Current opinion in gynecology and obstetrics最新文献

{"title":"Burden of Uterine Fibroids: An African Perspective, A Call for Action and Opportunity for Intervention.","authors":"P Igboeli, W Walker, A McHugh, A Sultan, A Al-Hendy","doi":"10.18314/cogo.v2i1.1701","DOIUrl":"10.18314/cogo.v2i1.1701","url":null,"abstract":"<p><p>Black women carry the burden of uterine fibroids, (AKA uterine leiomyomas), at a much higher rate than their racial counterparts. Thus, increasing awareness and discovering a solution to an endemic problem that plagues Sub-Saharan Africa is of critical importance, not only for the region itself, but also for the medical community globally. A collaborative, patient oriented, cost effective, and culturally sensitive approach must be at the forefront of this endeavor. While the exact pathogenesis of uterine fibroid development remains elusive, the racial disparity is well documented. Moreover, in the developed world, women are able to seek treatment through surgical and non-surgical means; however, sub-Saharan regions face their own challenges that, if not addressed, can ultimately extinguish the lives of many suffering women. Unfortunately, the literature is scarce on how to prevent fibroid development, which may be critical for women who do not have access to effective interventions. Recent research from our group and others has shown that vitamin D deficiency plays an important role in fibroid development and may be a preventable risk factor. Daily vitamin D supplementation is a low cost, effective intervention that could be implemented throughout the Sub-Saharan region. Similarly, education and increased awareness as to the nature and symptoms of uterine fibroids could improve the quality of life, remove negative social stigma, and reduce morbidity and mortality rates in women who seek medical care with advanced uterine fibroids.</p>","PeriodicalId":92345,"journal":{"name":"Current opinion in gynecology and obstetrics","volume":"2 1","pages":"287-294"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7344264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38138673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Pilot Randomized Controlled Trial of a Preoperative Patient Education Intervention to Improve Satisfaction and Reduce Resource Utilization in Gynecologic Surgery","authors":"Alexandre Buckley de Meritens, C. Baptiste, J. Hou, W. Burke, J. Wright, A. Tergas","doi":"10.18314/COGO.V1I1.1409","DOIUrl":"https://doi.org/10.18314/COGO.V1I1.1409","url":null,"abstract":"During the initial surgical consult patients may feel overwhelmed by the information they are given regarding their diagnosis and surgical plan. We looked to determine if a preoperative patient educational intervention would improve patient satisfaction and optimize use of medical services after discharge. Methods: We randomized women undergoing major gynecologic surgery by laparoscopy or laparotomy, to standard of care (Control) or a preoperative educational intervention. The pre-operative educational intervention consisted of: 1) a handout with information on inpatient and outpatient recovery and 2) a preoperative phone-call to review the handout and answer questions. At the post-operative visit, patients completed a Patient Satisfaction Questionnaire (PSQ-18), addressing satisfaction, interpersonal manner, communication, time spent with doctors and physician accessibility. The number of phone calls, emergency department visits and unscheduled post-operative clinic visits were quantified during the first 2 weeks after surgery. Descriptive statistics and t-tests were used for analysis.Results: 62 consecutive patients were randomized: 31 to intervention and 31 to the control group. Within the cohort 35 patients underwent laparoscopy and 21 laparotomy, 6 patients withdrew or cancelled their surgery. Forty postoperative patient satisfaction questionnaires were collected, 20 in the intervention group and 20 in the control group (response rate 71%). Intervention was associated to increased patient satisfaction. In the LSC group, the intervention improved patients’ perception of their physicians’ interpersonal manners, communication and time spent with the doctor (p < 0.05). Only one patient (3.5%) in the intervention group visited the ER post-operatively (laparotomy, wound separation) compared to 5 (17.8%) control patients (4 laparoscopy, 1 laparotomy, p < 0.05), all for minor complaints (pain, anxiety, incision).Conclusions: In our randomized trial this low-cost, feasible pre-operative educational intervention improves patients’ perception of their surgeons’ communication skills and decreased post-operative healthcare resource utilization. The effects are most pronounced in women undergoing minimally invasive surgery.","PeriodicalId":92345,"journal":{"name":"Current opinion in gynecology and obstetrics","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78346590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous Vaginal Delivery after Three Previous Caesarean Sections","authors":"Hani Shams Eldin, N. Oligbo","doi":"10.18314/COGO.V1I1.1318","DOIUrl":"https://doi.org/10.18314/COGO.V1I1.1318","url":null,"abstract":"Women with one previous caesarean section have 0.05% risk of uterine rupture, with two caesarean sections the risk increase to 1.36%. We could not find data on the risk of uterine rupture after three caesarean sections. Elective caesarean section is therefore offered to these women by their clinical professionals to eliminate the risk. However, we report a case of spontaneous vaginal delivery with an intact uterine scar in a woman with a previous three caesarean sections to show the possibility of vaginal birth in patients with repeated caesarean section. A 32-year-old female in her 4th pregnancy with previous three caesarean section 1st two emergencies and 3rd elective (Gravida 4, para 3) presented to the delivery suite in spontaneous labour at 39 weeks and 3 days with vaginal bleeding. Emergency call gone off and patient was transferred immediately to theatre, during transfer she pushed down while she was on the wheel chair and the baby head found to be delivered vaginally. A live healthy baby girl weighing 2590 g was delivered. The patient had Postpartum bleeding of 500 ml and 2nd degree perineal and labial tears; the patient was discharged home fit and well on day one postpartum. Repeated caesarean section increases maternal mortality and morbidity. Vaginal birth after repeated previous caesarean sections could still be an option in selected cases as safe vaginal delivery has been reported.","PeriodicalId":92345,"journal":{"name":"Current opinion in gynecology and obstetrics","volume":"103 2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74638193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Small Cell Carcinoma of the Ovary Hypercalcemic Type: A Case Report and Review of Literature","authors":"F. Guermazi, K. Meddeb, A. Mokrani, L. Charfi, Abouda Hs, Y. Yahyaoui, Feryel Letaief, A. Gabsi, H. Raies, N. Chraiet, M. Ayadi, A. Mezlini","doi":"10.18314/COGO.V1I1.1397","DOIUrl":"https://doi.org/10.18314/COGO.V1I1.1397","url":null,"abstract":"Small cell carcinoma of the ovary hypercalcemic type (SCCOHT) is an exceedingly rare aggressive malignancy. It typically affects young women. Herein we aimed to report a case of a 28-year-old woman treated for SCCOHT in Salah Azaiez Institute. The tumor was revealed by a delay of menses. The imaging found a large mass of the right ovary. The patient underwent a bilateral salpingo-oophorectomy, a total hysterectomy and a pelvic and a para-aortic lymphadenectomy. She subsequently received 6 cycles of adjuvant chemotherapy. Three years later, she presented a metastatic bone relapse.","PeriodicalId":92345,"journal":{"name":"Current opinion in gynecology and obstetrics","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82631241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Varicocele and Varicocele Surgery on Semen Quality, Erectile Function and Serum Hormone Levels","authors":"B. Mohamad Al-Ali, E. Persad, A. Lunacek, C. Mrstik, E. Plas","doi":"10.18314/cogo.v1i1.1431","DOIUrl":"https://doi.org/10.18314/cogo.v1i1.1431","url":null,"abstract":"Introduction: Many studies suggest that varicoceles are associated with hypogonadism and varicocele repair can increase testosterone levels and improve erectile function.Aim: The aim of this retrospective study was to analyze the impact of varicocele and varicocele surgery on testosterone level, semen quality, and erectile function.Methods: Our study included 265 infertile males with a clinical varicocele. This group was divided into three groups: group 1 (193) patients who did not receive surgery, group 2 (72 patients) who were operated on according to the Palomo procedure and group 3 (28 patients), who acted as a control group without a varicocele. All patients completed the International Index of Erectile Function IIEF-5 (German version) and underwent semen analysis. Serum testosterone, follicle stimulating hormone (FSH), and luteinizing hormone (LH) were measured at inclusion into the study and after surgery.Main outcome measures: Changes in semen quality, erectile function, and serum hormones after surgery.Results: The IIEF-5 scores in groups 1 and 2 were 21.01 ± 2.2; and 21.74 ± 1 respectively, and the resulting t-test for equality of variance was significant (p < 0.0001). Total testosterone level in groups 1 and 2 were 3.16 ± 0.37 and 3 ± 0.01, respectively, and the resulting t-test for equality of variance was significant (p < 0.0001). The results of the semen analysis were better in group 2 (after surgery) (28.6%, p < 0.001) in comparison to group 1. Interestingly, pre-operative serum testosterone levels were lower in patients with later improvement of semen analysis (p = 0.05). Body mass index (p = 0.8), pre-operative serum FSH (p = 0.9), LH (p = 0.2), and nicotine consumption (p = 0.6) were similar in both the group that saw improvement and the group with no change in semen quality.Conclusion: Semen quality improved in 28.6% of patients after varicocele surgery. Erectile dysfunction (ED) improved after varicocele surgery. We report that lower pre-operative serum testosterone level might be a possible indicator for successful surgical outcome.","PeriodicalId":92345,"journal":{"name":"Current opinion in gynecology and obstetrics","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79392281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Teratoma-Associated Anti-NMDAR Encephalitis","authors":"Wei-Hua Lou, Bin Yan, You Wang, W. Di","doi":"10.18314/cogo.v1i1.1270","DOIUrl":"https://doi.org/10.18314/cogo.v1i1.1270","url":null,"abstract":"Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune encephalitis that is associated with the NMDA receptor and has a good response to treatment. However, only a small number of cases related teratoma has been reported in literature. Here we report a case of teratoma-associated anti-NMDAR encephalitis. A 25-year-old woman with the presentation of fever for 20 days and psychiatric symptoms for 9 days was admitted to the hospital. This patient progressed to a minimally conscious state consistent with encephalitis. Considering the possibility of autoantibody-mediated encephalitis, laboratory tests were undertaken to observe the anti-NMDAR antibodies in cerebrospinal fluid (CSF) and serum, which confirmed the diagnosis of anti-NMDAR encephalitis. Furthermore, gynecological ultrasound investigation detected teratoma in the left ovary. After resection of the teratoma with Laparoscopic adnexectom and treatment with immunosuppressive therapy, the patient recovered gradually and was discharged one month after the operation. Due to the lack of clinical practice guidelines for the prevention and treatment of anti-NMDAR encephalitis, the disease is still difficult to diagnose because of its vague manifestations. For the further study, the clinic data of one case of teratoma-related anti-NMDAR encephalitis was analyzed and the relevant literatures were reviewed.","PeriodicalId":92345,"journal":{"name":"Current opinion in gynecology and obstetrics","volume":"101 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84762819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Involvement of Alternative Calcium Conductance on Human Myometrial Contractile and Pharmacological Properties","authors":"É. Rousseau, K. Labelle, L. Massenavette","doi":"10.18314/COGO.V1I1.1288","DOIUrl":"https://doi.org/10.18314/COGO.V1I1.1288","url":null,"abstract":"Objective: This study aimed to investigate the physiological role of alternative calcium conduct once contractions triggered by oxytocin and PGF? in human myometrium. This conductance, supported by TRPC and TRPV channels, may provide alternative pathways to control either free intracellular and/or submembrane Ca2+ - concentrations, which in turn will modulate membrane polarization and contractile responses. Study design: Uterine biopsies were obtained from consenting women undergoing elective caesarian delivery at term without labor (N = 29). Isometric tension measurements were performed on uterine strips (n = 174). Amplitudes, frequencies and areas under the curve (AUC) of phasic contractions as well as resting tone were measured under various experimental conditions. Norgestimate, which has been shown to inhibit TRPC isoforms, was added to isolated organ baths to delineate their putative functional involvement. In order to assess the role of TRPV4 channels, rhythmic activity triggered by uterotonic drugs was determined in the absence and presence of either 1 ?M HC-067047 (TRPV4 antagonist) or 100 nM GSK1016790A (TRPV4 agonist). Addition of 50 nM iberiotoxin (IbTX) as well as of 10 ?M NS-1619 was also used to assess the involvement of GKCa channels in controlling uterine reactivity and contractility.Results: Micromolar concentrations of norgestimate consistently decreased the resting tone, frequency and maximal amplitude of oxytocin - and PGF2? - induced contractions. In contrast, the TRPV4 agonist GSK1016790A abolished the rhythmic contractions, resulting in a strong and reversible tocolytic effect. Addition of iberiotoxin (a GKCa blocker) reversed the effects of GSK1016790A, while NS1619 mimicked the rapid tocolytic effects of the TRPV4 agonist. Conclusion: Acute pharmacological inhibition of TRPC channels by norgestimate had minor effects on contractile parameters although resting - tone was lowered. In contrast, selectiveTRPV4 activation led to GKCa activation, which in turn hyperpolarized the myometrial cell membrane, inactivating Ca2+ channels and efficiently abrogated contractile activity. Collectively, these data suggest that alternative calcium conduct ance may play a physiological role in the modulation of myometrial reactivity prior to delivery. A rapid switch from phasic contractions to quiescence by this new class of tocolytics may potentially be of interest in delaying parturition in preterm labor.","PeriodicalId":92345,"journal":{"name":"Current opinion in gynecology and obstetrics","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88444391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Premenstrual Syndrome Characteristics in Caucasian and Asian Women: A Survey - Based Study in Denmark","authors":"A. Nikbakht, P. Gazerani","doi":"10.18314/COGO.V1I1.1295","DOIUrl":"https://doi.org/10.18314/COGO.V1I1.1295","url":null,"abstract":"Women of reproductive age present one or more emotional or physical symptoms in premenstrual phase of their menstrual cycle, which is collectively called premenstrual syndrome (PMS). Estimates show that about 5 to 8% of women suffer from severe PMS. This form has been termed as premenstrual dysphoric disorder (PMDD). Diagnostic criteria have been proposed for PMDD. For the purpose of this research work, the term PMS was used to include variants of premenstrual syndrome in general. Common symptoms include but not limited to breast swelling, food cravings, bloating, mood swings and backache. The etiology of PMS remains unclear; but available evidence suggests that genetics and environmental factors may influence the PMS experience and its severity. The present study was designed to investigate PMS experience and characteristics in two ethnic groups of Caucasian and Asian women living in Denmark. An online survey-based methodology was applied to target Asians and Caucasians women (18-55 years) with PMS, living in different regions in Denmark. The questionnaire consisted of 36 questions to cover the required information for the purpose of this study. Regression analysis was applied to find the association between PMSassociated factors and ethnicity. Asian (47) in comparison with Caucasian women (47) presented with higher ratings of several PMS symptoms such as mood swings, depression and food cravings (p < 0.05). Asian women were also found with higher rate in digestion problems (p < 0.05) and higher rate of cramps and nausea during menstruation and a shorter menstruation period compared with the Caucasians (p < 0.05). This study highlighted that Asian women had higher rates of both psychological and physiological factors in relation to PMS. Potential reasons for a difference between Asian and Caucasian women living in Demark is not clear, and need further investigation.","PeriodicalId":92345,"journal":{"name":"Current opinion in gynecology and obstetrics","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79796293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervical Ectopic Pregnancies after Spontaneous Conception: Case Reports","authors":"S. A. Georgieva, E. Kovachev, Zhyvko Stoyanov Zhekov, S. Kisyov, K. Tsvetkov, A. Aleksandrov","doi":"10.18314/cogo.v1i1.1338","DOIUrl":"https://doi.org/10.18314/cogo.v1i1.1338","url":null,"abstract":"Cervical pregnancy (CP) is a rare form of ectopic pregnancy (< 1%) located on the lining of the endocervical canal with frequency at about 1 in 1 000 to 1 in 18 000 deliveries. Cervical gestation is extremely rare beyond 20 weeks and there are few reports in the literature of vaginal live birth with a high mortality risk. Awareness and early diagnosis is essential due to the possibility of a life-threatening hemorrhage, treated with hysterectomy in the past. Cervical ectopic pregnancy can be mistaken on ultrasound examination with similar pathologies and due to the differences in the management and the outcome an accurate diagnosis is of a great importance. Authors describe two cases of ectopic pregnancies in the isthmico-cervical region successfully terminated with a nonsurgical approach.","PeriodicalId":92345,"journal":{"name":"Current opinion in gynecology and obstetrics","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85086152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alarin: A Novel Circulating Peptide Hormone Linked to Luteinizing Hormone and Hiperandrogenismin Polycystic Ovary Syndrome","authors":"M. Çalan, M. Biçer, M. Alan, P. Alarslan, Aslı Guler, G. Kocabas, C. Imamoğlu, M. Aksit, G. Bozkaya, A. C. Acara, A. Baloğlu, Behnaz Aslanipour","doi":"10.18314/COGO.V1I1.1284","DOIUrl":"https://doi.org/10.18314/COGO.V1I1.1284","url":null,"abstract":"Alarin is a newly identified peptide hormone. It is implicated that alarinplays roles in regulation of energy metabolism and hypothalamo-pituitary-gonadal axis. Polycystic Ovary Syndrome (PCOS) is a common reproductive and metabolic disease in women during reproductive ages. Over-secretion of Luteinizing Hormone (LH) causes hyperandrogenism in women with PCOS. The purpose of the study was to determine the comparison of alarin levels in women with or without PCOS as well as to investigate the relationship between alarin and LH. Eighty-four women with PCOS and 84 age- and BMI- matched controls were recruited in this cross-sectional study. Circulating alarin levels were assessed via ELISA method. The hormonal and metabolic parameters of the recruited subjects were also determined. The circulating levels of alarin in PCOS subjects were higher than controls (6.11 ± 1.91 vs. 3.93 ± 1.60 ng/ml, P <0.001). Alarin showed a positive correlation with insulin resistance marker, BMI, LH and androgens. Moreover, alarin levels were elevated in women with PCOS having insulin resistance compared to those PCOS women without insulin resistance. In both control and PCOS groups, overweight subjects showed an elevation in circulating levels of alarin with respect to normal weight subjects. In the present study, Alarin level with the highest tertile dosage comparing to alarin level with the lowest tertile dosage could highly increase the probability of PCOS risk prevalence in women. Elevated alarin levels in women with PCOS were associated with not only LH and metabolic parameters but also high probability of having PCOS risk independently.","PeriodicalId":92345,"journal":{"name":"Current opinion in gynecology and obstetrics","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83761845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}