Osteoporosis in healthy postmenopausal women

Objectives: To determine the frequency of osteopenia and osteoporosis using dual energy x-ray absorptiometry in healthy postmenopausal women within five years of onset of menopause and also to compare the menopausal symptoms between two different age groups

Methodology: This cross sectional study was conducted at the outpatient department of Obstetrics and Gynecology, Fauji Foundation Hospital Rawalpindi from January 1[st] 2010 to May 31[st] 2010. DXA scan of the lumbar spine [L2- L4] and right hip [femoral neck] was requested. Osteoporosis was defined by a T-score of -1. Menopausal rating scale was used and all findings were recorded in predesigned proformas

Results: Out of a total of 33 subjects, who underwent dual energy x-ray absorptiometry, osteopenia and osteoporosis were found in 22 [66.7%] while only 11 [33.3%] have normal results. We took Null hypothesis H0: pi=0.5 against the alternative H1: pi>0.5. The test statistics is 22.4 and p value is zero. So H0 is rejected at all significance levels showing that ratio of abnormal DXA scan findings i.e. osteopenia and osteoporosis among healthy postmenopausal women is significantly much higher than normal findings. Also poor concentration, sexual dysfunctions, urinary symptoms, dyspareunia and joint pains were significantly more common in group II: age >50 than group I: age 50 or below [p-value <0.05]

Conclusion: Osteopenia and osteoporosis are significantly more common in healthy postmenopausal women in early years of menopause. Menopausal symptoms have a significant correlation with advancing age

Role of transvaginal ultrasound in identifying endometrial hyperplasia

Transvaginal sonography [TVS] is one of the diagnostic modalities used to evaluate endometrial pathologies in women with abnormal uterine bleeding. It permits use of high frequency ultrasound waves at greater proximity to the uterus. This study aimed at determining the diagnostic accuracy of TVS in identifying endometrial hyperplasia by comparing with histologic findings in perimenopausal women with abnormal uterine bleeding. This cross-sectional study was conducted in Department of Obstetrics and Gynaecology, Unit II, Fauji Foundation Hospital, from Sep 2011 to Mar 2012. A total of 263 perimenopausal women aged 40-50 years with abnormal uterine bleeding in the form of menorrhagia, metrorrhagia and polymenorrhagia were enrolled. Thickness of the endometrium was first measured by ultrasound and then was later confirmed by sampling of endometrium. The outcome was measured in terms of accurately diagnosing endometrial hyperplasia by TVS and then using histologic findings as gold standard to confirm. The mean age of selected patients was 45.3 +/- 3.2 years. Out of total 263 cases, 129 [49.0%] presented with menorrhagia, 120 [45.6%] presented as metrorrhagia while 14 [5.3%] had polymenorrhagia. The sensitivity and specificity of TVS was 100.0% and 63.7% respectively. Similarly positive predictive value [PPV] and negative predictive value [NPV] were 56.3% and 100.0% respectively. Diagnostic accuracy of TVS in identifying endometrial hyperplasia using histopathology as gold standard was found to be 75.6%. TVS has a moderate diagnostic accuracy in detecting endometrial hyperplasia. Due to the fact that transvaginal ultrasound is safe, acceptable and easily available in most secondary and tertiary care settings and is non-invasive in nature, in our opinion TVS is to be used as a 1st line diagnostic tool in patients who present with abnormal uterine bleeding

Frequency of ovarian malignancy in patients reporting with ovarian cysts

Objectives: To Investigate the frequency and type of ovarian cancer amongst patient who underwent surgery for ovarian cyst diagnosed on ultrasound

Study Design: A Prospective, Observational study

Place And Duration: 1st June 2002 to 31st May 2003. Fauji Foundation Hospital, Rawalpindi

Methodology: A total of 90 patients diagnosed as having ovarian cyst larger than 5X5 cm size were recruited from the outdoor patients department of Obstt/Gynae of Fauji Foundation Hospital. Their details were entered into a predesigned performa. All these patients underwent laparotomy after having detailed ultrasound of abdomen and pelvis. Their histopathology reports were followed up and the final analysis of the data was done

Results: In our study cases malignancy was reported in 18% [n=17] of the cases. Most common benign tumor was serous cyst adenoma 14.4 %[n = 13] while 5.5 % [n=5] had malignant serous cyst adenocarcinoma

Conclusion: All the patients reporting with ovarian cyst larger than 5cm should be carefully evaluated for malignancy

comparative analysis of frequency and patterns of ovarian tumours at a tertiary care hospital between two different study periods [2002-2009]

This study was conducted to investigate the frequency and type of ovarian tumors amongst patients who underwent surgery for ovarian cyst diagnosed on ultrasound and also to compare a change in pattern of type of tumors between 2002 and 2009. Comparative, Observational study. This study was carried out in the department of obstetrics and gynaecology Foundation University Medical College, Fauji Foundation hospital Rawalpindi that is a tertiary care hospital, from 1[st] June 2002 to 31[st] May 2003 [Study period 1, n=90] and from 1[st] November 2008 to 31[st] October 2009 [Study period 2, n=93]. All the patients who had ovarian cysts larger than five centimetres in size diagnosed on ultrasonography and planned for surgery were included in the study. All the relevant details were entered in prof or mas. Histopathology of excision biopsies was analysed. The overall incidence of ovarian tumors was 7.1% and 5.4% with a rate of malignancy 18% and 5.4% in period 1 and 2 respectively which was statistically non significant [p>0.05]. The most common malignant tumour was serous cyst adenocarcinoma during both study periods. The most common benign tumor was simple follicular cyst 25% during study period one and serous cyst adenoma 23% during period 2. The frequency and patterns of ovarian tumors has remained unchanged between 2002 and 2009

Comparison of biochemical and ultrasonographic features in hirsute females with polycystic ovarian syndrome and other causes of hirsutism

Polycystic ovarian syndrome is a heterogeneous disorder and one of the commonest endocrine disorders of women. One of its common presentations is hirsutism. The aim of this study was to evaluate the biochemical and ultrasonographic features of PCOS in patients with hirsutism and to compare these features with other etiologies of hirsutism in our setup. Comparative study. This study was conducted between 1[st] September 2007 to 31[st] December 2008 in the department of Obstetrics and Gynecology, Fauji Foundation Hospital Rawalpindi. All the female patients who presented to gynae and dermatology clinics with hirsutism were included in the study. A detailed history, clinical examination with special reference to Ferriman-Gallwey scoring system, endocrinological workup and abdominopelvic ultrasonography [USG] was done in all patients. We divided the patients into two groups, one labeled as PCOS group [i.e. treatment group] and the other control group including idiopathic hirsutism and other etiologies. Data was analyzed using STATA 11. Multivariant test and logit model was used for statistical analysis. A total of 74 patients were included in the study, 44 had PCOS and 30 were in the control group with other etiologies of hirsutism. Regarding the biochemical tests, only serum FSH, LH and progesterone levels showed statistically significant difference between the two groups [p-value 10 ml] between the two groups was also statistically significant [i.e. p-value

Etiology of primary amenorrhoea: a study of 50 cases

Amenorrhoea is one of the commonest reasons for referral of female patients to a gynaecology clinic. It is subdivided into primary and secondary. The etiology of primary amenorrhoea is complex. The aim of this study was to determine the etiological factors of primary amenorrhoea and to find out the mean age at first presentation. Descriptive Study. This Study was conducted in the department of Obstetrics and Gynaecology Foundation University Medical College Fauji Foundation Hospital Rawalpindi, from 1[st] January 2005 to 31[st] December 2007. 50 girls who reported to gynae outpatient department with the complaint of primary amenorrhoea were included in the study after informed consent. Detailed history, clinical examination and investigations [transabdominal ultrasonography, hormonal profile including serum FSH, LH and prolactin, karyotyping] were recorded in proformas for analysis. A total of 50 girls reported to gynae OPD with complaints of primary amenorrhoea over a period of 24 months with the mean age of 18.5 years at initial presentation. Almost half of the girls [48%] with normal secondary sexual characteristics had anatomical defects, rokitansky;s syndrome being the commonest, while those with absent secondary sexual characteristics had constitutional delay as the commonest cause. Mean age at first presentation is late. Anatomical causes are the commonest. Turner's syndrome is relatively uncommon in our patients

Etiology of hirsutism. Is there a correlation between menstrual regularity, body mass index and severity of hirsutism with the cause?

Hirsutes having regular menstrual history or with body mass index [BMI] within normal range or mild hisutism are often taken as idiopathic hirsutism. To investigate the hirustism in patients presenting in the Fauji Foundation Hospital [FFH], Rawalpindi and to determine if menstrual regularity, BMI and severity of hirsutism correlates with the cause. It was descriptive study over a period of fourteen months in the departments of Dermatology and Gynecology and Obstetrics of FFH, Rawalpindi. Females who presented to either department with hirsutism were enrolled in this study. A detailed history, clinical examination with special reference to Ferriman-Gallwey [FG] scoring system, endocrinological workup and abdominopelvic ultrasonography [USG] was done in all patients. SPSS version 12 was used for statistical analysis. Out of a total of 71 patients, the commonest cause of hirsutism in our study was polycystic ovarian syndrome [PCOS] in 57.7%. Idiopathic hirsutism was present in 22.6% and late onset congenital adrenal hyperplasia in 9.9% patients. Hyperprolactinemia and thyroid disorders were diagnosed in 4.2% respectively. One [1.4%] patient had multiple etiologies. The correlation between menstrual regularity, BMI and severity of hirsutism with the cause of hirsutism was not statistically significant [p >/= 0.05]. PCOS is the commonest cause in our study population. The correlation of menstrual regularity, BMI and severity of hirsutism with its cause is not statistically significant

Chorionic villus sampling: a safe tool for prenatal diagnosis of genetic disorders

To determine the safety and efficacy of chorionic villus sampling [CVS] for early prenatal diagnosis of genetic disorders. Descriptive study. Department of Obstetrics and Gynecology, Foundation University Medical College, Rawalpindi, from December 2002 to April 2006.Subjects who had high risk factors like personal or family history of genetic disorders were referred to us for CVS after 10 gestational weeks. Under local anaesthesia and ultrasound guidance [USG] guidance a special chorion biopsy double needle [outer guide and inner aspiration needle] was introduced through anterior abdominal wall into placenta to obtain specimen from chorionic villi. Women were observed for 1-2 hours to notice any immediate complications like uterine cramps and vaginal bleeding. Follow up was done till end of pregnancy to know the outcome. Specimen obtained was sent to laboratory for DNA analysis to diagnose beta-thalassaemia in 234 patients and for karyotyping to diagnose Down's syndrome in 17 patients. Of 252 CVS performed, sample was successfully obtained in 99.6% of cases and only one procedure failed. Most common indication was beta -thalassaemia [93.0%]. The immediate complications were uterine cramps in 41 [16.3%], vaginal bleeding in one [0.8%] and amniotic cavity puncture in six [2.4%] subjects. Noteworthy was the fact that miscarriage rate was quite low [2.4%]. At follow up no evidence of incorrect sampling was reported. Of 234 specimens for DNA analysis, 23.5% were homozygous for beta-thalassaemia, to whom termination of pregnancy [TOP] was offered to prevent birth of an abnormal baby. CVS is a safe and effective method for early prenatal diagnosis of genetic disorders. Its use can help in early detection and prevention of birth of babies with lethal genetic disorders