Transvaginal ultrasonography and endometrial histology in peri- and postmenopausal women on hormone replacement therapy.
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Endometrium↗
Biomedical subjects
J K Gupta
Publications and source records attributed to J K Gupta.
Surgical correction of congenital uterine anomalies.
Congenital uterine abnormalities have been associated with poor reproductive outcome. Anatomical corrections utilizing open or endoscopic surgery has been recommended to improve these outcomes. This article assesses the available evidence.
Abortion, Spontaneous↗
The risk of premalignant and malignant pathology in endometrial polyps.
OBJECTIVE: To evaluate the risk of premalignant and malignant pathology among endometrial polyps. DESIGN: Prospective cohort study. SETTING: Minimal Access Surgical Training (MAST) center in a large teaching hospital. METHODS: Among 248 patients seen in outpatient hysteroscopy clinic (1996-97), 62 had endometrial polyps. All patients had endometrial sampling for histological assessment. To determine the magnitude of malignant potential among polyps, we compared the pathological findings in polyps (cases) with non-polypoidal specimens (controls). RESULTS: Out of 62 polyps, histologically 53 (85.5%) were benign, seven (11.3%) had hyperplasia, and two (3.2%) were associated with malignancy. Hyperplasia was more frequent in endometrial specimens with polyps than in those without (11.3% vs 4.3%, p=0.04), but the incidence of carcinoma in the two groups was the same (3.2% vs 3.2%, p= 1.0). CONCLUSION: In abnormal uterine bleeding, hyperplasia was, but cancer was not, more common in women with endometrial polyps compared to those without polyps.
Cohort Studies↗
Abdominal, laparoscopic, and vaginal hysterectomy with bilateral salpingo-oophorectomy: a feasibility study for further evaluation in randomized trials.
BACKGROUND: The abdominal route is the traditional method of performing hysterectomy with bilateral salpingo-oophorectomy. In a feasibility study, we compared a nonconventional (vaginal) route for bilateral salpingo-oophorectomy at the time of vaginal hysterectomy (VH + BSO) to similar forms of hysterectomy performed abdominally or with operative laparoscopy. METHODS: Fifty-nine patients were subject to either total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH + BSO; n = 19), or laparoscopic-assisted vaginal hysterectomy and bilateral salpingo-oophorectomy (LAVH + BSO; n = 19) or VH + BSO (n = 21). RESULTS: VH + BSO resulted in a shorter operating time compared to LAVH + BSO (p < 0.001), shorter hospital stay compared with TAH + BSO (p = 0.001), and quicker long-term recovery compared to the other two operations. CONCLUSION: This preliminary but significant study shows that the vaginal route for salpingo-oophorectomy at the time of vaginal hysterectomy is superior to other methods of hysterectomy. A randomized trial is needed to confirm these initial findings.
Abdomen↗
Laparoscopic management of ectopic pregnancy.
The incidence of ectopic pregnancy has been rising over the last 20 years. The cause is multifactorial. The technical advancement in the field of minimal access surgery has greatly enhanced the possibility of both diagnosing and treating the condition effectively. The management of ectopic pregnancy can be expectant and surgical; the latter can be by open or laparoscopic methods. Laparoscopic surgery is usually performed when the patient is haemodynamically stable, the hCG is <6000 IU/L, the history is suggestive of minimal pelvic adhesions and when the pregnancy is confined within the tube. This procedure is, however, vastly dependent on the experience and expertise of the surgeon and the equipment facilities available. There are various means of treating ectopic pregnancy by laparoscopy. This includes laparoscopic salpingectomy, salpingotomy, and direct injection of cytotoxic agents. This article will present an overview to ascertain the effectiveness of minimal access surgery in managing ectopic pregnancy. There seems little doubt that laparoscopic management should be the first line of treatment. The way to realize its full potential is by formulating clear guidelines regarding the indication and implementation of laparoscopic surgery and emphasising the role of a fully structured training program to achieve the goals.
Female↗
The diagnostic accuracy of ultrasound scan in predicting endometrial hyperplasia and cancer in postmenopausal bleeding.
OBJECTIVE: To determine the accuracy of ultrasound scan in the diagnosis of endometrial hyperplasia and cancer in postmenopausal bleeding. DESIGN: A prospective diagnostic accuracy study (1996-97). SETTING: Minimal access surgical training centers in two large teaching hospitals. METHODS: Ultrasound scan and outpatient endometrial sampling were performed on 96 patients with postmenopausal bleeding. Patients unable to have these outpatient procedures had a formal inpatient hysteroscopy and curettage. Test performance characteristics were computed for ultrasound scan comparing its estimate of endometrial thickness with histologic diagnosis that served as a 'gold' standard. OUTCOME MEASURES: Accuracy of the ultrasonic endometrial thickness was estimated using sensitivity, specificity and predictive values for binary data. For multilevel data, the diagnostic accuracy was computed using likelihood ratios (LRs). An LR < decreased the probability that endometrial hyperplasia/cancer was present, whereas an LR > 1 increased the probability that such lesion was present. RESULTS: Using endometrial thickness > or =4 mm, the sensitivity of ultrasound to detect the endometrial malignancy was 92.9%, the specificity was 500%, and the positive and negative predictive values were 24.1% and 97.6% respectively. Analysis using likelihood ratio (LR) revealed that LR was 0.14 for endometrial thickness > or =4.0 mm, 0.94 for endometrial thickness 4.1-9.0 mm, and 3.3 for endometrial thickness >9.0 mm. CONCLUSION: In women with postmenopausal bleeding, malignancy can probably be safely excluded if sonographic endometrial thickness is < or = 4.0 mm. However, the probability of endometrial hyperplasia/cancer is not particularly altered by the knowledge that endometrial thickness on scan is >4.0 mm.
Biopsy↗
To peritonealize or not to peritonealize? A randomized trial at abdominal hysterectomy.
OBJECTIVES: Our purpose was to determine whether nonclosure of the visceral and parietal peritoneum alters the intraoperative or postoperative course at abdominal hysterectomy. STUDY DESIGN: The setting was a gynecology unit in a university teaching hospital. A parallel-group, single-blind randomized controlled trial was performed on 144 women who underwent abdominal hysterectomy with or without salpingo-oophorectomy. Seventy-six women were allocated to the control "closed" group and 68 women to the study "open" group. The main outcome measures were operative time, estimated blood loss, postoperative pain assessed by visual analog scale, and amount of postoperative analgesia. RESULTS: The mean operative time was shorter by 10 minutes (p < 0.001) and there was a 45 ml reduction of estimated blood loss in the nonclosure group (p=0.03). There were no differences in postoperative pain in the two groups. CONCLUSIONS: Peritoneal closure at abdominal hysterectomy provides no immediate postoperative benefits while unnecessarily lengthening surgical time and anesthesia exposure. We suggest that the traditional practice of visceral and parietal peritoneal closure be abolished at abdominal hysterectomy.
Adult↗
The Gupta-Frank clamp for salpingo-oophorectomy at vaginal hysterectomy.
BACKGROUND: When performing a vaginal hysterectomy, removal of the tubes and ovaries can be either necessary or desirable. We describe our experience with a new instrument called the Gupta-Frank clamp for performing vaginal salpingo-oophorectomy at the time of vaginal hysterectomy. INSTRUMENT: The stainless steel Gupta-Frank clamp is 260 mm long, and its shanks are curved to avoid impedance from the vaginal walls. The 70-mm jaws have a smooth curve, which allows both the round and infundibulopelvic ligaments to be incorporated into a single clamp bite. Each jaw has three serrated grooves, which interlock with the corresponding jaw grooves to give a 6-mm-wide atraumatic nonslip area. EXPERIENCE: We have used this instrument in 18 women undergoing bilateral salpingo-oophorectomy at the time of vaginal hysterectomy. A single clamp bite on each side was sufficient to accomplish salpingo-oophorectomy in all cases. There were no major complications. CONCLUSION: Salpingo-oophorectomy performed vaginally at the time of vaginal hysterectomy with the Gupta-Frank clamp is feasible and is accomplished easily and safely.
Equipment Design↗
Management of fetal choroid plexus cysts.
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Brain Diseases↗
Ectopic decidua in association with adenomyosis presenting as fibroids in pregnancy--a case report.
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Adult↗
Nucleolar organizer regions in neoplastic and non-neoplastic epithelium of the cervix.
Argyrophilic nucleolar organizer regions (Ag NORs) were counted in biopsies from 203 cases of various lesions of the cervix. The mean number of Ag NORs per nucleus was significantly higher in CIN (4.05 +/- 0.04) and malignancy (5.50 +/- 0.65) as compared to squamous metaplasia (1.74 +/- 0.32) and chronic cervicitis (1.54 +/- 0.42). Adenocarcinomas had higher Ag NOR counts compared to other carcinomas. Estimation of Ag NORs can be helpful in distinguishing benign lesions from CIN and malignancy of the cervix.
Adenocarcinoma↗
Purification and properties of levanase from Rhodotorula sp.
Levanase, a slime dissolving enzyme of Rhodotorula sp., was purified to approx. 26-fold by ammonium sulphate precipitation, DEAE and gel filtration (Sephacryl S-200) chromatography. The molecular mass of the enzyme was 39 kDa. The purified levanase showed maximum activity at pH 6.0 and 40 degrees C. Enzyme was quite stable at 4 degrees C and at pH 5.5 to 6.5. Hg2+ at a level of 10 mM completely inhibited the levanase activity, while 2-mercaptoethanol at the same concentration showed a 2.93-times increase in activity. In addition to levan, the enzyme also showed substrate specificity towards inulin.
Ammonium Sulfate↗
How should we investigate women with postmenopausal bleeding?
OBJECTIVE: To evaluate the optimum method(s) of investigating women with postmenopausal bleeding. DESIGN: Prospective study of 76 postmenopausal women. SETTING: Teaching Hospital. Interventions. All women had pipelle endometrial biopsy in outpatient clinic. Prior to inpatient hysteroscopy and uterine curettage, each woman had pelvic ultrasonography to measure the endometrial thickness and to exclude ovarian pathology. RESULTS: Pipelle biopsy was successful in 70% of cases and has a sensitivity of 70%. Hysteroscopy has superior diagnostic capabilities allowing direct visualisation of the endometrial cavity with directed biopsies. Endometrial thickness of > 5 mm used as an indicator of endometrial pathology compared to uterine curettage has a sensitivity of 83%, a specificity of 77%, and a positive predictive value of 54%. Ultrasound also detected five ovarian tumors, two of which were malignant and three missed by pelvic examination alone. CONCLUSIONS: We recommend the routine use of pelvic ultrasonography in all women with postmenopausal bleeding as it is an invaluable diagnostic tool in excluding ovarian pathology. In addition, sampling of the endometrial cavity, preferably with outpatient hysteroscopy, is mandatory for histological diagnosis. Overall, the combination of ultrasound and outpatient endometrial sampling would spare hospital admission for at least 60% of women with postmenopausal bleeding.
Biopsy↗
Clinical significance of fetal choroid plexus cysts.
Choroid plexus (CP) cysts are commonly detected on routine mid-trimester ultrasound scan. When associated anomalies are detected, the risk is sufficient to justify an invasive diagnostic test such as amniocentesis. However, the risk when no associated anomalies are detected is much less well defined. This information is required to determine the appropriate management in cases of apparently isolated CP cysts. We thought the only way to resolve the difficulties in counselling prospective parents was to conduct a prospective study in a large unselected population. A registry of fetal CP cysts detected over 3 years in the Yorkshire Region was compiled and we identified 524 CP cysts. These cases were then amalgamated and analysed with 1361 cases from prospective studies reported in the world English literature and a further 71 unpublished cases identified from a 2 year prospective series from Ninewells Hospital, Dundee. The risk of chromosomal abnormalities was 1 in 150 (95% CI 1 in 85, 1 in 261) when no fetal anatomic abnormalities, apart from the CP cysts themselves, were detected antenatally. The risk increased to approximately 1 in 3 if any other associated ultrasound abnormalities were detected antenatally. The risk did not appear to be related to whether or not cyst size diminished as gestation progresses, whether they were unilateral or bilateral, and whether they were small or large in size (60-80% < 10 mm). 76% of aneuploidic cases were trisomy 18 and 17% were trisomy 21. The risk of Down's syndrome in fetuses with CP cysts but no other anomalies detected antenatally is 1 in 880. The probability of a chromosomal abnormality is high when CP cysts are associated with any other antenatally detected anomaly, indicating a clear need to offering amniocentesis. The predictive value is much lower when no other anomalies are detected. In such cases, it is probably advisable to regard CP cysts as an indication for detailed ultrasound assessment, rather than invasive testing.
Brain Diseases↗
Assessment and management of fetal agenesis of the corpus callosum.
Prenatal counselling for fetal agenesis of the corpus callosum is difficult as the prognosis until now has been so uncertain. We have reviewed the current world English literature to provide the best probabilistic information for prospective parents. In total, there are 70 cases where the diagnosis was made prenatally. The diagnosis of apparently isolated agenesis of the corpus callosum (in the absence of other sonographically detectable anomalies) appears to carry an excellent prognosis, with an 85 per cent chance of a normal developmental outcome and a 15 per cent risk of handicap. Fetal karyotyping is recommended as there is a 1 in 10 risk of aneuploidy. If other anomalies are detected prenatally, the outcome is very poor. Termination of pregnancy is advised in these circumstances.
Abnormalities, Multiple↗
Management of apparently isolated fetal ventriculomegaly.
Early ultrasound examination can provide accurate antenatal diagnosis of many fetal congenital abnormalities but it is often difficult to translate this into prognosis because of the variable functional effects of similar anatomical changes. In the case of isolated fetal ventriculomegaly it is the prognosis that parents require in order to choose between continuing with the pregnancy or termination. The outcome for antenatally diagnosed ventriculomegaly seems to be worse than that reported in the neurosurgical literature for children treated with congenital hydrocephalus. Follow-up is available for 276 cases with apparently isolated ventriculomegaly who did not undergo termination of pregnancy. One hundred ninety-four (70 per cent) survived and of these 114 (59 per cent) had normal developmental quotient to follow-up. Intrapartum cephalocentesis to aid vaginal delivery is almost invariably associated with fetal/neonatal death. A favorable outcome of normal mental development is present in cases with borderline, stable (nonprogressive) isolated ventriculomegaly or cases in which ventriculomegaly has resolved in utero. Fetal surgery would seem to offer no benefit. The outcome is much worse when other associated congenital anomalies are present.
Cardiomegaly↗
Fetal pulse oximetry: a new method of monitoring the fetus.
Experimental pulse oximetry devices, similar to the existing systems used in adult and neonatal monitoring, can be used on the fetus to provide safe, and rapid information about oxygenation. They have been calibrated using fetal lambs and validated in human cross-sectional studies. Experiments have shown that fetal oxygen saturation decreases during normal labour, and drops after a uterine contraction especially with oxytocin-induced tachysystole. When the mother is given oxygen the fetal oxygen saturation increases. Readings are effected by caput and movement, and trends seem to be more meaningful than absolute values. Pulse oximetry can predict fetal outcome and a normal oxygen saturation result is specific for a good outcome perhaps even if the CTG is abnormal. However the technique is still experimental and there is insufficient data to support its use as a replacement for fetal blood sampling or a discriminator for an abnormal fetal heart trace.
Animals↗
Female genital tuberculosis--a retrospective clinico-pathologic study of 501 cases.
A retrospective clinico-pathological study of 501 cases of female genital tuberculosis (FGTB) observed from 1974 to 1991 was conducted. The frequency of FGTB was 1.8% in 1974 rising to 2.4% in 1982, thereafter showing a steady decline to 0.8% in 1989 and onwards. Two thirds of the patients were infertile and between 17 to 40 years of age, while 82.3% of all cases of FGTB were between 20-30 years of age. Involvement of the endometrium was noted in 99.5%, fallopian tubes in 94.7%, cervix in 81.5%, ovaries in 62.5% and vulva in 0.2% of cases. Extensive caseous lesions in the genital tract were a notable feature in elderly women 70 years of age. Staining for Acid Fast Bacilli was not found to be useful, however follow-up biopsies from endometrium and cervix in 45 cases on anti-tubercular therapy showed complete disappearance of the granulomas.
Adolescent↗