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Karambelkar AD, Bora RD. Magnetic Resonance Imaging of Pelvis: A One-stop Shop Modality for the Staging of Carcinoma of Cervix. J South Asian Feder Menopause Soc 2020; 8 (1):7-23.
Aim and objective: Magnetic resonance imaging (MRI) of pelvis as a one-stop shop modality for locoregional staging of carcinoma of the cervix. Compare the MRI staging with the clinical staging of the carcinoma of the cervix.
Materials and methods: We conducted pelvic MRI examinations on histological proved 83 cases of cervical carcinoma on MRI 1.5 T scanner.
Results: Magnetic resonance imaging demonstrated cervical mass in 79 out of 83 (95%) patients. No mass lesion was demonstrated in 4 out of 83 patients, who were clinically diagnosed as stage I. X2 test demonstrated X2 value of 43.6 and p value < 0.01 indicating a significant difference between staging by staging by MRI and that by clinical staging. Z score test also showed a significant difference in staging by MRI and that by clinical staging for stages IB, IIB, IIIB, and IVA with a p value < 0.05. The Z score (RD) was maximum for stage IIIB and minimum 0.034 for stage IIIA, suggesting that the greatest difference was observed in stage IIIB. We could not find any significant difference for stage IIIA, IA and stage IIA.
Conclusion: Magnetic resonance imaging is superior to clinical staging of the carcinoma of the uterine cervix in stage IB, IIB and IVA. Magnetic resonance imaging has an excellent ability to demonstrate the locoregional extent of the tumor. Hence, it should be used as a one-stop shop modality for the staging of cervical carcinoma.
Preeti Amit Kale,
Ketan Govindrao Jangale,
Introduction: Pelvic inflammatory disease (PID) refers to an infectious and inflammatory disorder of the female upper genital tract. It is common among young sexually active individuals and is a major health problem both in developed and developing countries. It is usually a polymicrobial infection; however, Chlamydia trachomatis is the commonest causative agent transmitted sexually. Pelvic inflammatory disease is diagnosed by history and clinical examination. The treatment is initially empiric. Only antibiotics are good in treatment for PID and “antibiotics with prebiotics” are a new promising treatment mode for the same. This comparative study aimed to measure efficiency and compliance of only antibiotics vs antibiotics with prebiotics in the treatment of mild, uncomplicated acute PID.
Setting: Multispecialty Hospital Pune. Duration: 6 months.
Materials and methods: A descriptive cross-sectional study was conducted in randomly selected 28 consecutive outpatients with mild uncomplicated acute PID. Comparative outcome of antibiotics and antibiotics with prebiotics in correlation with the reduction of amount, consistency, and malodor of vaginal discharge along with the reduction in fornical tenderness, compliance, and frequency of adverse drug reactions was done.
Results: Among 28 cases, 14 (50%) were treated with oral antibiotics and 14 (50%) with oral antibiotics with prebiotics. Comparative analysis on the reduction of amount, consistency, malodor of vaginal discharge, and reduction of fornical tenderness was significant, showing antibiotics with prebiotics more effective than antibiotics. Besides, compliance was better and there were fewer adverse drug reactions with antibiotics with prebiotics.
Conclusion: Antibiotics with prebiotics have better efficiency and compliance over only antibiotics in the treatment of mild, uncomplicated, acute PID.
Aim and objective: To evaluate the risk factors for surgical site infection in patients undergoing surgery in the gynecology department.
Materials and methods: This observational study was conducted among 200 women admitted for gynecological surgery. A detailed history and demographic and surgical details were noted. The recovery of these patients and the presence of surgical site infection (SSI) were also noted.
Results: Of the 200 participants, 21% developed SSI and 38% of overweight women and 24% women with anemia developed SSI. Mean duration of hospital stay was more in women with SSI.
Conclusion: We conclude that abnormal BMI, route of surgery, and amount of blood loss during gynecology surgery are important risk factors of SSI.
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Reddy S, Jayaprakash S, Venkatesh S. Comparative Study of the Diagnostic Accuracy of Transvaginal Sonography vs Hysteroscopy in Abnormal Uterine Bleeding. J South Asian Feder Menopause Soc 2020; 8 (1):30-33.
Introduction: Abnormal uterine bleeding (AUB) is one of the most common symptoms with which patients visit to a gynecologist. Abnormal uterine bleeding is responsible for more than one-third of gynecological consultations and nearly two-thirds of hysterectomies.1Aims and objectives:• To evaluate the accuracy of hysteroscopy in diagnosing various conditions causing AUB.• To compare hysteroscopic findings with transvaginal sonography (TVS) findings.Materials and methods: A prospective study was conducted on 100 women fitting into the inclusion criteria in the Department of Obstetrics and Gynaecology at Vydehi Institute of Medical Sciences and Research Center, Bengaluru. Detailed history, clinical examination, TVS, hysteroscopy, and preoperative investigations were carried out and results were correlated.
Results: In the present study, majority of the patients were in perimenopausal age group. Transvaginal sonography has showed 12% and 8.3% sensitivity in detecting polyp and submucosal fibroid when compared to hysteroscopy. Transvaginal sonography showed poor correlation with hysteroscopic findings for intracavitary pathology. Intrauterine adhesions were missed by TVS in three cases which were diagnosed by hysteroscopy.
Conclusion: There is an increased incidence of intracavitary uterine pathology in patients who present with AUB. The poor sensitivity of TVS in detecting intrauterine pathology urges us to suggest that hysteroscopy can be utilized as a first-line investigation in these patients. As many cases with intracavitary lesions and carcinoma were not diagnosed by TVS, the need for number of diagnostic hysteroscopies (invasive) could not be minimized by TVS (noninvasive) examinations. Hysteroscopy can be used not only for therapeutic purpose but also for diagnostic tool in cases who present with AUB, clinically enlarged uterus, and significant anemia.
Background: Endometrium that lies within the uterus may develop hyperplasia, due to various causes, of which unopposed estrogen exposure is the most common one. Endometrial hyperplasia may well mask an underlying malignancy and should be followed upon by further procedures to rule out underlying malignancy.
Materials and methods: This is a prospective observational study, from June 2017 to June 2019, at a tertiary care level teaching institution. Seventy patients who underwent hysterectomy following a diagnosis of endometrial hyperplasia with atypia were included.
Results: 95.7% were in multiparous group, 67.14 % were in perimenopausal, 30% in postmenopausal and 2.85% in reproductive age groups, 52.8% presented with abnormal uterine bleeding, 34.28% with postmenopausal bleeding and 12.85% were asymptomatic, 35.41% had diabetes mellitus, 22.91% had hypertension and 30.20% had obesity as comorbid factors. Positive family history for malignancy was noted in 3.1%. MRI findings suggested endometrial carcinoma in 27.2%. In cases in which MRI suggested non malignancy, 82.4% turned out to be malignant in the final histopathology report. Of the 70 patients, 40% had endometrial carcinoma (not otherwise specified), 30% had adenocarcinoma, 10% had serous carcinoma, 5.7% had papillary serous carcinoma and carcinosarcoma in 1.4%. 12.9% were declared to be nonmalignant by final histopathology reports. Except for two patients, all others had grade 1 well differentiated carcinomas.
Conclusion: This study demonstrates that endometrial carcinoma may be coexisting with endometrial hyperplasia with atypia, in majority of cases and available imaging modalities are not foolproof to rule out malignancy. Hence where appropriate hysterectomy may be suggested as the treatment option.
Simrat K Khosa,
Harkiran K Khaira,
Introduction: Making up 20–30% of cases in the outpatient clinic, abnormal uterine bleeding (AUB) is a common diagnosis with considerable social and economic impact. Complaints of heavy menstrual bleeding significantly affect the quality of life resulting in time off work, thus leading to surgical intervention including hysterectomy and ultimately posing a significant impact on the health care system. Timely and appropriate management will prevent most of these problems.
Materials and methods: Two hundred and forty-six women with AUB visiting outpatient Department of Obstetrics and Gynecology, AIMSR, Bathinda were included in the study after informed written consent. History and examination, ultrasonography, and serum thyroid-stimulating hormone (TSH) levels were done for all patients. The prevalence of thyroid hormone dysfunction in AUB was evaluated and the association between various menstrual patterns and thyroid profile was assessed.
Results: Out of 116 cases presenting with heavy menstrual bleeding, 79 were hypothyroid, 5 were hyperthyroid, and 32 were euthyroid. Also, out of the 37 cases presenting with light menstrual bleeding, 16 were hypothyroid closely followed by 13 hyperthyroid cases. These results were statistically significant. Moreover, the most common AUB pattern in the hypothyroid group was heavy menstrual bleeding (79 cases out of 117 cases), while in the hyperthyroid group was light menstrual bleeding (in 13 cases out of 22 cases).
Conclusion: The key to early diagnosis is to maintain a high index of suspicion and readily screen for the presence of abnormal thyroid function.
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Jadoon AK, Jadoon A, Jadoon SK. Role of Socioeconomic Status in Defining Perception of Women about Menopause-related Myths and Facts. J South Asian Feder Menopause Soc 2020; 8 (1):42-45.
Aim and objective: To assess variation in the perspective of women belonging to different socioeconomic backgrounds about facts and myths associated with menopause.
Materials and methods: The study was conducted at Ziauddin University Hospital over a period of 5 months; it is a prospective cross-sectional study. Sample size of 210 was taken. Based on income per capita, the socioeconomic status was determined. Perspective of women about menopause was assessed by questioning them about different myths and facts and how firmly they believed in them. The overall perception of the menopausal process was also documented. Data were entered and analyzed by version 20 of SPSS.
Results: Women from the lower class had the highest number of false beliefs and myths about menopause, followed by middle, and least of upper class. Similarly, upper class women had greater knowledge about facts of menopause. Majority of lower class women considered menopause to be a disease or a clinical condition (64%); however, majority of upper class women rendered it as a natural aging process (79%).
Conclusion: There seems to be a dire need of spreading knowledge about menopause to all women, especially those that lie below the poverty line; this would play a huge role in improvising their quality of life and the morbidities associated with ignorance.
Clinical significance: This study makes it clear that the perception of menopause among women belonging to poor class is scarce and based merely on myths, resulting in the negative attitude for seeking medical treatment if required leading to morbidity and poor quality of life.
Aim and objective: The aim of this study was to compare the two types of hysterectomy—abdominal and non-descent vaginal.
Materials and methods: A randomized prospective trial was conducted which included 400 patients. Two hundred in abdominal hysterectomy (group I) and 200 in non-descent vaginal (group II). The two groups were compared for the various intraoperative and postoperative parameters and data were analyzed.
Results: Vaginal hysterectomy had a definite advantage in the postoperative period in terms of shorter hospital stay and early mobility of the patient. The postoperative pain was also less with a statistically significant difference (p value 0.0006). Moreover, there were no wound infections in the group II.
Conclusion: Vaginal hysterectomy should be the preferred route of hysterectomy whenever feasible. The surgery is performed through the vagina and has greater patient satisfaction in the postoperative period.
Background: Parasitic fibroids are a rare type of fibroids without direct uterine attachment. They pose a diagnostic dilemma and often present atypically.
Case description: We report a rare case of large secondary parasitic fibroid in a 24 year unmarried female who presented with history of lump abdomen for 6 months. She had history of laparoscopic myomectomy done 2.5 years back for the same complaint with histopathology report suggestive of leiomyoma. On examination, it was found to be subserosal pedunculated fibroid. All the tumor markers were negative except CA 125 which was 225 IU/mL. Exploratory laparotomy was done. Uterus was normal size and seen separately. Bilateral tubes and ovaries were normal. A mass of size 30 × 22 × 15 cm, firm in consistency occupying all the quadrants of abdomen, was observed. It had no attachment to the uterus or to the bowel. Mass weighing 6.5 kg was removed completely and sent for histopathology. HPE report confirmed leiomyoma. Her postoperative period was uneventful.
Conclusion: If the patient had prior history of myomectomy and mass is separate from the uterus with its blood supply away from uterus, diagnosis of parasitic leiomyoma should be considered.
Clinical significance: During morcellation procedures, a thorough inspection and washing of peritoneal cavity must be carried out, and endoscopic bag should be used to prevent secondary parasitic leiomyoma.
Background: Cervical cancer (CC) is the second most common cancer among women in India, while renal cell carcinoma (RCC) is the most common malignancy of kidney with a rising trend. Association of RCC with other malignancies, such as bladder and rectal carcinoma, is well known but with pelvic tumors, such as CC, are rare.
Case description: A 45-year-old female P2L2 presented with the complain of foul-smelling discharge off and on and intermenstrual bleeding, was diagnosed having carcinoma cervix stage 2A, and later found to have RCC stage T1b on further evaluation. Patient underwent a radical hysterectomy with bilateral pelvic lymphadenectomy with partial nephrectomy. Histopathology of renal specimen showed clear cell carcinoma with infiltrated margins, for which interval complete nephrectomy was performed.
Conclusion: There are only few reports of dual cancers of cervix and kidney in literature. The recent increase in incidence is ascribed to improving imaging facilities.