Assessing a cut-off point for the diagnosis of abnormal uterine bleeding using the Menstrual Bleeding Questionnaire (MBQ): a validation and cultural translation study with Brazilian women

ABSTRACT BACKGROUND: Abnormal uterine bleeding (AUB) is a common condition, and the Menstrual Bleeding Questionnaire (MBQ) is used for its assessment. OBJECTIVES: To translate, assess the cut-off point for diagnosis, and explore psychometric properties of the MBQ for use in Brazilian Portuguese. DESIGN AND SETTING: Prospective cohort study including 200 women (100 with and 100 without AUB) at a tertiary referral center. METHODS: MBQ translation involved a pilot-testing phase, instrument adjustment, data collection, and back-translation. Cut-off point was obtained using receiver operating curve analysis. Menstrual patterns, impact on quality of life due to AUB, internal consistency, test-retest, responsiveness, and discriminant validity were assessed. For construct validity, the Pictorial Blood Assessment Chart (PBAC) and World Health Organization Quality of Life - abbreviated version (WHOQOL-BREF) were applied. RESULTS: Women with AUB were older, had higher body mass indices, and had a worse quality of life during menstruation. Regarding the MBQ's psychometric variables, Cronbach's alpha coefficient was > 0.70 in all analyses, high intraclass correlation coefficient was found in both groups; no ceiling and floor effects were observed, and construct validity was demonstrated (correlation between MBQ score, PBAC score, and clinical menstrual cycle data). No difference between MBQ and PBAC scores were perceived after the test-retest. Significant differences were found between MBQ and PBAC scores before and after treatment. An MBQ score ≥ 24 was associated with a high probability of AUB; accuracy of 98%. CONCLUSION: The MBQ is a reliable questionnaire for Brazilian women. The cut-off ≥ 24 shows high accuracy to discriminate AUB.

Importância do diagnóstico por imagem em pacientes com sangramento uterino anormal / Importance of diagnostic imaging in patients with abnormal uterine bleeding

O sangramento uterino anormal é diagnóstico sindrômico comum no consultório do ginecologista e pode comprometer substancialmente a qualidade de vida. O objetivo no diagnóstico de sangramento uterino anormal é distinguir pacientes com causas estruturais (anatômicas), como pólipo, adenomiose, leiomioma, malignidade e hiperplasia, de pacientes que apresentam anatomia normal, nas quais o sangramento pode ser devido a alteração dos mecanismos de coagulação, distúrbios ovulatórios, distúrbios primários do endométrio, iatrogenia, ou ter outra causa não classificada. O diagnóstico se inicia a partir de anamnese detalhada e exame físico geral e ginecológico completos, seguidos da solicitação de exames complementares (laboratoriais e de imagem), conforme indicado. O exame de imagem de primeira linha para identificação das causas estruturais inclui a ultrassonografia pélvica. Histerossonografia, histeroscopia, ressonância magnética e amostragem endometrial para exame de anatomia patológica são opções que podem ser incluídas no diagnóstico a depender da necessidade. O objetivo deste artigo é apresentar a relevância dos exames de imagem na investigação das causas de sangramento uterino anormal.

Abnormal uterine bleeding is one of the commonest presenting complaints encountered in a gynecologist's office and may substantially affect quality of life. The aim in the diagnosis of abnormal uterine bleeding is to distinguish women with anatomic causes such as polyp, adenomyosis, leiomyoma, malignancy and hyperplasia from women with normal anatomy where the cause may be coagulopathy, ovulatory disorders, endometrial, iatrogenic and not otherwise classified. Diagnosis begins with a thorough history and physical examination followed by appropriate laboratory and imaging tests as indicated. The primary imaging test for the identification of anatomic causes include ultrasonography. Saline infusion sonohysterography, magnetic resonance, hysteroscopy, endometrial sampling are options that can be included in the diagnosis depending on the need. The aim of this article is to present the relevance of imaging exams in the investigation of the causes of abnormal uterine bleeding.

Association of Clinical Presentation at Different Stages of Carcinoma Cervix

Background: Cancer cervix is the most common cancer in women in developing countries where screening facilities are inadequate. The incidence of cervical cancer is steadily declining in the developed world. The rate of cervical cancer is decreasing day by day due to their awareness of cervical cancer, especially its risk factors, and undertaking measure like routine screening tests. It may present with vaginal bleeding but symptoms may be absent until the cancer is in its advanced stage. This study aimed to analyze the association of clinical presentation at different stages of carcinoma cervix. Material & Methods: This descriptive study was conducted in Chittagong Medical College Hospital, taking 100 randomly selected patients of carcinoma cervix over one year (July 2019 to June 2020). The research protocol was approved by the research committee (Local Ethical committee). Informed written consent was taken from each patient. Results: Among the study subjects, most of the respondents (32, 32.0%) belonged to 51-60 years old followed by (24, 24.0%) 41-50 years and >60 years of age. Most (76, 76.0%) of the patients presented with blood-stained vaginal discharge. Significant numbers of the patient presented with foul smelling per vaginal discharge (72, 72.0%) and post-coital bleeding (68, 68.0%). Only 8% of the patients had haematuria signifying the advanced stage of the disease. Most of the patients about 72.0% sought medical advice within one year of developing symptoms. 56.0% of patients were menopausal, only 20.0% of patients had regular menstruation, and 24.0% of patients had irregular menstruation. 24.0% of patients had metrorrhagia and 2.0% of patients had dysmenorrhoea. Some degree of anemia was present in almost all patients. Only 16.0% of the patients had severe anemia 6.0% of the patients had dependent edema and 4.0% had lymphadenopathy. Most of the patients had cauliflower-type (54.0%) lesions in the cervix followed by 36.0% of patients who had the ulcerative type of growth in the cervix. Among the respondents, 96.0% of the patients had squamous cell carcinoma and only 4% had adenocarcinoma. Most (44, 44.0%) of the patients presented in the hospital with stage II ca cervix, followed by stage III (40, 40.0%). Conclusion: Most common presentation was blood-stained per-vaginal discharge, followed by foul-smelling per-vaginal discharge and post-coital bleeding. All the patients were clinically anemic, some showed severe anemia. The majority of the patient in this series showed a cauliflower-like lesion, followed by an ulcerative lesion. Among all patients majority (96.0%) had squamous cell carcinoma and the remaining had adenocarcinoma. Most of the patients presented in the hospital with stage II ca cervix, followed by stage III.

Reporting of uterine fibroids on ultrasound examinations: an illustrated report template focused on surgical planning / Relato de miomas uterinos em exames de ultrassonografia: um modelo de relatório ilustrado com foco no planejamento cirúrgico

Abstract Uterine fibroids are the most common benign gynecologic tumors in women of reproductive age, and ultrasound is the first-line imaging modality for their diagnosis and characterization. The International Federation of Gynecology and Obstetrics developed a system for describing and classifying uterine fibroids uniformly and consistently. An accurate description of fibroids in the ultrasound report is essential for planning surgical treatment and preventing complications. In this article, we review the ultrasound findings of fibroids, detailing the main points to be reported for preoperative evaluation. In addition, we propose a structured, illustrated report template to describe fibroids, based on the critical points for surgical planning.

Resumo Os miomas uterinos são os tumores ginecológicos benignos mais comuns em mulheres em idade reprodutiva, sendo a ultrassonografia a modalidade de imagem de primeira linha para seu diagnóstico e caracterização. A Federação Internacional de Ginecologia e Obstetrícia desenvolveu um sistema para descrever e classificar os miomas uterinos de forma uniforme e consistente. Uma descrição precisa dos miomas no laudo ultrassonográfico é essencial para o planejamento do tratamento cirúrgico e prevenção de complicações. Neste artigo, revisamos os achados ultrassonográficos de miomas, detalhando os principais pontos a serem relatados para avaliação pré-operatória. Além disso, propomos um modelo de relatório estruturado e ilustrado para descrição de miomas, com base nos pontos críticos para o planejamento cirúrgico.

Abnormal uterine bleeding in reproductive age: a comparative analysis between the five Brazilian geographic regions

SUMMARY OBJECTIVE: This study aimed to comparatively evaluate the presence of abnormal uterine bleeding and associated factors among women from the five official Brazilian geographic regions. METHODS: This is a cross-sectional, population-based, multicenter study of reproductive-age women from the five regions of Brazil. All participants answered questionnaires containing personal and socioeconomic data and information on uterine bleeding (self-perception and objective data). RESULTS: A total of 1,761 Brazilian women were included, 724 from the Southeast, 408 from the Northeast, 221 from the South, 213 from the North, and 195 from the Central-West. Considering women's self-perception, the prevalence of abnormal uterine bleeding was 37.56% in the North region, 39.46% in the Northeast, 21.54% in the Central-West, 29.56% in the Southeast, and 25.34% in the South (p<0.001). Abnormal uterine bleeding was more prevalent in the North and Northeast, where women had lower purchasing power, became pregnant more often, and were the only ones financially responsible for supporting the family more often (p<0.001). The menstrual cycle lasted <24 days in less than 20% of the women in all regions (p=NS). Among these, approximately 8 out of 10 women had never undergone treatment in four out of the five regions evaluated. More than half of the evaluated women reported a worsening of their quality of life during bleeding. CONCLUSION: The prevalence of abnormal uterine bleeding in Brazilian women was higher in the North and Northeast, followed by the Southeast, South, and Central-West regions. There was a worsening of quality of life during menstruation regardless of the woman's self-perception of abnormal uterine bleeding. Such results can direct the actions of health managers toward a better approach to abnormal bleeding.

Abnormal uterine bleeding and associated factors among female medical college students in Shanghai / 中国学校卫生

Objective@#To understand the prevalence and pattern of abnormal uterine bleeding (AUB) among female medical college students in Shanghai，to provide a basis for menstrual health intervention for female college students.@*Methods@#A total of 912 female medical students from a university in Shanghai were selected through cluster sampling. An anonymous questionnaire survey on menstrual history and related factors was conducted in March 2021.@*Results@#The prevalence of AUB among female medical college students was 39.9%, with cycle disordered and non cycle disordered AUB of 24.7% and 15.2%, respectively. Among female college students with AUB, 21.7% had two or three abnormal menstrual symptoms. Multivariate Logistic analysis showed that sleep quality was associated with both types of AUB, and female undergraduates with poorer and poor sleep quality were at increased risk of both cyclic disordered AUB ( OR =2.05) and non cyclic disordered AUB ( OR =2.00). Low BMI ( OR =1.66) and weight gain and loss ( OR =1.76) were associated with cycle disordered AUB. Frequent insomnia ( OR =2.45) was associated with non cyclic disordered AUB( P <0.05).@*Conclusion@#Abnormal uterine bleeding (AUB) is common in female college students, female medical college students with AUB have multiple concurrent abnormal bleeding patterns. Factors associated with AUB varied according to the type of AUB, with sleep quality correlates with both types of AUB.

Application of DNA methylation in detection of endometrial carcinoma in women with abnormal uterine bleeding at childbearing age / 中华检验医学杂志

Objective:This work aims to explore the application value of cervical exfoliated cell DNA (Cysteine dioxygenase type 1, CDO1 and CUGBP Elav-like family member 4, CELF4) methylation in the detection of endometrial cancer in women of childbearing age. Methods:From November 2021 to October 2022, a prospective study was conducted on a total number of 517 reproductive-age women with abnormal uterine bleeding who had surgical indications for hysteroscopy at the Xiangya Third Hospital of Central South University. The cervical exfoliated cells were collected for cytology, HPV (human papillomavirus) and gene methylation detection before operation. Clinical information of patients, level of tumor-related biomarkers, and endometrial thickness of transvaginal ultrasound (TVS) were also collected. Single factor regression method was used to analyze the high-risk factors of endometrial cancer. Receiver operating characteristic curve analysis was used to obtain the area under the curve(AUC), focusing on the screening efficacy of gene methylation test for endometrial cancer in women of childbearing age.Results:The age, body mass index (BMI)≥25 kg/m 2, endometrial thickness≥11 mm, CDO1 m ΔCt≤8.4, CELF4 m ΔCt≤8.8, and double gene methylation were associated with endometrial cancer in women of childbearing age, 1.16(1.08-1.25), 4.33(1.89-10.31), 9.49(3.88-26.69), 69.62(25.70-224.36), 23.64(9.66-63.99), 87.39(24.83-555.05), all P<0.05. The AUC was 0.90 (95% CI 0.83-0.97) of CDO1 m/ CELF4 m in diagnosing endometrial carcinoma was higher than others factors, with sensitivity and specificity of 91.7% (95% CI 80.6%-100%) and 88.8% (95% CI 86.0%-91.6%). TVS combined with DNA methylation detection further improved the sensitivity to 95.8% (95% CI 87.8%-100%), but could not improve the specificity 68.0% (95% CI 63.8%-72.1%). Conclusions:For women of childbearing age with abnormal uterine bleeding or abnormal vaginal discharge, the accuracy of cervical cytology DNA methyl detection of endometrial cancer is better than other non-invasive clinical programs. DNA methylation combined with TVS can improve the sensitivity of detection.

Treatment of Perimenopausal Anovulatory Dysfunctional Uterine Bleeding Based on Thought of Liver Being Innate Basis of Women / 中国实验方剂学杂志

Perimenopausal anovulatory dysfunctional uterine bleeding （ADUB） is a severe acute disease that is difficult to be dealt with in gynecology， accounting for about 70% of abnormal uterine bleeding. The significant differences in bleeding patterns make it particularly challenging to treat. The main manifestations of perimenopausal ADUB are prolonged menstrual period， inexhaustible menstrual bleeding， or heavy inter-menstrual vaginal bleeding， which allow it to be classified into the category of metrorrhagia and metrostaxis in traditional Chinese medicine （TCM）. After conducting in-depth research on this disease， physicians of the past dynasties have figured out its etiology and pathogenesis and accumulated rich experience in its differentiation and treatment， thus forming a relatively systematic theoretical system. The existing literature mainly focuses on four types of its pathogenesis， namely blood heat， blood stasis， spleen deficiency， and kidney deficiency， and there are few discussions on liver. However， patients with metrorrhagia and metrostaxis due to liver dysfunction are commonly seen in clinical practice. The theory of liver being innate basis of women explores the special physiological and pathological characteristics of women and emphasizes the important role of liver in the treatment of this disease based on its characteristic functions and meridian circulation. Considering the close relationship of liver Qi and blood with spleen， kidney， and thoroughfare and conception vessels， this paper discussed the TCM treatment of perimenopausal ADUB from the following four aspects： soothing liver Qi and nourishing liver blood， liver and kidney sharing the same source， simultaneous regulation of liver and spleen， and liver meridian circulation， so as to broaden the clinical treatment options. Perimenopause is a unique physiological period when women tend to suffer from Qi stagnation and blood deficiency. Liver， characterized by Yin in property and Yang in function， governs the free flow of Qi， induces ovulation， stores blood， and regulates blood volume. Therefore， the liver should be emphasized in the treatment of perimenopausal ADUB， which contributes to correcting the hormone disorder caused by abnormal ovulation， stopping bleeding， and alleviating perimenopausal symptoms. This paper has provided a new direction for the clinical treatment of perimenopausal ADUB .

Síndrome de Klipper-Trenaunay-Weber con compromiso vesical y uterino tratado por vía endoscópica y endovascular / Klippel-Trenaunay-Weber syndrome with vesical and uterine involvement treated by endoscopic and endovascular routes

El síndrome de Klippel-Trenaunay-Weber (SKTW) es una rara malformación venosa que, en general afecta a los miembros inferiores y, más raramente, a los superiores. Se caracteriza por formaciones angiomatosas cutáneas, várices e hipertrofia del miembro afectado. El compromiso genitourinario es sumamente infrecuente. Se presenta el caso de una paciente de 14 años. Ingresó por hematuria macroscópica de 48 h de evolución y metrorragia con grave compromiso hemodinámico. Se encontraba en estudio por presentar un hemangioma en el miembro inferior izquierdo que se extendía hasta la región pelviana. La uretrocistofibroscopía demostró la presencia de múltiples lesiones angiomatosas diseminadas en forma amplia en la vejiga, algunas de ellas con sangrado activo. La angioresonancia mostró una voluminosa formación hipervascularizada en contacto con la pared vesical a la cual desplazaba y fístulas arteriovenosas a nivel pelviano y en el miembro inferior izquierdo confirmando el diagnóstico etiológico. Se realizó una embolización arterial selectiva de los territorios ilíacos interno y externo e inmediatamente después una endocoagulación láser de los focos angiomatosos sangrantes. La hematuria remitió completamente en las 24 h posteriores al procedimiento. La metrorragia asociada al SKTW fue controlada mediante la utilización de análogos LHRH y progestágenos.

Klippel-Trenaunay-Weber syndrome (KTWS) is a rare venous malformation that generally affects the lower limbs and, more infrequently, the upper limbs. It is characterized by cutaneous angiomatous formations, varicose veins and hypertrophy of the affected limb. The involvement of the genitourinary tract is extremely infrequent. We expose the case of a 14 years old female patient who was admitted for macroscopic hematuria of 48 hours of evolution and metrorrhagia with severe hemodynamic decompensation. The patient was under study for presenting a hemangioma in the lower left limb that extended to the pelvic region. Urethrocystofibroscopy showed the presence of multiple wide-spread angiomatous lesions in the bladder, some of them with active bleeding. The angio-resonance showed a voluminous hypervascular formation in contact with the bladder wall showing several arteriovenous fistulas at the pelvic level and in the left lower limb confirming the etiological diagnosis. A selective arterial embolization of the internal and external iliac territories was performed and then, a laser endocoagulation of the bleeding angiomatous foci was carried out. The hematuria completely stopped within 24 hours later of the procedure. The metrorrhagia associated with KTWS was controlled by the use of LHRH analogs and progestogens.

Caracterización clínica y epidemiológica de pacientes diagnosticadas con embarazo molar durante los años 2012-2019 en el Hospital de Chillán / Clinical and epidemiological characterization of patients diagnosed with molar pregnancy during the years 2012-2019 in Hospital de Chillán

La enfermedad trofoblástica gestacional (ETG) constituye un conjunto heterogéneo de afecciones malignas y benignas derivados de la proliferación anormal del trofoblasto o de las células germinales de ambos sexos. La ETG tiene una incidencia variable a lo largo del mundo. A nivel nacional, no se han realizado estudios de caracterización epidemiológica de esta población y, frecuentemente, los datos manejados están basados en estudios extranjeros. Objetivo: Determinar las características clínicas y epidemiológicas de las pacientes diagnosticadas con embarazo molar en el período transcurrido entre el año 2012 y 2019, en el hospital Clínico Herminda Martin de Chillán. Materiales y métodos: Estudio observacional transversal de serie temporal, se consideró el número total de fichas clínicas del Hospital Clínico Herminda Martin de Chillán durante los años 2012 al 2019, con diagnóstico confirmado de Embarazo Molar. Los datos se registraron en la hoja de recolección de datos elaborada, realizándose los análisis estadísticos pertinentes. Resultados: Se analizaron 44 pacientes, la edad promedio de presentación fue de 30.96 años. Los principales síntomas de consulta fueron metrorragia 52.27% (n=23) y dolor abdominal 20.45% (n=9). El principal tratamiento efectuado fue aspiración y legrado en un 77,27% (n=34). El 4.54% (n=2) presentó recurrencia, presentando un segundo episodio de embarazo molar. Conclusiones: El embarazo molar es una patología poco frecuente, pero es un diagnóstico diferencial a tener en cuenta, sobre todo cuando nos enfrentamos a mujeres en edad fértil que consultan por metrorragia o dolor abdominal.

Gestational trophoblastic disease (GTS) is a heterogeneous group of malignant and benign conditions derived from abnormal proliferation of the trophoblast or germ cells of both sexes. GTS has a variable incidence throughout the world. Nationally, no epidemiological characterization studies have been carried out for this population and, frequently, the data handled is based on foreign studies. Objective: To determine the clinical and epidemiological characteristics of patients diagnosed with molar pregnancy between the period between 2012 and 2019 at the Hospital Clinico Herminda Martin of Chillan. Materials and methods: Retrospective observational descriptive cross-sectional study, considering the pregnancies registered at the Hospital Clinico Herminda Martin of Chillan during the years 2012 to 2019, with a confirmed diagnosis of Molar Pregnancy, as sample of study. The data were recorded on the prepared data collection sheet, performing the relevant statistical analyzes. Results: 44 patients were analyzed, the average age of presentation was 30.96 years. The main symptoms of consultation were metrorrhagia 52.27% (n = 23) and abdominal pain 20.45% (n = 9). The main treatment was aspiration and curettage in 77.27% (n = 34). 4.54% (n = 2) presented recurrence, presenting a second episode of molar pregnancy. Conclusions: Molar pregnancy is a rare pathology, but it is a differential diagnosis to take into account, especially when we are faced with women of childbearing age who consult due to bleeding or abdominal pain.

The Effect of Storage on Platelets in Platelet Rich Plasma and Platelet Concentrate

Introduction: Platelets are routinely isolated from wholeblood and stored in plasma for 5 days. The platelets undergovarious storage changes starting from collection, processingto storage and the underlying conditions within the patientswhich may affect the therapeutic benefit to the recipient. Studyaimed to assess the quality of platelets in platelet rich plasmaand platelet concentrate and to evaluate the effects of storageon platelets in platelet rich plasma and platelet concentrate.Material and methods: The study was carried out in theDepartment of Transfusion Medicine and Department ofMedical Laboratory Technology in Government MedicalCollege, Thiruvananthapuram after obtaining approval fromthe Institutional Ethical Committee. The study period was sixmonths. The samples were collected from platelet rich plasmaand platelet concentrate bags under sterile conditions. Theirquality was assessed using the parameters such as swirling,volume of the platelet concentrate, platelet count, WBC countand pH on day 0, day 3 and day 5 of storage.Results: A total of 64 samples were evaluated and of these95% have fullfilled all 5 parameters of quality control with ascore 5 and 5% had score 4. Thus in our study majority of theprepared units were of the desired quality. All the parameterswere assessed and the results obtained on both the units werewell above the values of recommended norms.Conclusion: The quality of platelet concentrates weremaintained well within the usual 5 days thus an extension ofplatelet storage time is recommended.

Hiperplasia endometrial y criterios ecográficos: reporte de caso y revisión de la literatura / Endometrial hyperplasia and sonographic criteria: Case report and literature review / Hiperplasia endometrial e critérios ecográficos: relato de caso e revisão da literatura

El objetivo de este artículo es revisar los criterios ecográficos de hiperplasia endometrial y evaluar los puntos de corte para indicar la realización de biopsia endometrial. Se reporta el caso de una mujer de 47 años, con cuadro clínico de 4 años de evolución de sangrado vaginal anormal tipo menorragia, metrorragia e hipermenorrea, en manejo con anticonceptivos orales, sin mejoría, y con ecografía transvaginal con diagnóstico de hiperplasia endometrial. Para el diagnóstico de patología endometrial en las mujeres posmenopáusicas con sangrado vaginal, los autores recomiendan un valor de corte del grosor endometrial por ecografía transvaginal entre 4-5 mm con sensibilidad del 98% y valor predictivo negativo del 99% debido a que valores superiores están altamente relacionados con carcinoma endometrial.

The aim of this article is to review the sonographic criteria of endometrial hyperplasia and define the cutoff value to indicate the completion of the endometrial biopsy due to its relationship with the risk of endometrial carcinoma. We report the case of a woman aged 47 with four years of vaginal bleeding characterized by menorrhagia, metrorrhagia, and hypermenorrhea being treated with oral contraceptives without improvement, and transvaginal ultrasound diagnosis of endometrial hyperplasia. For the diagnosis of endometrial pathology in postmenopausal women with vaginal bleeding, the authors recommend a cutoff value of endometrial thickness by transvaginal ultrasound of 4-5 mm with sensitivity of 98% and negative predictive value of 99% since higher values are closely related to endometrial carcinoma.

O objetivo deste artigo é revisar os critérios ecográficos de hiperplasia endometrial e avaliar os pontos de corte para indicar a realização de biopsia endometrial. Se reporta o caso de uma mulher de 47 anos, com quadro clínico de 4 anos de evolução de sangrado vaginal anormal tipo menorragia, metrorragia e hipermenorreia, em manejo com anticonceptivos orais, sem melhora, com ecografia transvaginal com diagnóstico de hiperplasia endometrial. Para o diagnóstico de patologia endometrial nas mulheres pós-menopáusicas com sangrado vaginal, os autores recomendam um valor de corte do espessura endometrial por ecografia transvaginal entre 4-5 mmcom sensibilidade de 98% e valor preditivo negativo de 99% devido a que valores superiores estão altamente relacionados com carcinoma endometrial.

Avaliação dos fatores associados aos pólipos endometriais / Evaluation of factors associated with the endometrial polyps

Introdução: Pólipos endometriais são lesões benignas de baixo potencial de malignidade, identificadas como protrusões do endométrio, que parecem estar relacionadas a diversos fatores sociodemográficos e clínicos. Objetivo: Identificar os fatores associados à ocorrência de pólipo endometrial em pacientes submetidas à videohisteroscopia. Métodos: Estudo caso-controle com 162 mulheres que realizaram o exame de videohisteroscopia em uma clínica privada de diagnóstico por imagem, entre janeiro e junho de 2016. A coleta de dados foi realizada através de prontuários. Estudou-se a associação das variáveis independentes com a presença de pólipos endometriais por meio de cálculo de odds ratio e seus respectivos intervalos de confiança, com nível de significância p < 0,05. A regressão logística binária foi realizada entre as variáveis com p < 0,25. Resultados: As pacientes foram divididas em 81 casos e 81 controles. A idade média das mulheres foi de 49,6 (± 12,5) anos. O tipo histológico mais frequente de pólipos endometriais foi o hiperplásico (34,7%), seguido do tipo funcional (33,3%). Foi detectado apenas um caso de carcinoma endometrial. A idade das pacientes, número de partos e cesarianas anteriores, idade da menarca, menopausa, uso de terapia hormonal ou anticoncepção hormonal e comorbidades como hipertensão arterial e diabetes não estiveram associados ao aparecimento de pólipo endometrial ao exame videohisteroscópico. A análise multivariada também não demonstrou associação entre o desfecho e cor de pele (p = 0,137), índice de massa corporal (p = 0,154), número de abortos anteriores (p = 0,869), presença de sangramento uterino anormal (p = 0,486) e seu tempo de duração (p = 0,157). Conclusão: As características clínicas e sociodemográficas avaliadas no presente estudo não estiveram associadas ao aparecimento de formações polipoides endometriais, identificadas pela videohisteroscopia.

Background: Endometrial polyps are benign lesions with low malignancy potential, identified as endometrial protrusions, which appear to be related to some sociodemographic and clinical factors. Objective: To identify the factors associated with the occurrence of endometrial polyp in patients submitted to videohysteroscopy. Methods: A case-control study that included 162 women who underwent videohysteroscopy at a private diagnostic imaging clinic between January and June of 2016. Data collection was done through medical records. The association of the variables was calculated by odds ratio and confidence interval, with significance level p < 0.05. Results: Patients were divided into 81 cases and 81 controls. The mean age of the women was 49.6 (± 12.5) years. The most frequent histological type of endometrial polyps was the hyperplastic (34.7%), followed by the functional type (33.3%). Only one case of endometrial carcinoma was detected. The age of the patients, number of previous vaginal deliveries and caesarean sections, age of menarche, menopause, use of hormonal therapy or hormonal contraception, and comorbidities such as hypertension and diabetes, were not associated with the appearance of endometrial polyp at videohysteroscopic examination. The multivariate analysis also showed no association between outcome and skin color (p = 0.137), body mass index (p = 0.154), number of previous abortions (p = 0.869), abnormal uterine bleeding (p = 0.486) and its duration (p = 0.157). Conclusion: The clinical and sociodemographic characteristics assessed in the present study were not associated with the appearance of endometrial polypoid formations, identified by videohysteroscopy.

Experience of Professor ZHANG Pingqing on Treatment of Uterine Bleeding / 浙江中医药大学学报

[Objective]To research professor ZHANG's clinical experience in treatment of metrorrhagia. [Methods] By following professor ZHANG diagnosis long time, it summarizes ZHANG's experience of Chinese medicine treatment on uterine bleeding and academics from the etiology and pathogenesis.[Results] ZHANG thinks that the pathogenesis of metrorrhagia, both cold and heat, will cause Chong Ren imbalance, so the method to reconstruct the menstrual cycle as the fundamental purpose, comprehensive use of TCM and western medicine adjuvant hormonal therapy. In the acute hemorrhage, the use of clearing heat and bleeding, liver-spleen -harmonizing remission with artificial cycle therapy according to syndrome differentiation and treatment of hemorrhage, clarifying the source and rectifying the primary on the basis of syndrome making a better clinical effect during the remission. [Conclusion] Professor ZHANG's treatment of uterine bleeding experience, unique, has a strong clinical significance, with learning and promotion of application value.

Discussion on Experience of ZHANG Liang-ying in Treating Polycystic Ovary Syndrome ;Combined with Dysfunctional Uterine Bleeding / 中国中医药信息杂志

Polycystic ovary syndrome (PCOS) and dysfunctional uterine bleeding (DUB) are common gynecologic endocrine diseases, and their etiology, pathology, diagnosis and treatment are related but also distinguishing. Some patients have PCOS and DUB at the same time, which is difficult to cure. Professor ZHANG Liang-ying has treated these patients with staging treatment based on syndrome differenciation, and has received desiable efficacy.

Diagnosis and treatment rules of metrorrhagia and metrostaxis in papers written by well-known doctors: Content analysis and clustering analysis / 中华医学图书情报杂志

Objective To discover the diagnosis and treatment rules of metrorrhagia and metrostaxis by analyzing the relevant papers published in the past 10 years.Methods Papers on diagnosis and treatment rules of metrorrhagia and metrostaxis written by well-known doctors were retrieved.The types of metrorrhagia and metrostaxis syndrome,diagnosis and treatment rules of metrorrhagia and metrostaxis syndrome,application of prescriptions in treatment of metrorrhagia and metrostaxis syndrome were analyzed by content analysis,frequency analysis and clustering analysis,respectively.Results One hundred and thirty-three papers on the diagnosis and treatment rules of metrorrhagia and metrostaxis were included in this paper with 35 types of metrorrhagia and metrostaxis syndrome involved,including 15 single syndromes,such as blood stasis,blood heat,Qi deficiency,spleen deficiency,kidney deficiency,blood deficiency,kidney-yang insufficiency.Metrorrhagia and metrostaxis was treated according to the differentiation of its symptoms and signs in combination with the menstrual cycle,age and bleeding of the patients.A total of 221 prescriptions were used in the treatment of metrorrhagia and metrostaxis.Conclusion Metrorrhagia and metrostaxis is usually occurred in spleen and kidney.lood stasis is its common pathogenesis.Metrorrhagia and metrostaxis is treated by well-known doctors according to the differentiation of its symptoms and signs,and prescriptions are used in a flexible way.

Cluster Analysis on Acupoint Selection Law for Treating Metrorrhagia and Metrostaxis Using Different Acupuncture and Moxibustion Methods / 世界科学技术-中医药现代化

This study was aimed to review literatures on the treatment of metrorrhagia and metrostaxis using acupuncture and moxibustion in recent 30 years.Database retrieval on literatures using acupuncture and moxibustion for treating metrorrhagia and metrostaxis was carried out.Statistical methods,such as frequency distribution and cluster analysis were employed in terms of frequently used medians,acupoints and methods.The results showed that there were a total of @@65 articles included in this study.The frequently used methods were acupuncture,moxibustion and auricular acupuncture.The frequently used meridians were the Spleen Meridian of Foot-Taiyin,the Ren meridian,the Bladder Meridians of Foot-Taiyang,and the auricular acupoints.The frequently used acupoints were related with the liver,spleen and kidney.Most acupoints were the meeting acupoints.Selections of auricular acupoints were related to the combination of disease differentiation and syndrome differentiation.The frequently used acupoints were clustered into four groups.Different group reflected different acupoint selection laws.Group 1,such as SP-6 (Sanyinjiao) and SP1 (Yinbai),circling along the Spleen Meridian,had effect on tonifying the spleen and kidney,nourishing blood,preventing bleeding and regulating menstruation.Group 2,such as RN-4 (Guanyuan) and ST-36 (Zusanli),in the upper and lower positions,were used for nourishing qi and blood.Group 3 and group 4 were mostly auricular acupoints,acupuncture and moxibustion in combination with syndrome differentiation.Group 3 had the effect on notifying kidney yin,reinforcing the spleen,regulating Chong and Ren meridian.Group 4 played a role in tonifying the kidney,activating blood,and soothing liver qi.It was concluded that the study on quantitative analysis of literatures on the treatment of metrorrhagia and metrostaxis using statistical method had inspirational effect on clinical treatment in terms of acupoint selection and combination.

The Connotation and Clinical Significance of the Similarities and Differences in Disease Treatment / 浙江中医药大学学报

[Objective]To explore the origin, connotation and clinical significance of the similarities and differences in disease treatment.[Methods]Refer to the ancient and modern literature, inquiry, analysis and summary of ancient and modern medicine to confirm the similarities and differences with different treatment, analysis, interpretation of different diseases with the same therapeutic principle and application, combined with clinical cases are discussed. [Results]Similarities and differences in disease treatment originated from"Huang Di Nei Jing"and developed in"Shang Han Za Bing Lun", and through successive generations of doctors in their respective clinical practice continuous use and efficacy, it is very scientific and effective to confirm the similarities and differences of disease treatment as an important method in Chinese medicine treatment. According to the change of pathogenesis of the same disease or different diseases, and to analyze the commonness or particularity of the contradiction, it is adopted the principle and method of different or same treatment. Case 1 diagnosed as metrorrhagia and metrostaxis, case 2 diagnosed as leukorrhagia, a common pathogenesis was developed through TCM syndrome differentiation: impairment of Chong and Ren channels, governance lost control, given the treating different diseases with same method;Case 3 and case 4 were diagnosed as late menstruation, but case 3 identified as asthenia of spleen and stagnation of wetness-evil and deficiency of menstruation, cases 4 diagnosed as Yin-blood deficiency and blood dryness dry, therefore with treating same disease with different methods, good clinical results were achieved. [Conclusion]The similarities and differences of disease are important characteristic of traditional Chinese medicine treatment, TCM is the spirit embodied in the process of clinical diagnosis and treatment, to explore its connotation and significance of clinical guidance, help to inherit and develop the TCM diagnosis and treatment of diseases, so as to better serve the clinic.

Sirolimus on Gorham-Stout disease. Case report / Sirolimus en la enfermedad de Gorham-Stout. Caso clínico

Abstract Background: Gorham-Stout disease (GSD) is a rare disease of unknown etiology characterized by vascular proliferation that produces destruction of bone matrix. Case description: This case is about 43 year old woman who begins with pain in sternum, dyspnea, abdominal mass and, serous-hematic pleural effusion. Imaging tests were performed showing lesions on 6th and 10th left ribs archs. Later, a thoracotomy was performed observed absence of the end of the 6th and lung, pleural and costal biopsy was token. The histologic features described lymphatic vascular proliferation in bone tissue of chest wall. Other pathologies were excluded and in view of the findings, GSD diagnosis was made. Treatment and outcome: treatment was initiated with sirolimus achieving remission of the disease after the first month; however, because the presence of metrorrhagia the treatment was discontinued, reappearing symptoms afterwards. For that reason the treatment was restarted getting disappearance of the symptoms again, 4 weeks later. Clinical relevance: we present the first clinical cases of EGS with pleural effusion with response to sirolimus treatment that could be an alternative to the current therapy.

Resumen Antecedentes: La enfermedad de Gorham-Stout (EGS), es una enfermedad poco común, de etiología desconocida, caracterizada por la proliferación vascular que produce destrucción de la matriz ósea. Caso clínico: Se presenta el caso de mujer de 43 años que comienza con dolor en el esternón, disnea y tumoración abdominal junto con derrame pleural izquierdo de características serohemáticas como forma de presentación de una EGS. En pruebas de imagen que mostraron lesiones líticas en el 6º y 10º arcos costales izquierdos. Posteriormente se realizó toracotomía con biopsia pulmonar, pleural y costal observándose ausencia del extremo de la 6ª costilla. En el estudio histopatológico se describe proliferación vascular linfática en tejido óseo de pared costal. Se excluyeron otras patologías y se diagnosticó EGS. Tratamiento y resultado: Se inició tratamiento con sirolimus consiguiendo remisión completa desde el primer mes. Sin embargo, tras la suspensión del tratamiento por metrorragias, presentó reaparición de los síntomas. Se decide entonces reiniciar el tratamiento, consiguiendo nuevamente desaparición de los síntomas, tras 4 semanas de tratamiento. Relevancia clínica: Se presenta el primer caso clínico de EGS en edad adulta con derrame pleural asociado y con respuesta clínica a sirolimus, fármaco que podría ser una alternativa a la terapéutica actual.

Malformación arteriovenosa uterina: a propósito de un caso / Arteriovenous uterine malformation: a case report

Paciente de 37 años que acudió a urgencias por metrorragia, G3P1A2, el último de ellos un aborto tardío en gestación gemelar monocorial biamniótica de 20 semanas hacía dos meses. En la ecografía destaca en zona miometrial un área de marcada vascularización de 67 x 45 mm. Tras descartar proceso residual gestacional y ante la sospecha de malformación arteriovenosa uterina se solicitó resonancia magnética nuclear y angiotac, tras confirmar la malformación vascular se programó para embolización de ambas arterias uterinas con el fin de preservar la fertilidad.

A 37-year-old patient came to the emergency due to metrorrhagia, G3P1A2, the last of them a late abortion in a 20 weeks monochorionic diamniotic twin pregnancy two months ago. Ultrasound revealed an intramiometrial area of 67 x 45 mm with increased vascularization area. A diagnosis of an arteriovenous malformation was considered. In order to confirm the diagnosis pelvic magnetic resonance and angiogram was performed. Once the vascular malformation was confirmed the patient was scheduled for transcatheter arterial embolization in order to preserve fertility.