Gynecologic Abnormalities Research Articles

Reproductive correlates of chronic fatigue syndrome

A case-control study was conducted to determine whether menstrual and gynecologic abnormalities precede the onset of chronic fatigue syndrome (CFS) in women with this disorder to a greater extent than that observed among healthy controls. We identified 150 women who met the 1988 Centers for Disease Control criteria for CFS from the Brigham and Women’s Hospital Cooperative CFS Research Center. A comparison group of 149 women being seen for nongynecologic conditions were selected from the waiting area of the Brigham and Women’s Hospital Internal Medicine outpatient department. Women with and without CFS completed self-administered questionnaires on menstrual, reproductive, and medical history. Women with CFS reported increased gynecologic complications and a lower incidence of premenstrual symptomatology. After adjustment for age, a somewhat greater number of cases compared with controls self-reported irregular cycles, periods of amenorrhea, and sporadic bleeding between menstrual periods. Factors suggestive of abnormal ovarian function—such as a history of polycystic ovarian syndrome, hirsutism, and ovarian cysts—were reported more often in CFS cases compared with controls. Frequent anovulatory cycles due to ovarian hyperandrogenism (PCOS) or hyperprolactinemia may increase risk for CFS through loss of the potential immunomodulatory effects of progesterone in the presence of continued estrogen production. We hypothesize that frequent anovulatory cycles due to PCOS and/or hyperprolactinemia may explain the increased reporting of gynecologic complications and the lower reported premenstrual symptomatology observed in women with CFS.

Sex Hormone Changes in Morbidly Obese Patients after Vertical Banded Gastroplasty

Serum sex hormone levels were measured preoperatively in 57 morbidly obese patients (19 men and 38 premenopausal women) and 12 months after vertical banded gastroplasty. In the male group, there was a significant decrease in estradiol and an increase in follicle-stimulating hormone (FSH), total testosterone and sex-hormone-binding globulin (SHBG). Among female patients, a significant decrease in estradiol, total and free testosterone and an increase in FSH and SHBG was found. Irregular menses present preoperatively in 5 women were corrected after successful weight loss. In conclusion, altered sex hormonal levels and gynecologic abnormalities associated with morbid obesity are corrected with adequate weight loss following vertical banded gastroplasty.

Implications of gynaecological abnormalities in pre-selection criteria for cervical screening: preliminary evaluation of 3602 subjects in south India.

Early detection and eradication of cervical cancer and its precursor lesions through organized mass cytological screening programmes have recently gained considerable attention in developing countries. Strategies for both cost saving and effective implementation are however required for mass cervical screening in developing countries. In an early cancer detection programme conducted in South India, we analysed cytological abnormalities in 3602 women and correlated the results with other factors, including age, gynaecological complaints, number of years of married life and parity to see if pre-selection for cytologic screening was possible. Only lower grades of dysplasia were found in asymptomatic women below the age of 40 years. In asymptomatic women, malignancy and higher grades of dysplasia were confined to women with a clinically abnormal cervix only. Univariate analysis also revealed that subjects with a parity of more than 3 and a married life of more than 20 years had a significantly higher number of cytological abnormalities. However, on a multivariate analysis the increased number of marital years was not found to be an independent variable. These results suggest that asymptomatic women below the age of 40 years with a married life of less than 20 years and parity below 3, may be excluded from screening campaigns, and that pre-selection for cytologic screening is possible by introducing a programme of clinical and speculum examination of the cervix.

Laparoscopic retropubic cystourethropexy

Study Objective. To evaluate the efficacy of laparoscopic retropubic urethrovesical suspension. Design. Retrospective review of charts of 62 women over a follow-up period ranging from 8 to 30 months. Setting. A suburban hospital in a major metropolitan area. Patients. Sixty-two women, age 34 to 69 years, gravidity 0 to 8, and parity 0 to 7, with gynecologic abnormalities requiring surgical intervention and with pure genuine urinary stress incontinence. Interventions. Each patient underwent a Burch or Marshall-Marchetti-Krantz procedure, modified to be performed at laparoscopy. Measurements and Main Results. Success was measured subjectively and objectively. Subjective success, determined by the lack of need to wear pads, was 100%. Objective success was assessed using several criteria: comparison of preoperative and postoperative symptom diaries; questionnaires; urine characteristics by straight catheter (office dipstick for nitrate, leukocyte estrace, bacteria, and white cell blood count, if suspicious urine culture and sensitivity); postvoid residual volume (<100 ml was considered complete); urethrovesical junction angle as determined by catheter or Q-Tip placement (upward, downward, or straight); bladder support; and negative standing stress test. All women reported satisfactory relief of symptoms, with subjective and objective improvement. None have noted urinary leakage during activities similar to those preoperatively associated with this condition. Conclusion. To date, the outcomes have been acceptable, although the limited numbers and relatively short follow-up prohibit any definitive conclusions.

Color Doppler US of children with acute lower abdominal pain.

The authors review the color Doppler ultrasonographic (US) features of appendicitis and other diseases that can manifest with acute lower abdominal pain. Causes of acute abdominal pain, other than appendicitis, include gynecologic abnormalities (ovarian cyst, ovarian torsion, pelvic inflammatory disease), gastrointestinal abnormalities (infectious enteritis, Crohn disease, mesenteric lymphadenitis, intussusception), and urinary tract diseases. On color Doppler images, inflammatory and infectious processes usually show locally increased blood flow, whereas cysts and twisted masses have absent blood flow. Enlarged lymph nodes also are avascular. Color Doppler US is a useful adjunct to gray-scale US in evaluating acute lower abdominal pain in children and can aid in defining and clarifying gray-scale abnormalities.

Chronic pelvic pain and neurotic behavior

Eighty-one women with chronic pelvic pain caused by a gynaecological abnormality (group 1) were compared with 81 women with chronic pelvic pain without an organic cause (group II). A control group of 46 pain-free women was included (group III).The purpose of this study was to investigate the hypothesis that patients with unknown pelvic pain would have more neurotic problems than patients with an organic cause for their pain. All patients were tested on the Minnesota Multiple Personality Inventory (MMPI). Women from group I and group II did not differ significantly on the neurotic triad of the MMPI. There was, however, a significant difference between group I and group III and between group II and group III on the MMPI scores.From the results it can be concluded that chronic pelvic pain can lead to neurotic behavior and that scores on the MMPI cannot differentiate between patients with or without organic chronic pelvic pain.

Ultrasonography shows no abnormality of pelvic structures in women with severe idiopathic constipation.

Patients with severe idiopathic constipation are almost exclusively women. Common presenting features include lower abdominal pain, irregular and painful menstruation, and a past history of gynaecological surgery. Pelvic ultrasonography was undertaken in 26 patients with severe idiopathic constipation and 21 age matched control women to detect any gynaecological abnormality. No difference was found in ovarian, uterine or pelvic vein morphology or size. The abdominal pain in these patients is related to the bowel disorder, and minor abnormalities of pelvic morphology on ultrasound are probably incidental findings.

Sexual problems of women with chronic pelvic pain

Eighty-one women with chronic pelvic pain caused by a gynaecological abnormality (group 1) were compared with 81 women with chronic pelvic pain without a demonstrable gynaecological disease (group II). A control group of 46 pain-free women was included (group III). All patients were tested on the Sexual Experience Scale (SES). Women from group I and group II did not differ significantly on the four subscales of the SES. There was, however, a significant difference when groups I and II were compared with group III, regarding the SES scores. From these results it can be concluded that patients with chronic pelvic pain have more sexual problems compared with pain-free patients. A model for practical work in the outpatient clinic has been constructed and introduced.

Four-year follow-up of electrocoagulation and tubal ring sterilizations in Costa Rica

An earlier analysis of 299 laparoscopic sterilizations comparing electrocoagulation and tubal ring occlusion techniques found no significant differences in rates of surgical complications. The risk of potentially serious complications, such as bowel/bladder burns, was considered higher with electrocoagulation suggesting that tubal rings might be the preferred technique. Examination of the same women through 48 months poststerilization showed no significant difference between the two techniques with respect to the incidence of gynecologic surgery performed subsequent to sterilization. Gynecologic abnormalities were similar for women in both groups. The rate of pregnancy was higher for tubal rings than for electrocoagulation (2.1 compared to 0.7 at 48 months) but this difference was not statistically significant.

Sex Hormonal Changes Accompanying Loss of Massive Excess Weight

With adequate weight loss following bariatric surgery, we previously found correction of the clinical gynecologic abnormalities associated with obesity. In this study, sex hormonal changes offered an explanation for the clinical findings.

Extraspinal abnormalities identified on lumbar spine CT

Retrospective review of 1517 lumbar CT examinations revealed extraspinal pathology in 22 (1.45%). Retroperitoneal tumors and lymphadenopathy as well as vascular, urinary tract and gynecologic abnormalities were identified. This study demonstrates the need to carefully evaluate the visualized portions of the abdomen and pelvis on all lumbar spine CT examinations even when the patient's symptomatology is suggestive of spinal abnormalities.

Radiation dose reduction during hysterosalpingography: an application of scanning-beam digital radiography.

Hysterosalpingography was performed in 31 patients by means of a low-dose scanning-beam digital radiographic system. The technique permits adequate evaluation of gynecologic abnormalities while allowing significant reduction in radiation: 2.4-mR (6.1 X 10(-7) C/kg) exposure to the skin and 0.7-mrad (7 X 10(-6) Gy) mean dose to the ovaries per image obtained. Sixteen patients demonstrated readily recognizable and documented abnormalities, corroborated by laparoscopy, laparotomy, or other supportive evidence.

Gynecologic masses: Value of magnetic resonance imaging

Forty-two women with gynecologic abnormalities were studied with the use of magnetic resonance imaging. Magnetic resonance imaging correctly assessed the origin of the pelvic mass in all patients. In the evaluation of leiomyoma, magnetic resonance imaging accurately depicted the number, size, and location of the lesion. In the evaluation of endometrial carcinoma, magnetic resonance imaging depicted the location of the lesion, the presence of cervical extension, and the depth of myometrial penetration in the majority of the cases. In the analysis of adnexal cysts, magnetic resonance imaging was sensitive in localizing the lesion and was able to distinguish serous from hemorrhagic fluid. This preliminary report indicates that magnetic resonance imaging may become a valuable imaging modality in the diagnosis of gynecologic abnormalities.

A two-year follow-up study of women sterilized in India

For large-scale program implementation, it is important to document both early and long-term safety and effectiveness of female sterilization methods. The results of this controlled, prospective, two-year study of 2,053 women who underwent sterilization in Baroda, India, show a marked decline in gynecological abnormalities over time; the incidence of gynecological pathology following sterilization was not significantly higher than what might be expected in the general population. The incidence of post-sterilization gynecological surgery was low. Significantly more women had weight gain than weight loss after sterilization. After sterilization, no change in menstrual cycle parameters was reported for the vast majority of women. Both favorable and unfavorable changes in menstrual cycle parameters were noted. The one-year and two-year pregnancy rates were 0.0 and 0.4 percent, respectively. No ectopic pregnancies were reported.

Design and preliminary observations of National Cooperative Diethylstilbestrol Adenosis (DESAD) Project.

The National Cooperative Diethylstilbestrol Adenosis (DESAD) Project has completed the major portion of its enrollment phase with the examination of more than 3000 daughters of women taking synthetic nonsteroidal estrogens (denoted DES) during pregnancies occurring from the early 1940s to the mid-1960s. The aims of the Project are to fill urgent needs for information on the prevalence and incidence of structural and epithelial abnormalities or neoplastic changes and their complications in these young women. Participants are grouped by mode of entry as identified by prenatal record review (40.1%), documented as DES-exposed but walking in (25.1%), or referred (22.8%) to the DESAD Project for examination, and not documented as exposed but having gynecologic abnormalities typical of those associated with DES exposure (12.0%). This study cohort, in part having paired controls, will be examined annually for at least 5 years. Details of the design and selected preliminary findings are reported.

A Comparative Study of the Tubal Ring Applied via Minilaparotomy and Laparoscopy in Postabortion Cases

Sterilization with tubal rings applied via minilaparotomy or laparoscopy was performed on 300 randomly selected postabortion subjects to evaluate the safety and effectiveness of the two surgical methods. One hundred and forty-nine procedures were performed by minilaparotomy and 151 by laparoscopy. Gas leakage due to equipment problems was the most common technical difficulty during laparoscopy, and difficulty in exteriorizing the tubes was the most common surgical difficulty. Women undergoing laparoscopy experienced significantly less pain during surgery and had significantly lower rates of immediate and early postoperative complications than those women undergoing minilaparotomy. The rates of gynecologic abnormalities at six and 12 months were similar for both procedures. At this writing, no pregnancies have been reported among the study subjects. The results of our study indicate that laparoscopy is superior to minilaparotomy when it is performed in a controlled hospital situation.

Gynecologic disease in young, sexually active women

There has been a significant change in adolescent sexual behavior in the past decade. This report of 1,594 young, sexually active women, primarily from middle and upper socioeconomic backgrounds, identifies the obstetric and gynecologic problems characteristic of the group. While supposedly in a low-risk category these patients displayed a high incidence of cervical epithelial abnormality, problem pregnancy, and other obstetric and gynecologic abnormality. The incidence of veneral disease was somewhat lower than anticipated.

Female sterilization via laparoscopy. A long-term follow-up study.

Madrigal, V., Edelman, D. A., Goldsmith, A. &amp; Brenner, Wm. E. (Asociación Demográfica Salvadoreña, San Salvador, El Salvador, International Fertility Research Program, Chapel Hill, N. C., and the Dept. of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, N. C., USA). Female sterilization via laparoscopy: A long‐term follow‐up study.Int J Gynaecol Obstet 13: 268–272, 1975.While interval female sterilization via laparoscopy appears to be a safe and effective procedure, long‐term follow‐up studies of this method have not been reported. To determine the incidence of gynecological abnormalities and failure after laparoscopic sterilization with electrocoagulation and division of the tubes, pertinent data were analyzed from 635 consecutive patients sterilized by this technique at the Asociación Demográfica Salvadoreña, El Salvador, in 1972–73. Of these patients, 86.2% have been seen for at least one follow‐up examination 4–31 months post‐sterilization. Significant gynecological abnormalities occurred in 2.4% of the cases within 4 to 8 months, in 3.0% of the cases within 15 to 21 months, and in 1.4% of the cases within 22 to 31 months of sterilization. Some changes in menstrual cycle function were noted. There was an increase over time in the proportion of patients who developed irregular menstrual cycles and dysmenorrhea. The failure rate of the procedure was 0.7%. Laparoscopic sterilization with electrocoagulation of the tubes appears to result in clinically acceptable rates of long‐term complications. To adequately evaluate the long‐term sequelae of sterilization, appropriate, long‐term comparative studies of various methods and techniques of tubal occlusion, including hysterectomy, will have to be conducted.

Letter: Screening for gynaecological abnormalities.

Letter: Screening for gynaecological abnormalities.

Gynaecological Abnormalities found at a Cytology Clinic

Gynaecological Abnormalities found at a Cytology Clinic