Self-efficacy and positive thinking as predictors of health-related quality of life in women with stress urinary incontinence.

BACKGROUND: Stress urinary incontinence (SUI), which causes involuntarily leakage of urine, has an impact on many women and may affect self-efficacy, which, in turn, can lead to poor health-related quality of life (QOL). This study aimed to explore the effects of sociodemographic and health information, symptom distress, self-efficacy, and positive thinking on the health-related QOL (general QOL and urinary incontinence-specific QOL) of women with SUI. METHODS: A cross-sectional study design was used. Women with SUI were recruited from the obstetrics and gynecology outpatient department and urodynamics examination room of a hospital by convenience sampling from August 2021 to March 2022. Participants were surveyed on the following questionnaires: Urogenital Distress Inventory, Geriatric Self-efficacy Index for Urinary Incontinence, Positive Thinking Scale, 12-Item Short-Form Health Survey (SF-12), and Incontinence Impact Questionnaire Short Form. RESULTS: Participants (N = 135) had a mean age of 53.76 years old. The mean SF-12 physical component summary score was 48.48 (physical QOL), and the mental component summary score was 46.56 (mental QOL). The urinary incontinence-specific QOL score was 16.01. Women with greater positive thinking and higher self-efficacy for urinary incontinence had better physical and mental QOL. Women with less symptom distress of urinary incontinence and higher self-efficacy for urinary incontinence had better urinary incontinence-specific QOL. CONCLUSION: The health-related QOL of women with SUI is affected by many factors, including positive thinking, self-efficacy, and symptom distress. Healthcare professionals can provide multifaceted programs to improve the health-related QOL of women with SUI.

Human papillomavirus genotyping as a predictor of high-grade cervical dysplasia in women with mildly cytologic abnormalities: a two-year follow-up report.

High-risk human papillomavirus (HR-HPV) DNA testing has emerged as another testing modality for women with mildly cytologic abnormalities. We conducted a two-year follow-up study of 108 women with mildly abnormal cervical cytology for detection of CIN 2/3. A cervical swab sample was obtained for HPV genotyping by a HPV blot and histologic follow-up results were correlated with HR-HPV types. Of the 108 cases, 93 (86.1%) were positive for HR-HPV DNA. HPV-16 was detected in 45.1% of patients. CIN grade 2 or 3 was confirmed in 25 (23.1%) of the 108 women during the two-year follow-up period. The two-year cumulative incidence rates of CIN 2/3 were 38.6% (17/44) among HPV-16- positive women, but only 5.6% among HR-HPV-positive women without HPV-16 or HPV-18. The sensitivity of a positive HPV-16 test for CIN 2/3 was 68.0%, the specificity was 67.5%. Our results demonstrated that the type-specific HPV-16 test increased sensitivity of detecting high-grade cervical dysplasia for women who have mildly cytologic abnormalities. The implication of the present findings is that HPV genotyping may identify women with the greatest risk of high-grade CIN.

P16 methylation is an early event in cervical carcinogenesis.

BACKGROUND: Aberrant gene promoter methylation is a critical event in tumorigenesis. The aim of this study was to explore the promoter hypermethylation of p16 and DAPK1 during the progression of cervical precancerous lesions. METHODS: A series of 98 cervical neoplasms (72 cervical intraepithelial neoplasia and 26 cervical carcinomas) were evaluated. The promoter methylation status of p16 and DAPK1 was assessed from cervical scrapings by methylation-specific polymerase chain reaction. RESULTS: For p16, the frequency of promoter hypermethylation showed an increasing trend from normal to dysplastic to invasive squamous cancer specimens, and this increase reached statistical significance (P < 0.0001). However, there was no significant difference in the promoter methylation state of DAPK1 with regard to the various grades of cervical lesions (P = 0.077). Specifically, methylation of p16 was a frequent event in the cervical carcinoma samples, and these figures were statistically significant compared with the normal and cervical intraepithelial neoplasia I cases (P = 0.015 and P = 0.021, respectively). CONCLUSIONS: These results imply that promoter hypermethylation of p16 occurs at an early stage of cervical neoplastic progression. This early event may play an initiating role in the malignant transformation of low-grade dysplasia into high-grade dysplasia and invasive carcinoma. We suggest that aberrant promoter methylation of p16 may serve as a useful biomarker during the follow-up of low-grade dysplasia.

Combined positron emission tomography-computed tomography and tumor markers for detecting recurrent ovarian cancer.

OBJECTIVE: To evaluate the accuracy of integrated FDG-PET/CT and tumor markers for the depiction of recurrent ovarian carcinoma. METHODS: Patients with pathologically proven ovarian cancer, who underwent cytoreductive surgery and 3-6 cycles of adjuvant chemotherapy, were included in this study. They all underwent a thorough physical examination, tumor marker determination, and FDG-PET/CT imaging. The sensitivity, specificity, accuracy, and positive and negative predictive values for the tumor detection with PET/CT versus different tumor markers were performed in relation to the results at histological analysis after second-look surgery or clinical follow-up. RESULTS: A total of 37 patients underwent FDG-PET/CT scans. Among them, 22 patients underwent exploratory laparotomy and 15 had diagnostic laparoscopy. Overall, 24 patients were documented to have ovarian cancer recurrence after second operation. FDG-PET/CT had sensitivity, specificity, accuracy, and positive and negative predictive values of 100, 85, 94, 92, and 100%, respectively. CONCLUSION: Our study has shown that PET/CT is a sensitive tool to assist in the early identification and recurrent ovarian cancer, amenable to secondary cytoreduction.

An adhesion barrier may induce peritonitis and abscess after laparoscopy-assisted myomectomy with vaginal extraction: report of a case.

Following a myomectomy, postoperative adhesions occur in many patients. Although laparoscopy has been shown to decrease the development of adhesions compared to laparotomy, adhesions still occur. There are several commercially available adhesion barriers but these are not designed to be easily applied during laparoscopic surgery. In this study, we report a case involving a 34-year-old patient who developed pelvic peritonitis and abscess without an obvious etiology; this might have been related to the off-label use of a bioabsorbable membrane converted into a slurry during recent surgery. Surgeons should be aware of such complications, which might be attributed to this product.

Decreased p21 expression in HPV-18 positive cervical carcinomas.

The aim of this study was to investigate the relationship between different human papillomavirus (HPV) genotypes and the expression of p53, p21 and p27 in cervical carcinomas. A total of 103 cases of cervical carcinomas were assayed for expression of p53, p21 and p27 by immunohistochemistry. HPV typing was carried out by two polymerase chain reaction-based methods. Overall, HPV prevalence was 97.1% among the cervical carcinomas in this study. HPV-16 was detected in 66% of the tumors, HPV-18 in 7.8%, HPV-16/18 in 7.8% and other HPV types in 15.5%. The expression of p53 and p27 was not related to HPV genotype. However, in the HPV-18 positive cervical carcinomas, expression of p21 was significantly decreased or completely absent (P = 0.019). Our results indicated that down-regulation of p21 was strongly associated with HPV-18 positive cervical carcinomas. The significantly lower expression of p21 protein in HPV-18 positive samples compared to HPV-18 negative cervical carcinomas supports the hypothesis that inactivation and degradation of p21 proteins by HPV-18 E7 may play an important role in the carcinogenesis of HPV-18 positive cervical neoplasia.

Total laparoscopic hysterectomy (TLH) versus coagulation of uterine arteries (CUA) at their origin plus total laparoscopic hysterectomy (TLH) for the management of myoma and adenomyosis.

We tried to evaluate the relative feasibility, surgical duration and complications of total laparoscopic hysterectomy (TLH) versus coagulation of uterine arteries at their origin (CUA) plus total laparoscopic hysterectomy for the management of myoma and adenomyosis, and to compare the estimated blood loss for both procedures. A total of 123 patients underwent TLH or CUA plus TLH for the treatment of symptomatic myoma and adenomyosis. Sixty-four women underwent TLH, whilst 68 women underwent coagulation of uterine arteries at their origin plus TLH. The mean weight and volume of the uterus as determined following TLH was 288.1+/-102.4 gm (range 182.1 approximately 396.2 gm.) and 451+/-340.6 cm(3) (range 107.4 approximately 792), respectively. The mean weight of the uterus following CUA plus TLH was 269.1+/-151.7 gm (range 215.8 approximately 430.1) whilst the mean uterine volume was 472.7+/-377.8 cm(3) (range 93.7 approximately 851.2). No significant differences with respect to surgical duration (95 vs. 96.5 minutes TLH vs. CUA + TLH; p>0.05), blood loss (177.2+/-80.1 ml for TLH and 154.9+/-30.21 ml for CUA+TLH; p>0.05) and mean+/-SD preoperative (12.05+/-1.70 gm/dl for TLH and 12.14+/-1.38 gm/dl for CUA+TLH; p>0.05) and post-operative hemoglobin level (11+/-1.03 for TLH and 11+/-1.49 for CUA + TLH; p>0.05) were observed between the two study groups. The blood loss for TLH is comparable to that for the CUA plus TLH procedure.

Should cystoscopy be routinely performed after laparoscopy-assisted vaginal hysterectomy?

This study was undertaken to determine the usefulness of routine intra-operative cystoscopy in documenting ureteral patency after laparoscopy-assisted vaginal hysterectomy (LAVH). There were eighty patients who underwent LAVH for benign tumors of the uterus (adenomyosis and myoma), uterine prolapse, persistent intraepithelial neoplasm of the cervix (CIN3) and cervical carcinoma in situ (CIS). Intra-operative cystoscopy with ureteral stenting was performed at the time of LAVH to evaluate the urinary tract. From among the 80 patients who underwent LAVH, 52 had myoma, 19 had adenomyosis, six patients had uterine prolapse, one had CIS and seven patients were diagnosed to have CIN3. Cystoscopy discovered one unsuspected bladder injury. Hematuria was the immediate complication caused by intraoperative cystoscopy. It was observed in ten patients. Urinary tract evaluation, including cystoscopy and ureteral stenting at the time of complex gynecologic surgery such as LAVH could be incorporated in the whole surgical procedure. It decreases morbidity associated with unrecognized injury.

Identical twins with ovarian endometriosis and mucinous borderline tumor: an unusual association.

OBJECTIVE: To report a case of monozygotic twins with unilateral ovarian tumors of different histology and character. DESIGN: Case report. SETTING: Medical center and teaching hospital. PATIENT(S): A 22-year-old woman with ruptured ovarian endometrioma and her twin with mucinous borderline tumor of the ovary. INTERVENTION(S): Ultrasonography, laparoscopic ovarian cystectomy, and salpingo-oophorectomy. MAIN OUTCOME MEASURE(S): Ovarian cystectomy for the twin with endometrioma and examination of the asymptomatic twin. RESULT(S): Diagnosis and treatment of the asymptomatic twin. CONCLUSION(S): Ovarian tumors present in monozygotic twins may not always be of the same histologic type.

Human papillomavirus DNA in triple neoplasms of the cervix, perianus and ureter in one woman.

BACKGROUND: Multiple malignancies of the urogenital tract have been reported. We investigated the etiological role of human papillomavirus (HPV) in the pathogenesis of urogenital cancers. CASE: We present a case of cervical squamous carcinoma in a 64-year-old woman who subsequently developed Bowen's disease in the perianal skin and transitional cell carcinoma of the ureter. HPV DNA was detected in these tumor specimens using polymerase chain reaction. CONCLUSION: The results strongly suggest that HPV may play a major role in the carcinogenesis of urogenital and perianal tumors.

Ovarian pregnancy torsion.

INTRODUCTION: Ovarian-cyst torsion is often seen in early pregnancy due to progesterone stimulation. It is the fifth-most-common gynecological emergency, with a reported incidence of 3%. An ectopic pregnancy implanted in the ovary is rare, occurring in only 0.5-1% of such pregnancies. CASE REPORT: We presented a case of ovarian pregnancy with concomitant ipsilateral side tubal torsion managed by laparoscopy. DISCUSSION AND CONCLUSIONS: Varying density distribution in the ovary can predispose to ovarian torsion. Emergency surgery may offer the possibility of avoiding the ablation of functional ovarian tissue. Early detection and prompt management can preserve fertility and ovarian function. The etiology, presenting syndrome and management are discussed.

Heterotopic Caesarean scar pregnancy combined with intrauterine pregnancy successfully treated with embryo aspiration for selective embryo reduction: case report.

Ectopic pregnancy situated in a Caesarean section scar is a rare but potentially life-threatening event. Because of its rarity, there are no universal treatment guidelines to manage this condition. We report a case of IVF-induced triplet heterotopic pregnancy of early gestational age that included one Caesarean scar pregnancy diagnosed as early as 6 weeks gestation. Treatment with embryo aspiration under vaginal ultrasonography for selective embryo reduction was given and the concurrent intrauterine twin pregnancy was preserved successfully.

Transvaginal three-dimensional ultrasonography combined with serum CA 125 level for the diagnosis of pelvic adhesions before laparoscopic surgery.

STUDY OBJECTIVE: To investigate the role of transvaginal three-dimensional ultrasonography combined with serum CA 125 level in diagnosing pelvic adhesions before scheduled laparoscopic surgery. DESIGN: Prospective study (Canadian Task Force classification II-1). SETTING: Tertiary care academic hospital. PATIENTS: Fifty-nine women with an adnexal mass diagnosed by two-dimensional transvaginal ultrasonography. INTERVENTION: Preoperative transvaginal three-dimensional ultrasonography and serum CA 125 level, followed by laparoscopy or laparotomy. MEASUREMENTS AND MAIN RESULTS: Pelvic adhesions were correctly identified by transvaginal three-dimensional ultrasonography in 26 of 32 women in whom the lesions were confirmed at laparoscopy or laparotomy. Mean serum CA125 level in women with adhesions was 70 +/- 73.7 U/ml, which was significantly higher than that in women without adhesions (24 +/- 16.16 U/ml, p = 0.004). The sensitivity of combined transvaginal three-dimensional ultrasonography and serum CA 125 level was 90%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 89%. The two methods showed strong agreement with surgical results (kappa = 0.889). Eight scheduled laparoscopies (13.6%) were converted to laparotomy due to severe adhesions. One patient (1.7%) experienced colon injury during laparoscopic adhesiolysis. CONCLUSION: Transvaginal three-dimensional ultrasonography combined with serum CA 125 level is sensitive in detecting pelvic adhesions before laparoscopic surgery. Patients with suspected severe pelvic adhesions should have preoperative bowel preparation to reduce the risk of intraoperative injury.

Heterotopic triplet pregnancy: report of a case with bilateral tubal pregnancy and an intrauterine pregnancy.

The first report of an ectopic pregnancy following IVF was published in 1976, and since then heterotopic pregnancies (HPs) have been reported at an increasing rate. Although cases of the co-existence of a bilateral tubal and an intrauterine pregnancy following IVF-embryo transfer have been reported, a case of heterotopic triplet pregnancy caused by unilateral tubal embryo transfer has not yet been published in the literature. Here we report on a 38-year-old women (gravida 3, para 1) with a history of infertility who presented to our infertility clinic for evaluation. Hysterosalpingography revealed bilaterally patent Fallopian tubes and stricture of the cervical canal. She conceived after receiving HMG combined with pure FSH, followed by IVF-tubal embryo transfer. Four embryos were replaced into the right tube. Approximately 5 weeks after tubal embryo transfer, the patient presented with lower abdominal tenderness and shock due to internal bleeding. She underwent an emergency laparotomy under the impression of HP. Bilateral tubal pregnancy with right tubal rupture was noted during the operation. The post-operative course was uneventful. Early intervention and thorough inspection of the peritoneal cavity in patients with haemodynamic instability can prevent jeopardizing the life of the mother as well as the ongoing pregnancy.

Uterine rupture in an unscarred uterus after application of fundal pressure. A case report.

BACKGROUND: Rupture of an unscarred uterus is rare, with a reported incidence of 1 in 8,000-15,000 pregnancies. We report a case occurring during labor. CASE: A 33-year-old woman, gravida 3, para 0, abortion 2, was admitted at 40 weeks' gestation with ruptured membranes. Fundal pressure was applied during delivery due to maternal exhaustion. Uterine rupture was diagnosed from palpation of the fetal extremities coupled with a decreased fetal heartbeat. A 6-cm transverse laceration was discovered over the lower uterine segment during emergency cesarean section. The uterus was sutured. There were no further complications, and the postoperative course was uneventful. CONCLUSION: Spontaneous rupture of the unscarred uterus during labor is rare, with only one case recorded at our institution over a 10-year period. Risk factors include weakness of the uterine muscle and the application of fundal pressure. Early detection and immediate surgical intervention are the mainstays of management.