Journal of Mid-life Health最新文献

Surgical mesh has been in use for urogynecological surgeries for a long, but they come with their own side effect profile and maybe life-altering consequences. We discuss a novel method of management of mesh erosion and infection in a patient with mesh sacrocolpopexy.

Background: Minimally invasive gynecologic surgery is safe and feasible procedure for benign gynaecological conditions with less morbidity.

Objective: To determine the best approach in benign gynecology and establish superiority of robotic over conventional laparoscopic hysterectomy in terms of safety and effectiveness.

Methods: Search strategy: Electronic databases: MEDLINE, Embase, CENTRAL (the Registry of Controlled Clinical Studies of the Cochrane Collaboration), Google scholar, Pubmed and Scopus were searched from 2010-2022. Selection criteria: All randomized controlled trials and quasi-randomised trials which compared robotic versus conventional laparoscopic hysterectomy were included to conduct this systematic review and meta-analysis to investigate compared to traditional approaches.

Results: Only five RCTs (326 patients in total) comparing robotic and conventional laparoscopic hysterectomy were included after a comprehensive literature search. Results of our analysis showed no clear benefit in any of the two techniques in operating time, estimated blood loss, length of hospital stay and overall complications.

Conclusion: This systematic review suggests no statistical difference in surgical and patient outcomes between robotic and conventional laparoscopic hysterectomy relating to OT, EBL, LOHS, overall complications, and survival.

Introduction: A palpable breast lump is a common diagnostic problem for clinicians and surgeons. Fine-needle aspiration cytology (FNAC) has many advantages such as less cost, less sample processing time, less pain, less chance of hematoma, and less discomfort. FNAC with cell block preparation further increased both sensitivity and specificity by nearly 100%. With the cell block preparation, we can also use newer tests like estrogen receptor-progesterone receptor-human epidermal growth factor receptor 2.

Aims: The aim of this study was to derive conclusions about the correlation, including sensitivity, specificity, positive and negative predictive values (NPVs), and the diagnostic accuracy of FNAC, with or without cell blocks, compared to the final histopathology in cases of palpable breast masses.

Materials and methods: A cross-sectional prospective study was conducted after getting approval from the Human Ethics Research Committee from January 2018 to December 2019, which included 65 patients. Patients diagnosed clinically for breast lumps who underwent diagnostic FNAC with cell block, followed by a histopathological examination at our hospital, were included in the study.

Results: FNAC without cell block sensitivity, specificity, positive predictive value (PPV), NPV, efficiency rate, and diagnostic accuracy are 91.3%, 100%, 100%, 90.1%, 86.2%, and 96.5%, respectively. FNAC with cell block sensitivity, specificity, PPV, NPV, efficiency rate, and diagnostic accuracy are all 100%. All of our results beat the standard estimate.

Conclusions: Fine-needle aspiration cytology is a patient-friendly, easy, reliable, repeatable, and simple diagnostic test. Whenever it is combined with cell block preparation, improves the accuracy of FNAC diagnosis which is more accurate and comparable to golden-standard biopsy with histopathology examination.

A middle-aged woman presented with history of fatigue, low mood, swelling of limbs, and facial puffiness. On detailed history taking, she also complained of salt craving, secondary amenorrhea, and loss of libido for almost a decade. Investigations revealed pan-hypopituitarism. She was started on appropriate hormonal therapy which saw a rapid resolution of symptoms within 2 weeks. Sheehan's syndrome may have an acute presentation or chronic. The symptoms may be subtle like fatigue or overt like hypotension and syncope. A high degree of suspicion of Sheehan's syndrome is essential for its timely management, and goes a long way in preserving the quality of life.

Surgery remains the gold standard treatment for endometrial cancer. Vaginal approach is suitable for candidates with low risk for lymph node metastasis or in elderly females with extensive comorbidities, especially when surgery is done for palliative purpose only. We herein describe a case of cancer endometrium in huge procidentia, managed by vaginal hysterectomy followed by hormonal therapy.

Background: The use of nontraditional lipid parameters for assessing clinical conditions is emerging; however, no study has identified thresholds for those parameters for the identification of cardiovascular disease (CVD) risk. The present study aimed to establish the thresholds of nontraditional lipid parameters and test its ability to identify CVD risk factors.

Methodology: A cross-sectional study in women (n = 369, age: 46 ± 13 years, body mass index (BMI): 26.31 ± 2.54 kg/m²) was conducted. Blood samples were collected and high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, total cholesterol (TC), and triglycerides (TGs) were estimated. Subsequently, nontraditional lipid parameters were calculated, namely non-HDL-C, Castelli's Risk Index II (CRI-II), CRI-I, lipoprotein combined index (LCI), atherogenic index (AI), and AI of plasma (AIP).

Results: Based on TC (≥200 mg/dL), the derived thresholds for non-HDL-C, CRI-II, CRI-I, LCI, AI, and AIP were 139 mg/dL, 2.29, 3.689, 58,066, 2.687, and 0.487, respectively. Similarly, based on the threshold of TG (≥150 mg/dL), the derived thresholds for non-HDL-C, CRI-II, CRI-I, LCI, AI, and AIP were 127 mg/dL, 2.3, 3.959, 58,251, 2.959, and 0.467, respectively. Out of considered five risk factors, non-HDL-C, CRI-II, CRI-I, LCI, and AI thresholds were capable in identifying four risk factors (physical activity, blood pressure, BMI, and age) and AIP was able to associate with two risk factors at most (blood pressure and BMI).

Conclusion: The derived thresholds of nontraditional lipid parameters were capable of differentiating between CVD risk and nonrisk groups suggesting the possible use of these thresholds for studying CVD risk.

Malignant transformation (MCT) of ovary is rare complications affecting elderly, squamous cell carcinoma being the most common. The prognosis worsens with extraovarian spread. We present two cases of MCT-derived SCC. Patients exhibited abdominal lump, pain, bowel symptoms, sometimes with weight loss; imaging revealed MCT. Age (51-60), postmenopausal status, large size (>20 cm), bilaterality, and complex ovarian lesions raised suspicion of malignancy. Elevated tumor markers (e.g., cancer antigen-125 and lactate dehydrogenase) were noted in one case. Intraoperative frozen section confirmed malignancy, guiding staging laparotomy. One case was advanced stage on histopathology. Intraoperative frozen section aids optimal staging.

Black cohosh (Cimicifuga racemosa) is a perennial plant used to treat menopause. This plant is known to have a serotonergic rather than estrogenic impact. It has been recommended to treat vasomotor symptoms associated with breast cancer patients. It also relieves symptoms such as night sweats and hot flashes, commonly called vasorelaxation. The variability in the study's results, doses, and assessment methods requires more rigorous research to establish its efficacy and safety. Standardized trials are needed to provide more precise information on the benefits and limitations of menopause treatment, informing women seeking alternatives to hormone therapy. Black cohosh has shown the potential to reduce the frequency and intensity of vasomotor symptoms in breast cancer patients undergoing tamoxifen treatment. In addition to its effectiveness in alleviating night sweats and hot flashes, the vasorelaxation properties contribute to its overall positive impact on menopausal symptoms. Due to discrepancies, varying dosages, and assessment techniques, further comprehensive studies are essential to determine the optimal dosage, long-term safety, and overall efficacy. Only through standardized trials can women make informed decisions about black cohosh as a viable alternative to hormone therapy during menopause.

This case report describes a rare example of a solitary abdominal wall metastasis in a middle-aged endometrial cancer (EC) survivor 3 years following disease-free status. Following induction chemotherapy, she had a margin-negative surgical excision of the abdominal tumor. Surprisingly, the patient has been disease-free for more than 3 years after the operation. This emphasizes the necessity of addressing single metastasis amenable to surgical resection, as well as the need for diligent monitoring to discover recurrences sooner. Understanding rare locations of recurrence, such as the abdominal wall, is critical for optimum EC therapy and care. The data given in this article adds to the existing body of information on atypical presentations and recurrent EC therapy. Additional research is required to develop evidence-based guidance.