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2.
Saudi Med J ; 40(8): 815-819, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31423519

RESUMO

OBJECTIVES: Abnormal uterine bleeding (AUB) is a leading cause of hysterectomies, the cause of which is usually diagnosed with preoperative endometrial sampling. We planned this study to assess the accuracy of diagnosing the histologic patterns of endometrium in the preoperative sample in reference to the final histologic diagnosis in hysterectomy. METHODS: We retrospectively reviewed medical charts between January 2011 and December 2015 at a tertiary hospital in Saudi Arabia and identified 43 cases of AUB with complete documentation. The histologic diagnoses were classified into normal and benign pathology group (N/B), or carcinoma and hyperplasia category (Ca/H). Measures of validity were used to compare endometrial sampling histological diagnoses to diagnoses following hysterectomy and Cohen's kappa to assess for agreement between the 2 modalities. Results: The median age of all patients was 49 years. Preoperative histologic examination showed 53.8% sensitivity, 90% specificity, 70% positive predictive values and 81.8% negative predictive values, 30.1%  false positive rates and 18.2% false negative rates. The agreement between preoperative and postoperative histologic diagnoses was moderate (79.1%, k=0.469). Conclusion: The accuracy of preoperative histologic examination was moderate. Our findings recommend cautious clinical decision making and limiting hysterectomy to women who do not respond to other therapeutic measures.


Assuntos
Carcinoma/patologia , Hiperplasia Endometrial/patologia , Neoplasias do Endométrio/patologia , Endométrio/patologia , Menorragia/patologia , Metrorragia/patologia , Adulto , Idoso , Carcinoma/complicações , Carcinoma/diagnóstico , Carcinoma/cirurgia , Tomada de Decisão Clínica , Hiperplasia Endometrial/complicações , Hiperplasia Endometrial/diagnóstico , Hiperplasia Endometrial/cirurgia , Neoplasias do Endométrio/complicações , Neoplasias do Endométrio/diagnóstico , Neoplasias do Endométrio/cirurgia , Endometrite/complicações , Endometrite/diagnóstico , Endometrite/patologia , Endometrite/terapia , Reações Falso-Positivas , Feminino , Humanos , Histerectomia , Menorragia/etiologia , Menorragia/terapia , Metrorragia/etiologia , Metrorragia/terapia , Pessoa de Meia-Idade , Pólipos/complicações , Pólipos/diagnóstico , Pólipos/patologia , Pólipos/terapia , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade
3.
Rev Assoc Med Bras (1992) ; 65(5): 714-721, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31166450

RESUMO

An isthmocele, a cesarean scar defect or uterine niche, is any indentation representing myometrial discontinuity or a triangular anechoic defect in the anterior uterine wall, with the base communicating to the uterine cavity, at the site of a previous cesarean section scar. It can be classified as a small or large defect, depending on the wall thickness of the myometrial deficiency. Although usually asymptomatic, its primary symptom is abnormal or postmenstrual bleeding, and chronic pelvic pain may also occur. Infertility, placenta accrete or praevia, scar dehiscence, uterine rupture, and cesarean scar ectopic pregnancy may also appear as complications of this condition. The risk factors of isthmocele proven to date include retroflexed uterus and multiple cesarean sections. Nevertheless, factors such as a lower position of cesarean section, incomplete closure of the hysterotomy, early adhesions of the uterine wall and a genetic predisposition may also contribute to the development of a niche. As there are no definitive criteria for diagnosing an isthmocele, several imaging methods can be used to assess the integrity of the uterine wall and thus diagnose an isthmocele. However, transvaginal ultrasound and saline infusion sonohysterography emerge as specific, sensitive and cost-effective methods to diagnose isthmocele. The treatment includes clinical or surgical management, depending on the size of the defect, the presence of symptoms, the presence of secondary infertility and plans of childbearing. Surgical management includes minimally invasive approaches with sparing techniques such as hysteroscopic, laparoscopic or transvaginal procedures according to the defect size.


Assuntos
Cesárea/efeitos adversos , Cicatriz/diagnóstico , Cicatriz/terapia , Doenças Uterinas/diagnóstico , Doenças Uterinas/terapia , Cicatriz/etiologia , Feminino , Humanos , Histeroscopia/métodos , Metrorragia/diagnóstico , Metrorragia/etiologia , Metrorragia/terapia , Fatores de Risco , Doenças Uterinas/etiologia
5.
Am J Case Rep ; 19: 1474-1479, 2018 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-30538215

RESUMO

BACKGROUND Obesity is one of the leading causes of morbidity and mortality globally and challenging to treat because of the multifactorial etiology and presentation. Individualized homeopathy takes into account factors that led to a patient's health condition and hence may have a role in the treatment of obesity and related co-morbidities; co-morbidities that may arising from the same etiology may respond as a whole to homeopathy treatment. CASE REPORT A 39-year-old Russian female who developed multiple problems after severe emotional stress was treated with individualized classical homeopathic therapy. Obesity, dysfunctional uterine bleeding, and dysautonomia were pathologies that showed improvement. CONCLUSIONS The response in this patient's case, supports the need for further investigation on the relevance of individualized homeopathy in these related conditions.


Assuntos
Distonia/terapia , Homeopatia , Metrorragia/terapia , Obesidade/terapia , Adulto , Distonia/complicações , Feminino , Humanos , Metrorragia/complicações , Obesidade/complicações
6.
BMJ Case Rep ; 20182018 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-30093465

RESUMO

A 17-year-old girl with a history of dysfunctional uterine bleeding (DUB) and severe dysmenorrhoea was treated with different conventional hormonal therapies for 16 months without improvement.Treatment with traditional Chinese acupuncture was started while she was taking oral contraceptives. She received a total of 27 treatments in 17 weeks. Her menstrual cycle normalised after 4 weeks (10 treatments). She continued to be regular during the rest of treatments and to date, 6 months after the treatment was discontinued. This report summarises the acupuncture treatment for DUB in this adolescent girl.


Assuntos
Terapia por Acupuntura/métodos , Metrorragia/terapia , Adolescente , Feminino , Humanos , Ciclo Menstrual
7.
BMC Complement Altern Med ; 17(1): 427, 2017 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-28851349

RESUMO

BACKGROUND: Many patients with gynecological disorders seek traditional medicine consultations in Asian countries. This study intended to investigate the utilization of traditional Chinese medicine (TCM) in patients with dysfunctional uterine bleeding (DUB) in Taiwan. METHODS: We analyzed a cohort of one million individuals randomly selected from the National Health Insurance Research Database in Taiwan. We included 46,337 subjects with newly diagnosed DUB (ICD-9-CM codes 626.8) from January 1, 1997 to December 31, 2010. The patients were categorized into TCM seekers and non-TCM seekers according to their use of TCM. RESULTS: Among the subjects, 41,558 (89.69%) were TCM seekers and 4,779 (10.31%) were non-TCM seekers. Patients who were younger tended to be TCM seekers. Most of the patients had also taken Western medicine, especially tranexamic acid and non-steroidal anti-inflammatory drugs (NSAIDs). More than half of TCM seekers (55.41%) received combined treatment with both Chinese herbal remedies and acupuncture. The most commonly used TCM formula and single herb were Jia-Wei-Xiao-Yao-San (Bupleurum and Peony Formula) and Yi-Mu-Cao (Herba Leonuri), respectively. The core pattern of Chinese herbal medicine for DUB patients consisted of Jia-Wei-Xiao-Yao-San, Xiang-Fu (Rhizoma Cyperi), and Yi-Mu-Cao (Herba Leonuri). CONCLUSIONS: TCM use is popular among patients with DUB in Taiwan. Further pharmacological investigations and clinical trials are required to validate the efficacy and safety of these items.


Assuntos
Medicina Tradicional Chinesa/estatística & dados numéricos , Metrorragia/terapia , Terapia por Acupuntura , Adolescente , Adulto , Estudos de Coortes , Terapia Combinada , Bases de Dados Factuais , Medicamentos de Ervas Chinesas/administração & dosagem , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Metrorragia/tratamento farmacológico , Taiwan , Adulto Jovem
8.
J Gynecol Obstet Hum Reprod ; 46(8): 613-622, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28716637

RESUMO

Abnormal uterine bleeding (AUB) is a common complaint that affects large numbers of women from puberty to menopause. It negatively affects health by causing anemia, and impacts the quality of life of women affected. AUB also has an economic impact for both women and society. Therefore, it should not be under- or overestimate and diagnosis, investigations and treatment should be proposed, taking into account the scientific data available in the current state of medical knowledge. Using the new terminology and etiologic classification of AUB is essential to communicate properly around the subject. The evaluation of the bleeding includes self-report and more objective methods. Work out should focus on diagnosing anemia and researching for causal factors. It is important to differentiate AUB caused by anatomical changes and functional causes, and the PALM-COIEN classification has been developed on that dichotomy. Investigations may include blood test, ultrasound, hysteroscopy and endometrial sampling is required in a certain number of situations. Treatment for AUB can be medical and/or surgical depending on the cause. Medical treatment is based on iron supplementation, hormonal and non-hormonal therapies. Surgical treatments include removal of a focal lesion, endometrial resection or destruction and hysterectomy. Age, desire for future pregnancy and etiology for AUB are key factors to consider before initiating a treatment. Treatment efficiency can be assessed using the same tools as pretherapeutic evaluation, and improvement of quality of life has now become the main goal for most international guidelines addressing the subject.


Assuntos
Menorragia/etiologia , Menorragia/terapia , Metrorragia/etiologia , Metrorragia/terapia , Tomada de Decisão Clínica , Feminino , Humanos , Anamnese , Exame Físico , Índice de Gravidade de Doença
9.
Minerva Ginecol ; 69(1): 75-83, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27284943

RESUMO

Abnormal uterine bleeding (AUB) is one of the commonest health problems encountered by women and a frequent phenomenon during menopausal transition. The clinical management of AUB must follow a standardized classification system to obtain the better diagnostic pathway and the optimal therapy. The PALM-COEIN classification system has been approved by the International Federation of Gynecology and Obstetrics (FIGO); it recognizes structural causes of AUB, which can be measured visually with imaging techniques or histopathology, and non-structural entities such as coagulopathies, ovulatory dysfunctions, endometrial and iatrogenic causes and disorders not yet classified. In this review we aim to evaluate the management of nonstructural causes of AUB during the menopausal transition, when commonly women experience changes in menstrual bleeding patterns and unexpected bleedings which affect their quality of life.


Assuntos
Metrorragia/etiologia , Perimenopausa , Qualidade de Vida , Feminino , Humanos , Metrorragia/diagnóstico por imagem , Metrorragia/terapia , Útero/diagnóstico por imagem
10.
J Pediatr Adolesc Gynecol ; 30(2): 243-246, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27751907

RESUMO

STUDY OBJECTIVE, DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Bleeding disorders (BD) occur in up to 50% of adolescents with heavy menstrual bleeding (HMB). This presents unique challenges to health care providers because of the complexity of treating the condition and such complexity can result in difficulty with patients understanding basic information about their condition, limit communication with medical providers, and patient compliance. The aim of the study was to use an electronic approach to enhance patient compliance with medications used to treat their HMB, and to provide educational access to adolescents with BD. This was a prospective cohort study involving patients in a Young Women's Bleeding Disorder Clinic at a single children's hospital. Subjects were given an iPod Touch (Apple Inc, Cupertino, CA) device (ITD), preloaded with the iPeriod (Winkpass Creations) application. Participants recorded information about their BD that they learned about on BD Web sites, and menses, and medications. Electronic and charted data were collected to monitor compliance with prescribed treatment regimens. All ITD allowed Wi-Fi access to allow teens to explore BD Web sites and knowledge was assessed. RESULTS: Twenty-three of 45 subjects completed the study. The mean age was 14.1 ± 1.9 years. Subjects who were compliant with the ITD (group 1), charted on baseline symptoms, menstrual flow (83.3%), cramps (100%, 23/23), breakthrough bleeding (95.6%, 22/23), mood (95.6%, 22/23), and medication use (91.7%) for a mean of 9.3 ± 3.1 months. Subjects who were nonusers (group 2) did not report on symptoms, their condition, or medication use in the device (n = 22). More than 75% (17/23) of subjects in group 1 used hormones alone or hormones with antifibrinolytic agents to control HMB. No subjects stopped or missed medications who were in group 1 intentionally, and also there were 9 enrollees within this same group who missed a medication related to awaiting the prescription to be filled from pharmacy. In group 2, 17 enrollees missed medications, resulting in 19% (4/22) of these enrollees being admitted to hospital for 1-2 days. In addition, enrollees in group 2 missed more medications on average compared with group 1. No subjects in group 1 required admission for HMB treatment failure during the study period, compared with those in group 2 (P = .006). All subjects in group 1 reported accessing Web sites using their ITD to learn about their BD. Groups 1 and 2 did not differ in the number of medications that were prescribed during the time frame (P = .77) or the number of follow-up clinic visits (P = .49). Furthermore, those in group 1 reported fewer breakthrough bleeding episodes than those in group 2 according to clinic notes (P = .03). Users of the ITD were given a set of knowledge questions. Group 2 subjects were not consistent users of the ITD use and did not complete the knowledge questions. Group 1 and 2 could not be compared with regard to knowledge as a result. CONCLUSION: ITD is an excellent tool for adolescents with HMB and BD to allow self-monitoring, provider monitoring, and improve educational access through engaging technology; compliance with device use was associated with several parameters suggestive of improved clinical outcomes.


Assuntos
Transtornos da Coagulação Sanguínea/terapia , Menorragia/terapia , Aplicativos Móveis , Educação de Pacientes como Assunto/métodos , Autocuidado/métodos , Adolescente , Antifibrinolíticos/uso terapêutico , Transtornos da Coagulação Sanguínea/complicações , Transtornos da Coagulação Sanguínea/psicologia , Feminino , Hormônios/uso terapêutico , Humanos , MP3-Player , Menorragia/etiologia , Menorragia/psicologia , Metrorragia/etiologia , Metrorragia/psicologia , Metrorragia/terapia , Cooperação do Paciente , Estudos Prospectivos , Resultado do Tratamento
11.
Prog. obstet. ginecol. (Ed. impr.) ; 59(4): 243-246, jul.-ago. 2016. ilus
Artigo em Espanhol | IBECS | ID: ibc-163909

RESUMO

La mayoría de los hematomas puerperales son secundarios a laceraciones o desgarros producidos como consecuencia del traumatismo del parto, y rara vez tienen consecuencias maternas importantes. En ocasiones, estos hematomas pueden expandirse y disecar el tejido circundante suponiendo una complicación obstétrica potencialmente grave. Aunque es necesario un diagnóstico y tratamiento precoz, su manejo no está estandarizado y es causa de controversia ya que la literatura no es concluyente en cuanto a los beneficios del tratamiento conservador respecto al quirúrgico. El propósito de presentar este caso es demostrar la importancia de las técnicas de imagen para la identificación del lugar de la hemorragia y la posibilidad de realizar una embolización arterial selectiva como alternativa eficaz para el control de la misma (AU)


Most puerperal haematomas are produced by lacerations or tears as a result of birth trauma and rarely have significant maternal consequences. These hematomas can sometimes expand and dissect surrounding tissues, becoming a potentially serious obstetric complication. Although early diagnosis and treatment is necessary, the management of these entities remains controversial and there is no conclusive evidence on the benefits of surgery compared with non-surgical treatment. The present case report illustrates the importance of imaging techniques in identifying the site of bleeding and the possibility of selective arterial embolization as an effective alternative for bleeding control (AU)


Assuntos
Humanos , Feminino , Adulto , Embolização da Artéria Uterina/métodos , Embolização da Artéria Uterina , Episiotomia/métodos , Hematoma/complicações , Hematoma/terapia , Metrorragia/complicações , Metrorragia/terapia , Hemorragia Pós-Parto , Angiografia/instrumentação , Angiografia/métodos , Extravasamento de Materiais Terapêuticos e Diagnósticos
14.
Artigo em Inglês | MEDLINE | ID: mdl-26803558

RESUMO

Abnormal uterine bleeding (AUB) is a common and debilitating condition with high direct and indirect costs. AUB frequently co-exists with fibroids, but the relationship between the two remains incompletely understood and in many women the identification of fibroids may be incidental to a menstrual bleeding complaint. A structured approach for establishing the cause using the Fédération International de Gynécologie et d'Obstétrique (FIGO) PALM-COEIN (Polyp, Adenomyosis, Leiomyoma, Malignancy (and hyperplasia), Coagulopathy, Ovulatory disorders, Endometrial, Iatrogenic and Not otherwise classified) classification system will facilitate accurate diagnosis and inform treatment options. Office hysteroscopy and increasing sophisticated imaging will assist provision of robust evidence for the underlying cause. Increased availability of medical options has expanded the choice for women and many will no longer need to recourse to potentially complicated surgery. Treatment must remain individualised and encompass the impact of pressure symptoms, desire for retention of fertility and contraceptive needs, as well as address the management of AUB in order to achieve improved quality of life.


Assuntos
Leiomioma/complicações , Leiomiossarcoma/complicações , Metrorragia/etiologia , Neoplasias Uterinas/complicações , Adenomiose/complicações , Transtornos da Coagulação Sanguínea/complicações , Feminino , Humanos , Leiomioma/terapia , Metrorragia/terapia , Pólipos/complicações , Neoplasias Uterinas/terapia
15.
Womens Health (Lond) ; 12(1): 71-7, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26756068

RESUMO

Uterine artery embolization (UAE) as a treatment option for fibroids was first reported by Ravina in 1995. Although rapidly adopted by enthusiasts, many were skeptical and its introduction varied widely across the globe. It was not until randomized controlled trials and registries were published and national guidance statements issued that UAE was accepted as a safe and proven treatment for fibroids. The technique is now established as one of the treatment options to be discussed with patients as an alternative to surgery for fibroid-associated heavy menstrual bleeding. Research is on-going to evaluate the relative merits of UAE compared with other medical and surgical treatment options for heavy menstrual bleeding, particularly for women wishing to maintain their fertility.


Assuntos
Metrorragia/terapia , Embolização da Artéria Uterina/métodos , Feminino , Humanos , Leiomioma/irrigação sanguínea , Leiomioma/terapia , Neoplasias Uterinas/irrigação sanguínea , Neoplasias Uterinas/terapia , Saúde da Mulher
16.
Zhongguo Zhong Xi Yi Jie He Za Zhi ; 36(9): 1061-1064, 2016 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-30645843

RESUMO

Objective To observe the correlation between serum sex hormone levels and different syndrome types of Chinese medicine (CM) in dysfunctional uterine bleeding (DUB) patients. Methods Totally 532 DUB patients were classified into 10 different syndrome types according to syndrome typing theories of CM, including Gan-depression transforming heat syndrome, Shen deficiency blood sta- sis syndrome, Shen-yin deficiency syndrome, Pi-Shen deficiency syndrome, qi and yin deficiency syndrome, qi and blood deficiency syndrome, Pi deficiency syndrome, qi stagnation blood stasis syndrome, damp-heat syndrome, yin deficiency blood heat syndrome. Besides, 6 serum levels of sex hormone were measured including follicular stimulating hormone (FSH) , luteinizing hormone (LH) , estradiol (E2) , progesterone (P) , testerone (T) , and prolactin (PRL) in patients with different syndrome types. Correlation study between syndrome types and sex hormones were performed using Logistic regression analysis. Results The distributions of DUB in CM were sequenced from high to low as uterine bleeding, menostaxis, preceded menstrual cycle, intermenstrual bleeding, and menorrhagia. The distributions of syndrome types were sequenced from high to low as yin deficiency blood heat syndrome, qi and blood deficiency syndrome, qi stagnation blood stasis syndrome, Shen-yin deficiency syndrome, Pi-Shen deficiency syndrome, Gan-depression transforming heat syndrome, Pi deficiency syndrome, Shen deficiency blood stasis syndrome, qi and yin deficiency syndrome, damp-heat syndrome. PRL level was positively correlated with Gan-depression transforming heat syndrome in the ratio of 1. 117 (P <0. 05). FSH level was positively correlated with Shen-yin deficiency syndrome in the ratio of 1. 327 (P <0. 05). LH level was positively correlated with Pi-Shen deficiency syndrome in the ratio of 1.342 (P <0.05). Conclusions DUB patients with various syndrome types of CM had different levels of sex hormones, with certain-laws manifested. Positive correlation existed between PRL level and Gan-depression transforming heat syn- drome, FSH level and Shen-yin deficiency syndrome, LH level and Pi-Shen deficiency syndrome.


Assuntos
Medicina Tradicional Chinesa , Metrorragia , Deficiência da Energia Yang , Deficiência da Energia Yin , Correlação de Dados , Feminino , Humanos , Metrorragia/diagnóstico , Metrorragia/terapia , Síndrome
17.
Int J Gynaecol Obstet ; 131(1): 74-7, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26140947

RESUMO

OBJECTIVE: To evaluate practice patterns of gynecologists in the management of abnormal uterine bleeding (AUB) in South Korea. METHODS: Between February 24 and March 12, 2014, a cross-sectional survey was performed through face-to-face interviews with 100 gynecologists selected through quota sampling reflecting regions and hospital types. Through the use of a questionnaire, the level of awareness and practice patterns regarding diagnosis and management of AUB were evaluated. RESULTS: Among 100 respondents, 60 reported that they had not previously heard of the International Federation of Gynecology and Obstetrics (FIGO) classification system. The standardization of AUB terminology was reported to be necessary or very necessary by 70 respondents. Pelvic ultrasonography would be used for diagnosis by 99 physicians. The most common first-line AUB treatment was combined oral contraceptives: 55 respondents would use them for heavy menstrual bleeding, 56 for intermenstrual bleeding, and 56 for polycystic ovary syndrome. Combined oral contraceptives were the preferred follow-up medication: 30 would use them for heavy menstrual bleeding, 24 for intermenstrual bleeding, and 52 for polycystic ovary syndrome. CONCLUSION: Despite implementation of the FIGO AUB classification system and guidelines, awareness and use among gynecologists in South Korea remains low.


Assuntos
Ginecologia/estatística & dados numéricos , Menorragia/terapia , Metrorragia/terapia , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Agências Internacionais , Masculino , Menorragia/classificação , Menorragia/diagnóstico , Metrorragia/classificação , Metrorragia/diagnóstico , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , República da Coreia , Inquéritos e Questionários , Terminologia como Assunto
18.
J Minim Invasive Gynecol ; 22(3): 489-94, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25573186

RESUMO

OBJECTIVE: To understand the meaning of endometrial thickening and bleeding in postmenopausal women who had previously undergone endometrial ablation (EA). DESIGN: Retrospective observational study. Canadian Task Force III. SETTING: Obstetrics and Gynecology Unit, Magna Graecia University, Catanzaro, Italy. PATIENTS: Sixty-three postmenopausal women who had previously undergone EA. INTERVENTIONS: A retrospective evaluation of clinical charts of postmenopausal women who had a follow-up visit after EA between January 2000 and August 2014. MEASUREMENTS AND MAIN RESULTS: The rates of endometrial thickening (with or without bleeding), endometrial atrophy, and cancer were determined. Postmenopausal bleeding was reported in 9 patients (14.3%). Endometrial thickening was observed in 51 patients (80.9%; mean ± SD endometrial thickness, 7.7 ± 3.0 mm). A significantly (p < .05) greater number of patients with an endometrial thickness of 5 to 10 mm was observed compared with those with an endometrial thickness of <5 mm or >10 mm. A significant (p = .001) difference in increase in endometrial thickness was observed between patients with and without bleeding. Overall, hysteroscopy plus endometrial biopsy was scheduled in 24 patients. In all bleeding women, a histological diagnosis of endometrial atrophy was demonstrated. Concerning bleeding-free women, in 14 patients with endometrial thickening of >10 mm, mucosal atrophy was detected. The only bleeding-free patient in whom an endometrial echogenic fluid collection was detected had a histological diagnosis of endometrioid endometrial cancer. Thus, patients who underwent hysteroscopy had a 95.8% rate of mucosal atrophy and a 4.2% rate of endometrial cancer. The overall cancer rate in our global population (menopause with previous EA) was 1.6%. CONCLUSION: Postmenopausal bleeding and sonographic detection of endometrial thickening in patients with previous EA are not necessarily related to a malignant disease. Nonetheless, ultrasound visualization of endometrial thickening plus an echogenic endometrial fluid collection in these patients always warrants an invasive diagnostic procedure regardless of whether or not bleeding is reported.


Assuntos
Técnicas de Ablação Endometrial/efeitos adversos , Neoplasias do Endométrio , Endométrio , Metrorragia , Atrofia/epidemiologia , Atrofia/patologia , Biópsia , Neoplasias do Endométrio/epidemiologia , Neoplasias do Endométrio/patologia , Endométrio/diagnóstico por imagem , Endométrio/patologia , Endométrio/fisiopatologia , Feminino , Humanos , Histeroscopia/métodos , Itália/epidemiologia , Metrorragia/diagnóstico , Metrorragia/epidemiologia , Metrorragia/etiologia , Metrorragia/terapia , Pessoa de Meia-Idade , Pós-Menopausa , Estudos Retrospectivos , Ultrassonografia
19.
Adolesc Med State Art Rev ; 26(3): 473-83, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27282007

RESUMO

Adolescent females frequently present to the ED with complaints that may be caused by a gynecologic emergency. Differentiating and excluding some of the common and most serious gynecologic emergencies reviewed in this article are critical. Timely and effective treatment of these conditions, once diagnosed, can result in better health outcomes.


Assuntos
Confidencialidade , Anticoncepção Pós-Coito/métodos , Emergências , Doenças Ovarianas/diagnóstico , Doença Inflamatória Pélvica/diagnóstico , Gravidez Ectópica/diagnóstico , Anormalidade Torcional/diagnóstico , Hemorragia Uterina/diagnóstico , Adolescente , Feminino , Humanos , Anamnese , Menorragia/diagnóstico , Menorragia/terapia , Metrorragia/diagnóstico , Metrorragia/terapia , Doenças Ovarianas/terapia , Doença Inflamatória Pélvica/terapia , Gravidez , Gravidez Ectópica/terapia , Gravidez não Planejada , Anormalidade Torcional/terapia , Hemorragia Uterina/terapia
20.
BMC Womens Health ; 14: 132, 2014 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-25370003

RESUMO

BACKGROUND: Abnormal uterine bleeding (AUB) is one of the most common debilitating menstrual problems and has remained one of the most frequent indications for hysterectomy in developing countries. Approximately in 40% of hysterectomy specimens, no definite organic pathology could be established. The problem is common worldwide but causes may vary from one region to another. This study may help gynecologists in our population to improve their therapeutic strategies by promoting minimally invasive uterus sparing modalities such as endometrial ablation and hysteroscopic resection of early proliferative lesions. METHODS: It was a prospective, cross-sectional study conducted at Liaquat National Hospital from 15(th) January 2010 till 14(th) July 2011 over a period of 18 months. Women who underwent dilatation and curettage for endometrial sampling with complaints of AUB were included in the study and histopathologic spectrum was determined. RESULTS: Polymenorrhea was the most common presenting pattern (30%, 72/241) with reproductive age women being the most susceptible (49.3%,119/241). The commonest histopathological spectrum was normal menstrual pattern (34%, 82/241) and the commonest pathology was hormonal imbalance (27%, 65/241), followed by endometrial polyp (14%, 34/241), chronic endometritis (12%, 28/241), atrophic endometrium (6%, 15/241), endometrial hyperplasia (5%, 12/241), and endometrial carcinoma (2%, 5/241). Chronic endometritis was commonly seen in reproductive age (18%, 21/119); hormonal imbalance (45%, 35/77) and endometrial hyperplasia (6.5%, 5/77) in perimenopausal age; endometrial polyp (35.5%, 16/45) and endometrial carcinoma (9%, 4/45) in postmenopausal age. CONCLUSION: Frequency of benign endometrial pathology is quite high in AUB, 236 participants (98%, 236/241). Histopathological spectrum in patients with AUB is quite variable with respect to age. The most common pattern of AUB was polymenorrhea. The most common pathology was hormonal imbalance. It is suggested that age was associated with more progressive lesions found in peri and postmenopausal age group such as endometrial hyperplasia and endometrial carcinoma. Yet endometrial polyp was the most common pathology found in postmenopausal women. Therefore, the management strategy should be individualized, as in most cases a restrictive approach is appropriate in order to avoid unnecessary hysterectomies.


Assuntos
Carcinoma/complicações , Neoplasias do Endométrio/complicações , Endométrio/patologia , Menorragia/etiologia , Metrorragia/etiologia , Oligomenorreia/etiologia , Pólipos/complicações , Adolescente , Adulto , Idoso , Atrofia/complicações , Criança , Doença Crônica , Estudos Transversais , Doenças do Sistema Endócrino/complicações , Endometrite/complicações , Feminino , Humanos , Hiperplasia/complicações , Menorragia/patologia , Menorragia/terapia , Metrorragia/patologia , Metrorragia/terapia , Pessoa de Meia-Idade , Oligomenorreia/patologia , Oligomenorreia/terapia , Paquistão , Pós-Menopausa , Estudos Prospectivos , Adulto Jovem
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