Detection of High-Grade Cervical Intraepithelial Neoplasia by Electrical Impedance Spectroscopy in Women Diagnosed with Low-Grade Cervical Intraepithelial Neoplasia in Cytology.

The authors attempt to address the importance of timely detection and management of cervical intraepithelial neoplasia (CIN) to prevent cervical cancer. The study focused on the potential of electrical impedance spectroscopy (EIS) as an adjunct to colposcopy, aiming to enhance the accuracy of identifying high-grade cervical lesions. Colposcopy, a widely used technique, exhibited variable sensitivity in detecting high-grade lesions, which relies on the expertise of the operator. The study's primary objective is to evaluate the effectiveness of combining colposcopy with EIS in detecting high-grade cervical lesions among patients initially diagnosed with low-grade CIN based on cytology. We employed a cross-sectional observational design, recruiting 101 women with abnormal cervical cytology results. The participants underwent colposcopy with acetic acid and subsequent EIS using the ZedScan device. The ZedScan results are categorized into color-coded probability levels, with red indicating the highest likelihood of high-grade squamous intraepithelial lesions (HSIL) occurrence. Results revealed that ZedScan exhibits a sensitivity rate of 89.5% and a specificity rate of 84% for detecting high-grade lesions. Colposcopy, on the other hand, recorded a sensitivity rate of 85.5% and a specificity rate of 92%. The agreement rate between ZedScan and biopsy is 79.2%, as indicated by a kappa coefficient of 0.71, while the agreement rate between colposcopy and biopsy is 74.3%, with a kappa coefficient of 0.71.

Fertility outcomes after treatment with intraperitoneal chemotherapy.

Intraperitoneal chemotherapy (IPC) administration has been added to the therapeutic protocols of cancers, confined to the abdominal cavity. Since, a survival benefit in patients treated with adjuvant IPC has been demonstrated, fertility questions are raised in these patients. A comprehensive search of the English literature of PubMed/MEDLINE, EmBase and Google Scholar databases was conducted, from their inception until April 2021, following the MOOSE guidelines. Twelve out of 473 studies were included in the final review and analysis. After treatment with IPC for peritoneal carcinomatosis, 19 women, who underwent fertility-sparing surgery, with 20 successful pregnancies were reported. The mean interval time between IPC and pregnancy was 38.4 months (range 9-168 months). In 16 cases, conception was spontaneous, three required in vitro fertilisation, whereas one pregnancy was achieved through intrauterine insemination. Mean disease-free survival was 76 months (range 24-177 months). Childbearing is a feasible approach in selected patients, after treatment with IPC. When future pregnancy is desirable, a multidisciplinary team of surgeons, gynaecologists, oncologists and reproductive specialists is required, to inform the patient thoroughly about the fertility preservation alternatives, without endangering patient's survival.

Prolapse of a large pedunculated uterine myoma.

We report a rare case of a large prolapsed pedunculated uterine myoma measuring 15 cm in its greater diameter. In order to make a surgical procedure safe and feasible, appropriate clinical predictors should be taken into account and pre- and intraoperative preparations be available to the surgeon's armamentarium.

Abdominal wall endometrioma: An insidious cause of delayed diagnosis.

An extremely rare extrapelvic position of endometriosis with a precise incidence of 0.07%-0.47%, leading usually to delayed and false diagnosis. Differential diagnosis should include that rare condition while ultrasonography remains a pivotal tool to unravel that enigma, especially in women with no specific symptoms and surgeries in the past.

Cloacal type defect of the anal canal following an obstetric anal sphincter trauma.

Neglected severe obstetric anal sphincter injuries may result in fecal incontinence. It is of paramount importance to identify such injuries at the time of vaginal delivery and have appropriate surgical training for optimal anatomical restoration of the perineal structures.

A Successful Pregnancy Despite the Presence of an Intrauterine Fetal Bone Fragment.

OBJECTIVE: Intrauterine retention of fetal bones following a termination of a pregnancy is a rare complication. Among the few reported cases in literature, there has been no report describing the birth of a live fetus, despite the presence of an embryonic ossicle within the endometrial cavity. CASE REPORT: A 28-year-old woman, with an obstetrical history of a miscarriage at the 19th week of gestation, underwent a diagnostic hysteroscopy for evaluation of pelvic pain and infertility, which revealed an intrauterine embryonic ossicle. The patient did not comply with our recommendations to undergo a surgical hysteroscopy. The patient's next visit was during her 9th week of gestation. She was followed up regularly at our Obstetrics Department. Her gestation was uneventful, while an elective caesarean section at the 39th week of gestation was performed. CONCLUSION: The present clinical case has demonstrated that achieving childbearing is possible, despite the requirement of removing such bone fragments.

Large cyst of the vaginal wall in pregnancy.

Large vaginal cysts during pregnancy are rare and can mislead Obstetricians to a false diagnosis, that of "Protruding membranes". Aspiration of the cyst can be easily performed, resulting in the collapsing of the cyst and an uneventful vaginal delivery can be conducted.

The Use of Norethisterone for the Treatment of Severe Uterine Bleeding in Adolescents: An Audit of Our Experience.

STUDY OBJECTIVE: The purpose of this prospective study was to assess the effectiveness of norethisterone (NET) in the management of abnormal uterine bleeding (AUB) in adolescents in a tertiary care center. DESIGN: This was a prospective audit focused on administering high doses of NET in female adolescents with complaints of AUB. SETTING: We included female adolescents who presented to our Emergency Gynecological Department or Adolescent Gynecological Outpatient Department from October 2016 to January 2019. PARTICIPANTS: The study included 29 female adolescents aged 11-17 (mean, 13.14) years. INTERVENTIONS: Patients were administered a daily dose of 10-30 mg, depending on the severity of the condition, bleeding duration, and patient weight. MAIN OUTCOME MEASURES: Cessation of vaginal bleeding. RESULTS: Mean age at menarche of our patient sample was 11.4 years (range, 10.7-14 years). AUB presented at a mean time of 24.6 months after menarche (range, 0-79 months). Blood transfusion was deemed necessary in 9 patients. Bleeding stopped at a mean of 46.1 (range, 8-120) hours after onset of treatment with NET. No serious adverse events were reported with NET administration, with only 3 cases of minor side effects. CONCLUSION: The use of NET is an effective and reliable treatment option among adolescents for whom control of AUB is desired in the acute setting.

Pemphigoid gestationis.

Pemphigoid gestationis is a rare autoimmune skin disorder emerging exclusively during pregnancy. Topical and oral glucocorticoids as well as oral antihistamines are the standard medications administered during pregnancy, aiming to relieve pruritus and to suppress extensive blister formation. Obstetricians should be able to recognize and treat this rare clinical condition accordingly.

Margin-free excision of small solid breast carcinomas using the Intact Breast Lesion Excision System®: is it feasible?

BACKGROUND: The Breast Lesion Excision System® (BLES®) is a stereotactic vacuum-assisted breast biopsy device that utilizes radiofrequency in order to excise non-palpable mammographic lesions for pathologic diagnosis. The purpose of this study was to evaluate the efficacy of BLES® in performing complete, margin-free excisions of small solid carcinomas. METHODS: Our retrospective study of prospectively enrolled patients included 50 cases of non-palpable, BIRADS ≥ 4, solid by means of mammography and sonography, lesions. All these patients underwent a BLES® breast biopsy procedure from June 2010 to June 2014 and had a malignant diagnosis. According to each patient's pathologic diagnosis, appropriate surgical treatment was recommended. Postoperatively, surgical specimens were histologically analyzed, aiming to determine whether residual malignant disease was present in the specimen cavity formatted by BLES®. RESULTS: Ductal carcinoma in situ (DCIS) was diagnosed in 5 patients and invasive carcinoma (IC) in 45 patients, at primary BLES® pathology report. Tumor-free resection margins (< 0.5 and < 1 mm) were accomplished in only 8/24 subcentimeter cases (33.3%). Absence of residual disease upon surgical excision was confirmed in 23/24 subcentimeter cases (95.8%) and 2/26 of the cases measuring > 1 cm (7.69%). Statistical analysis revealed that mammographic size was the only significant prognostic factor for complete excision (i.e., with no residual disease in the biopsy cavity) of a malignant lesion. CONCLUSIONS: Our results indicate that it is possible, when using the BLES® device, to completely excise small (≤ 10 mm) breast carcinomas that appear radiologically as solid lesions. This subset of patients should be investigated regarding the therapeutic potential of this method.

Giant condyloma acuminatum-malignant transformation.

Giant condyloma acuminata are associated with malignant transformation in up to 50% of cases, high recurrence rate, and poor prognosis. Treatment strategies have included wide local excision, abdominopelvic resection, and addition of radiotherapy and adjuvant and/or neoadjuvant systemic chemotherapy.

Langer's axillary arch.

Langer's axillary arch is usually asymptomatic and difficult to detect preoperatively. When present, it is important for surgeons operating in the axillary region, to identify correctly the relevant anatomy. Simple surgical division is curative and necessary in order to achieve exposure of the axillary contents, lymphatic dissection, and neurovascular preservation.