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At least 91 records · Page 5Linked to original sources
PubMed2005

[Gynaecological diagnosis of postmenopausal women with abnormal vaginal bleeding: a comparison with the guideline].

OBJECTIVE: The Dutch guideline for obstetrics and gynaecology recommends transvaginal echography for all patients with postmenopausal vaginal bleeding, followed by histological examination in case the double endometrium layer is either > 4 mm or cannot be measured. We assessed whether this guideline was applied in clinical practice. DESIGN: Prospective. METHOD: Data were collected on the diagnosis of 837 patients with post-menopausal vaginal bleeding who were seen in the gynaecology clinics of eight hospitals during the period 1 January 2001-31 December 2002. Subsequently, the actual practice was compared with the guideline, which was known in all the hospitals at the start of the study. RESULTS: Transvaginal echography was performed in 818 of 837 (98%) women. The thickness of the endometrium could not be measured in 74 (9%) patients, was < or = 4 mm in 361 (43%) women and > 4 mm in 383 (46%) women. In 56 (7%) patients, including 3 who refused further diagnostics, a histological diagnosis was not obtained even though it should have been according to the guideline. A histological diagnosis was obtained in 118 (13%) patients in whom this was not necessary according to the guideline. In 86 (10%) patients, a hysteroscopy and/or curettage was performed, even though a histological diagnosis by endometrial aspiration might have sufficed. CONCLUSION: Adherence to the guideline on the diagnostic management of postmenopausal bleeding was fairly good. Overdiagnosis was seen more frequently than underdiagnosis. The efficiency of the diagnostic management in women with postmenopausal bleeding might be increased by limiting histological examination to women with an increased endometrial thickness, and by relying on endometrium aspiration in these women.

Adult↗
PubMed1978

Vaginal abnormalities.

The embryologic development of the vagina is still disputed. The urogenital sinus and the mesonephric (wolffian) and paramesonephric (müllerian) ducts probably all play a role in the development of the vagina. Duplication, agenesis, mesonephric duct remnants, and hymen abnormalities are among the more common congenital anomalies of the vagina.

Female↗
PubMed2000

[Clinical study of four cases with malignant gestation trophoblastic tumor after mifepristone abortion].

OBJECTIVE: To describe the clinical characteristics of malignant gestational trophoblastic tumor after medical abortion used by mifepristone combined with misoprostol and its diagnosis and differential diagnosis from incomplete abortion. METHODS: Four cases with malignant gestational trophoblast tumor after medical abortion were presented focusing on the clinical manifestation and the methods of diagnosis and differential diagnosis. RESULTS: Irregular vaginal bleeding and abnormal high level of beta-human chorionic gonadotropin (hCG) in plasma were the common manifestation of the gestational trophoblast tumour and incomplete abortion after medical abortion. However, beta-hCG of the former after curettage was still higher by dynamic monitoring. Malignant gestational trophoblast tumor showed rich blood flow signal and low blood flow resistance index (RI, RI < 0.5) in uterus in color doppler echography, digital subtraction angiography (DSA) with abnormal enlargement of the arteria of uterine, arteriovenous fistula beside the uterine were the main characteristics of malignant gestational trophoblast tumour. CONCLUSIONS: Pay attention to the early stage malignant gestational trophoblast tumour among patients with abnormal vaginal bleeding after medical abortion. beta-hCG and DSA were the most effective methods to diagnose and differentially diagnose choriocarcinoma from the incomplete abortion among the patients with abnormal vaginal bleeding after medical abortion.

Abortifacient Agents, Steroidal↗
PubMed2000

Endometrial histopathology in 700 patients treated with tamoxifen for breast cancer.

OBJECTIVE: The aim of this study was the evaluation of endometrial histopathologic findings from 700 patients treated with tamoxifen (Tx) for breast cancer from two medical centers (United States and France). METHODS: A retrospective review of data including histologic slides from 134 hysterectomies and 566 endometrial biopsies from Tx-treated patients who presented with abnormal vaginal bleeding and/or abnormal sonograms was performed. Analysis of histologic characteristics included inactive/atrophic and functional endometria, endometrial polyps, hyperplasia and metaplasia, and endometrial cancer. Duration of Tx therapy was recorded when available, and its correlation with endometrial pathology was assessed. RESULTS: The only statistically significant difference between the data from the United States and France was the number of hysterectomies, which was almost double in France (27% vs 13.7%). Nonpathologic endometria made up 61.14% (inactive/atrophic 46%, functional 15.14%). Pathologic changes were found in 39.86% cases, of which polyps were 23.14%, glandular hyperplasia 8%, and metaplasia 3%; endometrial cancer made up 4.71% (33 cases). Nine cancers were well-differentiated endometrioid adenocarcinomas, and 24 were moderately or poorly differentiated, of which 13 had nonendometrioid components (serous, clear cell, MMMT). Fifteen cancers were found in endometrial polyps; 12 were invasive to the myometrium and 4 to blood vessels. The weight of the uteri exceeded 300 g in 15 cases, with 4 exceeding 900 g. The average age of all patients was 60.91 years and of the cancer patients alone it was 69.26 years. The shortest average duration of Tx therapy (2.5 years) was found in patients with inactive/atrophic endometria and the longest (6.8 years) in patients with endometrial cancer. Patients with endometrial polyps and cancer presented more often with abnormal vaginal bleeding than those with inactive/atrophic endometrium. CONCLUSIONS: Most Tx-treated patients had no pathologic endometrial changes. Endometrial polyps, hyperplasia, and metaplasia, consistent with an estrogen-agonist effect of Tx, were found in roughly one-third of all patients. The endometrial cancers were often high-grade and invasive tumors. Patients with endometrial pathology were more often symptomatic than patients with inactive/atrophic endometria.

Adult↗
PubMed1975

Screening and the detection of gonorrhea.

The purpose of a physician's screening for gonorrhea is the provision of comprehensive health care to patients who seek his care. Among sexually active young patients, gonorrhea is probably far more common than many other diseases a physician "screens" for during a routine physical examination. Since gonorrhea culture tests are too costly in time and money to be offered to every patient, guidelines can be used to select patients for screening who are most likely to have gonorrhea. The gonorrhea culture test should be carried out in the same spirit as a cervical cytology test, as a potential health benefit and without stigma.However, even more important than gonorrhea screening, from the standpoint of the patient, is (1) increased use of culture for diagnostic problem solving, particularly in women with dysuria, abnormal vaginal discharge, abnormal menstrual bleeding or lower abdominal pain, and (2) location and treatment of sex partners.

Cost-Benefit Analysis↗
PubMed1989

Association between bacterial vaginosis and acute cystitis in women using diaphragms.

We hypothesized that the increased vaginal fluid pH and altered vaginal microflora characteristic of bacterial vaginosis might predispose young women to introital colonization with Escherichia coli and to acute cystitis. To evaluate this hypothesis, we studied 291 women who presented with acute urinary symptoms for association of clinically defined bacterial vaginosis and vaginal conditions associated with this syndrome (increased vaginal fluid pH, absence of lactobacilli, and abnormal vaginal fluid gas-liquid chromatographic patterns) with E coli introital colonization and urinary tract infection. Escherichia coli introital colonization and urinary tract infection were both significantly more frequent among women with a high vaginal fluid pH, an absence of vaginal lactobacilli, or an abnormal vaginal fluid gas-liquid chromatographic pattern characteristic of bacterial vaginosis. Escherichia coli introital colonization was also more frequent in women with bacterial vaginosis. These associations and an association of bacterial vaginosis and E coli urinary tract infection were strong only among the 144 women who were diaphragm users. We conclude that bacterial vaginosis, or an altered vaginal microflora as reflected by an abnormal gas-liquid chromatographic pattern characteristic of bacterial vaginosis, is associated with E coli introital colonization and acute symptomatic urinary tract infection in women who use diaphragms.

Acute Disease↗
PubMed1998

Risk assessment, symptoms, and signs as predictors of vulvovaginal and cervical infections in an urban US STD clinic: implications for use of STD algorithms.

OBJECTIVE: To identify clinical epidemiological correlates of cervical and vaginal infections and assess alternative algorithms, including two new reproductive tract infection (RTI) algorithms, for syndromic management of these infections. DESIGN, SETTING AND SUBJECTS: We prospectively studied clinical manifestations and risk correlates of cervical and vaginal infections in a randomly sampled group of 779 female patients seeking evaluation for a new problem at a Seattle STD clinic. METHODS: One experienced clinician performed standardised history, physical examination, and microscopy. Reference laboratories performed microbiological tests. Three levels of retrospective evaluation of algorithms included risk assessment and symptom review (RAS) alone; addition of speculum and bimanual examinations; and further addition of microscopy. RESULTS: (1) Chief complaint of abnormal vaginal discharge predicted a significantly lower rate of gonorrhoea (GC) or chlamydial infection (CT) than rates observed with no complaint of vaginal discharge. Only the elicited symptom of yellow vaginal discharge (not the more common symptoms of increased or malodorous vaginal discharge) predicted GC or CT. Chief complaint of abnormal vaginal discharge itself predicted trichomoniasis (TV) and bacterial vaginosis (BV), not cervical infection. Candida albicans was strongly associated with the chief complaint of vulvar pruritus, not with the chief complaint of abnormal vaginal discharge. (2) Applying these algorithms in STD clinics only to women with the chief complaint of abnormal vaginal discharge, rather than to all women, decreases sensitivity for GC or CT, without increasing positive predictive value (PPV). Criteria for inclusion of patients have more effect on the performance of these algorithms than do the levels of evaluation used. (3) A modified World Health Organisation (WHO) algorithm applied only to patients with symptoms of vaginal discharge, involving treatment of RAS positives for cervical infection, followed by treatment of vaginal infections and cervicitis based on examination of RAS negatives and positives, had a sensitivity of 50% and PPV of 33% for cervical infection, and very low sensitivity for BV, TV, and for vulvovaginal candidiasis (VVC). (4) An RTI algorithm derived from these data, and applied to all STD patients, involving RAS and examination of all RAS negatives, provided treatment to all cases of BV and TV associated with symptoms of vaginal discharge; treatment of all VVC associated with symptoms of vulvar pruritus; treatment for GC and GT to all RAS positives (using easily elicited risk factors) and to RAS negatives with signs of cervicitis or PID. This algorithm had a sensitivity of 87% and a PPV of 33% for GC or CT in this population, with its 24% prevalence of GC or CT. The sensitivity for BV, TV, and VVC greatly exceeded that of the modified WHO algorithm. (5) A modified RTI algorithm, involving examination rather than treatment of RAS positive women, no examination of RAS negatives, decreased the sensitivity for cervical infection to 55% but increased the PPV to 51%. CONCLUSIONS: Syndromic management of vaginal discharge offers relief of symptoms, prevention of transmission of trichomonas, and perhaps prevention of complications of BV. The 51% PPV of the modified RTI algorithm probably would warrant treatment and partner notification for GC and CT in settings with similar rates of GC and CT where more specific tests are lacking. However, as the prevalence of GC or CT decreases, the ratio of uninfected to infected who receive treatment with these algorithms would increase greatly, making the algorithms potential victims of their own success.

Adult↗