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Objective To systematically evaluate and sequentially analyze the clinical efficacy and safety of Baogong Zhixue Granules for the treatment of abnormal uterine bleeding due to ovulation disorder.Methods The randomized controlled trials(RCTs)of Baogong Zhixue Granules for the treatment of abnormal uterine bleeding due to ovulation disorder were retrieved from the databases of CNKI,Wanfang Data,VIP,China Biology Medicine,PubMed,Embase,and Cochrane Library from the establishment of the databases to January 5th,2023.Literature screening and data extraction were conducted according to Cochrane Handbook for Systematic Reviews of Interventions,and Meta-analysis was performed by RevMan 5.4.Results Totally 15 articles were included,involving 1 425 patients.Meta-analysis results showed that Baogong Zhixue Granules could effectively improve the clinical efficacy of abnormal uterine bleeding due to ovulatory disorder(RR=1.17,95%CI[1.13,1.23],P<0.000 01),shorten hemostasis time[bleeding control time(MD=-6.35,95%CI[-8.89,-3.81],P<0.000 01),complete hemostasis time(MD=-12.56,95%CI[-16.22,-8.89],P<0.000 01)],reduce endometrial thickness(MD=-1.26,95%CI[-1.71,-0.80],P<0.000 01),reduce hemoglobin loss(MD=13.35,95%CI[11.41,15.29],P<0.000 01),improve the score of uterine bleeding(MD=-2.22,95%CI[-2.43,-2.01],P<0.000 01),and reduce the recurrence of disease(RR=0.37,95%CI[0.19,0.72],P=0.004).There was no statistical significance between the test group and the control group in terms of adverse reactions(P=0.82).The trial sequential analysis of the total efficiency was carried out,and the cumulative included research passed the traditional threshold and trail sequential analysis threshold.Conclusion Baogong Zhixue Granules have a certain clinical efficacy in the treatment of abnormal uterine bleeding due to ovulation disorder,but there may be publication bias in the study,and higher quality clinical RCTs need to be carried out.
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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.
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Endometrial ablation (EA) is a minimally invasive surgical procedure to reduce abnormal uterine bleeding contemplated for women who have achieved their reproductive goals. EA consists of the destruction of the endometrial layer with preservation of the uterus, although EA has lower complication rates than hysterectomy, it may be associated with metrorrhagia recurrence. One of the major causes of treatment failure is incomplete ablation of the endometrium. Thanks to techniques that have been developed in recent years, endometrial ablation can be performed on an outpatient basis, including by radiofrequency ablation. The main objective of this case series was to report four cases in which Radiofrequency Endometrial Ablation (RFEA) was used to treat abnormal uterine bleeding at a single ambulatory surgical center in Brazil. Hysteroscopic evaluation of the uterine cavity was performed immediately prior to the RFEA to diagnose possible endometrial pathologies and again at the conclusion of the procedure to assess the aspect of the newly treated endometrium. Verification of the completeness of the ablation was assessed by a third hysteroscopy 30 or 60 days after the ablation. In this case series RFEA was efficacious and safe for outpatient use. Although radiofrequency endometrial ablation can be performed without the use of the hysteroscope, we believe it is an important tool for the timely verification of the completeness of the endometrial ablation. (AU)
A ablação endometrial (AE) é um procedimento cirúrgico minimamente invasivo destinado a mulheres com prole estabelecida visando redução do sangramento uterino anormal. A AE consiste na destruição da camada endometrial com a preservação do útero, apesar da AE possuir menores índices de complicação do que a histerectomia, pode estar associada a recorrência do sangramento. Uma das causas da falha de tratamento é a ablação incompleta do endométrio. Atualmente, a ablação endometrial pode ser realizada ambulatorialmente graças às técnicas que vêm sendo desenvolvidas nos últimos anos, as quais incluem o uso de radiofrequência. O objetivo dessa série de casos é descrever 4 casos de Ablação Endometrial por Radiofrequência (AERF) para o tratamento de sangramento uterino anormal realizados em um mesmo ambulatório especializado no Brasil. Uma avaliação histeroscópica da cavidade uterina foi realizada imediatamente antes da AERF para diagnosticar possíveis patologias endometriais e imediatamente ao final do procedimento, para avaliar o aspecto do endométrio recém tratado e a necessidade de nova aplicação de radiofrequência. A integralidade da ablação foi verificada por uma terceira histeroscopia após 30 ou 60 dias depois da ablaçao. A técnica mostrou-se adequada para uso ambulatorial. Embora a ablação endometrial por radiofrequência possa ser realizada sem o uso do histeroscópio, acreditamos que seja uma ferramenta importante para a verificação oportuna da integralidade da ablação endometrial. (AU)
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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.
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Humanos , Feminino , Hemorragia Uterina/diagnóstico por imagem , Exame Físico/métodos , Pólipos/diagnóstico por imagem , Útero/patologia , Colo do Útero/patologia , Endométrio/fisiopatologia , Adenomiose/complicações , Ginecologia/métodos , Hiperplasia/complicações , Leiomioma/complicações , Anamnese/métodosRESUMO
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.
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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.
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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.
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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.
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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.
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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 .
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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.
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Humanos , Feminino , Adolescente , Síndrome de Klippel-Trenaunay-Weber/cirurgia , Procedimentos Endovasculares/métodos , Metrorragia/cirurgia , Pelve , Síndrome de Klippel-Trenaunay-Weber/patologia , Síndrome de Klippel-Trenaunay-Weber/diagnóstico por imagem , Angiografia por Ressonância Magnética/métodos , Doenças da Vesícula Biliar/cirurgia , Doenças da Vesícula Biliar/patologia , Hemangioma/cirurgia , Hemangioma/patologia , Hematúria/cirurgia , Hematúria/patologia , Metrorragia/patologiaRESUMO
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.
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Humanos , Feminino , Gravidez , Adulto , Mola Hidatiforme/diagnóstico , Doença Trofoblástica Gestacional , Mola Hidatiforme/epidemiologia , Dor Abdominal , Chile/epidemiologia , Diagnóstico Diferencial , Estudo Observacional , MetrorragiaRESUMO
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.
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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.
Assuntos
Humanos , Feminino , Hiperplasia Endometrial , Doenças Uterinas , Hemorragia Uterina , Neoplasias do Endométrio , MetrorragiaRESUMO
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.
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[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.
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[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.
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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.
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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.
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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.