Abdominal wall endometriosis after a caesarian section--an interesting case report

BACKGROUND

Endometriotic foci can be rarely found on the surgical incision following caesarean delivery and on perineotomy site following vaginal delivery.

CASE

A 33-year-old woman with a history of caesarian section five years prior was admitted to the present clinic due to right groin pain with increasing intensity during menstruation. Ultrasound revealed an endometrioma-like subcutaneous mass directly under the right edge of the Pfannenstiel scar. The mass (3.5 x 2.4 x 2 cm) was removed en bloc with ultrascissor.

CONCLUSION

The prevailing argument supports that it is a complication caused by the iatrogenic dispersal of endometrial material. Symptoms onset vary from one to five years postoperatively and mainly include pain and enlargement of the mass during menstruation. Diagnosis may be demanding due to the atypical presentation of the disease. Symptoms exacerbate during menstruation in only 20% of all cases. Abdominal ultrasound is extremely useful for diagnosis. The treatment of choice is surgical excision.

Total infusion of low molecular weight iron-dextran for treating postpartum anemia

AIM

135 puerperal women with iron deficiency anemia participated in our prospective randomized controlled trial in order to investigate alternative treatments to blood transfusion for anemia.

MATERIALS AND METHODS

The criteria for the diagnosis of anemia were Hb < 8 g/dl and ferritine < 10 microg/dl. Women were randomly separated in two groups, A and B. Women of group A (n = 109 women) received a total amount of 1000 mg low molecular weight (LMW) iron-dextran intravenously in two doses. Group B (n = 26) was the control group. They received orally 800 mg daily for 30 days of iron protein-succinylate. Three weeks later women of both groups underwent a full blood count analysis.

RESULTS

Hemoglobin and ferritin levels increased significantly in group A compared to group B (p < 0.0001). No adverse side-effects due to the treatment were noted in either group.

CONCLUSION

It seems that total iron-dextran infusion is a safe and rapid therapy of iron-deficiency postpartum anemia increases the Hb level more rapidly than oral ferrous sulfate, and it also appears to replenish iron stores more rapidly.

Correlation between asymmetric dimethylarginine maternal plasma levels and preeclampsia

OBJECTIVE

To aim of our study is to support the correlation between blood pressure and asymmetric dimethyl argine (ADMA) concentrations as a possible marker for early diagnosis of the preeclampsia syndrome.

STUDY DESIGN

We attempted to calculate in 38 pregnant women with preeclampsia (group A) plasma levels of the main inhibitor to nitric oxide synthase (NOS), which is ADMA, and to compare our findings with the levels of ADMA in 36 non preeclamptic pregnant women (group C) and also with the levels in 29 pregnant women who had a history of preeclampsia in previous pregnancies (group B). Maternal venous EDTA plasma samples of 5 ml were collected and analyzed to measure the ADMA concentrations in each subject. Statistical analysis was performed using the Graph Pad Instat Mann-Whitney test, unpaired, non parametric test, two-tail p values.

RESULTS

There was no statistical difference between the three groups regarding maternal and gestational age (24-32 weeks). There was a significant statistical difference between the three groups regarding ADMA levels. The two-tailed p value between group A and group C (normal group) was < 0.001, between group A and group B < 0.002 and between group B and group C < 0.002.

CONCLUSION

In conclusion we have observed that ADMA probably fulfills many of the criteria to be characterized as a preeclamptic factor and an accurate cut-off point matched to each week of pregnancy should be determined.

Verification of the accuracy of cervical cytology reports in women referred for colposcopy

OBJECTIVE

To verify the accuracy of cervical cytology in correlation with colposcopic and histological findings. DESIGN/SETTING/POPULATION/METHODS: In this retrospective chart review study 545 women, referred to the outpatient clinic for colposcopy, were included in the study. During the 4-year study period, two consultants performed the colposcopies and further necessary procedures, whereas patient charts were reviewed by two of the co-authors.

RESULTS

The median age of the study population was 35 years (range: 16-65). Thirty-four percent of the cases were new and 11% of the women were referred after receiving their first ever cervical smear. Ninety-two percent (503/545) of the colposcopies were satisfactory. Concordance between colposcopic findings and the histology report was 87%, whereas concordance between cytology and histology reports was as low as 60% for HPV-related lesions, 72% for LGSIL and 86% for HGSIL. "See and Treat" was offered to 53 (10%) women and 48 (90.5%) of them had high-grade lesions on histology justifying treatment at the first visit.

CONCLUSIONS

The concurrent use of cytology and colposcopy provides better chances for earlier detection of lesions demanding intervention; 80%-90% of patients with severe dyskaryotic smears will have a histology report confirming CIN III. See and treat management can be decided sometimes, if supported by the colposcopic findings, and an audit should confirm accuracy to, at least, 90% of cases.

Pregnancy-associated breast cancer--a review analysis

The aim of the present review was to assess the relationship between pregnancy and/or lactation and breast cancer, the influence of pregnancy on mortality and prognosis of the disease, the consequences of breast cancer to the current pregnancy and also to discuss the future perspective for women's fertility.

MATERIALS AND METHODS

Articles were obtained from Medline (1988 present) using as keywords breast cancer, pregnancy, breastfeeding, lactation, carcinoma and pregnancy.

RESULTS

Unfortunately, delays in diagnosis and treatment are common during pregnancy and the prognosis is thus worsened. Nulliparity, early menarche and late age at first pregnancy are associated with increased risk for breast cancer. Breastfeeding confers a protective effect on risk of breast cancer, which appears to be related to the duration of breastfeeding. In cases of advanced metastatic disease during the first 14 to 15 weeks of pregnancy when chemotherapy is necessary for prompt treatment, termination of pregnancy may be proposed, particularly if the patient is ER-positive. Modified radical mastectomy is probably the procedure most frequently used today. In general chemotherapy should be delayed until after 14 to 15 weeks of gestation and radiation should be reserved until post delivery. Several authorities generally advise that future pregnancy should be delayed for at least two years after breast cancer treatment.

CONCLUSION

Breast cancer has an equivalent prognosis in pregnant and non pregnant patients when matched by age and stage at diagnosis. Women are invariably best treated by multidisciplinary teams.

Intravenous administration of iron sucrose for treating anemia in postpartum women

BACKGROUND

To compare the efficacy of oral and intravenous administration of iron supplements for treating postpartum anemia.

METHODS

One hundred and four anemic postpartum women were studied prospectively. The criteria for the diagnosis of anemia were Hb<8 gr/dl and ferritine<10 microg/dl. They were randomised into two groups. Group A consisted of 78 women who received i.v. a total amount of 300 mg iron sucrose in three days. Group B consisted of 26 women, who received orally 800 mg iron proteinsuccinylate daily for four weeks.

RESULTS

At the end of the study, in group A the increase of Hb mean level was 4.6 gr/dl and of ferritin mean level was 105 mg/L. In group B the increase in hemoglobin mean level was 2.3 gr/dl and ferritin mean level was 68 mg/L. There was significant difference in the increase of hemoglobin level (p=0.0001) and also in the increase in ferritin level (p=0.0004) between the two groups.

CONCLUSION

Intravenous administration of iron sucrose seems to be safe and it helps postpartum women to recover early from anemia.

Toxoplasmosis during pregnancy: a case report and review of the literature

Although toxoplasmosis is considered harmless for a non-pregnant woman, it is potentially harmful during pregnancy, especially at first trimester. The aim of this study is to increase our alertness and monitoring in case of toxoplasmosis during pregnancy, given that when diagnosed it can be effectively treated.We present a case of a healthy 26 years old adult woman, found with toxoplasmosis during the 13th week of pregnancy. The role of frequent maternal and fetus immunological tests, PCR-tests of the amniotic fluid and ultrasound screening of the fetus throughout pregnancy was of great value. The patient was treated with spiramycin (1 grx3) from the 16th week of pregnancy. The patient was subjected to cesarean delivery at the 36th week of pregnancy due to preterm contractions and history of previous cesarean delivery. The newborn was a healthy girl with a birth weight of 2880 gr. A two-year follow up of the baby revealed no medical condition. Maternal infections are a serious medical condition during pregnancy. Toxoplasmosis when diagnosed on time and treated properly can lead to healthy offspring.

A four-year retrospective study of amniocentesis: one centre experience

AIM

Monitor the performance of the amniocentesis procedure for prenatal diagnosis and particularly the acquisition of results (time to get, success in getting them).

MATERIALS AND METHODS

This is a retrospective review of case notes of all pregnant women undergone amniocentesis in our department during the period 2002-2005. Two main operators performed the procedure, using 22 gauze needle usually and 20 gauze should longer needle was needed. Sevendy three patients undergone amniocentesis. The reasons for having this procedure were: increased risk for Down syndrome in 68% (50/73), maternal request in 24% (18/73), suspicious ultrasound findings in 4% (3/73) and family history in 3% (2/73). Maternal age ranged from 20 to 45 years and the gestation time that amniocentesis was performed was 15 to 23 weeks. Fluorescence in situ hybridization (FISH) and culture were used in order to obtain karyotype results.

RESULTS

In 92% (67/73) of cases one needle pass was needed. FISH and culture were performed in 96% (70/73) of cases, FISH only in 3% (2/73) and culture only in 1% (1/73). The chromosome results were normal in 93% (68/73) of cases, Down's syndrome in 4% (3/73) and Edwards syndrome in 3% (2/73). The outcome of pregnancies was: live births in 89% (65/73), stillbirths at 32 weeks and 35 weeks in 3% (2/73), miscarriages in 1% (1/73 at 19 weeks, 3 weeks after the amniocentesis), terminations in 7% (5/73, due to chromosomal abnormalities). Sixty one women delivered at term (84%) and 6 women (8%) delivered preterm.

CONCLUSION

The post amniocentesis rate of miscarriage is calculated at 1% in our centre. FISH analysis can relieve stress of couples by reducing the waiting time for results.

Tension free vaginal tape underneath bladder base: does it prevent cystocele recurrence?

OBJECTIVE

The target of the current prospective study was to assess the effectiveness of the polypropylene tapes in preventing recurrence of cystocele formation when placed underneath the bladder base.

MATERIALS AND METHODS

Twenty-two Caucasian women, predominantly postmemopausal with marked descent of the anterior, middle and/or posterior pelvic segment, participated in the study. Vaginal reconstructive surgery including anterior colporrhaphy and Kelly placation, posterior colpoperineorrhaphy and/or hysterectomy, was undertaken in all subjects. The polypropylene tape was placed not under the midurethra, as often performed in stress urine incontinence (SUI) cases, but underneath the bladder base as an adjunct to the anterior colporrhaphy sutures. The postoperative follow up lasted 2 years and was carried out every 4 months. The assessment of the anatomic result included evaluation of the operated sites and the position of the tapes inserted on clinical grounds and after perineal sonography. Urodynamic assessment was performed in the presence of urinary incontinence.

RESULTS

In all patients the postoperative correction of the anterior vaginal wall was sufficient, 14 subjects did not present genitourinary symptoms and therefore were considered as cured; three patients were designated as improved because despite sufficient anatomic correction of the anterior vaginal segment they reported urinary incontinence symptoms. Retropubic haematoma occurred in 1 patient, transient urge incontinence in 1, transient stress incontinence in 1, and persistent stress incontinence also in 1. There was no erosion of the tape noticed. Mean residual urine was 30 ml, mean bladder base distance to the inferior edge of the symphysis pubis was 1.2 cm and the mean total vaginal length was 7 cm.

CONCLUSION

Despite the relative short follow up period and the limited number of patients enrolled, we conclude from our study that the use of polypropylene tapes as an adjunct for fortification of the anterior pelvic segment could provide an option in preventing recurrence of cystocele formation.

Fine needle aspiration cytology of the ovary: is it reliable?

PURPOSE OF INVESTIGATION

The purpose of this study was to evaluate the cytologic findings from the fluid of ovarian cysts in comparison with the histologic diagnosis.

METHODS

Over a four-year period all women with single ovarian cysts and no evidence of malignancy from ultrasound examination and tumour marker levels were included in the study. Prior to removal of the cyst, fluid was aspirated from the cyst and prepared for cytologic examination. Subsequently the ovarian cyst wall and biopsy from the ovary were sent for histologic examination. The cytologic findings were compared to the histologic diagnosis.

RESULTS

The material of the study was 120 ovarian specimens from 107 women. Twenty-four (20%) of the specimens submitted for cytology were non diagnostic and a comparison between cytologic and histologic findings was possible in 96 cases. The sensitivity and the specificity of fine needle aspiration (FNA) cytology of the ovary was 25% and 97%, respectively.

CONCLUSIONS

FNA cytology of the ovary is an accurate method for predicting benign ovarian histologic findings in carefully selected populations.

A case of vulvar metastasis from rectal cancer--regional resection of the right vulva labium and vulvar reconstruction with a rhomboid transposition flap: case report

A 72-year-old woman visited our hospital to clarify the etiology of pain, swelling and ulceration of the right large vulva labium. Rectal cancer and pulmonary metastatic tumor were detected, and the rectal cancer was resected. Biopsy from the right vulva labium revealed that the vulvar tumor was a metastatic cancer originating from rectal cancer. Our patient underwent regional resection of the right vulva labium and the area lacking tissue was covered by a rhomboid transposition flap. Our patient experienced necrosis of the tip of the flap and the wound was healed by secondary intention.

Cervical human papillomavirus infection; epithelial abnormalities in human immunodeficiency virus infected women

OBJECTIVE

The aim of the study was to determine the prevalence of cervical infection with human papillomavirus (HPV) in human immunodeficiency virus (HIV) infected women.

MATERIALS AND METHODS

Cervical Papanicolaou tests, colposcopy and biopsies were performed in 21 HIV seropositive women.

RESULTS

Four patients (19%) had an abnormal smear test, one had CIN-II (4.7%) and three had cervical warts (14.2%).

Hormone replacement therapy at the threshold of 21st century

The management of postmenopausal women has become a major focus for the medical profession. The menopause era should progress from a period of "chaos" to an orderly understanding of the many issues related to the menopause and hormone replacement therapy (HRT). Although HRT has beneficial clinical effect and positive benefit/risk ratio, understanding of the side effects and weight gain, and, especially, a fear of cancer limit compliance. New data from long-term, controlled, prospective studies on the effects of different HRT schedules on cancer, cardiovascular disease and osteoporotic fracture risk are needed. HRT should be considered either as for prevention or for individualized care since women experience menopause as individuals, care should be taken not to make inappropriate generalizations. The priority should be the administration of appropriate medication to women with the best result in order to improve health care and quality of life. New therapeutic options will offer substantial medical advancement for the treatment of postmenopausal women.