Post-menopausal vaginal bleeding caused by carcinoma of the appendix: a case report

<p>Abstract</p> <p>Introduction</p> <p>Post-menopausal blood loss is a common complaint of patients seen in gynecological practice. The most frequent malignancy found in cases of post-menopausal bleeding is endometrial cancer. Other causes can be malignancies of the rest of a woman's genital tract or metastases from other tumors. To the best of our knowledge, it appears that this is the first published case of a post-menopausal primary appendiceal carcinoma presenting with vaginal blood loss.</p> <p>Case presentation</p> <p>A 75-year-old Caucasian woman with a history of vaginal hysterectomy presented with a 10-month history of post-menopausal blood loss. After extensive examination and discussion, ovarian carcinoma was suggested. Microscopic examination of the tissue removed at laparotomy revealed an adenocarcinoma of the appendix. She was treated with adjuvant radiotherapy and with palliative chemotherapy after 14 months because of intra-abdominal metastatic disease.</p> <p>Conclusion</p> <p>Post-menopausal blood loss in a patient with a history of hysterectomy is uncommon and always needs further investigation.</p

Endometriosis centers of expertise in the Netherlands:Development toward regional networks of multidisciplinary care

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A Structured Assessment to Decrease the Amount of Inconclusive Endometrial Biopsies in Women with Postmenopausal Bleeding

Objective. To determine whether structured assessment of outpatient endometrial biopsies decreases the number of inconclusive samples. Design. Retrospective cohort study. Setting. Single hospital pathology laboratory. Population. Endometrial biopsy samples of 66 women with postmenopausal bleeding, collected during the usual diagnostic work-up an

Patient preferences for disposable and reusable vaginal specula and their willingness to compromise in the era of climate change: A cross-sectional study

Objective: To evaluate patient satisfaction on gynaecological examination with metal, plastic and biobased plastic vaginal specula, and to investigate whether patients are willing to compromise on comfort for a more sustainable healthcare system. Design: Cross-sectional study: population-based survey. Setting: Gynaecological outpatient clinics in five Dutch hospitals. Population: Patients during general gynaecology consultation hours. Methods: A survey containing two questions about patient demographics, four about comfort and five about sustainability and healthcare was distributed. Main outcome measures: Comfort score (scale 1–10). Secondary outcomes: (1) temperature, size and ease of insertion, (2) willingness to compromise for a more sustainable healthcare system. Results: In all, 196 patients completed the survey. Biobased plastic vaginal specula scored significantly higher on comfort than the metal ones (mean 8.03 ± 1.65 versus 7.26 ± 1.51 respectively; P < 0.001). The biobased plastic vaginal speculum is significantly the most comfortable on temperature, whereas the metal speculum is the least comfortable (P < 0.007). Most patients are willing to compromise on comfort or are open to the reuse of disposables to contribute to a more sustainable healthcare. The majority of patients (77%) urge healthcare organisations to combat climate change. Conclusions: There is a small but statistically significant difference in favour of a biobased plastic speculum regarding comfort score, although it might be questioned whether this is clinically relevant. Furthermore, patients are willing to compromise on comfort for a more sustainable healthcare, which should be a contributing factor in speculum selection

Factors associated with home hazards: findings from the Malaysian Elders Longitudinal Research study

Aim: Previous studies have investigated home hazards as a risk factor for falls without considering factors associated with the presence of home hazards. The present study aimed to determine patterns of home hazards among urban community-dwelling older Malaysians, and to identify factors contributing to home hazards. Methods: Cross-sectional data from the initial wave of the Malaysian Elders Longitudinal Research study were used. Basic demographics were obtained from the Global Questionnaire. Basic and instrumental activities of daily living were measured using the Katz and Lawton-Brody scales, and home hazards were identified using the Home Falls and Accidents Screening Tool. Participants were also asked if they had fallen in the previous 12 months. Results: Data were analyzed from 1489 participants. Hazards were frequently identified (>30%) in the toilet and bathroom areas (no grab rail, no non-slip mat, distant toilet), slippery floors, no bedside light access and inappropriate footwear. Lower educational attainment, traditional housing, Chinese ethnicity, greater number of home occupants, lower monthly expenditure, poor vision and younger age were the factors independently associated with home hazards. Conclusions: This study provides evidence that home hazards are a product of the interaction of the individual's function within their home environment. Hazards are also influenced by local sociocultural and environmental factors. The relationship between home hazards and falls appears complex and deserves further evaluation

The diagnostic work-up of women with postmenopausal bleeding

In this thesis we describe the diagnostic work-up that can be used to diagnose or exclude endometrial cancer in women with postmenopausal bleeding. Despite the many studies investigating this, there is no consensus in literature. The diagnostic steps vary in different guidelines, depending on the structure of patient flow in different settings and healthcare systems, as well as the availability of specific procedures. One important question in this thesis is if we can reassure women with a benign result of endometrial sampling. Is it (cost-)effective to diagnose and remove endometrial polyps to prevent recurrent bleeding? And is it necessary to diagnose and remove a polyp to detect a possible endometrial (pre)cancer? From the randomised trial described in this thesis, we can conclude that in women with PMB, a thickened endometrium and benign endometrial sampling, operative hysteroscopy does not reduce recurrent bleeding. Yet, hysteroscopy detected focal endometrial (pre) cancer in 6% of women who had benign endometrial sampling. This finding indicates that in these women, further diagnostic work-up is warranted to detect focal (pre)cancers missed by endometrial sampling. Furthermore, we can conclude that the diagnostic accuracy of endometrial sampling is lower that we thought based on previous literature. We have also looked into the value of predictionmodels, which we could use to select women with a high risk of endometrial cancer for further diagnostic work-up based on their patient-characteristics. We can conclude that until now, no predictionmodels are available which can select women based on their characteristics, without on the other hand missing women with endometrial cancer