Impact of Adenomyosis and Endometriosis on Chronic Pelvic Pain after Niche Repair.

Chronic pelvic pain (CPP) is one of the main isthmocele symptoms, together with abnormal uterine bleeding and secondary infertility. When patients undergo a laparoscopic niche repair surgery, it is important to determine if they present associated pathologies, such as adenomyosis and/or endometriosis, which are also a cause of CPP. A retrospective study was performed on 31 patients with CPP undergoing a laparoscopic niche repair. The pre-operative ultrasound was analyzed to determine the presence of adenomyosis. Endometriosis was histologically diagnosed. CPP outcome was evaluated at early (3-6 months) and late (12 months) post-operative follow ups. In our population of 31 women presenting CPP, only six of them (19.4%) did not have any associated pathology. In the group of 25 patients with associated pathology, 10 (40%) had no benefit from the reconstructive surgery in terms of CPP at early follow-up (3-6 months) and 8 (32%) in the post-operative period at 12 months. Patients with CPP who undergo niche repair should be carefully selected as CPP does not seem to be a good indication for uterine scar repair in patients with concomitant adenomyosis and endometriosis.

Pre-OPerative accelerated radiotherapy for early stage breast cancer patients (POPART): A feasibility study.

Pre-operative 5-fraction breast radiotherapy followed by immediate breast-sparing surgery and sentinel node procedure was feasible in 14 patients with 15 clinical early-stage breast cancers. However wound problems occurred frequently and was documented in 5 of the 14 patients: 2 patients with a mastitis needing antibiotics, 2 patients developed a fistula with exudate needing antibiotics and local disinfection and 1 patient developed a fistula needing surgical reintervention. Other acute and late iatrogenic events were rather limited. Two patients had a pathological lymph node involvement, which underlines the importance to perform the sentinel node procedure before pre-operative radiotherapy.

Fetal and infant health outcomes among immigrant mothers in Flanders, Belgium.

OBJECTIVE: To compare fetal and infant mortality between immigrant and native-born mothers in Flanders, Belgium. METHODS: In a population-based study, data from 326 166 neonatal deliveries, collected by the Study Center for Perinatal Epidemiology and the Belgian Civil Birth Registration system between January 2004 and December 2008, were analyzed. Immigrant mothers were defined as women born in any country other than Belgium, and were grouped by country of origin according to the World Bank Atlas definition of low-, middle-, and high-income countries. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated to evaluate the association between immigration and fetal/infant outcome. RESULTS: In univariate analysis, fetal and infant mortality rates were significantly higher among immigrants than among native-born mothers (fetal: crude OR, 1.50; 95% CI, 1.29-1.75; infant: crude OR, 1.47; 95% CI, 1.29-1.67). Fetal/infant death rates were highest among mothers originating from low-income countries. In multivariate analysis, however, most differences became non-significant: only the early neonatal death rate remained significantly higher (adjusted OR, 1.30; 95% CI, 1.06-1.60), whereas the fetal death rate appeared lower (adjusted OR, 0.67; 95% CI, 0.57-0.80), among immigrant mothers. CONCLUSION: After adjustment for relevant characteristics, fetal/infant mortality was comparable between immigrant women and native-born women in Flanders.

Association between bacterial vaginosis and cervical intraepithelial neoplasia: systematic review and meta-analysis.

OBJECTIVE: Bacterial vaginosis (BV), the most common vaginal disorder among women of reproductive age, has been suggested as co-factor in the development of cervical cancer. Previous studies examining the relationship between BV and cervical intra-epithelial neoplasia (CIN) provided inconsistent and conflicting results. The aim of this study is to clarify the association between these two conditions. METHODS: A systematic review and meta-analysis were conducted to summarize published literature on the association between BV and cervical pre-cancerous lesions. An extensive search of electronic databases Medline (Pubmed) and Web of Science was performed. The key words 'bacterial vaginosis' and 'bacterial infections and vaginitis' were used in combination with 'cervical intraepithelial neoplasia', 'squamous intraepithelial lesions', 'cervical lesions', 'cervical dysplasia', and 'cervical screening'. Eligible studies required a clear description of diagnostic methods used for detecting both BV and cervical pre-cancerous lesions. Publications were included if they either reported odds ratios (OR) and corresponding 95% confidence intervals (CI) representing the magnitude of association between these two conditions, or presented data that allowed calculation of the OR. RESULTS: Out of 329 articles, 17 cross-sectional and 2 incidence studies were selected. In addition, two studies conducted in The Netherlands, using the national KOPAC system, were retained. After testing for heterogeneity and publication bias, meta-analysis and meta-regression were performed, using a random effects model. Although heterogeneity among studies was high (χ(2) = 164.7, p<0.01, I(2) = 88.5), a positive association between BV and cervical pre-cancerous lesions was found, with an overall estimated odds ratio of 1.51 (95% CI, 1.24-1.83). Meta-regression analysis could not detect a significant difference between studies based on BV diagnosis, CIN diagnosis or study population. CONCLUSIONS: Although most studies were cross-sectional and heterogeneity was high, this meta-analysis confirms a connection between BV and CIN.

Bacterial vaginosis is associated with uterine cervical human papillomavirus infection: a meta-analysis.

BACKGROUND: Bacterial vaginosis (BV), an alteration of vaginal flora involving a decrease in Lactobacilli and predominance of anaerobic bacteria, is among the most common cause of vaginal complaints for women of childbearing age. It is well known that BV has an influence in acquisition of certain genital infections. However, association between BV and cervical human papillomavirus (HPV) infection has been inconsistent among studies. The objective of this meta-analysis of published studies is to clarify and summarize published literature on the extent to which BV is associated with cervical HPV infection. METHODS: Medline and Web of Science were systematically searched for eligible publications until December 2009. Articles were selected based on inclusion and exclusion criteria. After testing heterogeneity of studies, meta-analysis was performed using random effect model. RESULTS: Twelve eligible studies were selected to review the association between BV and HPV, including a total of 6,372 women. The pooled prevalence of BV was 32%. The overall estimated odds ratio (OR) showed a positive association between BV and cervical HPV infection (OR, 1.43; 95% confidence interval, 1.11-1.84). CONCLUSION: This meta-analysis of available literature resulted in a positive association between BV and uterine cervical HPV infection.