Nongynecologic Diseases Research Articles

The Comorbidity of Endometriosis and Systemic Lupus Erythematosus: A Systematic Review.

Autoimmune diseases manifest in genetically predisposed individuals exposed to certain triggers that aggravate immune dysfunction and result in an exacerbated immune response in the form of hyperactivity to both the humoral and cell-mediated response. The devastating reality apart from the severity of the disease is that multiple immune diseases could co-occur, increasing the patient's physical, psychological, and financial burden. Autoimmune diseases are utterly deranging. One of the dreadful autoimmune diseases is systemic lupus erythematosus (SLE). SLE is a rheumatological disease that affects multiple systems, and there are no predictors to know which system will be affected in the future. It could affect the mucocutaneous system. It could also present with hematological, rheumatological, neuronal, renal, pulmonary, and cardiac manifestations. SLE is prevalent in females, predominantly in the childbearing age group. The pharmacological therapy and bombarding pathophysiology of the disease lead to obstetrical and gynecological complications such as infertility, abortion, miscarriage, and stillbirth. Over the past decade, the autoimmune disease comorbidity increased eminently. One of the common associations is rheumatological diseases (like rheumatoid arthritis, Sjogren syndrome, and SLE) with gynecological diseases (e.g., endometriosis and uterine fibroids). SLE and endometriosis have strong associations, and the prevalence of each condition is relatively high among the female population. Endometriosisis a chronic disease triggered by inflammation, hormonal milieu, and other predisposing factors that lead to the fibrous tissue that lines the uterus (endometrial tissue) to be implanted at sites other than the uterus, commonly in the peritoneum and mesentery.The pathogenesis of this association remains unexplained. The approved theory is that their immune dysfunction is summarized by the elevated humoral and cell-mediated response, which leads to an attack to the epithelium, mesothelium, and Serosa and leads to fibrous tissue deposition in different sites other than the uterus. Statistical evaluations have shown a remarkable association between autoimmune diseases and both gynecological and nongynecological diseases.

Increased overall morbidity in women with endometriosis: a population-based follow-up study until age 50

To investigate whether there is an association between endometriosis and nongynecological diseases in the general female population by age 50? A prospective cohort study. Study participants with and without endometriosis were identified from a general population-based birth cohort. The analyzed data, linking to the national hospital discharge registers, spanned up to the age of 50 years. Endometriosis case identification was based on national register data and self-reported diagnoses, producing a study population of 349 women with endometriosis and 3,499 women without endometriosis. International Classification of Diseases diagnosis codes from 1968 to 2016 were accumulated from the Finnish national Care Register for Health Care, whereas self-reported symptoms and continuous medication usage data were collected from the questionnaires distributed at age 46. The associations between endometriosis and comorbidities wereassessed using logistic regression models that included several covariates. The odds ratios and 95% confidence intervals (CIs) were modeled. Endometriosis subtype and temporal analyses were also performed. Women with endometriosis were on average twice as likely to have hospital-based nongynecological diagnoses as women without endometriosis (adjusted odds ratio [aOR] 2.32; 95% CI, 1.07-5.02). In more detail, endometriosis was associated with allergies, infectious diseases, pain-causing diseases, and respiratory diseases. Moreover, the affected women presented with nonspecific symptoms and signs (aOR 3.56; 95% CI, 2.73-4.64), especially abdominal and pelvic pain (aOR 4.33; 95% CI, 3.13-4.76) more often compared with nonendometriosis controls. The temporal analysis revealed that diagnoses accumulated at a significantly younger age among women with endometriosis than in nonendometriosis counterparts. Women with endometriosis have a high risk for several chronic diseases compared with women without endometriosis, underlying the need for awareness and targeted resources for these women in the health care system. Moreover, endometriosis should be considered in the presence of nonspecific symptoms and abdominal pain, as they may conceal the disease and cause considerable delay in diagnosis and treatment.

Extragenital Endometriosis in the Differential Diagnosis of Non- Gynecological Diseases.

Endometriosis is a chronic, benign disease that affects approximately 10% of women of childbearing age. Its characteristic clinical features are dysmenorrhea, dyschezia, dysuria, dyspareunia, and infertility. The manifestations of extragenital endometriosis (EE) are a diagnostic challenge, as this disease can mimic other diseases due to its unusual location with infiltration of various organs and corresponding symptoms. This review is based on publications retrieved by a selective search of the literature on the commonest extragenital sites of endometriosis, including the relevant current guideline. Current evidence on the treatment of extragenital endometriosis consists largely of cohort studies and cross-sectional studies. The treatment is either surgical and/or conservative (e.g., hormonal therapy). Gastrointestinal endometriosis is the most common form of EE, affecting the rectum and sigmoid colon in nearly 90% of cases and typically presenting with dyschezia. Urogenital endometriosis is the second most common form of EE. It affects the bladder in more than 85% of cases and may present with dysuria, hematuria, or irritable bladder syndrome. The diaphragm is the most common site of thoracic endometri - osis, potentially presenting with period-associated shoulder pain or catamenial pneumothorax. Endometriosis affecting a nerve often presents with sciatica. In abdominal wall endometriosis, painful nodules arise in scars from prior abdominal surgery. There is, as yet, no causally directed treatment for chronic endometriosis. The treatment is decided upon individually in discussion with the patient, in consideration of risk factors and after assessment of the benefits and risks. Timely diagnosis is essential.

Folate contraception and clinical practice

Since the first pill, there has been a significant evolution of hormonal contraception: low- and micro-dose drugs have appeared, drugs with components as close as possible to endogenous hormones have been developed, new dosage regimens and routes of contraceptive administration have been created. Modern combined oral contraceptives are not only used to prevent unwanted pregnancies, but are also widely used to treat a number of gynecological and non-gynecological diseases. In recent years, two new combined oral contraceptives with folate supplementation have been developed. The main purpose of adding folate to contraceptives is the prevention of fetal malformations, which is ensured by an increase in the level of folate in the body of women of reproductive age against the background of contraception and after its withdrawal.

Incidence of complications after laparoscopic and hysteroscopic surgeries for uterine myomas

Aim: to assess the incidence of complications after laparoscopic and hysteroscopic myomectomy.Materials and methods. The results of 378 laparoscopic and 292 hysteroscopic surgeries for uterine fibroids (myomas) have been retrospectively analyzed. All patients were examined for their history of gynecological and concomitant non-gynecological diseases, past surgeries, and the menstrual, sexual and reproductive functions. The patients underwent clinical blood analysis, urinalysis, electrocardiography and chest X-ray test, blood group and rhesus factor determination, hemostasis assay, blood analysis for RV, HIV and tumor markers, as well as transabdominal and transvaginal ultrasound using SSD-1200 and SSD-2000 devices (Aloka Ltd, Japan). We characterized the patients by the type of surgical intervention (laparoscopic or hysteroscopic), and also by age, indications for surgery, the number of fibroids and their locations, size of the uterus, presence of extragenital and genital disorders, and also by the surgery techniques. The post-surgery complication incidence rate was calculated and expressed as percentage (%), arithmetic mean (M), and standard error of the mean (m).Results. The overall incidence of severe postoperative complications did not differ between laparoscopic (2.7 ± 0.8 %) and hysteroscopic (2.1 ± 0.8 %) operations for uterine myomas (p > 0.05). The incidence of complications was significantly higher in women operated by laparoscopy if they underwent simultaneous operations (12.3 ± 4.0 % vs. 0.6 ± 0.4 % for non-simultaneous operations), if the number of fibroids was > 4 (3.9 ± 1.4 % vs. 1.1 ± 0.8 % in those with < 4 fibroids), in the presence of anemia (8.2 ± 2.9 % vs. 1.0 ± 0.6 % in cases with no anemia), and in patients with menstruation disorders (4.9 ± 1.8 % vs. 1.3 ± 0.7 % with normal menstruation). The operated patients significantly differed by the number of uterine fibroids: the average number of fibroids was larger in those operated laparoscopically (2.9 ± 0.05 vs. 2.3 ± 0.04; p < 0.01); the proportion of patients with 4 or more fibroids was also significantly higher in those patients (53.7 ± 2.6 % vs. 30.1 ± 2.7 %; p < 0.001). The compared groups also differed in the location of their myomas.Conclusion. The risk of postoperative complications after laparoscopic surgery is relatively high if simultaneous operations take place, if the number of fibroids is ³ 4, and in the presence of anemia or menstruation disorder.

Comorbidity of gynecological and non-gynecological diseases with adenomyosis and endometriosis.

ObjectiveAdenomyosis and endometriosis are relatively common gynecological diseases that exhibit many common features. This study identified gynecological and non-gynecological diseases that exhibited comorbidity with adenomyosis and endometriosis in Korean women.MethodsWe used Health Insurance Review and Assessment data from 2009 to 2011 and searched for adenomyosis and endometriosis (coded as N80.1 and D25 in International Classification of Disease, 10th revision [ICD-10], respectively). We selected records from patients who had independent disease occurrences in each year, and comorbidities were estimated using Fisher's exact test. We computed each year's similarities and combined 3 years' results using Fisher's P-value summation method.ResultsA total of 61,516 patients' data were collected during the study period. The prevalence of adenomyosis and endometriosis were similar each year: 12.4% and 9.3% in 2009, 12.5% and 9.4% in 2010 and 13.3% and 9.1% in 2011, respectively. Meta-analysis revealed that 31 ICD-10 codes were significantly related with adenomyosis, and 44 ICD-10 codes were related with endometriosis. Gynecological diseases, such as leiomyoma and benign ovarian tumor, were significantly related to adenomyosis and endometriosis. Non-gynecological diseases, such as anemia and hypercholesterolemia, were also related to adenomyosis and endometriosis.ConclusionWe must monitor for the presence of gynecological and non-gynecological diseases with co-morbidities during evaluations and follow-up of patients with adenomyosis or endometriosis.

CA 125 Elevation: A Descriptive Etiological Study

Introduction: CA 125 (Cancer/Carbohydrate antigen 125) is a surface antigen expressed mostly by the ovarian cancer cells. Hence, it is widely used as a tumour marker for detection and monitoring the progression of such cancers. CA 125 is also expressed by cells of different tissues such as pleura, pericardium, Mullerian epithelium, peritoneum etc. Objective: To identify the different causes leading to elevation of CA 125 and to estimate the elevation of CA 125 in ovarian and non-ovarian causes. Materials and Methods: A total of 1800 patients testing for CA 125 during the time period January 2011 to December 2013in Kasturba Medical College constituent hospitals, Mangalore were screened. Out of these, OPD patients and in-patients with CA 125 1000 U/mL). To find association of CA 125 with age, patients were stratified into 3 groups based on their age as Group A (15- 35 years), Group B (36-55 years) and Group C (≥ 56 years).Parameters like age, BP, hemoglobin, CA 125,renal profile and diagnosis of all the patients were evaluated. Results: Out of 236 patients 54.7% were suffering from malignant ovarian diseases, 31.3% benign ovarian disease, 12% non-gynecological diseases and 2% from gynecological diseases of non-ovarian origin. Mean age for malignancies was 55 ± 10.6 years for benign diseases was 34±12.7 years. Incidence of malignancy among the 4 groups (based on CA 125 level) was 34.4%, 48.8%, 68.7% and 91.6% respectively. Increase in both age and CA 125 levels was highly significant in patients suffering from ovarian malignancies when compared to those with benign ovarian diseases (p<0.001).Difference in CA 125 levels was also statistically significant between malignant and non gynaecological disorders and between benign ovarian and non gynaecological disorders as well (p<0.001). Conclusion: In spite of higher levels of CA 125 in ovarian carcinoma cases compared to other diagnosis in our data, results confirm the high false positive rate and non-specificity associated with CA 125 as a biomarker as it was seen to increase in numerous other diseases.

Nongynecologic Findings on Pelvic Ultrasound

Ultrasound (US) is considered the first-line imaging modality of choice in women presenting with pelvic complaints. Although imaging is focused on detecting abnormalities of the uterus and adnexa, occasionally nongynecologic findings are detected, which may or may not explain the patient's symptoms. Many of these findings are related to the gastrointestinal (GI) tract. Although most of these GI abnormalities are better diagnosed with computed tomography (CT), symptoms are often nonspecific and US may be the first imaging modality requested by referring clinicians. Sonographers should be aware of the possibility of nongynecologic diseases in patients with pelvic symptoms, particularly if US evaluation of the female reproductive tract does not provide an answer to the clinical question. Careful attention to the bowel when performing a pelvic US may allow the sonographer to diagnose GI pelvic diseases such as appendicitis, diverticulitis, colitis, bowel obstruction, mesenteric adenitis, epiploic appendagitis, Crohn disease, and even GI malignancy. As concerns grow regarding the radiation dose of pelvic CT, the use of iodinated contrast material, and imaging costs, US examination may be increasingly requested as an initial imaging study in patients in whom GI diseases is primarily suspected in the pelvis, and familiarity with the various sonographic manifestations will aid considerably in establishing the correct diagnosis.

Diagnostic performances of HE4 and CA125 for the detection of ovarian cancer from patients with various gynecologic and non-gynecologic diseases

Objectives We compared diagnostic performance of CA125 and HE4 in various gynecologic and non-gynecologic diseases. Design and methods Sera from 176 patients with various diseases were collected, and CA125 and HE4 levels were compared. ROC curves were constructed to estimate the diagnostic performance. Results Levels of both markers were elevated in ovarian cancer. CA125 was also high in benign gynecologic diseases, but HE4 was not. CA125 levels of pregnant women were higher than those of control group, and HE4 was increased in chronic renal diseases. The sensitivity for discriminating ovarian cancer from healthy or benign conditions was 44.8% for HE4 and 55.2% for CA125 at 95% specificity. The ROC-AUC values for HE4 and CA125 were 0.85 and 0.87 respectively. Conclusions HE4 demonstrated comparable diagnostic performances to CA125, though each marker had its own strengths and weaknesses. Combining CA125 and HE4 might be more advantageous than either one alone.

Effect of Antibiotics on Vulvovaginal Candidiasis: A MetroNet Study

Vulvovaginal candidiasis (VVC) is believed common after systemic antibiotic therapy, yet few studies demonstrate this association. In this pilot study, we evaluate the effect of short-course oral antibiotic use on VVC. Nonpregnant women aged 18 to 64 years who required >or=3 days oral antibiotics for nongynecological diseases were recruited from a family medicine office. Age-matched (+/-5 years) women seen in the same clinic for noninfectious problems were recruited as controls. The main outcomes are incidence of symptomatic VVC and prevalence of positive vaginal Candida culture 4 to 6 weeks after antibiotics. Eighty (44 in antibiotic group) women were recruited; 14 of 79 (95% CI, 0.11-0.28) had asymptomatic vaginal Candida cultures positive at baseline. During follow-up, 10 of 27 (95% CI, 0.22-0.56) women in antibiotic group were Candida culture positive. In contrast, 3 of 27 (95% CI, 0.04-0.28) women in the control group were Candida culture positive (relative risk, 3.33; P = .03). Meanwhile, 6 of 27 (95% CI, 0.11-0.41) women in antibiotic group developed symptomatic VVC whereas none (95% CI, 0-0.12) of the women in the control group developed vaginal symptoms (relative risk, infinity; P = .02). Baseline Candida culture did not predict subsequent symptomatic VVC after antibiotics. In this pilot study, the use of short courses of oral antibiotics seems to increase prevalence of asymptomatic vaginal Candida colonization and incidence of symptomatic VVC. Larger cohort studies are needed to confirm these findings.

Prevalence and histologic diagnosis of adnexal cysts in postmenopausal women: An autopsy study

The purpose of this autopsy study was to examine the prevalence and histologic condition of adnexal cysts in postmenopausal women. Adnexa of 234 postmenopausal women who had died from nongynecologic diseases were examined by the team pathologist. Ovarian cysts were found in 36 of the women (15.4%). Nine women (3.8%) had ovarian cysts with a diameter between 20 and < or =50 mm; 4 women (1.7%) had cysts that were >50 mm in diameter. Four women had bilateral ovarian cysts. Paraovarian cysts were found in 11 women (4.7%). All cysts were benign, except for 1 woman, who had bilateral serous cystadenoma of borderline type. Macroscopically, the borderline cysts were multilocular with mean diameters of 60 mm and 15 mm, respectively. Because of the high prevalence of benign adnexal cysts, the identification of small unilocular cysts in postmenopausal women should be regarded as a normal finding.

Chronic pelvic pain in females and obscure hernias

Chronic pelvic pain is a very common condition in the female population of the United States. Some authors suggest that this entity prompts up to one-third of all outpatient gynecological visits [Kloch 1995]. Heretofore, chronic pelvic pain has been associated with female genital tract disease; however, recent observations have shown that this syndrome can be due to a multitude of problems, not the least of which are abdominal and pelvic wall hernias. This report is intended to emphasize the role of non-gynecologic diseases, particularly rare abdominal and pelvic wall hernias, in the genesis of chronic pelvic pain and the need for general surgeons to be involved with the investigation and management of this frequently frustrating gynecological problem.

Unusual appearances of uterine leiomyomas: MR imaging findings and their histopathologic backgrounds.

Typical appearances of uterine leiomyoma at magnetic resonance (MR) imaging are well established, and diagnosis is usually easy. However, cases that, are extremely difficult to differentiate from other conditions are occasionally encountered. To understand the wide spectrum of MR imaging findings, such unusual appearances can be classified into three categories: degeneration and other histopathologic findings, specific types of unusual leiomyomas, and unusual growth patterns. The common types of degeneration are hyaline (>60% of cases), cystic (approximately 4%), myxoid, and red. Edema is not a phenomenon of degeneration but is a common histopathologic finding (approximately 50% of cases). Hemorrhage, necrosis, and calcification (approximately 4% of cases) may also be observed. Specific types of unusual leiomyomas include lipoleiomyoma and myxoid leiomyoma, which may have MR imaging features characteristic enough to allow differentiation from other gynecologic and nongynecologic diseases. Intravenous leiomyomatosis, metastasizing leiomyoma, diffuse leiomyomatosis, and peritoneal disseminated leiomyomatosis represent unusual growth patterns; other unusual growth patterns are retroperitoneal growth, parasitic growth, and the pattern that may occur in cervical leiomyoma. Because leiomyomas are the most common gynecologic tumors and are exclusively benign, it is important to be familiar with the variety of MR imaging appearances of uterine leiomyomas to distinguish them from other significant diseases.

SCC Antigen in Malignant and Nonmalignant Squamous Lesions

Squamous cell carcinoma (SCC) antigen (Ag) present and expressed in normal epithelium and epithelial tissues is used primarily as tumor marker of SCC of the uterine cervix. In this review, we considered factors interfering in vitro with the collection of samples and assay procedures, benign and malignant nongynecological diseases which may be the cause of elevated serum levels of SCC Ag. Contamination with skin or saliva strongly influences SCC Ag levels. SCC Ag is elevated in several benign lesions, including pulmonary (tuberculosis, adult respiratory distress syndrome, pulmonary infiltration with eosinophilia, sarcoidosis, bronchogenic cyst) and skin (eczema, pemphigus, erythroderma epidermitis, psoriasis) diseases. Elevations are observed in SCC malignancies of the head and neck, esophagus, skin, lung, urothelium, anal canal and vulva.

Analytical and clinical performance of improved Abbott IMx CA 125 assay: comparison with Abbott CA 125 RIA

We compared the improved Abbott IMx cancer antigen (CA) 125 assay (cat. no. 7A89) with the Abbott CA 125 RIA. Serum specimens were from healthy perimenopausal women (n = 124) and from patients with benign gynecologic and nongynecologic diseases (n = 124), ovarian carcinoma (n = 104), or other malignancies (n = 193). The IMx assay detected as little as 0.193 kAU/L CA 125 (AU = arbitrary Abbott unit), demonstrated up to 29% overestimation upon serum dilution, low within-assay (2.7-5.6%) and between-assay (4.8-8.2%) CVs, and no high-dose hook effect < or = 46,000 kAU/L nor influence from human anti-mouse antibodies in serum of women injected with OC 125 F(ab')2. Values by IMx were 20% lower than by RIA for healthy perimenopausal women (n = 100; IMx = 0.80 RIA - 2.5 kAU/L), and at least 50% higher for those with benign or malignant ovarian disorders at concentrations < 100 kAU/L. Receiver-operating characteristic (ROC) curve analysis of ovarian neoplasma vs perimenopausal controls indicated a gain of specificity and sensitivity with the improved IMx assay over the RIA, but ROC performance was the same with either assay if patients with benign ovarian disorders were used as controls.

Evaluation of a simple line width test involving magnetic resonance spectroscopy of plasma in carcinoma of the ovary

Magnetic resonance spectroscopic (MRS) measurement of human plasma has been reported as a generally applicable marker for malignancy: patients with malignancy had a MRS line width significantly different from patients with benign diseases or healthy controls. The authors investigated the value of this test in 213 women with ovarian carcinoma, benign pelvic masses, benign nongynecologic diseases, and healthy controls. The MRS measurements were performed on plasma samples at 21 degrees C or 27 degrees C. The line width parameters were obtained by averaging the width at half the height of the methyl and methylene peaks on the resonance spectra. At 27 degrees C using 33 Hz as the threshold for an abnormal result, there was a significant correlation between the result of the test and the presence or absence of malignancy. However, the study demonstrates that the specificity (0.44) and positive predictive value (0.42) are too low for the test to be useful in the management of patients with carcinoma of the ovary. At 21 degrees C no correlation between the results of the test and the clinical status of women with carcinoma of the ovary were observed. In 47 patients the test did not predict preoperatively the benign or malignant nature of a pelvic mass.

Monoclonal antibody assays for measuring ovarian tumor antigen in blood. Detection of NB/70K in patients with ovarian cancer and nongynecologic diseases.

Blood levels of human ovarian tumor antigen NB/70K were measured using four different monoclonal anti-NB/70K antibody radioimmunoassays (NB12123, NB12913, NB13834, and NB13831 assays). Four hundred thirty-two blood samples were obtained from apparently disease-free controls, from patients with benign and malignant ovarian tumors, and from patients with benign nontumorous and malignant diseases of the breast, lung, and gastrointestinal systems. The means, medians, and percent of samples that had elevated levels of NB/70K were calculated for each group of patients or controls for each assay. For all control versus malignant disease comparisons, there were statistically significant differences in all assays. For all benign versus malignant disease comparisons in the ovary, breast, lung, and gastrointestinal systems, there were statistically significant differences in all assays with the exception of the benign versus malignant gastrointestinal disease comparison in the NB12123 assay. Elevated NB/70K levels were detected in blood from ovarian cancer patients, almost all of whom had adenocarcinomas. Elevated NB/70K levels were also detected in blood samples from patients with adenocarcinoma, squamous, and clear cell carcinomas of the lung as well as in adenocarcinoma and ductal carcinoma of the breast. These results indicate that NB/70K is a marker for different pathologic types of malignancies.