scholarly journals Cycle-related Diarrhea and Dysmenorrhea are Independent Predictors of Peritoneal Endometriosis, Cycle-related Dyschezia is an Independent Predictor of Rectal Involvement

2020 ◽  
Vol 80 (03) ◽  
pp. 307-315
Author(s):  
Kristin Nicolaus ◽  
Laura Reckenbeil ◽  
Dominik Bräuer ◽  
Robert Sczesny ◽  
Herbert Diebolder ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Correct Diagnosis ◽  
Final Diagnosis ◽  
Rectal Involvement ◽  
Initial Symptoms ◽  
Peritoneal Endometriosis ◽  
Risk Probability ◽  
Binary Regression Analysis ◽  
Group 2 ◽  
Infertile Patients

Abstract Introduction The clinical presentation of endometriosis is extremely varied. Because endometriosis symptoms may overlap with symptoms caused by gastroenterological disorders, this can lead to misdiagnosis and a considerable delay in arriving at the correct diagnosis. The aim was to evaluate the type and duration of endometriosis-related symptoms and to identify predictors for patterns of involvement depending on symptoms. Material and Method The data of 266 consecutive patients who were operated on in the Endometriosis Center between 1/2016 and 12/2017 after receiving a histologically verified diagnosis of endometriosis were recorded. In addition to recording the clinical parameters, a questionnaire was distributed to the patients, who were asked about their medical history. Infertile patients were grouped together as Group 1 and compared to non-infertile patients (Group 2). Results The response rate for returned questionnaires was 79.47% (182/229). 41.8% of patients reported that they were infertile and 91.8% reported pelvic pain. In more than ⅓ of cases in both groups, more than 10 years passed between the initial symptoms and the final diagnosis (39.4 vs. 37.5%). On average, patients consulted 2.72 (± 1.58) resp. 3.08 (± 1.72) doctors before they presented to a hospital or were referred for laparoscopic diagnostic workup (p = 0.162). Cycle-related diarrhea (odds ratio 2.707; 95% CI: 1.063 – 6.895, p = 0.037) and dysmenorrhea (odds ratio 2.278; 95% CI: 1.193 – 4.348, p = 0.013) were associated with involvement of the pelvic peritoneum, cycle-related dyschezia was associated with rectal involvement by a factor of 4.6 in binary regression analysis (odds ratio 4.659; 95% CI: 1.132 – 19.186; p = 0.033). Conclusion Cycle-related diarrhea and dysmenorrhea increase the risk probability of peritoneal endometriosis. Dyschezia increases the risk probability of rectal endometriosis.

Influence of Toileting Behaviour on Anterior Vaginal Wall Prolapse Natural Course

2021 ◽  
Author(s):  
Osman Kose ◽  
Yavuz Tarik Atik ◽  
Deniz Gul ◽  
Burak Uysal ◽  
Haci Ibrahim Cimen ◽  
...  
Keyword(s):  
Symptom Control ◽  
Pelvic Organ ◽  
Vaginal Wall ◽  
Anterior Vaginal Wall ◽  
Natural Course ◽  
Sitting Position ◽  
Anterior Vaginal Wall Prolapse ◽  
Initial Symptoms ◽  
Group 2 ◽  
Group 1

Abstract Background: Many risk factors have been proposed for POP, and the cause seems most plausible to be multifactorial. This study aimed to investigate the effect of toileting behaviors on the anterior vaginal wall prolapse (AVWP) natural course.Methods: The data of 75 women who had been operated for symptomatic AVWP were recorded. The patients with grade ³II AVWP were included in this study, and they were divided into two groups according to voiding and defecation position. The volunteers who were voiding in the sitting position defined as Group 1, and Group 2 included the volunteers who were voiding in squatting position. The Colo-Rectal-Anal Impact Questionnaire (CRAIQ), Pelvic Floor Impact Questionnaire (PFIQ), Pelvic Organ Prolapse Impact Questionnaire (POPIQ), Urinary Impact Questionnaire (UIQ) and visual analog pain scores were used for evaluation of patients’ symptoms. Results: 44 patients enrolled in group 1 (sitting position) and 31 patients enrolled in group 2 (squatting position). BMI, number of parity, menopause duration, topical estrogen using, comorbidities, presence of constipation and urinary incontinence, and ped count for incontinence were similar in both groups. The time from initial symptoms to surgery was demonstrated shorter in group 2, 12 (3-73) and 24 (2-182) months, respectively (p=0.001). The PFIQ and POPIQ scores and the POP-related VAS score were statistically higher in patients who were voiding and defecating in squatting positions. Conclusion: Questioning the toileting position of patients with AVWP may be effective on the treatment option of the patient and may be beneficial on symptom control.

Primary leptomeningeal lymphoma masquerading as infectious tubercular meningitis

2021 ◽  
Vol 14 (9) ◽  
pp. e243574
Author(s):  
Salini Sumangala ◽  
Thidar Htwe ◽  
Yousuf Ansari ◽  
Lidia Martinez- Alvarez
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Correct Diagnosis ◽  
Central Nervous System Lymphoma ◽  
Final Diagnosis ◽  
Csf Analysis ◽  
Antitubercular Treatment ◽  
Lymphoma Treatment ◽  
Work Up ◽  
Timely Treatment

Primary central nervous system lymphoma (PCNSL) is infrequent and often poses diagnostic conundrums due to its protean manifestations. We present the case of a South Asian young man presenting with raised intracranial pressure and a lymphocytic cerebrospinal fluid (CSF) with pronounced hypoglycorrhachia. Progression of the neuro-ophthalmic signs while on early stages of antitubercular treatment led to additional investigations that produced a final diagnosis of primary leptomeningeal lymphoma. Treatment with chemoimmunotherapy (methotrexate, cytarabine, thiotepa and rituximab (MATRix)) achieved full radiological remission followed by successful autologous transplant. This case highlights the difficulties and diagnostic dilemmas when PCNSL presents as a chronic meningeal infiltrative process. While contextually this CSF is most often indicative of central nervous system tuberculosis and justifies empirical treatment initiation alone, it is essential to include differential diagnoses in the investigation work-up, which also carry poor prognosis without timely treatment. High suspicion, multidisciplinary collaboration and appropriate CSF analysis were the key for a correct diagnosis.

scholarly journals The diagnosis of delirium in 80 emergency unit patients

1998 ◽  
Vol 56 (2) ◽  
pp. 176-183
Author(s):  
AFONSO CARLOS NEVES ◽  
RICARDO DE CASTRO CINTRA SESSO ◽  
HENRIQUE BALLALAI FERRAZ ◽  
SÍLVIO FRANCISCO ◽  
JOÃO BAPTISTA DOS REIS-FILHO
Keyword(s):  
Correct Diagnosis ◽  
Diagnostic Testing ◽  
Final Diagnosis ◽  
Initial Diagnosis ◽  
University Hospital ◽  
Emergency Unit ◽  
Predictive Values ◽  
Kappa Test ◽  
History Of ◽  
Sensitivity Specificity

We evaluated the initial and final diagnosis of 80 patients with delirium arriving at the emergence unit of a university hospital in a large Brazilian city over a period of 30 months up to December 1991. The diagnosis was based on the DSM-IIIR criteria. Patients with a known history of head trauma or epileptic seizure and patients younger than 13 years were excluded. Only patients with a disease of up to 7 days were included.The patients were subdivided into four etiologic groups: vascular; associated with the use of alcohol; infectious-parasitic; miscellaneous.The results showed a rate of correct diagnosis ranging from 65 to 80% with the use of kappa test (standard good to excelent). Sensitivity, specificity, positive predictive and negative predictive values had results showing different conditions for initial diagnosis in each group. This study can help the initial diagnosis of delirium and the choice for diagnostic testing.

Transthyretin-assoziierte familiäre Amyloidpolyneuropathie

2018 ◽  
Vol 143 (06) ◽  
pp. 427-430
Author(s):  
Christoph Niemietz ◽  
Christoph Röcken ◽  
Matthias Schilling ◽  
Jörg Stypman ◽  
Constantin Uhlig ◽  
...  
Keyword(s):  
Amyloid Fibrils ◽  
Clinical Symptoms ◽  
Chronic Inflammatory Demyelinating Polyneuropathy ◽  
Correct Diagnosis ◽  
Vitreous Body ◽  
Final Diagnosis ◽  
Autonomic Nerves ◽  
Loss Of Weight ◽  
Peripheral Polyneuropathy ◽  
Immunohistochemical Evidence

AbstractTransthyretin-related Familial Amyloid Polyneuropathy (ATTR Amyloidosis, former FAP, here called TTR-FAP) is a rare, progressive autosomal dominant inherited amyloid disease ending fatal within 5 – 15 years after final diagnosis. TTR-FAP is caused by mutations of transthyretin (TTR), which forms amyloid fibrils affecting peripheral and autonomic nerves, the heart and other organs. Due to the phenotypic heterogeneity and partly not specific enough clinical symptoms, diagnosis of TTR-FAP can be complicated. False diagnoses can include idiopathic polyneuropathy, chronic inflammatory demyelinating polyneuropathy, diabetic neuropathy as well as paraneoplastic syndrome. Hence, it is assumed that many cases remain unreported. Early and correct diagnosis of TTR-FAP is crucial, since appropriate therapeutic options exist. TTR-FAP should always be differentially diagnosed, when apart from a progressive peripheral polyneuropathy, additional symptoms as autonomic dysfunction, cardiomyopathy, gastrointestinal disorders, unexpected loss of weight, carpal tunnel syndrome, restrictions of renal function, epileptic fits, and corneal and vitreous body clouding occur. Histological evidence of amyloid and successive immunohistochemical evidence of transthyretin as well as genetic testing for transthyretin mutations, lead to an accurate diagnosis.

Desmoid tumor of the anterior abdominal wall in a female (Clinical case)

2018 ◽  
pp. 116-118
Author(s):  
M.V. Makarenko ◽  
◽  
D.O. Govseyev ◽  
S.V. Gridchin ◽  
N.H. Isaeva ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Desmoid Tumor ◽  
Clinical Case ◽  
Anterior Abdominal Wall ◽  
Correct Diagnosis ◽  
Final Diagnosis ◽  
Histological Findings ◽  
History Of ◽  
Slow Growing ◽  
Wall Tumor

Desmoid tumors (also called desmoids fibromatosis) are rare slow growing benign and musculoaponeurotic tumors. Although these tumors have a propensity to invade surrounding tissues, they are not malignant. These tumors are associated with women of fertile age, especially during and after pregnancy and postoperative surgeries. Our clinical case is interesting because of the rarity of the pathology and the difficulties in setting the correct diagnosis. The patient, with a history of laparoscopic myomectomy (2012), was preparing for a routine surgery for the endometrioma of the anterior abdominal wall, according to the results of the ultrasound and computed tomography. After surgical treatment, the final diagnosis was changed, based on the histological findings. Key words: desmoid tumor, abdominal wall tumor, fibroid.

P–711 The association between thyroid autoimmunity and serum level of anti-Müllerian hormone in infertile patients with normal ovarian reserve undergoing in vitro fertilisation

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
A Albu ◽  
D Albu
Keyword(s):  
Serum Level ◽  
Ovarian Reserve ◽  
Thyroid Autoimmunity ◽  
In Vitro Fertilisation ◽  
Free T4 ◽  
Infertile Women ◽  
Group 2 ◽  
Infertile Patients ◽  
Group 1

Abstract Study question Is there a relationship between thyroid autoimmunity and serum level of anti-müllerian hormon (AMH) in infertile women with normal ovarian reserve undergoing in vitro fertilisation (IVF)? Summary answer In infertile women with normal ovarian reserve serum AMH level above 5ng/ml is associated with higher level of thyroid hormones and less frequent thyroid autoimmunity What is known already Previous studies suggest that thyroid autoimmunity is associated with a decreased ovarian reserve. Moreover, it was reported that thyroid hormone administration could improve serum AMH level. However, the relationship between serum AMH level and thyroid autoimmunity and function in infertile women with normal ovarian reserve undergoing IVF is largely unknown. Since in IVF the serum AMH level is an important marker which dictate the management of the couple, the identification of all the factors possibly related to this parameter is very important. Study design, size, duration: We performed a retrospective study in the Department of Reproductive Medicine of a private hospital. The medical records of all consecutive patients who underwent IVF between January 2015 and December 2018 with all causes of infertility were reviewed. Study group included 581patients with a mean age of 34.4±4.1 years, mean AMH of 3.78±2.4 ng/mL, mean serum TSH level of 1.89±1 microUI/ml and mean serum free T4 level of 1.05±0.98 ng/dl. Participants/materials, setting, methods Patients with known thyroid disorders or under thyroid hormone treatment at the moment of evaluation were excluded. Only patients with serum level of thyroid stimulating hormone (TSH), free tyroxine (free T4), anti thyroid peroxidase antibodies (ATPO,) anti thyroglobulin antibodies (ATG), AMH and age available for analysis were included in the study. This parameters are evaluated on a systematic basis in all the patients undergoing IVF in our Department, except very few cases. Main results and the role of chance Patients were divided according to their serum AMH level in two groups: group 1 with AMH level 5 ng/ml and below (n = 450 patients) and group 2 with AMH above 5 ng/ml (n = 131 patients). When the two groups were compared we found that patients in group 2 were younger in comparison with patients in group 1 (32.9±3.8 versus 35±4 years, p < 0.0001). After adjustment for age, patients in group 2 had significantly higher serum free T4 level (1.07±0.12 versus 1.04±0.14 ng/dl, p = 0.015), lower ATG (17.59±41.8 UI/ml versus 39.4±136.16 UI/ml, p < 0.018) and presented less frequently with high ATPO antibodies (35% versus 41.8%, p = 0.047). In a logistic regression model with AMH as a dependent variable, free T4, but not TSH was independently and positively associated with higher AMH levels (above 5 ng/ml) (p = 0.025) after adjustment for anti thyroid antibodies levels. Morever, in this logistic model the presence of high ATPO, but not ATG, were negatively related to higher AMH level (p = 0.037). Limitations, reasons for caution Patients included in this study are infertile patients with indication for IVF treatment. Therefore, the results of this study should be used with caution in other populations Wider implications of the findings: Our study suggest that serum AMH level might be related to thyroid autoimmunity, but also to thyroid hormones levels. If confirmed by further studies, this findings could offer a way to improve serum AMH level and to better understand the markers of ovarian reserve in an IVF setting. Trial registration number NA

Identification of zoonotic Enterocytozoon bieneusi genotypes in pre-weaned Korean native calves

2020 ◽  
Author(s):  
Sunwoo Hwang ◽  
Seung-Uk Shin ◽  
SuHee Kim ◽  
Ji-Hyoung Ryu ◽  
Kyoung-Seong Choi
Keyword(s):  
Odds Ratio ◽  
Age Groups ◽  
Common Species ◽  
Enterocytozoon Bieneusi ◽  
Reservoir Host ◽  
Zoonotic Potential ◽  
Genotype I ◽  
The Republic ◽  
Group 2 ◽  
The Relationship

Abstract Background: Enterocytozoon bieneusi is the most common species of microsporidia that can infect humans and various animals worldwide. To date, information on the prevalence and genotypes of E. bieneusi infection in cattle in the Republic of Korea is limited. Therefore, in this study, we aimed to investigate the prevalence and genotypes of E. bieneusi circulating in pre-weaned Korean native calves and determine the age pattern of E. bieneusi infection and the relationship between E. bieneusi and diarrhea. Results: The overall prevalence of E. bieneusi was 16.9% (53/314) in pre-weaned calves by PCR. The prevalence of E. bieneusi was the highest in September (36.2%), followed by March (28.3%). E. bieneusi infection (c 2 = 5.82, P = 0.016) was associated with diarrhea in calves. The present results indicated that E. bieneusi infection was statistically associated with calf age (c 2 = 11.61, P = 0.003); the prevalence of E. bieneusi was significantly higher in calves aged 21-40 days (odds ratio = 2.90, 95% confidence interval: 1.54-5.45; P = 0.001) than in those aged 1-20 days. Interestingly, E. bieneusi infection showed an association with diarrhea only in calves aged 1-20 days (c 2 = 5.82, P = 0.010). Five genotypes, BEB4 ( n = 12), BEB8 ( n = 23), CHN6 ( n = 1), I ( n = 1), and J ( n = 16), were identified, and all these genotypes belonged to Group 2. The genotype BEB8 was the most prevalent in all age groups regardless of diarrhea. On the other hand, the genotype I was identified only in one calf aged 10 days with diarrhea. Except for CHN6, the four other genotypes were mostly observed in cattle, and all of them have zoonotic potential. Conclusions: This is the first report of the genotypes BEB4 and CHN6 in pre-weaned Korean native calves. The results revealed the presence of zoonotic E. bieneusi in pre-weaned Korean native calves, demonstrating that cattle may play an important role as a reservoir host in E. bieneusi transmission to humans.

Risk factors for blood-contaminated cerebrospinal fluid collection in dogs

2019 ◽  
Vol 186 (16) ◽  
pp. e8-e8
Author(s):  
Aran Nagendran ◽  
Daniel Sanchez-Masian ◽  
Erika Bersan ◽  
Camilla Jayne Cooper ◽  
Rita Gonçalves
Keyword(s):  
Risk Factors ◽  
Cerebrospinal Fluid ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Body Condition Score ◽  
Fluid Collection ◽  
Final Diagnosis ◽  
Time Of Day ◽  
Blood Contamination ◽  
Potential Risk Factors

ObjectiveTo determine the risk factors for blood contamination during cerebrospinal fluid (CSF) collection in dogs.Study design and methodsThis is a prospective study of 170 CSF samples. Data collected included signalment of the patient, body condition score, site of CSF collection (cerebellomedullary cistern (CMC) or lumbar cistern (LC)), number of attempts, clinician expertise, final diagnosis, time of day, skull conformation and day of the week. Analysis of the CSF samples was then performed, and the presence of blood contamination (red blood cells >500/µl) was recorded. Logistic regression was used to quantify the association of potential risk factors of the procedure. Multivariate analysis was performed on the variables that were statistically significant.ResultsOf the 170 CSF samples, 53 per cent were collected from the CMC (n=90) and 47 per cent from the LC (n=80). Blood contamination was seen in 20 per cent (n=34) of the samples, 8.9 per cent (n=8) in CMC and 32.5 per cent (n=26) in LC samples. Increased odds of obtaining a contaminated CSF sample were associated with lower level of clinician expertise (odds ratio: 2.5; 95 per cent confidence interval: 0.9–6.7; P=0.046) and with LC versus CMC collection site (odds ratio: 8.1; 95 per cent confidence interval: 2.1–12.9; P=0.001).Clinical significanceThere is increased likelihood of blood contamination when collecting CSF from the LC compared with the CMC site. Increased clinician experience reduced the risk of CSF blood contamination, but none of the other variables examined significantly influenced this.

scholarly journals Ovarian fibrosarcoma: A single-institution experience and a review of the literature

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Ting-Ting Sun ◽  
Ning-Hai Cheng ◽  
Dong-Yan Cao ◽  
Peng Peng
Keyword(s):  
Large Scale ◽  
Pelvic Mass ◽  
Final Diagnosis ◽  
College Hospital ◽  
Ki 67 ◽  
Nccn Guidelines ◽  
Surgical Methods ◽  
Initial Symptoms ◽  
Positive Rate ◽  
Low Incidence

AbstractOvarian fibrosarcoma is an extremely rare and malignant sex cord-stromal tumor. Due to its low incidence and poor prognosis, until now, very few cases have been reported, and most of the reported cases have been sporadic. Therefore, the treatments and prognostic factors of ovarian fibrosarcoma are still debatable. Here, we report 5 cases of ovarian fibrosarcoma that presented at Peking Union Medical College Hospital over the past 20 years. The 5 patients were 41, 51, 54, 76, and 76 years of age when initial symptoms of pelvic mass or pain appeared. On ultrasound, this disease usually manifests as unilateral pelvic masses, within which uneven echo enhancement and some blood flow signals are observed. No significant increase was observed in the levels of preoperative tumor markers, such as serum CA125 and sex hormones. The final diagnosis depends on postoperative histopathological results since these tumors are easily misdiagnosed when intraoperative frozen sections are used for examination. Pathologic examinations showed that the tumor cells were spindle-shaped with moderate to severe atypia and high mitotic counts. The immunohistochemistry profile is not specific, but the positive rate of Ki-67 was consistent with the degree of malignancy and the prognosis of patients with this tumor. In addition, the tumor may also be positive for Vimentin, α-inhibin, SMA, estrogen receptor and progesterone receptor. Significant differences were observed in the surgical methods used, and no unified chemotherapy regimen has been established. The overall survival was > 15, >7, > 6, <1, and < 1 year for each patient. After reviewing the literature, evidence-based large-scale case studies were lacking. For treatments, complete cytoreductive surgery plus regimens typically used against malignant sex cord-stromal tumors, as described in the NCCN guidelines, are recommended. Due to its low incidence, both multicenter clinical studies and molecular studies are required to provide gynecologists with a better understanding and guidance for future management of patients with ovarian fibrosarcoma.

scholarly journals Disseminated Neuroblastoma in an Adult Presenting the Picture of Thrombocytopenic Purpura

Blood ◽  
1956 ◽  
Vol 11 (3) ◽  
pp. 273-278 ◽  
Author(s):  
WILLIAM N. CHRISTENSON ◽  
JOHN E. ULTMANN ◽  
STEVEN C. MOHOS
Keyword(s):  
Bone Marrow ◽  
Acute Leukemia ◽  
Idiopathic Thrombocytopenic Purpura ◽  
Clinical Picture ◽  
Correct Diagnosis ◽  
Blood Picture ◽  
Thrombocytopenic Purpura ◽  
Metastatic Lesions ◽  
Initial Symptoms ◽  
Immature Cells

Abstract A case of neuroblastoma in an adult with extensive metastatic lesions is presented. The initial symptoms and findings suggested idiopathic thrombocytopenic purpura. The blood picture and changes in the clinical picture later led to a diagnosis of acute leukemia. Autopsy disclosed the correct diagnosis, which would have been possible antemortem had the implication of pseudorosette arrangement of immature cells in the bone marrow and the possible occurrence of neuroblastoma in an adult been fully appreciated.

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