Abnormal Bleeding Research Articles

Heterotopic pregnancy and the influence of letrozole

Introduction: Heterotopic pregnancy has become increasingly common following increased use of assisted reproductive techniques. We will examine one uncommon instance of a heterotopic pregnancy occurring in the setting of a young woman undergoing letrozole therapy for primary infertility, making it an uncommonly seen case. Case Report: We report a young otherwise healthy female G1P0 at approximately 6 weeks gestation, who was referred from her primary care office to the Emergency Department with progressive abdominal pain that started 12 hours prior and had started to exhibit signs of hemodynamic instability. History was significant for difficulty with conception requiring letrozole treatment. Emergency laparoscopy was performed and confirmed additional ectopic pregnancy in the right fallopian tube with blood originating from the fimbriated end. Evacuation of hemoperitoneum and removal of ectopic pregnancy was completed without complication. She was discharged from the hospital in stable condition. Conclusion: In any woman of reproductive age presenting with lower abdominal pain or abnormal bleeding, there should be a strong suspicion for a pregnancy until confirmed otherwise. These patients may benefit from prompt imaging with pelvic ultrasound to assist in earlier detection of ectopic embryo implantation and, subsequently, earlier intervention. Salpingectomy, ideally via laparoscopic approach, remains the gold standard for diagnosis and treatment of patients with a ruptured ectopic pregnancy in the setting of a heterotopic pregnancy, although surgical intervention is associated with poorer outcomes for the intrauterine pregnancy.

Nonsevere Hemophilia: The Need for a Renewed Focus and Improved Outcomes.

People with nonsevere hemophilia (PWNSH) are phenotypically more diverse than those with severe hemophilia. Perceptions relating to a "nonsevere" phenotype have contributed to fewer research initiatives, fewer guidelines on optimal management, and a lack of standards for surveillance and clinical assessment for affected individuals. In many cases, episodes of abnormal bleeding could, if investigated, have led to earlier diagnosis. Furthermore, the major recent developments in therapy for hemophilia have largely focused on severe disease and, as a group, PWNSH have not been included in many key clinical trials. Benefiting people with severe disease, innovative replacement therapies have generally targeted factor levels that are above those present in a large proportion of PWNSH. Therapeutic advances can lead to improvement in phenotype for people with severe hemophilia over that currently experienced by many PWNSH. As a result, we are approaching a point where PWNSH may, in many countries, have a higher risk of bleeding and restriction in lifestyle than those with severe disease but with more limited therapeutic options. Given the multiple major advances in treatment for people with hemophilia, it is timely to review the aspects of nonsevere disease, to ensure equity in care and management for all individuals with this condition.

The usefulness of p16 and COX-2 expression on the prediction of progression to endometrial cancer.

Endometrial cancer (EC) is the most commonly diagnosed gynecological cancer. Endometrial hyperplasia (EH) is a more common diagnosis than EC. Endometrial hyperplasia is found in approximately 1.5% of all women presenting with abnormal bleeding. Endometrial hyperplasia progresses to EC, and especially, cancer risk increases in cases with atypical hyperplasia. p16, one of the tumor suppressor proteins involved in the cell cycle, and COX-2, one of the key enzymes of prostaglandin synthesis, are important markers for the diagnosis of both EH and EC. There is lack of consensus in the classification, diagnosis and treatment of EH. The subject of changes in the cell cycle in the progression of endometrial pathologies may help to identify and prevent these affected pathways in the treatment stage. The aim of this study is to investigate the expression of p16 and COX-2 during the development of EC from EH. We investigated COX-2 and P16 expressions in patients with proliferative endometrium, complex/simple endometrial hyperplasia and endometrioid adenocarcinoma. p16 expression increased in EH and EC (p<0.001). COX-2 expression was increased in endometrial cancer compared to other groups, but this increase was not found to be statistically significant. Although p16 and COX-2 expression were increased in patients with advanced grade/stage, lymphovascular invasion, and >50% of myometrial invasion, this increase was not statistically significant. More detailed studies are needed to investigate the prognostic significance of the COX-2 molecule. COX-2 might be a potential biomarker for the prognosis of endometrial cancer and a potential therapeutic target for EC treatment. Also, it might be used to prevent the progression of precursor lesions to invasive EC.

A new perspective on Endometrial Carcinoma classification and management strategies in context of molecular subtypes.

Endometrial cancer is the most common gynecological cancer and the second most prevalent female malignancy in the developed world. It is typically diagnosed in postmenopausal women, presenting with the characteristic clinical symptom of uterine abnormal bleeding. In the past, only two histological types were considered. However, it has become increasingly evident that endometrial cancer is a clinically heterogeneous disease, and this heterogeneity is closely associated with the diversity of underlying molecular alterations. The Cancer Genome Atlas classification has significantly advanced the diagnosis, risk stratification, and management of endometrial cancer by categorizing it into four molecular subgroups, each characterized by distinct mutational burdens and copy number alterations.

Teratogenic effect of 1.3 bis (p-Hydroxyphenyl)urea on Wistar rats (Rattus norvegicus L.)

Pain is a physiological disorder that pregnant women often experience, so they take various medications to relieve the pain. Many pain relievers on the market have teratogenic effects on pregnant women. 1.3 bis(p-Hydroxyphenyl)urea is a modification of p-aminophenol and has analgesic and anti-inflammatory properties and fewer hepatotoxic side effects. However, its safety in pregnant women has not been studied. This research continues our previous research to determine the teratogenic effects on white rat fetuses and toxic effects on pregnant white rats after administering 1.3 bis(p-Hydroxyphenyl)urea. The teratogenic effect test was carried out on pregnant rats divided into five groups with doses of 50, 500 and 1000 mg/kg BW, CMC Sodium 0.5%, and Gabapentin 50 mg/kg BW as the control group. Rats marked as pregnant were given test preparations and observed for toxic symptoms, and then fetal weight, body length, internal malformations and bone malformations were observed surgically. The study showed that administration at 50 and 500 mg/kg BW doses did not have a teratogenic effect. However, at a dose of 1000 mg/kg BW, it causes teratogenic effects characterized by fetal bleeding and bone abnormalities.

Müllerian adenosarcoma with sarcomatous overgrowth and heterologous elements: A case report and literature review

Uterine mullerian adenosarcoma (MA) is a rare biphasic tumour that accounts for less than 0.5% of uterine neoplasms. The age range of presentation is wide, with the median age in the 5th decade of life. It usually has a good prognosis; however, it worsens when it presents with sarcomatous overgrowth, heterologous elements or infiltrates the myometrium.We report the case of a 63-year-old woman presenting with abnormal vaginal bleeding and a sensation of solid material coming out of the cervical canal who was diagnosed with mullerian adenosarcoma with sarcomatous overgrowth (MASO) and presence of heterologous elements after performing a mass biopsy and subsequent hysterectomy.We reviewed the literature, focusing especially on the differential diagnoses to be evaluated, as well as the differences in prognosis and treatment according to whether or not they present histologic features of poor prognosis.

A Case Report of a Rare Cause of Diagnostic Dilemma in the Management of Gestational Choriocarcinoma

Choriocarcinoma belongs to one extreme of molar pregnancy, the other end is hydatidiform mole. It is a fast-growing tumor that occurs in a woman’s uterus but can easily metastasize to the lungs, liver, and brain. The abnormal tumor cells start in the tissue that would normally become the placenta. Choriocarcinoma developed after a normal pregnancy in 1 in 50,000, miscarriages in 1 in 15,000, and complete mole 1 in 40. The tumor may mimic uterine fibroid, especially when it presents as a uterine mass (which is not the common presentation) posing an initial diagnostic dilemma, as seen in our patient. The patient was an 18years P0+1 whose last normal menstrual period was a year before presentation. She presented with a history of loss of 14-week conception, then followed by 11months history of abnormal scanty vaginal bleeding lasting 21-27 days monthly, the patient was found to be mildly pale but had stable vital signs, she had a uterine mass of about 22weeks size, abdominal ultrasound scan revealed uterine fibroid. In the process of investigation serum pregnancy test was done and was found to be positive, with markedly elevated serum beta hcg. We made an assessment of choriocarcinoma and we commenced her on chemotherapy, she received 4 courses but with no decline in beta HCG. She had a total abdominal hysterectomy and histology confirmed choriocarcinoma, serum beta HCG was then immediately noticed to decline, she had further chemotherapy, and the patient did well subsequently. Huge choriocarcinoma may be mistaken for uterine fibroid, hence a high index of suspicion for choriocarcinoma is important if a patient presents with a recent history of miscarriage, uterine mass, vaginal bleeding, and a positive pregnancy test.

Postmenopausal endometriosis: a challenging condition beyond menopause.

Postmenopausal endometriosis is a complex condition that challenges the conventional belief that endometriosis resolves with menopause. Despite the cessation of menstruation, a subset of women continues to experience or develop endometriosis-related symptoms during the postmenopausal period. Thus, this review aimed to shed light on postmenopausal endometriosis, exploring its clinical features, diagnostic considerations, management approaches, and the potential impact on women's health. PubMed/Medline, Scopus, and Web of Science databases were used for the research, with only articles in English language, using the following terms: "postmenopausal endometriosis," "menopause," "management," "treatment," and "quality of life," from inception to 2023. The clinical features of postmenopausal endometriosis include persistent or recurrent pelvic pain, dyspareunia, bowel, or urinary symptoms and, occasionally, abnormal vaginal bleeding. The absence of menstrual cycles presents a diagnostic challenge, as the traditional diagnostic criteria for endometriosis rely on menstrual patterns. Visual cues may be less evident, and the symptoms often overlap with other gynecological conditions, necessitating a thorough evaluation to differentiate postmenopausal endometriosis from other potential causes. Management approaches for postmenopausal endometriosis encompass surgical intervention, hormonal therapies, pain management, and individualized care. Postmenopausal endometriosis significantly impacts the quality of life, sexual health, and long-term well-being of women. Understanding the clinical features, diagnostic challenges, and management approaches of postmenopausal endometriosis is crucial for healthcare professionals to provide effective care and to improve the quality of life of women affected by this condition.

Abstract 1011: A comprehensive comparative analysis of African Americans’ early onset and late onset colorectal cancer: A 60 year study in underserved population serving hospital

Abstract Background: The incident of early onset of colorectal cancer (EOCRC) is increasing in adults including in African Americans (AA). Aim: To investigate differences between EOCRC compared to late onset colorectal cancer (LOCRC) in AA patients. Methods: We reviewed demography, pathology and colonoscopy records of patients seen at Howard University Hospital from 1959 to 2023. This retrospective cohort consists of 175 EOCRC cases (&amp;lt;45 years) and 2025 LOCRC cases (&amp;gt;45 years). The age-adjusted rates for EOCRC and LOCRC were calculated for the age categories &amp;lt;45 and above 45. Results: The cohort comprised predominantly AA individuals (&amp;gt;85%). Gender distribution showed slightly more females (1074, 53%) than males, with no significant difference observed between EOCRC and LOCRC groups (p=0.94). Initial symptoms at presentation were prevalent in both EOCRC (93.8%) and LOCRC (92.6%). Notably, EOCRC exhibited a higher incidence of abdominal pain (23.3% vs. 17.2%, p=0.05) and changes in bowel habits (24.4% vs. 14%, p=0.05) compared to LOCRC. However, other symptoms such as melena, hematochezia, weight loss, and anemia were less prevalent in EOCRC than in LOCRC. Additionally, comorbidities like hypertension (HTN), diabetes mellitus (DM), and inflammatory bowel disease (IBD) were less frequent in EOCRC compared to LOCRC. Family history of colon cancer in first-degree relatives was notably higher in EOCRC (15.5%) compared to LOCRC (3.2%, p=0.01). Pathology reports indicated a higher occurrence of neuroendocrine tumors in EOCRC (2.8%) than in LOCRC (1.4%). Complications such as gastrointestinal bleeding and abdominal CT abnormalities were more frequent in EOCRC. Location-wise, EOCRC was primarily observed in the left sigmoid and rectosigmoid regions (p=0.01). Metastasis to other organs was more prevalent in EOCRC than in LOCRC (p=0.04) suggesting more aggressive and advanced lesions. Surgical interventions were slightly more common in EOCRC (80.4%) than in LOCRC (79.1%). Type of polyps and stage distribution showed some variations between the two groups. Interestingly, the incidence of colorectal cancer showed fluctuations over the years, peaking between 1980 and 1989 before declining in recent years, probably as a result of colonoscopy popularization. Conclusion: CRC incidence is increasing among young AA who display highly advanced and more metastatic tumors in comparison with LOCRC. While current screening programs seems to have decreased CRC prevalence in individuals older than 45, special attention needs to be addressed to young AA adults as well, to counter the observed trend, as they have the highest incidence of CRC among young population groups by race/ethnicity. Detailed analysis of the molecular landscape of EOCRC AA tumors is needed to understand the differential pathways and mechanisms defining these early onset cancers. Citation Format: Suryanarayana Reddy Challa, Mrinalini Deverapalli, Nasrin Farjana, Lakshmi Gayathri Chirumamilla, Reza Oskrouchi, Swetha Mynedi, Mudasir Rashid, Karthikeyan Senthilvelan, Babak Shokrani, Rabia Zafar, Angesom Kibreab, Farshad Aduli, Adeyinka Laiyemo, Zaki Sharif, Hassan Brim, Hassan Ashktorab. A comprehensive comparative analysis of African Americans’ early onset and late onset colorectal cancer: A 60 year study in underserved population serving hospital [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1011.

Molecular mechanism analysis of a family with hereditary coagulation F Ⅺ deficiency caused by compound heterozygous mutations

A 34 year old female patient was scheduled to undergo surgical resection due to a "breast nodule". Preoperative examination revealed an activated partial thromboplastin time (APTT) of 66.2 seconds, coagulation factor Ⅺ activity (FⅪ: C) of 2%, and FⅪ antigen (FⅪ: Ag) of 40.3%. The patient and family members showed no abnormal bleeding symptoms. Diagnosed as hereditary coagulation factor Ⅺ deficiency. Genetic testing revealed that the F11 gene had a heterozygous nonsense mutation in exon 10, c.1107C>A (p.Tyr351stop), and a heterozygous missense mutation in exon 13, c.1562A>G (p.Tyr503Cys). The father and son were p Heterozygous carriers of Tyr351stop mutation, while the mother and daughter are p Heterozygous carriers of Tyr503Cys mutations. The in vitro expression results showed that p The Tyr351stop mutation resulted in a significant decrease in the transcription level of F11 gene, while p The Tyr503Cys mutation has no effect on the transcription level and protein expression level of F11 gene, but it leads to a significant decrease in the level of FⅪ:C in the cell culture supernatant.

Phthalates and uterine disorders.

Humans are ubiquitously exposed to environmental endocrine disrupting chemicals such as phthalates. Phthalates can migrate out of products and enter the human body through ingestion, inhalation, or dermal application, can have potential estrogenic/antiestrogenic and/or androgenic/antiandrogenic activity, and are involved in many diseases. As a female reproductive organ that is regulated by hormones such as estrogen, progesterone and androgen, the uterus can develop several disorders such as leiomyoma, endometriosis and abnormal bleeding. In this review, we summarize the hormone-like activities of phthalates, in vitro studies of endometrial cells exposed to phthalates, epigenetic modifications in the uterus induced by phthalate exposure, and associations between phthalate exposure and uterine disorders such as leiomyoma and endometriosis. Moreover, we also discuss the current research gaps in understanding the relationship between phthalate exposure and uterine disorders.

Maternal periodontitis may cause lower birth weight in children: genetic evidence from a comprehensive Mendelian randomization study on periodontitis and pregnancy

ObjectivesThis study aims to comprehensively investigate the potential genetic link between periodontitis and adverse pregnancy outcomes using a two-sample Mendelian Randomization approach.Materials and methodsWe employed robust genetic instruments for chronic periodontitis as exposure data from the FinnGen database. Data encompassing various pregnancy stage outcomes, including pre-pregnancy conditions (irregular menstruation, endometriosis, abnormal reproductive bleeding, and female infertility), pregnancy complications (hemorrhage, spontaneous miscarriage, and abnormalities in products), and post-pregnancy factors (single spontaneous delivery, labor duration, and birth weight of the child), were obtained from the UK Biobank. The random-effects inverse-variance weighted (IVW) method was utilized to compute primary estimates while diligently assessing potential directional pleiotropy and heterogeneity.ResultsOur findings indicate a negative association between periodontitis and labor duration (odds ratio [OR] = 0.999; 95% confidence interval [CI]: 0.999 to 1.000; P = 0.017). Individuals with periodontitis are more likely to deliver lower-weight infants (OR = 0.983; 95% CI: 0.972 to 0.995; P = 0.005). We found no evidence of pleiotropy or heterogeneity in aforementioned two associations. We did not observe casual links with pre-pregnancy conditions and pregnancy complications.ConclusionsThis Mendelian Randomization study underscores the genetic influence of periodontitis on specific adverse pregnancy outcomes, particularly concerning labor duration and lower birth weight deliveries.Clinical relevanceOur study emphasizes the critical importance of maintaining periodontal health during pregnancy and offers genetic evidence supporting these associations. Further investigation is required to delve deeper into the specific underlying mechanisms.

Migration of Intra-Uterine Devices.

Intrauterine devices (IUDs) are a widely used contraceptive. Possible complications from IUDs include failed insertion, pain, vasovagal reaction, infection, abnormal bleeding, and expulsion. Uterine perforation and migration of the IUD are rare complications occurring in approximately 1-2 per 1000 insertions. We executed a systematic review by reviewing all case reports and case series on IUD migration, published between December 2002 and December 2022. Our review indicates that about half of these patients present with pain and that a third are completely asymptomatic. The most common sites of migration are the intestine, bladder, and omentum. We found that the preferred method for removing the migrated IUD is laparoscopy. Generally, there are no lasting injuries after the removal of the migrated IUD, but occasionally, severe complications have been reported. Healthcare providers should be vigilant about this rare complication, especially in cases of painful insertion or the presence of other risk factors for perforation. When uterine perforation is diagnosed, it is advisable to remove the IUD to prevent severe complications.

Residual calcified material volume of β–tricalcium phosphate with platelet-rich fibrin in unilateral alveolar bone graft

BackgroundThis study aimed to evaluate the effectiveness of β-tricalcium phosphate (β-TCP) and platelet-rich fibrin (PRF) in unilateral alveolar bone graft, involving the percentage of residual calcified material and the average labiopalatal thickness of the grafts on cone beam computed tomography at 6 months after surgery, comparing two age groups 12 years and under and over 12 years old.ResultsThe mean preoperative defect volume was 0.93 ± 0.20 cm3, with no significant difference between the two groups (p = 0.652). In the postoperative period, we did not record any abnormal bleeding and no infection was observed. Six months after surgery, the mean percentage of residual calcified material was 63.53 ± 16.48% with a significantly higher difference in the age group 12 and under (p < 0.001), and the mean average labiopalatal thickness of the grafted bone was 5.72 ± 1.09 mm with a significantly higher difference in the age group 12 and under (p = 0.011).ConclusionUsing β-TCP and PRF in alveolar bone graft surgery has acceptable effectiveness clinically and on CBCT images, with significantly higher differences of the percentage of residual calcified material and the average labiopalatal thickness of the grafted bone in the group 12 years old and younger than in the older group.

Transcriptomic Analysis Reveals Intrinsic Abnormalities in Endometrial Polyps.

Endometrial polyps (EPs) are benign overgrowths of the endometrial tissue lining the uterus, often causing abnormal bleeding or infertility. This study analyzed gene expression differences between EPs and adjacent endometrial tissue to elucidate intrinsic abnormalities promoting pathological overgrowth. RNA sequencing of 12 pairs of EPs and the surrounding endometrial tissue from infertile women revealed 322 differentially expressed genes. Protein-protein interaction network analysis revealed significant alterations in specific signaling pathways, notably Wnt signaling and vascular smooth muscle regulation, suggesting these pathways play critical roles in the pathophysiology of EPs. Wnt-related genes DKK1 and DKKL1 were upregulated, while GPC3, GREM1, RSPO3, SFRP5, and WNT10B were downregulated. Relevant genes for vascular smooth muscle contraction were nearly all downregulated in EPs, including ACTA2, ACTG2, KCNMB1, KCNMB2, MYL9, PPP1R12B, and TAGLN. Overall, the results indicate fundamental gene expression changes promote EP formation through unrestrained growth signaling and vascular defects. The intrinsic signaling abnormalities likely contribute to clinical symptoms of abnormal uterine bleeding and infertility common in EP patients. This analysis provides molecular insights into abnormal endometrial overgrowth to guide improved diagnostic and therapeutic approaches for this troublesome women's health condition. Confirmation of expanded cohorts and further investigations into implicated regulatory relationships are warranted.

Heartache to Happiness: Managing a Six Year Hormonal Subfertility with a Successful Rate of Conception

Background: The inability to conceive is emotionally distressing and indeed a very painful struggle in which the pain stays with the individual every day. Hormonal disorders are the leading cause of infertility globally. They do not only include the hypothalamic pituitary ovarian axis but also the none-reproductive endocrine glands. Hormonal management helps promote ovum maturation, which triggers ovulation, increasing the likelihood of conception. Case presentation: We report a 36-year-old African lady who presented with an inability to conceive for six years since marriage and it was associated with an irregular menstruation cycle length of twenty-four to thirty-six days. She had anovulatory cycles for seven years, and high Prolactin levels. Her body mass index was 34.4kg/m2. She had visited several hospitals in and outside Tanzania without success in conceiving. At Bugando Medical Centre we managed her case by diet, fertility awareness, and medical management. She conceived after three months of treatment. Conclusion: Anovulatory cycles with abnormal bleeding patterns are a major cause of infertility in reproductive woman. Basic hormonal profiles are essential to confirm where the problem is. Prolactinemia and insulin resistance affects ovulation. Fertility awareness, lifestyle changes, and medical management will bring back happiness to most women with subfertility secondary to hormonal disorders.

Knowledge of Cervical Cancer and Attitude Toward Cervical Cancer Screening Among the First-Year School of Midwifery Students in FMC Nguru, North-Eastern Nigeria

Cervical cancer occurs due to Infection by high-risk human papillomavirus (HPV) and subsequent integration of the HPV genome into the host chromosome of cervical epithelial cells. The viral proto-oncogenes, mainly E6 and E7, are responsible for the initial changes in the epithelial cells of the transformation zone of the cervix. The viral proteins inactivate two main tumor suppressor proteins, p53, and retinoblastoma (pRb). Inactivation of these host proteins disrupts both the DNA repair mechanisms and apoptosis, leading to rapid cell proliferation. Cervical cancer is the 4th most common cancer among women worldwide, it ranked 14th among all cancers worldwide. There are 500,000 new cases of cancer of the cervix annually, and about 250,000 mortalities all over the world from cervical cancer. About 80% of all these cases occur in low-income countries. In Nigeria, there are 12,075 new cases of cervical cancer and 7,968 deaths due to cervical cancer per year. The study was a cross-sectional type aimed at exploring the knowledge of the participants on cancer of the cervix and their attitude toward cervical cancer screening using a semi-structured questionnaire in FMC Nguru. Results: The total number of participants was 29(n=29). The mean age of the respondents was 20.9 +/-2. 8SD. Concerning the knowledge of cervical cancer among the participants, 27(93.1%) heard of cervical cancer. Most of the respondents do not know the cause of cervical cancer, as only 10(34.5%) know that cervical cancer is associated with HPV. The risk factors for cervical Cancer are not known by most of the respondents as 14(48.3%) agreed that having a relative who had the disease is a risk factor, while only 10(34.5%) agreed that HPV is a cause of the pathology. There was poor knowledge regarding the presentation of cancer of the cervix, abnormal vaginal bleeding is the most popular way of presentation known by 13(44.8%) of the respondents while only 8(27.6%) know that cervical cancer can present with bleeding after sexual intercourse, five of the respondents (17.2%) showed smelling vaginal discharge as the mode of presentation, dysuria by only 2(6.9%). A good number of the participants know about cervical screening 26(89.7%). Twenty-eight respondents (96.6%) are willing to go and have themselves screened for cervical cancer if they are asked to do so, and 27(93.1%) will advise some other people to go for the screening. A good number of the respondents, 27(93.1%) are aware that cancer of the cervix can be prevented. Conclusion: The students had a good awareness of cervical cancer and cancer of the cervix screening and had a positive attitude toward having themselves screened whenever the chance was available, and also had a positive attitude toward being willing to convince other people to go for the screening, but demonstrated less knowledge on cervical cancer causes, risk factors and mode of presentation. Hence there is a window of opportunity to deliver more health education to the students and by extension to the larger population.

Vaginal foreign bodies in pediatric population - presentation, diagnostic challenges, and role of vaginoscopy: A case series

Background: Vaginal foreign bodies (VFBs) in the pediatric population pose diagnostic and management challenges. This is due to the usual difficulty in obtaining an appropriate history, difficulty in conducting a vaginal examination, and the fallibility of conventional imaging modalities in picking most of the vaginal foreign bodies. In prepubertal who present with abnormal vaginal discharge or vaginal bleeding, the diagnosis of a vaginal foreign body should be considered, and appropriate care should be provided. Vaginoscopy is an excellent diagnostic and therapeutic modality for these cases. Case series: Between 2018 and 2023, 6 children aged between 3 and 6 years underwent vaginoscopy at our institution, having presented with diverse vaginal symptoms. The mean age was 4.5 years. Three presented with vaginal bleeding, two had recurrent vaginal discharge, and one had a history of trauma to the genitalia. There were no cases suspicious of sexual abuse. All except two had a normal external genital examination, with one having a small excoriation on the labia and the other having superficial perineal injuries due to trauma. All six cases had intact hymens. Vaginoscopy was performed using a 4-mm scope. Vaginal foreign bodies of varying size and consistency were retrieved from three patients. One patient had inflammatory changes on the proximal anterior vaginal wall. Two had normal findings. All 6 children tolerated the procedure well, with an excellent response to treatment. Conclusion: Correct diagnosis and management of pediatric vaginal foreign bodies is challenging compared with the adult population. A high index of suspicion is necessary for any young girl presenting with vaginal bleeding or abnormal vaginal discharge. Vaginoscopy is a safe and efficient diagnostic and therapeutic procedure for vaginal foreign bodies in the pediatric population.

RECONSTRUCTION OF ORBITAL FLOOR FRACTURES USING SILICONE BLOCK IMPLANT

Abstract&#x0D; Introduction &amp; Objectives : It has long been a controversial-both the materials for orbital floor reconstruction and the timing of surgery. Silicone block implant is affordable and readily available especially in developing countries. Due to its complications and the development of other materials, silicone block implant has rarely been used. This study aims to evaluate the outcomes of timing of surgery and the use of silicone block implant in orbital floor fractures reconstruction.&#x0D; Methods : We conducted a retrospective review of patients who had orbital floor fractures and undergone reconstruction surgery using silicone block implant in Cipto Mangunkusumo Hospital from January 2017 to December 2021. These patients then divided into three groups based on their surgery interval time. Outpatient notes, Computed Tomography (CT) reports, surgical admission notes, records and complications were recorded. Patients with follow-up less than three months were excluded.&#x0D; Results : Thirty-one patients were included (23 males, 8 females) with age 18-60 years old being dominant. Thirty (96.8%) patients had unilateral fractures, 23 patients (74.2%) came with impure fractures, and fractures mostly caused by traffic accidents (83.9%). Subconjunctival bleeding and eyelid abnormalities were found as the majority of ocular involvement. Symptoms with the greatest improvement were different between three groups based on surgery interval time. Besides, only one extruded implant was found.&#x0D; Conclusion : Silicone block implant provides good outcomes with minimal complications even after late surgical repair of orbital floor fractures.

Endometrial Cancer in a Transgender Man with Prolonged Exogenous Testosterone Use.

Hormone therapy (HT) in transgender males requires monitoring. For amenorrheic transmasculine individuals on HT, episodes of abnormal vaginal bleeding should be assessed promptly. A 33-year-old transgender man on exogenous testosterone therapy for medical gender transition was found to have stage IV endometrioid endometrial adenocarcinoma. Surgical resection was performed for symptom control, and the patient was treated with palliative chemotherapy. The tumor was androgen receptor-negative, and, after a multidisciplinary discussion of the risks and benefits of continuing exogenous testosterone, testosterone therapy was restarted postoperatively. Long-term androgen use may have unknown implications for the development of malignancy, and treating reproductive organ cancer in transgender males may be complicated by the desire to continue androgen therapy.