Intrathoracic endometriosis resulting in catamenial pneumothorax.

A woman in her early 40s presented with right-side chest pain radiating to the ipsilateral shoulder coinciding with her menstrual periods. She complained of worsening dysmenorrhoea over the preceding 6 months. Chest radiograph was notable for pneumothorax. Conservative management through hormonal suppression was initially pursued but proved ineffective for preventing recurrence. The patient ultimately underwent video-assisted diagnostic thoracoscopic surgery through robotic approach; intraoperative findings confirmed the presence of endometrial deposits of the diaphragm, confirming the cause of the patient's catamenial pneumothorax. The patient recovered well and was started on a gonadotropin-releasing hormone antagonist 3 weeks following her operation.

Female Pelvic Conditions: Chronic Pelvic Pain.

Chronic pelvic pain (CPP) is defined as at least 6 months of pain originating from the lower abdomen or pelvis that is not associated with pregnancy. Symptoms include abdominal bloating, low back pain, and dyspareunia. CPP is considered a symptom and not a diagnosis. The etiology may involve a specific organ or condition (eg, endometriosis, adhesions). The most common associated conditions are endometriosis, interstitial cystitis, irritable bowel syndrome, and depression. The history and physical examination are essential in the evaluation. A comprehensive history that encompasses the gynecologic, obstetric, surgical, and psychosocial histories is key. The psychosocial history should include screening for depression, anxiety, posttraumatic stress disorder, and physical and sexual abuse because of their association with CPP. The physical examination should include musculoskeletal, abdominal, and gynecologic examinations. The choice of laboratory tests and imaging studies should be guided by the history and physical examination findings. Management is multimodal and involves management of associated conditions, pharmacotherapy, surgeries and procedures, physical therapy, and behavior and lifestyle therapies. The multidisciplinary care team typically consists of the primary care physician, subspecialty physicians (eg, gynecology, pain management, psychiatry, gastroenterology, urology), a physical therapist, and a behavioral health subspecialist.

Female Pelvic Conditions: Abnormal Uterine Bleeding.

Abnormal uterine bleeding (AUB) is the term used to describe uterine bleeding that varies from the normal parameters of menstruation. This term replaces several previously used terms with less clear or conflicting definitions, including dysfunctional uterine bleeding, irregular menstrual bleeding, and menorrhagia. PALM-COEIN is a classification system for the etiologies of AUB in nongravid menstruating women. PALM refers to discrete structural entities (ie, polyp, adenomyosis, leiomyoma, malignancy and hyperplasia); COEIN refers to nonstructural etiologies (ie, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet classified). The prevalence of AUB is estimated to be 35% or higher. The history and physical examination are key in the evaluation of patients with AUB. Patients with symptomatic acute blood loss require urgent evaluation for potential hemodynamic instability. For women 45 years and younger with AUB, endometrial biopsy is indicated if specific risk factors for endometrial cancer are present. Endometrial biopsy is indicated for all patients with AUB who are older than 45 years or have postmenopausal bleeding. Management of AUB is determined by its etiology, and typically consists of medical therapy (ie, combination oral contraceptives, progestin-containing intrauterine devices, tranexamic acid, nonsteroidal anti-inflammatory drugs). Patients with structural lesions may require surgical procedures. Management should be individualized and patient desire for current or future fertility should be considered.

Female Pelvic Conditions: Polycystic Ovary Syndrome.

It is estimated that polycystic ovary syndrome (PCOS) affects about 10% of women of reproductive age in the United States. Principal risk factors include obesity and a family history of PCOS. A diagnosis of PCOS should be considered in women with irregular or absent menstrual cycles, issues related to hyperandrogenism, or infertility. The Rotterdam diagnostic criteria require two of the following three factors: oligo- or anovulation, clinical and/or biochemical signs of hyperandrogenism, and polycystic ovaries identified on ultrasonography. Laboratory tests are recommended to rule out other conditions and factors, including thyroid conditions, hyperprolactinemia, atypical congenital adrenal hyperplasia, and tumors. The mainstays of treatment are lifestyle changes to achieve weight loss and combination oral contraceptives (COCs). (PCOS is an off-label use of COCs.) A weight loss of 5% to 10% has been shown to decrease PCOS symptoms. Medical or surgical management of obesity may be indicated. COCs provide endometrial protection and help manage acne and hirsutism. (Hirsutism is an off-label use of COCs. Acne is an off-label use of some COCs.) Routine acne treatments also are used. Hirsutism may improve with topical cosmetic treatments, spironolactone, or finasteride. (Hirsutism is an off-label use of spironolactone and finasteride.) Infertility is a common issue in patients with PCOS. The aromatase inhibitor letrozole is the first-line treatment for PCOS-related anovulation. Gonadotropin-releasing hormone analogues also are used to induce ovulation. (This is an off-label use of letrozole and gonadotropin-releasing hormone analogues.).

Female Pelvic Conditions: Genitourinary Syndrome of Menopause.

Genitourinary syndrome of menopause (GSM) is a term that describes the genital, urinary, and sexual changes that occur in women because of a lack of estrogen. This most commonly is because of menopause, but can be because of a hypoestrogenic state caused by hyperprolactinemia, oophorectomy, premature ovarian failure, chemotherapy, or radiation. GSM describes a group of signs and symptoms that affect quality of life and progress over time, including vaginal dryness, dyspareunia, dysuria, urinary urgency, and frequent urinary tract infections. GSM is underdiagnosed. It affects 65% of women 1 year after the onset of menopause, and 84% of women 6 years after menopause. Physicians routinely should ask all perimenopausal and postmenopausal women about GSM symptoms. The diagnosis is made clinically, based on the history and physical examination. Use of nonhormonal lubricants and vaginal moisturizers should be recommended as first-line therapies. Vaginal estrogen is the most effective treatment. Other therapies include vaginal dehydroepiandrosterone (DHEA), ospemifene, systemic estrogen therapy, and pelvic floor physical therapy.

Obstructive sleep apnea: a diagnostic and treatment guide.

Patients with this common sleep disorder often fit the classic profile- - but not always. Here' s help knowing what to look for and when to test, as well as how best to treat it.

Children of parents with a mental illness visiting psychiatric facilities: perceptions of staff.

Children of parents with mental illness have been identified as a hidden population within mental health services, despite many clients being parents. In Australia, children of parents with a mental illness have been the focus of initiatives aimed at promoting their health and well-being and developing family-focused services. However, there has been little focus on children visiting acute inpatient mental health facilities. The aim of this study was to understand the experiences of children, their parents and carers, and staff when children visit, to better inform service planning. A qualitative exploratory research framework was used, and data were gathered through interviews. This paper presents the findings from the perspective of staff. Findings indicated that staff experienced being in a dilemma about children visiting and there were barriers to implementing family-friendly services. While staff mostly agreed in principle that children's visiting was beneficial, there was a lack of local policy and guidelines, and ad hoc arrangements existed. In addition, staff were unsure of their role with children, felt ill-equipped to talk to children about mental illness; and lacked knowledge of age-appropriate resources. Models of inpatient care need to be developed with a family focus that acknowledges the parental roles of clients and supports children visiting.

Children visiting parents in inpatient psychiatric facilities: perspectives of parents, carers, and children.

A significant number of clients utilizing mental health services will also be parents. Being a child of a parent with mental illness increases health risks for the child, and hospitalization of the parent has been identified as one of the most difficult times for children. However, few proactive measures have been taken to understand or provide for the needs of children visiting psychiatric inpatient facilities. The aim of this exploratory study was to identify the perspectives children, their parents, nominated carers, and clinicians from their experience of children visiting. The study used qualitative data gathered from interviews to develop an understanding of the issues. The purpose of this paper was to present the findings from parents, carers, and children. Children indicated that they wanted to visit and to remain involved with their parent, but that there was little support from staff. Families indicated that children visiting psychiatric inpatient facilities were not well managed, and they received little support about decisions around children visiting. The issue of children visiting psychiatric facilities when they have a parent who is an inpatient appears not to have been addressed in models of inpatient mental health care.

Knowledge of the cervical cancer screening process among rural and urban illinois women undergoing colposcopy.

OBJECTIVE: To describe knowledge of the cervical cancer prevention process among rural and urban women referred for evaluation of abnormal cytology. MATERIALS AND METHODS: Women with abnormal screening cervical cytology attending university colposcopy clinics (n = 178) were asked about demographic factors and knowledge of Pap testing, human papillomavirus (HPV) infection, and risk factors for cervical cancer. Responses were tabulated, and correlations assessed. RESULTS: Only 131 (74%) of 176 responding women understood that Pap tests evaluate the cervix, whereas 137 (78%) understood that Pap tests should be repeated at intervals of 1-3 years. The cancer screening function of a Pap test was identified by 122/177 (69%), but only 99 (56%) knew HPV is sexually transmitted and causes warts and premalignant changes. Rural residence was not associated with knowledge, but older women were more likely to know the nature of the Pap test (p =.005) and the meaning of an abnormal Pap test (p = .04). Women in higher income strata were more likely to understand the meaning of an abnormal Pap test (p = .03), the nature of HPV (p = .005), and risk factors for cervical cancer (p = .03). College graduates were better (p = .0005), and women of greater parity were less (p = .02) able than others to identify the nature of HPV, although neither differed from others in ability to answer other questions correctly (p > .1). CONCLUSIONS: Income and education are better predictors of knowledge of the cervical cancer prevention process than rural residence. Higher rates of cervical cancer in rural areas may reflect lower educational attainment and lower income.