Journal of Mid-life Health最新文献

Leiomyosarcomas (LMS) arise from smooth muscle cells with more predilection to the uterus, abdomen, retroperitoneum, and blood vessels. LMS of vagina is very rare and usually presents in the early stage as an asymptomatic mobile mass with no clinical features of malignancy and gives the appearance of a benign lesion which can easily be mistaken for a Bartholin's cyst or a vaginal fibroid. The chances of metastasis in LMS are high with poor survival rates. Histopathology confirms the diagnosis and treatment still remains controversial due to less data on this rare malignancy. Even though there is no evidence that leiomyoma can transform into LMS, benign-looking vaginal fibroids need to be resected to avoid misdiagnosis of LMS. We present a case of vaginal LMS which was mistaken to be Bartholin's cyst due to the lack of knowledge of this aggressive tumor and further management.

Endosalpingiosis is a nonneoplastic lesion defined by the presence of tubal epithelium at ectopic sites such as the peritoneum, bladder, appendix, and even uterus. They may be asymptomatic and detected incidentally on ultrasonography. However, cystic endosalpingiosis is also known to be a mimicker of ovarian neoplasms. It is crucial for both the clinician and the pathologist to be aware of this benign lesion so that overdiagnosis and overtreatment can be avoided. We report a case of endosalpingiosis of the uterine serosa in a 45-year-old woman which was misdiagnosed as an adnexal cyst on radiological investigations.

Diabetes mellitus (DM) is a syndrome of chronic metabolic disease which leads to all kinds of complications. Elderly people with DM have significantly higher fear of falling and balance problem scores as compared to those who did not have DM. This literature review aims: (1) to determine the risk factors for balance disorders in the elderly population with DM, (2) to describe valid and reliable balance measurement tools in the elderly population with DM, and (3) to describe the nonpharmacological management in dealing with balance disorders in the elderly population with DM. Several risk factors that cause balance disorders in the elderly with DM are related to complications of the disease they suffer, such as diabetic peripheral neuropathy, decreased sensory abilities, decreased motor skills, and decreased cognitive condition of the elderly with DM. Measuring instruments that can be used in the elderly population with DM to assess balance include the Mini-Balance Evaluation Systems Test, the Berg Balance Scale, and computerized measuring instruments with center of pressure analysis. Several nonpharmacological interventions are suggested in overcoming balance problems in the elderly with DM, including a combination of balance exercise and gait training, strength or resistance training, aquatic exercise, tai chi, yoga, technology-based exercise, electrotherapy, use of insoles, and whole-body vibrations.

Introduction: Colposcopy is important for triaging any abnormal cervical screening test. Scarcity of trained colposcopists and colposcopy centers is a big hurdle to screening programs in low- and middle-income countries.

Objectives of the study: The objective was to assess the performance of the artificial intelligence incorporated into the mobile optical device technologies (ODT) Enhanced Visual Assessment (EVA visual check) against physician colposcopic diagnosis and the gold standard of histopathology.

Materials and methods: It was a cross-sectional observational study conducted on women referred to a colposcopy clinic following an abnormal screening test. Colposcopic examination was performed by colposcopists using the MobileODT EVA system. Physician's impression and Visual Check analysis were compared with the final histopathological analysis or cytology. Cases with normal cytology and normal colposcopy did not undergo biopsy, and these were considered normal.

Results: A total of 2050 women were screened, and 147 screen-positive women were recruited in the study. EVA Visual Check had a sensitivity of 86.8% (75-95), specificity of 28.7% (20-39), positive predictive value (PPV) of 40.7% (32-50), negative predictive value (NPV) of 79.4% (62-91), and diagnostic accuracy of 49.7% (41-58) for diagnosing cervical intraepithelial neoplasia (CIN) 1+ lesions. EVA Visual Check has a sensitivity of 89.3% (72-98), specificity of 26.1% (18-35), PPV of 22.1% (15-31), NPV of 91.2% (76-98), and diagnostic accuracy of 38.1% (30-46) for CIN 2+ lesions.

Conclusion: MobileODT EVA colposcope with AI has sensitivity comparable to physician's diagnosis, whereas specificity, PPV, and NPV were less than that of physician's diagnosis. It could prove valuable for triage of screen-positive women for further management.

Background: Accurate prediction of ovarian masses preoperatively is crucial for optimal management of ovarian cancers.

Objective: The objective of this study was to identify the risk of malignancy index (RMI) incorporating menopausal status, serum carbohydrate antigen 125 levels, and imaging findings for presurgical differentiation of benign from malignant ovarian masses and to evaluate the diagnostic ability of four different RMIs.

Materials and methods: Women presenting with ovarian masses from August 2018 to January 2020 were evaluated preoperatively with detailed history, examination, imaging, and tumor markers. RMI 1-4 was calculated for all patients. Evaluation of the diagnostic utility of four different RMIs for preoperative identification of malignancy was based on the increment of the area under the receiver operating characteristic curve. Histopathological diagnosis was used as the gold standard test.

Results: One hundred and twenty-one patients fulfilling the eligibility criteria were enrolled in this study. Benign tumors constituted 61 (50.4%) out of 121 cases, followed by malignant tumors and borderline tumors constituting 49 (40.49%) cases and 11 (9.09%) cases, respectively. The sensitivity of RMIs 1, 2, 3, and 4 was 77.0%, 63%, 77.0%, and 77.0%, respectively, and the specificity was 84%, 86%, 77%, and 71%, respectively. The RMI 2 had higher specificity at predicting malignancy than other RMIs while diagnostic accuracy was highest in RMI 1.

Conclusion: The RMI method is a simple and cost-effective technique in preoperative differentiation of ovarian masses.

Osseous metaplasia (OM) of the cervix without involvement of the uterus is an extremely rare entity. Only few cases had been reported in the literature. We reported a rare case of OM of the cervix clinically mimicking cervical cancer. A 52-year-old female presented with chief complaints of leukorrhea and an unusual sensation of mass in the vagina. On clinical examination, the uterus, adnexa, pouch of Douglas, vulva, and perineum-all were normal except the cervix which was hypertrophied with surface irregularities. Histopathological examination of the cervix showed OM of the cervix. Since this is a benign entity, proper diagnosis is essential to avoid misdiagnosis of malignant tumors, especially malignant mesenchymal tumors.

Angiolipoleiomyoma is a benign mesenchymal mass composed of smooth muscle, mature adipose tissue, and abnormal blood vessels. It is rarely diagnosed in uterine masses and its prevalence among benign uterine lesions is 0.06%. We report the case of a 40-year-old female presenting with a complaint of heavy menstrual bleeding. Computed tomography scan revealed a large uterine mass with the right ovarian cyst. Histopathological examination confirmed the nature of the lesion as a benign angiolipoleiomyoma with a dermoid cyst of the right ovary. This rare association is reported to apprise gynecologists to consider this unusual tumor during the management of uterine masses.

Aims and objective: To validate calf circumference as a reliable clinical tool for measuring muscle mass in postmenopausal women.

Materials and methods: A cross sectional study done at Ram Manohar Lohia Hospital, New Delhi from February 2023 to September 2023. Thirty postmenopausal women were enrolled for this study. Women with surgical menopause, premature ovarian failure, chronic debilitating illness and morbid obesity were excluded. In these women, muscle mass was measured using calf circumference. Also, Appendicular skeletal muscle index (ASMI), a measure of muscle mass was calculated using DEXA scan (Gold standard). The muscle mass was taken as a parameter by both methods to detect sarcopenia. The collected data was analysed and statistically evaluated to clinically validate calf circumference as a reliable tool for measuring muscle mass in Indian postmenopausal women.

Results: In our study, the values at different cut offs of calf circumference was compared to ASMI scoring using gold standard investigation DEXA Scan. The better accuracy was found for the cut off point 32 cm of calf circumference with sensitivity of 100%, specificity of 60%, positive predictive value of 71.4%, negative predictive value of 100% and accuracy of 80%. The prevalence of sarcopenia was found to be 70%.

Conclusion: Calf circumference can be used as reliable clinical tool to assess sarcopenia as a measure of muscle mass in Indian postmenopausal women.

Spontaneous perforations in pyometra occur rarely. Incidence is only 0.01%-0.5% in gynecological patients. Tubo-ovarian abscess (TOA) is seen less in postmenopausal women amounting the 6%-18% of the total cases of TOA reported. A 52-year-old P₃L₃ postmenopausal woman with abdominal pain was admitted to hospital. Emergency laparotomy was performed in view of pyoperitoneum. Intraoperatively, 1000 cc of foul-smelling pus was suctioned out from the peritoneal cavity a 2 cm × 2 cm sized perforation was seen at the right fundal region of the uterus and a right sided TOA was seen extending to the uterine cavity, left sided ovary was normal. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. The patient got discharged on the 36^th postoperative hospitalization day. Histopathological study revealed uterine purulent inflammation with no evidence of malignancy. The diagnosis of spontaneous perforation of pyometra is rarely made preoperatively and the possibility of a perforated pyometra should, therefore, be considered when elderly women suffer from acute abdominal pain. Hysterectomy and bilateral salpingo-oophorectomy may be the best choice procedure in these patients. There is probably a new trend in the epidemiology of TOA, occurring in older women who do not present the traditional risk factors for pelvic inflammatory disease and TOA.