15 research outputs found
Wandering Spleen: A Rare Case of an Adnexal Lesion
The wandering spleen (WS) is a rare condition in which the spleen is not
found in its usual location in the left hypochondrium but is positioned
in the lower abdomen or the pelvis. This is a case of a 21-year-old
woman who presented with chronic, intermittent, and subtle pain in the
left lower quadrant of her abdomen. After clinical examination and
ultrasound evaluation, an adnexal lesion was detected in the left lumbar
area, and no splenic tissue was found in the left hypochondrium. The
wandering spleen should be included in the differential diagnosis when
encountering a patient with non-typical or acute abdominal pain.
Accurate diagnostic evaluation can be performed with low-cost imaging
modalities such as Doppler ultrasound
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
The p16/ki-67 assay is a safe, effective and rapid approach to triage women with mild cervical lesions
Objective The aim of this study was to evaluate the diagnostic accuracy
and efficiency of p16/ki-67 dual stain in the identification of CIN2+
lesions, in Greek women with ASCUS or LSIL cytology.
Methods A total of 200 women, 20 to 60 years old, were enrolled in the
study. All samples were cytologically evaluated and performed for
p16/ki-67 and high-risk HPV (HR-HPV) test. All patients were referred to
colposcopy for biopsy and histological evaluation. Three cervical cancer
(CC) screening strategies were designed and the total direct medical
costs of the procedures during our clinical trial were evaluated, from a
healthcare perspective.
Results HPV 16 as expected was the most common HR-HPV type followed by
HPV 31 and HPV 51. The risk for CIN2+ was significantly higher in HPV
16/18 positive cases. p16/ki-67 demonstrated a high sensitivity for
CIN2+ identification in both ASCUS and LSIL groups (90.4% and 95%,
respectively). HR-HPV test with sensitivity 52.3% and 65.5%, as well
as colposcopy with sensitivity 14.3% and 36% respectively in ASCUS and
LSIL group, showed inferior results compared to p16/ki-67. The
specificity of p16/ki-67 for ASCUS and LSIL was 97.2% and 95.2%
respectively, inferior only to colposcopy: 100% and 100%, lacking
however statistical significance. HR-HPV test instead, presented the
lowest specificity: 76.4% and 71.4% respectively in comparison to the
other two methods. From a healthcare perspective, the costs and benefits
of the tests implementation for the annual screening and triaging, in
three CC screening strategies, were also calculated and discussed.
Conclusions The results of the study indicate that p16/ki-67 is a safe
and rapid assay that could be used to detect CIN2+ among women with mild
cervical lesions, presenting both high sensitivity and specificity and
could minimize the psychological and economic burden of HPV screening
Recurrent benign leiomyomas after total abdominal hysterectomy. Rich or poor estrogenic environment may lead to their recurrence?
INTRODUCTION: Benign metastasizing leiomyomas represent benign lesions
consisted by leiomatosous tissue and could be observed in positions away
from their usual localization, the human uterus. They commonly affect
women that have undergone total hysterectomy. Approximately 100 similar
cases have been reported in the literature, so the case we present is
rare and reviewing the literature and needs to be reported.
PRESENTATION OF CASE: We report a case of a 55 year old Greek woman,
gravida five and para three, who attended our unit 3 years ago
complaining of occasionally lower abdominal pain and irritation the last
months. Fourteen years ago she underwent abdominal hysterectomy and left
salpingo-oophorectomy due to a 13 cm uterine leiomyoma. In the meantime
she underwent two surgical procedures for recurrent benign leiomyomas.
DISCUSSION: When patient was admitted at this time, clinical examination
revealed a palpable mass of 5 cm. The transvaginal ultrasonography
revealed 3 masses in the lower pelvis of unknown origin. The patient
underwent a new laparotomy revealing three masses of benign leiomyomas
with low mitotic activity.
CONCLUSION: Our case supports the recurrent appearance of leiomyomas in
pelvis after total abdominal hysterectomy and is one of few reports in
literature where the tumors appear in the same patient both in estrogen
rich and estrogen poor environment. Additionally, we show the importance
of transvaginal ultrasonography and 3 dimensional power Doppler in the
differential diagnosis of pelvic masses. Thus, transvaginal
ultrasonography seems to be a pivotal tool for the diagnosis and follow
up of these challenging lesions. (C) 2018 The Authors. Published by
Elsevier Ltd on behalf of IJS Publishing Group Ltd
A Randomized Controlled Trial on the Efficacy and Safety of Low-Dose hCG in a Short Protocol with GnRH Agonist and Ovarian Stimulation with Recombinant FSH (rFSH) During the Follicular Phase in Infertile Women Undergoing ART
tau his study aims to investigate whether the addition of low-dose hCG
throughout stimulation in infertile women undergoing IVF improves IVF
outcome parameters. This is a prospective, multicenter, randomized,
double-blind, placebo-controlled, Phase IIIb clinical study, conducted
in three university IVF units. We studied whether the addition of 100 IU
hCG/day to a short GnRH agonist IVF protocol from the onset of the
follicular phase (group 1, n=40) or placebo (group 2, n=41) had any
impact on the number of high-quality transferred embryos at day 2 and
clinical pregnancy rates. The comparison encompassed descriptive
statistics, and univariate and multivariate analyses. Concerning the
primary outcomes, we found no differences in both the number of
high-quality embryos (>= 2) at day 3 [21/40 (52.5%) vs. 14/41
(34.2%), p=0.095] and clinical pregnancy rates [10/40 (25%) vs.
10/41 (24.4%), p=0.949], respectively. Similarly, there were no
differences concerning the secondary outcomes preset for this trial.
According to the results of the multivariate logistic regression
analysis, no significant associations were noted for primary outcomes
(clinical pregnancy: adjusted OR=0.89, 95% CI: 0.29-2.75; (>= 2
excellent quality embryos at day 3: adjusted OR=0.54, 95% CI:
0.21-1.42, with group 1 set as reference category); similarly, no
differences were noted with respect to secondary outcomes, except from
the increased odds of >= 2 poor-quality embryos at day 3 occurring in
group 2 (adjusted OR= 11.69, 95%CI: 1.29-106.19). The addition of
low-dose hCG to a short GnRH agonist protocol for IVF does not improve
the number of top-quality embryos and clinical pregnancy rates
Evaluation of IOTA-ADNEX Model and Simple Rules for Identifying Adnexal Masses by Operators with Varying Levels of Expertise: A Single-Center Diagnostic Accuracy Study
Objectives The discrimination of ovarian lesions presents a significant
problem in everyday clinical practice with ultrasonography appearing to be the
most effective diagnostic technique. The aim of our study was to externally
evaluate the performance of different diagnostic models when applied by
examiners with various levels of experience
Prospective internal validation of mathematical models to predict malignancy in adnexal masses: results from the International Ovarian Tumor Analysis (IOTA) Study
Purpose: To prospectively test the mathematical models for calculation of the risk of malignancy in adnexal masses that were developed on the International Ovarian Tumor Analysis (IOTA) phase 1 data set on a new data set and to compare their performance with that of pattern recognition, our standard method. Methods: Three IOTA centers included 507 new patients who all underwent a transvaginal ultrasound using the standardized IOTA protocol. The outcome measure was the histologic classification of excised tissue. The diagnostic performance of 11 mathematical models that had been developed on the phase 1 data set and of pattern recognition was expressed as area under the receiver operating characteristic curve (AUC) and as sensitivity and specificity when using the cutoffs recommended in the studies where the models had been created. For pattern recognition, an AUC was made based on level of diagnostic confidence, Results: All IOTA models performed very well and quite similarly, with sensitivity and specificity ranging between 92% and 96% and 74% and 84%, respectively, and AUCs between 0.945 and 0.950. A least squares support vector machine with linear kernel and a logistic regression model had the largest AUCs. For pattern recognition, the AUC was 0.963, sensitivity was 90.2%, and specificity was 92.9%. Conclusion: This internal validation of mathematical models to estimate the malignancy risk in adnexal tumors shows that the IOTA models had a diagnostic performance similar to that in the original data set. Pattern recognition used by an expert sonologist remains the best method, although the difference in performance between the best mathematical model is not large
Prospective Study on the Correlation between CART and Leptin Gene Expression, Obesity, and Reproductive Hormones in Individuals Undergoing Bariatric Surgery
Obesity, a global health concern affecting 650 million individuals of all ages worldwide, prompts health complications, including fertility issues. This research investigates the impact of bariatric surgery on morbidly obese females under 40, examining the relationship between CART and leptin gene expressions and reproductive hormones. Post-surgery, a significant reduction in BMI (16.03 kg/m2, n = 29) was observed, accompanied by notable hormonal changes. FSH levels showed a mean difference of 3.18 ± 1.19 pre- and post-surgery (p p p p p = 0.005; leptin: rs = 0.75, p < 0.001), shed light on potential molecular pathways connecting gene expressions with reproductive hormones post-bariatric surgery. Our study uniquely investigates the interplay between genetic markers, infertility, and bariatric surgery in women. It stands out by providing distinctive insights into the development of personalized treatment strategies for obesity-related infertility, contributing to a deeper understanding of this complex medical issue