1,720,976 research outputs found
Breast cancer or metastasis? An unusual case of metastatic malignant pleural mesothelioma to the breast
Full text linkBackground: Metastases to the breast from extramammary malignancies are very rare, and ruling out the
diagnosis of primary breast tumor is important in order to decide on clinical management and predict prognosis.
Case presentation: Clinical examination revealed in a 49-year-old hairdresser a 3-cm hard lump adherent to
the underlying layers in the right breast. Trucut biopsy was performed. Histology showed a solid proliferation of
medium-sized neoplastic polygonal cells. Immunohistochemical analysis showed tumor cells diffusely positive for
cytokeratin 8/18 and calretinin and focally positive for cytokeratin 5/6 and Wilms’ tumor 1, e-cadherin, and human
bone marrow endothelial-1. Estrogen receptors and progesterone receptors were negative. The final diagnosis was
metastatic epithelioid malignant pleural mesothelioma.
Conclusions: Immunohistochemistry is an important tool for a conclusive diagnosis of malignant pleural
mesothelioma. Owing to the degree of histological and immunohistochemical overlap, a high level of clinical
suspicion is essential in order to avoid unnecessary mutilating surgery
Obstetric and perinatal outcomes of teenage pregnant women: A retrospective study
No full textBackground: Teenage pregnancy is a worldwide social problem. The aim of this study is to provide more data for a better understanding of the possible maternal and foetal risks associated with teenage pregnancies. Methods: the hospital records of all pregnant women, aged between 14 and 19, from the obstetric registers of the Policlinico Umberto I Hospital in Rome, between 2000 and 2010, have been completely reviewed (n=184). For each pregnant woman socio-demographic characteristics, obstetric history, pregnancy and birth outcomes were also determined. Our results were compared with a control group composed of 150 primigravida adult women aged 20-29 years who delivered at the Policlinico Umberto I Hospital in Rome in the same period. Results: the mean age ± SD of the study group was 17.9 ± 1.2, while that of the control group was 25.4 ± 2.4. The control group had a significantly lower risk of preterm delivery (p=0.000). The rate of low birth weight babies born to the young mothers was significantly higher than that of babies born to the adult mothers (p=0.036). The study group had a lower risk of instrumental delivery and a higher proportion of spontaneous delivery (p=0.000). Finally, we observed a statistically significant difference of the APGAR score at the fifth minute between the two groups (p=0.004). ConclusionS: our results seemed to confirm the outcomes of previous studies for adolescent pregnant women, mainly regarding the increased risks of preterm deliveries and low birth weight babies, the higher incidence of spontaneous vaginal delivery and the lower incidence of instrumental delivery
Is HE4 serum level a valid screening test in women candidates for kidney transplant? A case report and a review of literature
No full textWhile studying a candidate for kidney transplant it is essential to exclude active malignant diseases. Serum biomarkers help to exclude specific cancers. Tumor markers are proteins secreted by neoplastic cells that can mark their activities. HE4 is a new tumor marker used in ovarian cancer. It is an epithelium protein that appears overexpressed in ovarian cancer, but it is also present in other normal human tissues. Often in patients with kidney failure serum biomarkers are increased compared to healthy people. We report a case of a Caucasian woman suffering from kidney failure examined by our team to be included on the kidney transplantation list. Patient had a known pelvic mass. Determination of serum biomarkers, CA125 and HE4, was performed to exclude pelvic tumor, and we found high levels of HE4 with normal levels of CA125. A new transvaginal ultrasound was performed on the patient and it showed a pelvic mass near the left ovary. This mass resulted bigger than in the previous ultrasound, performed about a month before. We decided to perform a pelvic CT for improved diagnostic accuracy. The reports of this exam showed that the mass was a hematoma correlated with a previous knee prosthetic surgery. Even tough many serum biomarkers are higher in patients with renal failure, there is no study to demonstrate that HE4 blood levels are modified in these patients. This case report shows how HE4 can be elevated in people in hemodialysis in a benign situation, also in a pelvic mass not from the genital tract. There is no similar case described in literature
Evaluating the acute abdomen in the pregnant patient
No full textAcute abdominal pain in pregnancy presents diagnostic and therapeutic challenges. Ultrasound remains the primary imaging investigation of the pregnant abdomen because of its availability, portability, and lack of ionizing radiation. MR imaging has been shown to be useful in the diagnosis of gynecologic and obstetric problems and in the setting of acute abdomen during pregnancy. MR imaging is often used when ultrasound is inconclusive. Computed tomography is the investigation of choice when there is a life-threatening situation and in case of traumatic injuries, when a rapid diagnosis is required
Imaging of stone disease in pregnancy
No full textRenal colic is the most frequent non-obstetric cause for abdominal pain and subsequent hospitalization during pregnancy. Intervention is necessary in patients who do not respond to conservative treatment. Ultrasound (US) is widely used as the first-line diagnostic test in pregnant women with nephrolithiasis, despite it is highly nonspecific and may be unable to differentiate between ureteral obstruction secondary to calculi and physiologic hydronephrosis. Magnetic resonance imaging (MRI) should be considered as a second-line test, when US fails to establish a diagnosis and there are continued symptoms despite conservative management. Moreover, MRI is able to differentiate physiologic from pathologic dilatation. In fact in the cases of obstruction secondary to calculi, there is renal enlargement and perinephric edema, not seen with physiological dilatation. In the latter, there is smooth tapering of the middle third of the ureter because of the mass effect between the uterus and adjacent retroperitoneal musculature. When the stone is lodged in the lower ureter, a standing column of dilated ureter is seen below this physiological constriction. MRI is also helpful in demonstrating complications such as pyelonephritis. In the unresolved cases, Computed tomography remains a reliable technique for depicting obstructing urinary tract calculi in pregnant women, but it involves ionizing radiation. Nephrolithiasis during pregnancy requires a collaboration between urologists, obstetricians, and radiologists
What is the role of intrauterine transfusion after single intrauterine death in monochorionic twin pregnancies? Evidence from a systematic review and meta-analysis
No full textObjective: To investigate the role of intrauterine transfusion (IUT) in affecting the outcome of the surviving twin showing sign of fetal anemia after a single intrauterine fetal death (IUFD) in monochorionic (MC) twin pregnancies. Methods: PubMed, Medline and Embase databases were searched (2010-2024). The inclusion criteria were studies reporting the outcome of fetuses showing signs of fetal anemia, defined as the presence of the peak systolic velocity (PSV) of the middle cerebral artery (MCA) >1.5 MoM, after single IUFD receiving compared to those not receiving IUT. The outcomes observed were preterm birth (PTB) <34 and 28 weeks of gestation, either iatrogenic or spontaneous, co-twin intra-IUFD, co-twin neonatal death (NND), anomalies at pre- or post-natal brain imaging, abnormal neurodevelopmental outcome. Risk of bias of the included studies was assessed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. The GRADE methodology was used to assess the quality of the body of retrieved evidence. Random effect meta-analyses of proportions were used to analyze the data. Results: Six studies (78 twin pregnancies complicated by single IUFD showing signs of fetal anemia) were included in the systematic review. Assessment of risk of bias of observational studies according to the ROBINS-I tool is presented. Only one study reported a non-matched comparison between anemic fetuses undergoing compared to those not undergoing IUT, so we could not calculate the summary odd ratios, and we reported the results as pooled proportions. PTB occurred in 51.25% (95% CI 35.76-66.62) of cases < 34 weeks and in 17.99% (95% CI 5.84-34.91) < 28 weeks of gestation. Co-twin IUFD and NND were reported in 8.02% (95% CI 2.30-16.78) and 15.49% (95% CI 7.89-25.05), while abnormal findings at pre-or post-natal brain imaging in 20.30% (95% CI 11.61-30.69). Abnormal neurodevelopmental outcome was reported in 5.93% (95% CI 2.50-18.30). Conclusion: There is a very low grade of evidence that IUT can affect the outcome of anemic fetuses after single IUFD in MC pregnancies. The findings how this systematic review, in view of the limitations of the included studies, highlighted the need for large multicenter studies sharing objective protocols of prenatal management and post-natal assessment of pregnancies complicated by single IUFD are needed to report whether IUT in the anemic fetus after single IUFD can prevent mortality and neuromorbidity
Quality of sexual life in women with primary Sjögren syndrome
No full textOBJECTIVE:
To assess the quality of sexual life of women with primary Sjögren syndrome (pSS) and to identify its correlations with disease activity and damage, quality of life, and mood disorders.
METHODS:
The quality of sexual life of 24 women with pSS was assessed with the Female Sexual Function Index (FSFI). Twenty-four healthy women, matched by age and hormonal status, were enrolled as controls. Mood disorders and quality of life were investigated using the Hospital Anxiety and Depression Scale (HADS) and the Medical Outcomes Study Short Form-36. Patients underwent a gynecological visit with vaginal pH measurement, cervicovaginal swabs, and Pap smears. Disease activity and damage were assessed by the European League Against Rheumatism Sjögren syndrome disease activity and damage indexes.
RESULTS:
Patients with pSS showed a pathological mean FSFI score (19.1 ± 7.33) significantly different from controls (p = 0.004), both in menstruating women (p = 0.006) and in menopausal women (p = 0.03). Major differences between the 2 groups were detected in dyspareunia (p < 0.005), lubrication (p = 0.006), desire (p = 0.004), and arousal (p = 0.018). The FSFI score was inversely correlated with age (p = 0.008) and anxiety HADS (p = 0.031). No early anatomical changes, swabs, and Pap smear alterations were revealed in patients with pSS; however, vaginal pH was higher than normal in premenopausal patients (6.0 ± 0.77).
CONCLUSION:
Both premenopausal and postmenopausal women with pSS have a worse sexual quality of life. We reported a greater prevalence of dyspareunia that is statistically significant when compared with controls. The FSFI could be a useful tool to assess this topic, but has been neglected in the care of patients with pSS heretofore
Tuberculous endometritis in woman with abnormal uterine bleeding: a case report and literature review
No full textGenital tuberculosis accounts for 15-20% of all extrapulmonary cases, with the endometrium being the second most common site of infection.
A 32-year-old native Ethiopian woman presented with intermenstrual vaginal bleeding for the past one month. There was no personal or family history of tuberculosis. The gynecological pelvic exam showed only an enlarged uterus. Transvaginal ultrasound revealed a thickened, heterogeneous and microvacuolar endometrium, with a central area of vascularization. The hysteroscopy picture posed the suspicion of atypical tuberculosis, describing a thickened, friable endometrium with vacuolized and cystic appearance. A positive Mantoux skin test was confirmed by QuantiFERON-TB Gold and then by definitive histological examination. Vaginal bleeding stopped 3 weeks after starting target medical treatment. A year later ultrasound and hysteroscopy were negative
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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