Previous History Of Hysterectomy Research Articles

A Rare Case of Internal Hernia of Partial Volvulus Right Colon through Foramen of Winslow & Its Management by Laparoscopic Approach

Introduction: Foramen of Winslow hernias is a rare and critical form of internal hernia that can present in individuals with signs and symptoms of bowel obstruction. This case report entails the operative management of a right-side colon herniation through the foramen of Winslow in an elderly female with a previous history of Hysterectomy. The patient presented with worsening abdominal pain, nausea, and multiple episodes of vomiting. Delay in diagnosis often results in higher morbidity and mortality. Case Presentation: A 46 years old female, presented with acute upper abdominal pain, constipation, and loss of appetite for 24 hrs. Computed tomography showed foramen of Winslow hernia with partial volvulus right colon as content with incomplete rotation of gut which was managed laparoscopically without the need for bowel resection. The patient recovered well with no postoperative complications and no immediate technical failure of repair confirmed by a cross-sectional study. The patient is doing well on follow-up. Discussion: Herniation of the bowel through the foramen of Winslow is very rare, comprising only 8% of all internal herniations. Historically, the majority of cases were diagnosed intra-operatively during laparotomy. Bowel resection was often done in cases of ischemia. In recent times, early diagnosis & increasing expertise in minimal access surgery that is resulting in a lower morbidity and mortality rate along with other added benefits of minimal access surgery. Conclusion: Herniation contents through the foramen of Winslow is a rare condition. Patients will present with sudden onset abdominal pain. Early imaging helps to recognise the diagnosis and could prevent bowel ischemia & its management with minimal access surgery leads to early recovery, shorter hospital stay, less pain & early return to work.

Pulmonary Benign Metastasizing Leiomyoma: Case Report of Late Occurrence in Postmenopausal Patient

Introduction: Pulmonary benign metastasizing leiomyoma (PBML) is a rare condition that occurs most commonly in young women of reproductive age some years after hysterectomy. The aim of this study was to report a PBML case which occurred 33 years after hysterectomy in a postmenopausal patient. Case report: A 59-year-old female diabetic patient, G2P2A0, with dyslipidemia, a non-smoker and ex-alcoholic (quit in the 90s), with pulmonary symptoms was referred to the health service. A chest computed tomography (CT) revealed multiple pulmonary nodules. A previous history of hysterectomy at 26 years of age led to a diagnostic hypothesis of PBML. The patient underwent segmentectomy of the largest nodule (measuring 1.2 x 0.9 cm) located in the left lung. Histopathology and immunohistochemistry studies confirmed the diagnosis of PBML. Conclusion: The patient is currently in good physical condition (regression of previous pulmonary symptoms) and scheduled for clinical follow-up. A new chest CT will be performed in 6 months.

Histologic-Proven Recurrence of Endometriosis after Previous Ablation Vs. Excision Surgery

<h3>Study Objective</h3> compare incidence of recurrence of endometriosis after previous ablation or excision surgery for endometriosis. <h3>Design</h3> retrospective study. <h3>Setting</h3> academic medical center. <h3>Patients or Participants</h3> all patients who underwent excision endometriosis surgery from January 2013 to December 2020 who had history of previous ablation or excision surgery for endometriosis either at study institution or outside institution. <h3>Interventions</h3> repeat excision surgery for endometriosis. <h3>Measurements and Main Results</h3> Of the 139 patients that met inclusion criteria, 47 had previous ablation and 92 had previous excision of endometriosis. Differences in baseline characteristics at time of repeat surgery between the two groups included age < 35 (59.6% vs. 41.3%, p=0.04), historical American Society of Reproductive Medicine (ASRM) stage of endometriosis (Stage 1-2: 76.6% vs. 43.5%; Stage 3-4: 23.4% vs. 54.3%, p<0.001), and history of previous hysterectomy (2.1% vs. 14.1%, p=0.026). Overall, 80.5% of patients were found to have histologic evidence of endometriosis on repeat surgery. For those without versus with recurrence, proportion of nulliparity (59.3% vs. 72.3%, p=.21), interval since prior surgery (mean months 42 vs. 41, p=0.07), number of surgeries for endometriosis prior to surgery of interest (mean 2.5 vs. 1.7, p=0.92), previous hysterectomy (7.4% vs. 10.7%, p=0.61) and postoperative hormonal suppression (63% vs. 56.2%, p=0.73) did not differ. Overall recurrence did not vary by type of previous surgery (82.9% ablation vs. 79.3% excision). However, for those with previous ASRM stage 1-2, recurrence incidence was higher if ablation was previously performed (84.8% vs. 63%, p=0.04). <h3>Conclusion</h3> Most women pursuing repeat surgery for endometriosis are found to have histologic evidence of endometriosis recurrence. Excision surgery has lower recurrence of endometriosis for patients with lower ASRM stage. Although possible that initial surgery undertreated pre-existing disease, these findings support excision surgery as the preferred surgical approach for treatment of endometriosis.

The Sonographic Sliding Sign: can it predict the need for open as opposed to minimally invasive surgery, a case report

: The “sliding sign” seen on transvaginal ultrasound (TVS) was originally described to pre-operatively identify adhesions in the pelvis. The absence of freely moving intestine in a whirlwind pattern is consistent with a “negative” sliding sign and increased risk of adhesions. We began using it in pregnant patients with previous cesarean section to see if this information could help alert obstetricians to the presence of dense adhesions to the myometrium, and therefore, guide better management of these patients during child birth. We also theorized that a search for a “sliding sign” trans-abdominally could help guide general surgeons enter the abdomen in patients who had previous abdominal surgery. A patient with a history of previous hysterectomy and oophorectomy who subsequently required colectomy underwent sonographic evaluation for the sliding sign and the absence of the “sliding sign” changed the scheduling of the operative approach from a laparoscopic right colectomy to an open approach. We believe that ultrasonographic evaluation for the “sliding sign” should become standard for all patients with a previous history of abdominal surgery who are being considered for a minimally invasive approach. As ultrasonographic robes with bluetooth capabilities that interface with smart phones become more affordable, it is felt that ultrasonographic examinations could become part of the standard physical exam done by abdominal surgeons.

Inappropriate pelvic floor muscle activation during forced exhalation and coughing in elderly female inpatients with urinary incontinence

BackgroundReduced pelvic floor muscle (PFM) contraction strength is a common condition in elderly female patients with urinary incontinence (UI). However, little data exist to demonstrate the importance of appropriate PFM activation during exhaling and coughing. ObjectivesTo analyse breathing and coughing patterns in elderly female inpatients with UI, and to assess PFM activation patterns during exhalation and coughing. DesignRetrospective chart data analysis. Patients and methodsData from 177 elderly female inpatients with UI were analysed to determine voluntary PFM contraction strength, as well as PFM activation and displacement of the pelvic floor (PF) and abdominal wall during forced exhalation and coughing. Clinical data were obtained by means of inspection and digital palpation in the course of a routine clinical UI assessment. Data collected were correlated with age, body mass index and number of childbirths, and categorised by predominant UI symptoms, history of previous hysterectomy and history of PFM training. ResultsIndependent of voluntary PFM contraction strength, nearly all patients (n=168) demonstrated bulging of the abdominal wall and PF during forced exhalation and coughing instead of contracting the PFMs and consequently lifting the PF, which would be in accordance with physiological breathing synergies. None of the nine women who reflexively contracted the PFM physiologically in accordance with an expiratory breathing pattern complained of symptoms of stress UI alone. ConclusionA high percentage of elderly females with UI do not activate their PFMs appropriately during forced exhalation and coughing, possibly contributing to or exacerbating UI.

Intravenous Leiomyoma with Intracardiac Extension: A Rare Late Presentation After Hysterectomy

Intravenous leiomyoma is a rare, benign smooth muscle tumor arising from intrauterine venules or the myometrium. It can rarely present as intracardiac mass long after hysterectomy. In this case report we describe a 40-year-old female with previous history of hysterectomy, presenting with an intracardiac mass which was successfully managed with single stage tumor resection under cardiopulmonary bypass. Subsequent histopathology showed features of leiomyoma. The diagnosis of intravenous leiomyoma with cardiac extension should be kept in a female patient presenting with intracardiac mass with previous history of myomectomy or hysterectomy.

Intensity-modulated Radiation Therapy (IMRT) May Reduce Diarrhea With Similar Treatment Efficacy Even In Japanese Treatment Strategy For Cervical Cancers

The RTOG 1203 trial showed that IMRT after hysterectomy could reduce acute radiation enteritis (ARE) compared to 3-dimensional conformal radiotherapy (3DCRT). However, it should be investigated whether IMRT could reduce ARE in radical radiotherapy for cervical cancers, considering the inter- and intra-fractional motions of the uterus (5-15 mm) and larger target volume. In Japan, treatment strategy for cervical cancers differs from that of other countries. The intestine is shielded during whole-pelvic irradiation (WPI) and brachytherapy starts earlier. Thus, even in 3DCRT, the ARE incidence can be lower than in other countries. We applied radical IMRT for cervical cancers using tomotherapy and investigated whether the IMRT protocol could reduce ARE and other toxicities. We reviewed patients with cervical cancers treated at 3 institutions that employed the same protocol. In the protocol, patients with UICC 8th stage IB-IVA cervical cancers received radical WPI ± paraaortic irradiation with 45-50.4 Gy delivered at a daily fraction of 1.8 Gy five times a week. Platinum-containing chemotherapy was delivered to ≥ stage III or tumors with ≥ 4 cm in the maximum diameter. After 20-30 Gy of WPI depending on the stage, the rectum, bladder and intestine were shielded and intracavitary brachytherapy (2-4 times at a point A dose of 5-6 Gy) was carried out. In IMRT, a block structure was contoured instead of the center shielding in 3DCRT. The block structure median dose was reduced to ≤ 0.9 Gy/fr. From 2007 to 2011, 3DCRT was used. From 2012, the IMRT protocol was introduced. We compared the IMRT and 3DCRT groups. All patients treated with the protocols were analyzed except patients with: 1) previous history of hysterectomy or radiotherapy and 2) small cell cancer. ARE was defined as the increase in stool of 4–6 times per day over the baseline. In total, 169 patients were treated according to the protocols. Of them, IMRT was delivered to 93 (median age, 63 years) and 3DCRT to 76 (61 years). Chemotherapy was administered to 73 in the IMRT group and 50 in the 3DCRT group (p = 0.08). Lymph node metastases were seen in 44 in the IMRT group and 26 in the 3DCRT group (p = 0.12). The 3-year overall survival and locoregional recurrence rates after IMRT were 84% and 17%, respectively. In the 3DCRT group, these rates were 70% and 20%, respectively. No difference was seen between the 2 groups (p > 0.2). ARE occurred less frequently in the IMRT group than in the 3DCRT group (17/93 vs 24/76, p < 0.05). Grade 3 toxicities were observed in 5 in the IMRT group (rectal bleeding 2, sigmoid colon stenosis 1, bladder tamponade 2) and in 3 in the 3DCRT group (rectal bleeding 1, small intestinal perforation 2) (p = 0.73). There was no ≥ grade 4 toxicity in both groups. Even in the Japanese treatment strategy for cervical cancers, use of IMRT may reduce ARE with similar treatment efficacy.

Predictors of successful ring pessary use in women with pelvic organ prolapse.

Pelvic organ prolapse (POP) is a common chronic health issue. Pessary rings are used for conservative management. To date, there is little evidence on objective anatomical findings as predictors of successful ring pessary management. To determine any association between history, clinical and four-dimensional translabial ultrasound (TLUS)/pelvic floor ultrasound examination and pessary success. From November 2013 to November 1015, all new patients presenting with symptomatic prolapse to a tertiary urogynaecological unit underwent an assessment including interview, clinical examination, that is, International Continence Society POPQ (pelvic organ prolapse quantification) and TLUS. Women with symptomatic prolapse were offered conservative management with a ring pessary. Those who agreed had a ring inserted that day. Successful trial of pessary use was defined as continued use for at least threemonths. Retrospective analysis of imaging data was performed blinded to other data. Statistical analysis was performed to assess the relationship between history, examination and imaging and pessary success. Of 525 patients seen during the inclusion period, 177 had symptomatic prolapse. One hundred and twenty-eight were offered a pessary, 89 accepted. Five had incomplete data, leaving 84. Forty- Two(50%) werestill using the pessary at athree-month follow-up. Predictors associated with failure included being pre-menopausal (P=0.031), a previous hysterectomy (P=0.051), increasing genital hiatus and perineal body (Gh+Pb) (P=0.013), posterior compartment prolapse(P=0.027) and a larger hiatal area on Valsalva on TLUS (P=0.049). Pre-menopausal status (P=0.003), increasing Gh+Pb (P=0.011) and previous hysterectomy (P=0.001) remained significant on multivariate analysis. A history of previous hysterectomy is a predictor of pessary failure as are Gh+Pbon Valsalvaand premenopausal status.

Integrated cervical cancer screening in Mayuge District Uganda (ASPIRE Mayuge): a pragmatic sequential cluster randomized trial protocol

BackgroundCervical cancer is almost entirely preventable through vaccination and screening, yet remains one of the ‘gravest threats to women’s lives’ according to the World Health Organization. Specific high-risk subtypes of human papillomavirus (HR-HPV) are well-established as the primary cause of cervical cancer. Uganda has one of the highest cervical cancer incidence rates in the world (54.8 per 100,000) as a result of limited screening access and infrastructure. The integration of a self-collected cervical cancer screening program using HPV testing within existing community-based primary health care services could increase access to screening and reduce cervical cancer rates among Ugandan women.MethodsUsing a pragmatic, sequential, cluster randomized trial design; we will compare the effectiveness of two cervical cancer screening models for self-collected HPV testing: 1) community health worker recruitment (door-to-door); and 2) community health meetings. In Mayuge district, Uganda, 31 villages are randomized to one of two treatment arms. Due to the nature of this trial, blinding is not possible. Women are eligible to participate if they have no previous history of hysterectomy or treatment for cervical cancer or pre-cancer and are aged 25–49 years old. All participants receive an integrated package of cervical cancer screening and education. Samples are tested for HPV using GeneXpert point of care testing. All women who test positive for HR-HPV types are referred to a designated health centre for follow-up inspection by Visual Inspection with Acetic acid (VIA) and treatment with thermal ablation. The primary outcome for the trial is the number of women who attend follow-up for VIA screening at a designated Health Centre after a positive HR-HPV test out of all women screened per arm. Secondary outcomes include: cervical cancer screening knowledge; patient-reported experience measures for self-collected cervical cancer screening; and HPV incidence.DiscussionResults from this study will inform the national scale-up of cervical cancer screening in Uganda, aligning with the World Health Organization’s target of achieving cervical cancer elimination through the pillar of increased HPV screening coverage.Trial registrationISRCTN, ISRCTN12767014. Registered 14 May 2019, https://doi.org/10.1186/ISRCTN12767014;clinicaltrials.gov, NCT04000503; Registered 27 June 2019, https://clinicaltrials.gov/ct2/show/NCT04000503Protocol versionJanuary 8, 2020, version 1.

Primary vaginal malignancies: a single oncology centre experience

Primary vaginal malignancies constitute a rare entity. The aim of this study was to review all primary vaginal malignancies diagnosed in an oncologic referral centre over 11 years. A total of 35 cases were retrospectively analysed, including clinical and MRI features. Squamous cell carcinoma (SCC) was the most frequent histologic subtype (77.1%), followed by adenocarcinoma (14.3%). There was no statistically significant difference for the mean age at diagnosis or for the mean largest diameter of the tumour. Most SCCs (95%) were homogeneous on T2-weighted imaging, while all adenocarcinomas were heterogeneous (p = .0001). Concerning location, both SCCs (59.3%) and adenocarcinomas (80%) occurred more often on the upper third. However, regarding the wall of origin, all adenocarcinomas originated on the anterior vaginal wall (p = .0002), while SCCs (62.5%) had a predisposition for the posterior wall (p = .017). Regarding the history of previous hysterectomy, in the SCC group, 73.3% of patients with previous hysterectomies had cervical dysplasia (p = .018).Impact statementWhat is already known on this subject? MRI plays an important role in the initial approach of primary vaginal malignancies. In previous studies, it is said that SCCs usually appear homogeneous on T2WI, with the intermediate-high signal, while adenocarcinomas are often homogeneously hyperintense. Regarding location, it is known that SCCs usually arise from the posterior wall of the upper third, while adenocarcinomas often originate on the anterior wall of the proximal third.What do the results of this study add? In this study, we found that all of our cases of adenocarcinomas were heterogeneous on T2WI, with high-signal intensity areas, while SCCs were predominantly homogeneous, and this association was statistically significant. We could also confirm the data in the literature regarding the most common location of these tumours. This study also showed an association between vaginal SCC and a previous hysterectomy with cervical dysplasia.What are the implications of these findings for clinical practice and/or further research? The histologic type of vaginal malignancy has clinical and management impact. Although MRI is usually performed after histologic characterisation, this is not always the case. We think that this study can constitute a starting point to better understand the MRI features of these rare tumours. Although this technique will obviously never preclude histologic characterisation, it may provide some initial hint on the type of tumour and its aggressiveness.

Assessment of Uterine Abnormalities by Sonography

A uterine malformation is a type of female genital malformation resulting from an abnormal development of the Mullerian duct(s) during embryogenesis. Symptoms range from amenorrhea, infertility, recurrent pregnancy loss, and pain, to normal functioning depending on the nature of the defect.Study was conducted for about the 12 month. In this duration the subjects between the age group of 18-48 years females were studied. The patients with pregnancy and having previous history of Hysterectomy was not considered for the study. Sampling technique adapted for the study as Complete Enumeration Method, Ultrasonography images are collected from radiology department, these images evaluated and subjected to statistical data analysis and results were analysed.From the data in the 10 females congenital abnormalities were observed. In 5 females Arcuate uteri was seen. Bicornuate was seen in 3 Female and Agenesis is observed in 2 Females. When examining the various types of a uterine anomaly, the most common finding was bicornuate uterus; the second most common was septate uterus. In current study most common uterine abnormality is arcuate uterus. Keywords: Uterine Abnormalities, Mullerian agenesis, Sonographic, Assessment.

GIST or Not - A Unique Case of Low Grade Endometrial Stromal Sarcoma with Review of Literature

Endometrial stromal sarcoma (ESS) is a mesenchymal neoplasm that usually occurs as a primary tumor of the uterine corpus, but rarely arises in other sites, such as the ovary, pelvic cavity, mesentery, omentum and intestine. Endometrial stromal sarcoma is a malignant subtype of endometrial stromal tumor arising from the stroma (connective tissue) of the endometrium rather than the glands. There are three grades for endometrial stromal tumors. All the cases yet reported in literature had a history of previous hysterectomy with or without a diagnosis of ESS. Here we present a unique case of Low grade ESS where the patient presented with vague abdominal pain, loss of weight and anemia. On evaluation with USG and CT demonstrated a lobulated mass in mesentery which led to the diagnosis of a GIST from small bowel. Intraoperatively the lesion was in omentum with no attachment to mesentery. The enlarged uterus with fibroids were also removed along with the omental mass after a clinicopathological discussion which suggested the possibility of ESS with primary in the uterus. The histopathology demonstrated Low grade Endometrial sarcoma which was supported by immunohistochemistry

The effect of hysterectomy on colonoscopy completion: a systematic review and meta-analysis.

The primary aim of colonoscopy is a complete and thorough examination of the colon. There are a number of factors, however, that can potentially increase the difficulty of completing a colonoscopy. A significant proportion of women eligible for colorectal cancer screening have undergone hysterectomy. A history of hysterectomy is frequently considered to make colonoscopy more difficult, although there is no consensus in the literature. The aim of this study is to assess the effect of hysterectomy on colonoscopy completion. A systematic search of PubMed, Embase, and the Cochrane database identified 6 eligible studies. Studies that compared colonoscopy completion rates in women with a previous history of hysterectomy and women with no history of pelvic surgery were selected for review. Meta-analysis was performed by using random-effects methods. The primary outcome used was colonoscopy completion rate. The outcomes were calculated as odds ratio with 95% CI. A total of 5947 patients were included in the final analysis. The average hysterectomy rate was 26.3% ± 14.5%. The colonoscopy completion rate was significantly reduced in patients with a history of hysterectomy compared with those with no history of pelvic surgery (87.1% vs 95.5%) (OR, 0.28; 95% CI, 0.16-0.49; p < 0.001). Analysis of the funnel plot demonstrated nonsignificant across-study publication bias. There was significant across-study heterogeneity (Cochran Q, 19.6; p = 0.002). The endoscopist's experience is poorly defined in some studies. Indication for colonoscopy was not provided in all cases. There is significant across-study heterogeneity. Colonoscopy completion rates appear decreased in women with a history of hysterectomy, but the available literature is heterogenous. Further studies in this area are warranted.

Prevalence of pelvic organ prolapse and related factors in a general female population.

Objective:The aim of this study was to assess the prevalence and the related factors of pelvic organ prolapse (POP) in a female population to whom health care services are offered.Materials and Methods:1354 of the 3000 women admitted to the outpatient clinic between June 2008 and December 2008 were enrolled as they accepted to participate to the study. 34 of these patients with a history of previous hysterectomy and/or any kind of pelvic reconstructive surgery were excluded. Baseline characteristics, as well as medical and obstetric history of the patients were recorded. All women underwent vaginal examination to determine the degree of prolapse by pelvic organ prolapse quantification (POPQ) system. POP-Q stages ≥2 were defined as prolapse. Women with and without prolapse were compared. Regression analysis was used in order to determine the independent predictors.Results:Prolapse (stage ≥2) was detected in 358 patients (27.1%). Patients with prolapse were found to be significantly older and heavier. They had a higher waist to hip ratio and had a higher parity. Compared to women without prolapse, cesarean rate was significantly lower in women with prolapse (10.6% vs. 20.8%; p<0.001), and the mean birth weight of the babies of the women with prolapse was significantly higher (3584±574 vs. 3490±389 g, p=0.004). Prevalence of prolapse was found to be decreased as the level of education increased. Waist to hip ratio (OR:46.2, CI: 3.3-655, p=0.005), parity (OR:1.5, CI:1.3-1.7, p<0.001), vaginal delivery (OR:1.5, CI: 0.3-0.8, p=0.005), and menopausal status (OR:1.2, CI: 1.1-1.4, p=0.005) were found to be independent predictors of development of POP.Conclusion:In the present study, POP was found to be associated with waist to hip ratio, parity, vaginal delivery, and menopausal status.

Five-year outcome of concurrent radiotherapy and chemotherapy in Saudi women with locally advanced cervical cancer: single-institution experience

BACKGROUND AND OBJECTIVESWe aimed to evaluate long-term treatment outcomes and toxicity profile of combined radiotherapy and chemotherapy in Saudi women with locally advanced cervical cancer.DESIGN AND SETTINGSRetrospective study in a tertiary care cancer center in Riyadh, Saudi Arabia.METHODS AND MATERIALSThe medical records of patients with histopathologically proven, locally advanced cervical cancer were analyzed. These patients received three-dimensional conformal radiotherapy with concurrent chemotherapy followed by high dose rate brachytherapy in our center between July 2007 and April 2012. The data regarding the safety profile, response rates, occurrence of locoregional or distant failure, disease-free survival, and overall survival rates were recorded.RESULTSThe median follow-up period was 60 months (range, 8–66) for 74 patients. The median age of study population was 52.3 years (32–78), and the stage IIB was the predominant stage (49 patients [66.2%]). A total of 45 patients (60.9%) had radiologic-positive pelvic ± para-aortic lymphadenopathy. The 5-year locoregional and distant control rates were 84.3% and 78.5%, respectively. The 5-year disease-free and overall survival rates were 75.7% and 64.5%, respectively. Stage, nodal status, and hemoglobin levels were found to be important prognostic factors for locoregional and distant control. Acute grade 3 hematological and nonhematological toxicities were seen in 4 (5.4%) and 4 (5.4%) patients. Late toxicities were mild, and only 1 (1.4%) patient presented with subacute intestinal obstruction.CONCLUSIONConcurrent chemoradiation in Saudi women with locally advanced cervical cancer showed better locoregional and distant control and survival rates with minimal toxicity.

Age-of-onset of menopause is associated with enhanced painful and non-painful sensitivity in fibromyalgia

Fibromyalgia (FM) is a chronic pain condition characterized by high prevalence in women. In particular, estrogen deficit has been considered as a potentially promoting factor of FM symptoms. This study was aimed to examine the relationship between age-of-onset of menopause and pain sensitivity in FM. For this purpose, pain sensitivity was assessed in 74 FM and 32 pain-free control women. All participants were postmenopausal and underwent a detailed semi-structured clinical interview, including data about menopause transition, previous history of hysterectomy or ovariectomy, and menses time. Participants were divided into two groups depending on age-of-onset of menopause: early menopause [≤49 years] vs. late menopause [>49 years]. Pain and non-pain thresholds were assessed by using cold, heat, mechanical, and electrical stimulation. FM women showed higher overall pain sensitivity as compared with healthy subjects. FM women with early age-of-onset of menopause displayed greater pain and non-pain sensitivity than FM women with late age-of-onset of menopause, whereas no differences were observed in healthy women due to age-of-onset of menopause. These results suggest that an early transition to menopause (shortening the time of exposure to estrogens) may influence pain hypersensitivity and could be related to aggravation of FM symptoms.

Acute abdomen by gossypiboma

Retained foreign bodies after surgery is a quite rare condition, which can have medico-legal consequences. Foreign bodies forgotten in the abdomen include towels, artery forceps, pieces of broken instruments or irrigation sets, and rubber tubes. The most common surgically retained foreign body is the laparotomy sponge. Such materials cause foreign body reaction in the surrounding tissue. The complications caused by these foreign bodies are well known, but cases are rarely published because of medico-legal implications. We report a case of 41-year-old female who was admitted with complaints of intestinal obstruction who had a previous history of hysterectomy performed 2 months back, at another hospital. Pathologists must be aware of this entity and its proper reporting, as the cases are liable to go to court. Surgeons must recognize the risk factors that lead to a gossypiboma and take measures to prevent it.

Safety of Trans Vaginal Mesh procedure: Retrospective study of 684 patients

To study peri-surgical complications after cure of genital prolapse by vaginal route using interposition of synthetic prostheses Gynemesh Prolene Soft (Gynecare) following the Trans Vaginal Mesh (TVM) technique. The present retrospective multicentered study comprised 684 patients who underwent surgery at seven French centers between October 2002 and December 2004. All patients had a genital prolapse >or=3 (C3/H3/E3/R3) according to International continence society (ICS) classification. According to each case, prosthetic interposition was total, or anterior only or posterior only. Patients were systematically seen 6 weeks, 3 months and 6 months after surgery. Multivaried statistical analysis followed a model of logistic regression applied to each post-surgical complication. The mean age of patients was 63.5 years (30-94). The mean follow-up period was 3.6 months. 84.3% of patients were post-menopause, 24.3% had hysterectomy, 16.7% previous cure of prolapse, and 11.1% cure of stress urinary incontinence (SUI). During the procedure, hysterectomy was combined in 50.3% of cases, cervix amputation in 1.5%, and cure of SUI in 40.9%. 15.8% were treated for a cystocele only. 14.8% had only a rectocele +/- elytrocele and 69.4% had a prolapse touching both compartments, anterior and posterior. In peri-surgical complications, (2%) were five bladder wounds (0.7%), one rectal wound (0.15%) and seven hemorrhages greater that 200 mL (1%). Among early post-surgical complications (during the first month after surgery) (2.8%) were two pelvic abscesses (0.29%), 13 pelvic hematomas (1.9%), one pelvic cellulitis (0.15%), two vesicovaginal fistulas and one rectovaginal fistula (0.15%). Among late post-surgical complications (33.6%) there were 77 granulomas or prosthetic expositions (11.3% [6.7% in the vaginal anterior wall, 2.1% in the vaginal posterior wall and 4.8% in the fornix]), 80 prosthetic retractions (11.7%), 36 relapse of prolapse (6.9%) and 37 SUI de novo (5.4%). Multivaried analysis shows that previous history of hysterectomy or placing of an isolated anterior prosthesis increase the risk of peri-surgical complication; preserved uterus and isolated posterior prosthesis lessen the risk of granulomas and prosthetic retractions; and association of a Richter's intervention increases the rate of prosthetic retractions. Cure of genital prolapse with synthetic prostheses interposed by vaginal route is now reliable and can be reproduced with a low rate of peri- and early post-surgical complications. However, our study shows a certain number of late post-surgical complications after insertion of strengthening synthetic vaginal implants (prosthetic expositions and prosthetic retractions). These retrospective results will soon be compared to a prospective study.

Five-year compliance with hormone replacement therapy in postmenopausal Chinese women in Hong Kong

Objectives: To assess 5-year compliance with hormone replacement therapy (HRT) in Hong Kong Chinese women and the reasons for long-term compliance or non-compliance. Methods: A telephone survey using a standardized questionnaire was conducted in 187 postmenopausal women who had commenced HRT in a referral-only specialist clinic of a university teaching hospital 5 years previously. Over this 5-year period, the cohort had been referred out to primary care doctors once they had become stabilized on treatment. Results: The 5-year compliance rate was 71.1%. The overall compliance rates were nearly the same from 2 and 5 years. ‘Doctors’ advice’ was the most important reason for maintenance of long-term compliance, accounting for 88.0% of all compliant cases. The most frequent reason for non-compliance was that of the experience of side effects. Other important reasons were fear of cancer, fear of other side effects, and discouragement from other doctors. Overall, 16.0% of women expressed concern regarding potential side effects or risk of breast cancer. Younger age at menopause and at time of initial consultation, shorter duration of menopause at presentation and previous history of hysterectomy were associated with a higher degree of compliance at 5 years. Presence or absence of menopausal symptoms, on the other hand, was not a significant factor. Conclusions: The 5-year compliance rate in this cohort of Hong Kong Chinese women was comparable to that reported from predominantly Caucasian populations. The physicians’ role in encouraging postmenopausal women to achieve long-term HRT compliance was observed.

Coronary vasomotor reactivity among normotensive african and white american subjects with chest pain

Excess cardiovascular morbidity and mortality among African (black) Americans is the subject of intensive investigation but the etiology remains speculative. One hypothesis proposes that inherent, or intrinsic, differences in coronary vascular reactivity and endothelial function predispose African Americans to enhanced vasoconstriction and/or depressed vasodilation, resulting in excess ischemia. The objective of this study was to establish whether coronary vasoreactivity differs among normotensive, nondiabetic African and white Americans with normal arteries referred for coronary arteriography because of chest pain. Eleven African American (8 female, 3 male) and 28 white American (9 female, 19 male) normotensive, euglycemic patients with normal coronary arteries were prospectively recruited for invasive testing of coronary artery and microvascular relaxation using the endothelium-dependent and -independent agents, acetylcholine and adenosine; a Doppler tipped intracoronary guidewire; and quantitative coronary angiography. The study cohort consisted of 17 women (44%) and 22 men (56%) with a mean age of 46 +/- 10 yrs. Of 8 African American women, 6 were premenopausal and 2 were postmenopausal on estrogen replacement therapy. Of 9 white American women, 2 were premenopausal, 1 was 46-year old with a previous history of hysterectomy without ovariectomy, 2 were postmenopausal on estrogen replacement therapy, 2 were perimenopausal and 44- and 54-year old, and 2 were postmenopausal without estrogen replacement therapy. In response to maximal infusion of acetylcholine, epicardial coronary arteries and resistance vessels dilated similarly in black and white subjects. Dose-response curves revealed no significant racial differences during submaximal graded infusion of acetylcholine. In response to peak effect of adenosine, there were no racial differences in dilation of the microcirculation. In the absence of hypertension, diabetes mellitus, and angiographic evidence of coronary artery disease, African American women demonstrate no evidence of intrinsic predisposition to enhanced coronary conduit vasoconstriction or depressed microcirculatory dilation in response to the endothelium-dependent and -independent vasodilator agonists-acetylcholine and adenosine-when compared with responses of similar white men and women. Because of low enrollment of black males, definitive conclusions cannot be drawn regarding this group.