Series Of Female Patients Research Articles

Clinical and Laboratory Characteristics of Patients with Peritoneal Tuberculosis Mimicking Advanced Ovarian Cancer.

Objectives Peritoneal tuberculosis can mimic advanced abdominal malignancy. We describe clinical and laboratory characteristics in a series of female patients with peritoneal tuberculosis who were referred to a tertiary cancer center with a diagnosis of suspected advanced ovarian/primary peritoneal cancer. Materials and Methods Details of clinical features, laboratory results including serum tumor markers, radiological findings, and ascitic fluid evaluation were retrospectively collected from hospital records for patients diagnosed to have peritoneal tuberculosis and reported descriptively. Statistical Analysis Descriptive statistics was performed using SPSS Statistics for Windows software, version 20.0 (SPSS, Chicago, Illinois). Results Between January 2009 and December 2017, 120 patients of peritoneal tuberculosis with a median age 41 years (range, 15–79 years) were identified. Of these 112 (93.3%; 95% CI 88.9–97.8%) patients had ascites and 63 (52.5%; 95% CI 43.6–61.4%) had adnexal mass at presentation. Mean serum cancer antigen 125 (CA-125) level was 666.9 (range, 38–18,554) U/mL. Ascitic fluid was negative for malignant cells in all patients and lymphocyte rich exudate was seen in 103 (91.9%; 86.9–97.0%) patients. Ascitic fluid adenosine deaminase (ADA) level was more than 40 U/L in 107 (95.5%; 95% CI 91.7–99.4%). Ascitic fluid Ziel–Neelsen staining was positive in 4/62 (6.5%; 95% CI 0.3–12.6%) patients while ascitic fluid culture examination for mycobacterium tuberculosis was positive in 7/59 (11.9%; 95% CI 3.6–20.1%) patients. The diagnosis of tuberculosis was based on image-guided biopsy in 44 (36.7%) patients, surgical biopsy in 8 (6.7%) patients, and a combination of clinicoradiological and laboratory features in 68 (56.7%) patients. All patients received standard antitubercular treatment. Conclusions The study results suggest that peritoneal tuberculosis has clinical, radiological, and serological profile which may mimic advanced ovarian/primary peritoneal cancer. Peritoneal tuberculosis should be considered in the differential diagnosis of advanced abdominal malignancy.

The Incidence of Pregnancy-Associated Cushing's Disease and Its Relation to Pregnancy: A Retrospective Study.

Purpose: Cushing's disease (CD) is one of the most severe endocrine disorders and primarily affects women of reproductive age. The peripartum period has been observed to be a common time to develop CD. This study aims to retrospectively analyze the clinical characteristics of CD potentially associated with pregnancy and to evaluate relevant pregnancy outcomes.Methods: Patients who underwent surgery from January 2010 to May 2019 at Peking Union Medical College Hospital (PUMCH) with biochemically and pathologically confirmed CD were retrospectively analyzed. Pregnancy-associated CD was defined as CD onset during gestation or within 12 months after delivery or abortion. Data including demographics, biochemical tests, magnetic resonance imaging (MRI) findings, and disease outcomes were obtained from all patients by reviewing their medical records. Information regarding pregnancy was collected through a supplementary online questionnaire.Results: In a series of female patients (n = 70) of reproductive age with childbearing desire, 27.1% (n = 19) met the criteria for pregnancy-associated CD. The timing of diagnosis of pregnancy-associated CD was 2.7 ± 3.4 years after symptom onset, and the overall remission rate for these women was 89.5%. Three patients with pregnancy-associated CD developed hypertension during pregnancy, two of whom had new-onset hypertension at 16 weeks of gestation and one of whom had a complication of severe diabetes. The rates of spontaneous abortion and preterm birth among the women with pregnancy-associated CD were 26.3 and 28.6%, respectively. The proportions of all low-birth-weight (LBW) newborns (p = 0.002) and term LBW newborns (p = 0.033) were significantly higher in the pregnancy-associated CD group than in the non-pregnancy-associated CD group.Conclusions: In this study, a total of 27.1% of women of reproductive age with CD had pregnancy-associated CD, which might be induced by the hormonal milieu of pregnancy. An increased risk of having a LBW newborn was observed among mothers with pregnancy-associated CD. A high degree of clinical suspicion for CD may be warranted in the peripartum period. Patients with symptoms suspicious for CD throughout pregnancy and after childbirth, such as early-onset hypertension, severe hyperglycemia, and persistent weight gain, should be carefully diagnosed and closely monitored by clinicians.

MP76-18 A NOVEL QUANTITATIVE MEASURE OF BLADDER HYPER-SENSITIVITY IN ANALYSIS OF BLADDER DIARY WITH THE PATIENT'S SELF-REPORTED URINARY PERCEPTION GRADES

popular graft material for male urethroplasty. Buccal mucosa grafting has been described in females, but not critically evaluated. We believe this represents the largest series of female patients using buccal mucosa having undergone the dorsal onlay buccal urethroplasty (DOBU). We hypothesize that this technique will have improved recurrence free rates, no fistula formation, improved post-op incontinence rates, and no greater risk of clitoral pain compared with ventral onlay, vaginal graft techniques. METHODS: A retrospective case series was compiled from 2009-13 identifying female subjects who underwent DOBU via suprameatal approach. All patients underwent pelvic exam, as well as supine stress test. Endpoints included recurrence of stricture verified by cystoscopy, uroflow, post-void residual, presence of urinary tract infection, pain, fistula formation, incontinence, and complications from both the donor site and the vagina. RESULTS: Six subjects were identified. Mean follow up was 16.9 months. No stress incontinence was noted pre-operatively, and none developed post-op. No fistulas were noted. Mean stricture length was 1.2cm and mean graft length was 2.75cm. One stricture recurrence was noted (16%) which required dilation. Mean pain score went from 3.5/10 to 0/10 on a 10 point Likert scale (p1⁄40.075). UTIs per year went from 4.3 to 0.3 (p1⁄40.038). Maximum voided velocity increased from 5.6 to 12.65 cc/sec (p1⁄40.049), and mean post void residual decreased from 305 to 41cc (p1⁄40.099). No urethral or vaginal complications were reported, but 2 patients reported donor site morbidity. No clitoral anesthesia or pain was reported. CONCLUSIONS: DOBU is durable and compares favorably with other reported techniques to repair female urethral stricture. It can be safely considered instead of vaginal graft urethroplasty using ventral onlay for the female with urethral stricture.

Urinary dysfunction in women with multiple sclerosis: analysis of 61 patients from Rio de Janeiro, Brazil

The aim of the present study is to describe the type and frequency of bladder dysfunction in a series of female patients with multiple sclerosis (MS) from Rio de Janeiro, and analyze the role of the urologist in the multidisciplinary team. A team of urologists and a neurologist from the Hospital da Lagoa, Rio de Janeiro, Brazil, interviewed female patients with MS about illness onset, urologic follow-up since diagnosis, current stage of the disease and current urological symptoms. The interview was followed by an urodynamic testing, ultrasound of the urinary tract and urinalysis. Data resulting from the interviews and exam results were gathered and submitted to statistical evaluation. Sixty one patients were evaluated, with average age of 41.4 years. Urinary symptoms such as urinary incontinence, urinary hesitancy, urinary retention, urinary urgency and incomplete bladder emptying were reported in 44% of patients as initial signs of MS disease. Mean disease duration was 8 years and all patients (100%) with the primary progressive form of the disease and 63.5% with the relapsingremitting presentation had urological symptoms. Analysis of complementary exams showed that 37.7% of urinalysis, 8.2% of the urinary tract ultrasound exams and 66.7% of the urodynamic evaluations were abnormal and the most frequent abnormality were overactive neurogenic bladder. Only 4 patients (6.6%) had seen an urologist during the course of their disease and only 1.6% had performed an urodynamic evaluation. This study shows a high prevalence (68%) of urinary dysfunction in a female population with MS. Urologic care should be part of the multidisciplinary team since the beginning of the disease. An urodynamic evaluation and simple urinalysis should be included in the routine testing during disease follow-up due to the high incidence of neurogenic bladder and other urologic complications.

Gynecologic-tract sparing radical cystectomy with long term result: report of 55 cases

Objective To report a series of female patients with bladder cancer who underwent gynecologic-tract sparing radical cystectomy with long term follow-up. Methods Fifty-five female patients between the ages of 25 and 82 years who underwent gynecologic-tract sparing radical cystectomy between 1990 and 2010 were reviewed retrospectively.Pathologic characteristics and survival ( overall and cancerspecific) were reported.Survival was estimated using Kaplan-Meier methods,and Cox proportional hazards regression analyses were performed to determine factors associated with mortality. Results Five patients were lost in follow up.Fifty-five women with a mean follow-up of 55.2 months were analyzed.The 3,5 and 10-year cancer specific survival (CSS) was 65％,61％ and 61％,respectively,and the corresponding overall survival (OS) was 61％,54％ and 42％,respectively.For patients with organ confined disease ( ≤ pT2N0M0) the 5-year CSS and OS was 84％ and 72％,while for those with non organ confined disease ( ≥pT3N0M0) the 5-year CSS and OS reduced to 29％ and 29％.Pathologic lymph node status (HR =3.877,P =0.019) and pathologic staging ( HR =3.992,P =0.011 ) were the only clinical or pathologic characteristics significantly associated with survival. Conclusions For patients with pathologically organ-confined bladder cancer ( ≤ pT2 N0 M0 ),gynecologic-tract sparing radical cystectomy is an oncologically safe treatment modality,while for those with ≥ pT3N0M0 or positive pelvic lymph nodes,gynecologic-traet sparing radical cystectomy may need large scale randomized control trials to justify its validity,pathological stage and lymph node status are the most important key points when choosing appropriate patients. Key words: Urinary bladder neoplasms; Carcinoma; Female; Cystectomy; Retrospective studies

C-Erb-b2 Oncogene Expression in Intraductal Proliferative Lesions of the Breast

The ductal intraepithelial neoplasia (DIN) classification which proposes new approaches to the diagnosis, terminology and differential diagnosis of intraductal proliferative lesions of the breast was applied to a series of female patients comprising C-erbB2 oncogene expression which may serve as an adjunct to the morphology by immunohistochemistry. The study was performed using the data of 94 patients. There was no difficulty encountered in the diagnosis of intraductal hyperplasia (IDH). In patients with Atypical Ductal Hyperplasia (AIDH), the diagnosis could be made by using the 2-mm rule of the DIN classification in patients who exhibited cytologic and structural characteristics of Ductal Carcinoma in Situ (DCIS) alone or in conjunction with classical IDH patterns. However, in lesions that mimicked classical IDH patterns despite displaying cytological features of in situ carcinomas, the experience and view point of the pathologist played a more prominent role. When the DIN classification criteria were applied to grade DCIS lesions, although the system was found to be practical, it did not provide adequate differentiation in intermediate grade (grade II-DIN 2) patients and further improvement was considered desirable. Fourty-five cases (47.8%) IDH, 19 (20.2%) AIDH, and 30 (31.9%) were DCIS. There were statistically significant differences in the levels of c-erbB2 oncogene expression between IDH, AIDH and DCIS lesions (p<0.001). In DCISs, grade, cell size, pleomorphic nuclear atypia showed statistically significant associations with c-erbB2 oncogene expression. These results suggest that c-erbB2 oncogene expression is a valuable marker in the differential diagnosis and prognostic evaluation of patients with intraductal proliferative lesions.

Breast Cancer in Patients with Hodgkin's Lymphoma Predominantly Treated with Anthracycline – Based Chemotherapy with or without Radiotherapy: A Preliminary Analysis.

Abstract BACKGROUND: Hodgkin's lymphoma (HL) is a highly curable neoplasm with &amp;gt;70-80% of the patients becoming long-term survivors. The success of treatment however, is associated with long term complications, namely breast cancer, especially if treated with extended-field radiotherapy (RT) at a curative dose as monotherapy. The oncogenic effect of limited field and relatively low-dose RT combined with anthracycline-based chemotherapy (CT) – the current standard of treatment for early stage disease - is not well investigated. The aim of the study is to describe the incidence of breast cancer in a series of patients treated predominantly with anthracycline-based CT with or without RT of limited field and dose.PATIENTS AND METHODS: Among 1125 patients in our database, 479 were females and were evaluated for the occurrence of breast cancer. Important baseline features were: Median age 28 years (14-81); clinical stage I, II, III, IV 17%, 55%, 15%, 13%; B-symptoms 37%; Nodular sclerosis 77%, mixed cellularity 15%, lymphocyte predominance 6%; Anthracycline based CT 86%, MOPP-based CT 12%, RT only without CT 2%; Radiotherapy 74%, mostly to the involved field, usually 2800-3000 cGy. The cumulative incidence of breast cancer was estimated by the Kaplan-Meier method.RESULTS: The median follow-up of the 479 female patients was 88 months: 36% were followed-up for &amp;gt;10 years. At the time of the analysis 6 cases of breast cancer were recorded for a 5-, 10- and 20-year cumulative incidence of 0.5%, 1.7% and 4.4%. The median age of the 6 patients was 43 years (26-54) at diagnosis of HL and 46.5 years (33-63) at breast cancer diagnosis. Clinical stages were I (n=1), II (n=3), III (n=1) and IV (n=1) and 4/6 patients had B-symptoms at diagnosis. All patients were in their 1st complete remission when breast cancer was diagnosed at a median time of 67 months from HL diagnosis (8-198). All 6 patients had received anthracycline-based CT and had been irradiated at a median dose of 2870 cGy, but the mediastinum or the axillae were included in the RT field only in 3/6 patients. Among 646 male patients, a single case of breast cancer was recorded in a 49 year old patient, 265 months after high-dose (4300 cGy) mantle field RT followed by MOPP/ABVDx6.DISCUSSION: In a series of female patients with HL, a median age of 28 years at diagnosis and a median follow-up of ∼7.5 years (&amp;gt;10 years in 36% of them), who were predominantly treated with modern CT with or without limited field and dose RT, the 10- and 20-year incidence of breast cancer was 1.7% and 4.4%, with 6 cases recorded. Three of the cases developed clearly outside the irradiation field. We also recorded a single case of male breast cancer, which was very likely treatment related. Whether these cases are in excess of those expected for the population studied, as well as the features and outcome of breast cancer in HL survivors are currently being investigated. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6069.

Gynecologic-tract sparing extra peritoneal retrograde radical cystectomy with neobladder

We report on a series of female patients with transitional cell carcinoma of the bladder who underwent extraperitoneal retrograde radical cystectomy sparing the female reproductive organs with neobladder creation. 14 female patients between the ages of 45 and 72 years who underwent gynecologic-tract sparing cystectomy (GTSC) with neobladder between 1997 and 2002 were retrospectively reviewed. Our surgical technique is also described. Radical cystectomy is accomplished by a retrograde method sparing the uterus, adnexa, vagina and distal urethra. An orthotopic neobladder was constructed using small bowel or sigmoid colon, brought extraperitoneally, and anastomosed to the distal urethra. Operating time ranged from 4.5 to six hours with a mean of 5.3 hours. Ten patients were able to void satisfactorily while four required self-catheterization for complete emptying of the bladder. Seven patients were continent day and night and another 7 reported varying degrees of daytime and nighttime incontinence. One patient died of metastases and another of pelvic recurrence. There were no urethral recurrences. Patient satisfaction with the procedure was high. Gynecologic-tract sparing cystectomy with orthotopic neobladder is a viable alternative in female patients with muscle invasive traditional cell carcinoma of the bladder, providing oncological safety with improved quality of life. Our extraperitoneal technique, which is an extension of our successful experience with retrograde extraperitoneal radical cystectomy in men, minimizes intraoperative complications and simplifies the management of post-operative morbidity with the neobladder.

Urinary epidermal growth factor concentrations in various human malignancies.

We determined the concentrations of immunoreactive epidermal growth factor in the urine (U-irEGF) of 97 adult patients with various malignancies, including carcinomas of the urinary bladder, kidney, stomach, colon, rectum, breast, endometrium, uterine cervix, ovary, vagina, prostate, pancreas and thyroid, liposarcoma and skin melanoma. The relative U-irEGF concentrations (ng m-1 creatinine) were higher (P = 0.002) for the whole series of female patients than for healthy controls matched for sex and age. Such difference did not appear for male patients. The only specific group with a statistically supranormal U-irEGF concentration (P = 0.0005) comprised women with endometrial carcinoma of the uterus.

Psychotherapy and the Iatrogenic ‘Love Affair’

After giving an introductory outline of the phenomenology and theoretical aspects of the concept "love affair", the author proceeds to review a number of symptomatic love affairs arising in the lives of a series of female patients during the course of analytically oriented psychotherapy.. The material is presented in its general aspects and in the form of one detailed case history. In subsequent discussion the author attempts to explain the genesis of these love affairs in terms of phase-speciifc conflicts in the patient and certain iatrogenic aspects of the therapy.

Initial psychiatric illness in involutional women. III. Electroencephalographic findings.

A Multi-Dimensional study of a consecutive series of female patients, aged 40–55,in whom psychiatric illness necessitated first admission to a mental hospital, has already been reported in its general and clinical aspects and in relation to the psychological test findings.