condition. It is recommended by the American College of Obstetricians and Gynecologists that pelvic examinations be performed when indicated by medical history or symptoms. Women with current or a history of cervical dysplasia, gynecologic malignancy, or in utero diethylstilbestrol exposure should be screened and managed according to guidelines specific to those gynecologic conditions. Based on the current limited data on potential benefits and harms and expert opinion, the decision to perform a pelvic examination should be a shared decision between the patient and her obstetrician-gynecologist or other gynecologic care provider.
Topics: Female; Gynecological Examination; Humans; Pregnancy; Unnecessary Procedures
PubMed: 30247363
DOI: 10.1097/AOG.0000000000002895 -
Obstetrics and Gynecology Oct 2018The pelvic examination has long been considered a fundamental component of the well-woman visit, and many women and gynecologic care providers view this visit as an...
The pelvic examination has long been considered a fundamental component of the well-woman visit, and many women and gynecologic care providers view this visit as an opportunity to discuss sexual and reproductive health issues. Traditionally, a pelvic examination is performed for asymptomatic women as a screening tool for gynecologic cancer, infection, and asymptomatic pelvic inflammatory disease; some obstetrician-gynecologists and patients consider it important in detecting subclinical disease, despite evidence to the contrary. Given changes in screening recommendations and the ability to screen for sexually transmitted infections using less-invasive methods, reevaluation of the role of the pelvic examination for asymptomatic, nonpregnant women is warranted. A limited number of studies have evaluated the benefits and harms of a screening pelvic examination for detection of ovarian cancer, bacterial vaginosis, trichomoniasis, and genital herpes. Data from these studies are inadequate to support a recommendation for or against performing a routine screening pelvic examination among asymptomatic, nonpregnant women who are not at increased risk of any specific gynecologic condition. It is recommended by the American College of Obstetricians and Gynecologists that pelvic examinations be performed when indicated by medical history or symptoms. Women with current or a history of cervical dysplasia, gynecologic malignancy, or in utero diethylstilbestrol exposure should be screened and managed according to guidelines specific to those gynecologic conditions. Based on the current limited data on potential benefits and harms and expert opinion, the decision to perform a pelvic examination should be a shared decision between the patient and her obstetrician-gynecologist or other gynecologic care provider.
PubMed: 30247359
DOI: 10.1097/AOG.0000000000002896 -
Inflammatory Bowel Diseases Jan 2019Patients with refractory inflammatory bowel disease (IBD) might require a subtotal colectomy with construction of an ileostomy. Due to the risk of nerve damage and...
BACKGROUND
Patients with refractory inflammatory bowel disease (IBD) might require a subtotal colectomy with construction of an ileostomy. Due to the risk of nerve damage and pelvic sepsis, the diverted rectum is often left in situ. Evidence on long-term complications of this rectal stump is limited, particularly in patients with Crohn's disease (CD). In addition to the risk of development of neoplasia, diversion proctitis is a frequently reported rectal stump associated complication. Surprisingly, clear recommendations concerning rectal stump surveillance and timing of proctectomy are lacking.
METHODS
Through the use of a pathology database and a review of medical records, we established a cohort of IBD patients with a diverted rectum. Among these patients, long-term complications of the rectal stump were identified. Main endpoint was advanced neoplasia (carcinoma or high-grade dysplasia [HGD]) in the rectal stump. Risk factors for advanced neoplasia were identified using Cox regression modeling. In the second, prospective part of the study, a questionnaire was sent out to 165 patients with either a rectal stump in situ or who had undergone a proctectomy, in order to identify differences in patient-reported outcome measures associated with the excision of the rectal stump.
RESULTS
From 530 patients with IBD and a (temporal) diversion of the rectum, we included 250 patients in whom the rectal stump was left in situ for more than 12 months. The majority of patients was female (61%) and had Crohn's disease (67%). On follow-up (median 8 years), 8 carcinomas, 2 cases of high-grade dysplasia, and 7 cases of low-grade dysplasia were found with incidence rates of 3.9 and 8.5 per 1000 patient-years of follow-up for cancer and all neoplasia, respectively. The 8 cases of rectal stump cancer (RSC) were diagnosed after a median of 15 years after colectomy. A history of colorectal neoplasia was associated with advanced rectal stump neoplasia. Out of 191 patients with endoscopic follow-up, rectal stump inflammation occurred in 161 (88.5%) patients. Results of the questionnaire did not show a significant difference in quality of life between patients with and patients without a rectal stump, although the latter group reported significantly more sexual and urinary symptoms than patients with a rectal stump in situ. The majority of rectal stump patients reported rectal blood loss, but 65.5% of them were not or barely limited in daily life by their rectal stumprelated problems.
CONCLUSION
Rectal stump cancer has a low incidence rate, with patients with a history of colonic neoplasia carrying the highest risk of developing this severe complication. We observed no significant differences in quality of life between rectal stump and postproctectomy patients, but proctectomy surgery is associated with sexual and urinary complications.
Topics: Adult; Colectomy; Female; Follow-Up Studies; Humans; Incidence; Inflammatory Bowel Diseases; Male; Netherlands; Postoperative Complications; Proctitis; Prognosis; Prospective Studies; Quality of Life; Rectal Neoplasms; Retrospective Studies; Survival Rate
PubMed: 30085111
DOI: 10.1093/ibd/izy253 -
Case Reports in Veterinary Medicine 2018A 17-week-old crossbred finishing pig was presented for lameness of approximately one week. Clinical evaluation, including ophthalmologic examination, revealed ataxia,...
A 17-week-old crossbred finishing pig was presented for lameness of approximately one week. Clinical evaluation, including ophthalmologic examination, revealed ataxia, partial flaccid paresis of the pelvic limbs, skin lesions at feet and claws, and severely reduced vision/blindness. Both eyes had multiple persistent pupillary membranes (iris-to-iris and iris-to-lens) and hypermature cataracts. Histopathological examination of the eyes revealed microphthalmia, microphakia with cataract formation, myovascularised membrane in the vitreous, retinal detachment, and retinal dysplasia. Microscopic examination of tissues collected postmortem demonstrated nonsuppurative polioencephalomyelitis with the most prominent inflammatory lesions in the lumbar spinal cord. Subsequently, presumed Teschen/Talfan disease was confirmed by porcine teschovirus identification in the spinal cord using the reverse transcription-polymerase chain reaction (RT-PCR). To the authors' knowledge, this is the first case report describing in detail histopathological changes in the porcine congenital microphthalmic syndrome.
PubMed: 30034906
DOI: 10.1155/2018/2051350 -
Revue Des Maladies Respiratoires Jun 2018Most women with cystic fibrosis reach adulthood and should have appropriate gynecological follow-up and contraception. (Review)
Review
INTRODUCTION
Most women with cystic fibrosis reach adulthood and should have appropriate gynecological follow-up and contraception.
BACKGROUND
There is no specific contra-indication to any contraception due to cystic fibrosis itself. Combined estrogen-progesterone contraception can be used in most cases (including transplanted women). In case of transplantation, intra-uterine devices should be used carefully (risk of pelvic inflammatory disease, potential risk of contraceptive failure with copper intra-uterine devices). Hormonal contraceptives may not be effective in women taking corrective treatments aiming to correct the maturation defect of the chloride channel. Screening for cervical cancer is recommended with a pap smear every three years for women aged 25-65, but yearly and starting at a younger age among transplanted women who are at higher risk for cervical dysplasia. Human Papillomavirus vaccination should be offered to all young women.
OUTLOOK
Women with cystic fibrosis and health care providers should be better informed on screening and on sexual and reproductive health to avoid unplanned pregnancies, to take into account drug interactions and to prevent cervical disease.
CONCLUSION
Regular and specific gynecological management is mandatory in cases of cystic fibrosis.
Topics: Continuity of Patient Care; Contraception; Cystic Fibrosis; Female; Follow-Up Studies; Genital Neoplasms, Female; Gynecology; Humans; Monitoring, Physiologic; Papillomavirus Infections; Papillomavirus Vaccines
PubMed: 29958717
DOI: 10.1016/j.rmr.2017.08.004 -
The British Journal of Dermatology Apr 2019In addition to the extent of atypical keratinocytes throughout the epidermis, actinic keratoses (AKs) are histologically characterized by downward-directed basal-layer...
BACKGROUND
In addition to the extent of atypical keratinocytes throughout the epidermis, actinic keratoses (AKs) are histologically characterized by downward-directed basal-layer expansion. It is not known whether this growth pattern correlates with the risk of developing invasive squamous cell carcinoma (iSCC).
OBJECTIVES
To characterize the prevalence of downward-directed basal-layer expansion of AKs adjacent to iSCC.
METHODS
The epidermis overlying and adjacent to iSCCs was assessed histologically. We determined the histological grade (AK I-III), basal growth pattern (PRO I-III) and accompanying parameters such as adnexal involvement.
RESULTS
Among 307 lesions, 52·4% of AKs were histologically classified as AK grade I, 38·1% as AK II and 6·8% as AK III (χ -test, P < 0·001). Only 2·6% of adjacent epidermal samples did not show any atypical keratinocytes. The epidermis adjacent to iSCCs was classified as having a PRO I basal growth pattern in 25·7%, PRO II in 31·9% and PROIII in 39·4% of cases. Only 2·9% of AKs showed no basal growth (χ -test, P < 0·001). In total 118 AKs (48·8%) showed extension into adnexal structures. These AKs were graded as PRO I in 18·6% of cases, PRO II in 30·5% and PRO III in 50·8%. The epidermis above iSCCs could be assessed only for upwards-directed growth and showed no significant differences in the three AK grades (P = 0·42).
CONCLUSIONS
Basal proliferative AKs, as well as atypical keratinocytes restricted to the lower third of the epidermis, are most commonly seen adjacent to iSCC, with less evidence for full-thickness epidermal dysplasia. Our study supports the important role of dysplastic keratinocytes in the epidermal basal layer and their potential association with iSCC.
Topics: Aged; Aged, 80 and over; Cancer Care Facilities; Carcinoma, Squamous Cell; Cell Proliferation; Epidermis; Female; Germany; Head; Head and Neck Neoplasms; Humans; Keratinocytes; Keratosis, Actinic; Male; Prevalence; Retrospective Studies; Severity of Illness Index; Skin Neoplasms
PubMed: 29526028
DOI: 10.1111/bjd.16536 -
La Tunisie Medicale Oct 2016Cervical cancer is the second gynecological cancer Tunisian women after breast. This is a sexually transmitted disease including the role of HPV has been proven....
PROBLEM
Cervical cancer is the second gynecological cancer Tunisian women after breast. This is a sexually transmitted disease including the role of HPV has been proven. Cervical cancer screening is possible due to the accessibility of the cervix with a speculum examination and implementation of cervical smear.
AIM OF THE WORK
To study the epidemiological and clinical data of patients, analyze the results of the Pap test, colposcopy and cervical biopsy staging are the lesions observed in colposcopy, compare the results of smears, colposcopy and cervical biopsy.
METHODS
A retrospective analytical study about 120 observations of patients who underwent colposcopy and biopsy of the cervix over a seven year period from January 2006 to December 2012.
RESULTS
The mean age of patients was 46.6 years. The mean gravidity was 4.99. The mean parity was 4.07. The average age of first sexual intercourse was 24 years. 95.83% of the patients were married. Four patients had multiple partners, 3, 33%. Eighty-one patients 67.5% were genital activity. Two patients had a history of pelvic infection is 1.66%. A history of repeated low genital infection were found in 20 patients, or 16.66%. HPV testing was requested for two patients. The genotypes found were 16, 35 and 53. The most common reasons were essentially pathological smears, pelvic pain and exploration of bleeding. The FCU was performed in 98 patients either in 81.66% of cases. The smear was pathological in 83 patients or 84.69% of smears. He showed: a persistent inflammatory smears in 64 women, or 65.30% of the cases, 6 ASCUS or 6.12% of cases, 13 cervical dysplasia or 13.26% of cases: 8 CIN1 or 8.16% of event; 1 CIN2 or 1.02% and 4 CIN 3, or 4.08% of cases. Colposcopy was indicated before an abnormal smear: In 83 patients either in 69.16% of cases. Colposcopy was performed in front of an abnormal appearance of the cervix in 37 patients. Colposcopy has concluded that: normal cervix in 28 patients or 23.33% of the cases, cervicitis appearance in 15 patients or 12.5% of cases, ectropion in 23 patients or 19.2% of cases, with TAGI 47 patients or 39.2% of cases, a TAG2 in 6 patients either 5% of cases, ulceration in a patient or 0.83% of cases. Cervical biopsy objectified normal mucosa in 19 patients, or 15.8% of cases. She objectified cervical metaplasia in 11 patients, or 9.2% of cases, ectropion in a patient, or 0.8% of cases, cervicitis in 56 patients, or 46.7% of cases, condyloma in 2 patients, 1.7% of cases, CIN 1 in 6 patients, 5% of cases, CIN2 in 4 patients, soit3,3% of CIN3 and in 3 patients, 2.5% of cases. FCU had a sensitivity of 60%, a specificity of 95.18%, positive predictive value of 69% and a negative predictive value of 93%. The sensitivity of colposcopy was 66% and specificity of59%. Positive predictive value of 18% and a negative predictive value of 92%. For high-grade dysplasia, colposcopy had a sensitivity of 85%, specificity 58%, positive predictive value of 11.3% and a negative predictive value of 98%. Cervical biopsy finds carcinoma in situ in two cases and squamous micro-invasive carcinoma in one case. The treatments were performed essentially a cervical electrocoagulation in 8 patients, a cone biopsy in 7 patients and post conization hysterectomy in 2 patients.
CONCLUSION
Colposcopy is a harmless and reliable examination to guide the cervical biopsy. Tracks smear, colposcopy and directed biopsy confirmed.
Topics: Adult; Aged; Colposcopy; Female; Humans; Middle Aged; Papanicolaou Test; Papillomaviridae; Papillomavirus Infections; Pregnancy; Retrospective Studies; Sensitivity and Specificity; Uterine Cervical Neoplasms; Vaginal Smears; Young Adult; Uterine Cervical Dysplasia
PubMed: 28972254
DOI: No ID Found -
La Tunisie Medicale Oct 2016Cervical cancer is the second gynecological cancer Tunisian women after breast. This is a sexually transmitted disease including the role of HPV has been proven....
PROBLEM
Cervical cancer is the second gynecological cancer Tunisian women after breast. This is a sexually transmitted disease including the role of HPV has been proven. Cervical cancer screening is possible due to the accessibility of the cervix with a speculum examination and implementation of cervical smear.
AIM OF THE WORK
To study the epidemiological and clinical data of patients, analyze the results of the Pap test, colposcopy and cervical biopsy staging are the lesions observed in colposcopy, compare the results of smears, colposcopy and cervical biopsy.
METHODS
A retrospective analytical study about 120 observations of patients who underwent colposcopy and biopsy of the cervix over a seven year period from January 2006 to December 2012.
RESULTS
The mean age of patients was 46.6 years. The mean gravidity was 4.99. The mean parity was 4.07. The average age of first sexual intercourse was 24 years. 95.83% of the patients were married. Four patients had multiple partners, 3, 33%. Eighty-one patients 67.5% were genital activity. Two patients had a history of pelvic infection is 1.66%. A history of repeated low genital infection were found in 20 patients, or 16.66%. HPV testing was requested for two patients. The genotypes found were 16, 35 and 53. The most common reasons were essentially pathological smears, pelvic pain and exploration of bleeding. The FCU was performed in 98 patients either in 81.66% of cases. The smear was pathological in 83 patients or 84.69% of smears. He showed: a persistent inflammatory smears in 64 women, or 65.30% of the cases, 6 ASCUS or 6.12% of cases, 13 cervical dysplasia or 13.26% of cases: 8 CIN1 or 8.16% of event; 1 CIN2 or 1.02% and 4 CIN 3, or 4.08% of cases. Colposcopy was indicated before an abnormal smear: In 83 patients either in 69.16% of cases. Colposcopy was performed in front of an abnormal appearance of the cervix in 37 patients. Colposcopy has concluded that: normal cervix in 28 patients or 23.33% of the cases, cervicitis appearance in 15 patients or 12.5% of cases, ectropion in 23 patients or 19.2% of cases, with TAGI 47 patients or 39.2% of cases, a TAG2 in 6 patients either 5% of cases, ulceration in a patient or 0.83% of cases. Cervical biopsy objectified normal mucosa in 19 patients, or 15.8% of cases. She objectified cervical metaplasia in 11 patients, or 9.2% of cases, ectropion in a patient, or 0.8% of cases, cervicitis in 56 patients, or 46.7% of cases, condyloma in 2 patients, 1.7% of cases, CIN 1 in 6 patients, 5% of cases, CIN2 in 4 patients, soit3,3% of CIN3 and in 3 patients, 2.5% of cases. FCU had a sensitivity of 60%, a specificity of 95.18%, positive predictive value of 69% and a negative predictive value of 93%. The sensitivity of colposcopy was 66% and specificity of59%. Positive predictive value of 18% and a negative predictive value of 92%. For high-grade dysplasia, colposcopy had a sensitivity of 85%, specificity 58%, positive predictive value of 11.3% and a negative predictive value of 98%. Cervical biopsy finds carcinoma in situ in two cases and squamous micro-invasive carcinoma in one case. The treatments were performed essentially a cervical electrocoagulation in 8 patients, a cone biopsy in 7 patients and post conization hysterectomy in 2 patients.
CONCLUSION
Colposcopy is a harmless and reliable examination to guide the cervical biopsy. Tracks smear, colposcopy and directed biopsy confirmed.
Topics: Biopsy; Cervix Uteri; Colposcopy; Female; Humans; Middle Aged; Papanicolaou Test; Papillomaviridae; Papillomavirus Infections; Pregnancy; Retrospective Studies; Sensitivity and Specificity; Tunisia; Uterine Cervical Neoplasms; Vaginal Smears; Uterine Cervical Dysplasia
PubMed: 28685798
DOI: No ID Found -
Kardiologiia Jun 2016Diagnosis of dilation (D) cardiomyopathy (CMP) requires exclusion not only of inflammatory and genetically determined forms but also of some rare diseases. This 51 year...
Diagnosis of dilation (D) cardiomyopathy (CMP) requires exclusion not only of inflammatory and genetically determined forms but also of some rare diseases. This 51 year old patient with history of moderate arterial hypertension approached a cardiologist because of new onset atrial fibrillation and dyspnea. Echocardiography detected dilation of all cardiac chambers with relatively preserved ejection fraction, causing suspicion of DCMP. Among conditions excluded were coronary atherosclerosis, congenital heart defect with left to right shunt, primary pulmonary hypertension, pulmonary embolism, hypertensive heart, tachycardia induced CMP, arrhythmogenic right ventricular dysplasia, noncompaction myocardium. Further examination revealed massive pelvic arteriovenous malformation with branches of right internal iliac artery and inferior mesenteric artery as feeding vessels. This malformation was considered the leading cause of DCMP. Successful multistage embolization of feeding arteries was associated with reduction of cardiac chambers, alleviation of valvular regurgitation and pulmonary hypertension, restoration of sinus rhythm. Presentation of this case is followed by discussion of possible mechanisms of heart failure with high cardiac output and preserved systolic function in patients with arteriovenous malformations with left to right shunt. Approaches to interventional treatment of these malformations are also discussed.
Topics: Chronic Disease; Echocardiography; Heart Failure; Humans; Hypertension, Pulmonary; Male; Middle Aged; Systole
PubMed: 28290856
DOI: 10.18565/cardio.2016.6.102-108 -
Case Reports in Dermatology 2016Eccrine syringofibroadenoma (ESFA) is an uncommon benign adnexal neoplasm which derives from cells of the acrosyringium of eccrine sweat glands. The clinical appearance...
Eccrine syringofibroadenoma (ESFA) is an uncommon benign adnexal neoplasm which derives from cells of the acrosyringium of eccrine sweat glands. The clinical appearance is nonspecific but the histological features are typical. Five clinical subtypes of ESFA exist: (1) solitary ESFA; (2) multiple ESFA associated with ectodermal dysplasia; (3) multiple ESFA without cutaneous features; (4) unilateral linear ESFA (nevoid), and (5) reactive ESFA associated with inflammatory or neoplastic dermatoses. We report the case of a 42-year-old man with long-standing diabetes and neuropathy, presenting with a 4-year history of asymptomatic erythematous plaques on a background of brown hyperpigmentation on the left foot. The clinical presentation and histopathological findings are compatible with reactive ESFA.
PubMed: 27462220
DOI: 10.1159/000446469