Journal of Mid-life Health最新文献

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.

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.