Long-Term Follow Up of Sexual Function and Steroid Levels in Women after Perimenopausal Hysterectomy with or without Concomitant Oophorectomy.

Hysterectomy, most often performed because of bleeding disorders or uterine leiomyoma, is one of the most common major surgical procedures in women and is usually performed during the perimenopausal period on ages 45-55 years. Hysterectomy may be combined with bilateral salpingo-oophorectomy, as a risk-reducing procedure to minimize the risk of ovarian cancer. An open question is whether concomitant oophorectomy, with cessation of ovarian androgen secretion, has any long-term effects on sexual function. In the present prospective cohort study of women undergoing benign hysterectomy, the long-term (10-12 years) effects on sexual function and changes in sex hormone levels were investigated in women having undergone perimenopausal hysterectomy, with or without concomitant bilateral salpingo-oophorectomy. Originally, 491 women (mean age around 50 years) were operated with (patient preference) either only hysterectomy (HYST) or hysterectomy plus bilateral salpingo-oophorectomy (HYST + BSO), and 441 women (90%; HYST; n = 271 and HYST + BSO; n = 170) completed a one-year survey. In the present study, 185 women (42%) of the cohort with one-year follow up participated in the long-term follow up after 10-12 years. Follow-up was with the 10-item McCoy Female Sex Questionnaire and blood analysis of levels of testosterone, estradiol and sexual-hormone-binding globulin. The results showed that specific aspects of sexual function were lower after HYST + BSO compared to HYST 10-12 years after surgery. These lowered items were frequency of sexual fantasies, enjoyment of sexual activity, sexual arousal, and orgasmic frequency. No long-term differences in sex hormone levels were found between the two groups. In conclusion, some items related to sexual function were lower after HYST + BSO in a long-term perspective study, although the levels of testosterone were unaltered. This finding may have implications for clinical recommendations concerning prophylactic salpingo-oophorectomy or for hysterectomy during the perimenopausal age.

Pulmonary Embolism in COVID-19 Treated with VA-ECLS and Catheter tPA.

BACKGROUND: Novel coronavirus 2019 (COVID-19) has been the focus of the medical world since being declared a pandemic in March 2020. While the pathogenesis and heterogeneity of COVID-19 manifestations is still not fully understood, viral evasion of cellular immune responses and inflammatory dysregulation are believed to play essential roles in disease progression and severity. CASE PRESENTATION: We present the first case of a patient with COVID-19 with massive pulmonary embolism treated successfully with systemic thrombolysis, VA-ECLS, and bail out catheter directed thrombolysis. He was discharged from the hospital after an eventful hospital course on therapeutic anticoagulation with warfarin. CONCLUSIONS: We present the first case of a patient with COVID-19 with massive pulmonary embolism (PE) treated successfully with systemic thrombolysis, VA-ECLS and bail out catheter directed thrombolysis. In our experience catheter directed thrombolysis comes with an acceptable bleeding risk despite use of mechanical circulatory support, particularly with meticulous attention to vascular access and dose response monitoring.

Sex and age interact to determine clinicopathologic differences in Alzheimer's disease.

Women reportedly make up two-thirds of Alzheimer's disease (AD) dementia sufferers. Many estimates regarding AD, however, are based on clinical series lacking autopsy confirmation. The Florida Autopsied Multi-Ethnic (FLAME) cohort was queried for AD cases with a total of 1625 identified ranging in age from 53 to 102 years at death. Standard neuropathologic procedures were employed and clinical information was retrospectively collected. Clinicopathologic and genetic data (MAPT and APOE) were stratified by sex. Within the neuropathologically diagnosed AD cohort, the overall number of women and men did not differ. Men were younger at onset of cognitive symptoms, had a shorter disease duration, and more often had atypical (non-amnestic) clinical presentations. The frequency of autopsy-confirmed AD among women and men stratified by age at death revealed an inverse U-shaped curve in men and a U-shaped curve in women, with both curves having inflections at approximately 70 years of age. Regional counts of neurofibrillary tangles differed in women and men, especially when examined by age intervals. Women had overall greater severity of neurofibrillary tangle counts compared to men, especially in the hippocampus. Men were more often classified as hippocampal sparing AD, whereas limbic predominant AD was more common in women. Men and women did not differ in frequency of MAPT haplotype or APOE genotype. Atypical clinical presentations, younger age at onset and shorter disease duration were more frequent in men, suggesting that the lower reported frequency of AD in men may be due to more frequent atypical clinical presentations not recognized as AD. Our data suggest that neuropathologically diagnosed AD cases have the same frequency of women and men, but their clinical presentations and ages at onset tend to differ.

Autogenous Vein Wrapping versus In Situ Decompression for Management of Secondary Cubital Tunnel Syndrome after Surgical Fixation of Elbow Fractures: Short-Term Functional and Neurophysiological Outcome.

PURPOSE: The aim of this study was to compare the functional and neurophysiological outcome of in situ decompression versus in situ decompression augmented with autogenous vein wrapping in management of secondary cubital tunnel syndrome at the elbow following fixation of elbow fractures. METHODS: A prospective comparative randomized study was performed on 29 patients who were divided into two groups: group I (in situ decompression) and group II (in situ decompression augmented with autogenous vein wrapping). We measured the patients' demographics, subjective reports of symptoms, and objective evaluation of the functional and neurophysiological outcomes of both groups. RESULTS: Group II patients achieved statistically better results in both neurophysiological scoring and clinical sensory rating but not in all other parameters. CONCLUSION: Autogenous vein wrapping for secondary cubital tunnel syndrome after elbow fracture fixation only provides a better sensory outcome. LEVEL OF EVIDENCE: Level II, therapeutic prospective comparative study.

Differences in aspects of personality and sexuality between perimenopausal women making different choices regarding prophylactic oophorectomy at elective hysterectomy.

BACKGROUND: Retrospective studies have indicated differences in sexuality and general psychological well-being between women who have undergone hysterectomy only and those undergoing hysterectomy and oophorectomy. These differences may be the result of dissimilarities in the groups of women who choose the respective operation. OBJECTIVE: To compare the preoperative characteristics of women who choose to undergo prophylactic oophorectomy with the corresponding characteristics of those who choose to retain their ovaries when undergoing hysterectomy on benign indication. POPULATION: Perimenopausal women (aged 45-55), scheduled for hysterectomy on benign indication, were evaluated within 2 months before surgery. A total of 217 women chose hysterectomy only and 106 women chose hysterectomy with concomitant prophylactic oophorectomy. METHODS: Socioeconomic and health data, personality (Karolinska Scale of Personality), sexuality (McCoy's Female Sexuality Questionnaire), well-being (Psychological General Well-Being index), the prevalence of climacteric symptoms (modified Kupperman's index) and the women's attitude to hormone replacement therapy were investigated. RESULTS: Women who later underwent prophylactic oophorectomy in addition to hysterectomy had higher anxiety-related scores, lower sexual variable scores and poorer emotional partner relationships. This group was also characterized by more episodes of irregular bleeding, a greater prevalence of climacteric symptoms and a more extensive use of hormonal replacement therapy, in comparison with women who later underwent hysterectomy only. CONCLUSION: Personality, sexuality and the nature and severity of preoperative symptoms in women who chose prophylactic oophorectomy differ markedly from the same variables in those who chose to keep their ovaries at elective hysterectomy. These differences must be taken into consideration when evaluating studies comparing these aspects of quality of life after hysterectomy or hysterectomy with concomitant oophorectomy. Furthermore, psychosexual aspects such as sexuality and well-being can not be reliably studied with a retrospective design in these patient groups.

Prophylactic oophorectomy at elective hysterectomy. Effects on psychological well-being at 1-year follow-up and its correlations to sexuality.

OBJECTIVE: In a prospective study, the 1-year psychological well-being outcome after oophorectomy-hysterectomy, compared to hysterectomy-only and the correlations between the changes in psychological well-being and the changes in sexuality were evaluated. STUDY POPULATION: Perimenopausal sexually active women (n=362), scheduled for hysterectomy on benign indication, were recruited. Three hundred and twenty-three women (89%) completed the 1-year follow-up; 217 women spared their ovaries and 106 underwent concomitant oophorectomy. METHODS: Psychological well-being was studied by the psychological general well-being index (PGWB) and sexuality by the McCoy's sex questionnaire. The prevalence of climacteric symptoms was reported by the modified Kupperman's index. Hormone-replacement therapy was recorded. Postoperative, all oophorectomized and the hysterectomy-only women with climacteric symptoms were recommended estrogen-replacement therapy. RESULTS: The two groups did not differ in PGWB, neither before surgery nor at 1-year follow-up. Postoperative, both groups showed increased well-being regarding depressed mood, general health and total score. Besides, the hysterectomy-only group had increased vitality and the hysterectomy-oophorectomy group showed increased positive well-being and decreased anxiety. Most of the sexual parameters showed positive correlation to the PGWB parameters. The correlations were strong regarding parameters of overall sexual satisfaction, weak, regarding sexual motivation and relationship to partner, while absent regarding coital frequency. CONCLUSION: Concomitant prophylactic oophorectomy, at elective hysterectomy, does not negatively affect psychological well-being in adequately estrogenized perimenopausal women. Indeed, both hysterectomy-only and hysterectomy-oophorectomy have a positive effect on psychological well-being. Most aspects of sexuality are correlated to aspects of psychological well-being.

Perimenopausal androgen decline after oophorectomy does not influence sexuality or psychological well-being.

OBJECTIVE: To determine whether oophorectomy during the perimenopause, with the associated decline in ovarian androgens, affects sexual function and psychological well-being negatively. DESIGN: Prospective, observational study comparing sexuality and psychological well-being in women after hysterectomy only (HYST) vs. hysterectomy and concomitant oophorectomy (HYST+BSO). SETTING: University hospital and district general hospital. PATIENT(S): Three hundred sixty-two perimenopausal women scheduled for elective hysterectomy on benign indication were recruited and 323 (89%) completed the 1-year follow-up (217 in the HYST group and 106 in the HYST+BSO group). INTERVENTION(S): The patients were evaluated preoperatively and 1 year after surgery. Postoperatively, estrogen replacement therapy was recommended to all women in the HYST+BSO group and to HYST group subjects with climacteric symptoms. MAIN OUTCOME MEASURE(S): Sex steroids (T, androstenedione, DHEA-S, and E(2)) and sex hormone-binding globulin (SHBG) were measured. Free androgen index and free E(2) index were calculated. Sexuality (McCoy's Female Sex Questionnaire) and psychological well-being (Psychological General Well-Being Index) were evaluated. RESULTS(S): Preoperatively, no hormonal differences were found between the two groups. At 1-year follow-up, all sex steroid levels and indices were decreased and SHBG was increased in the HYST+BSO group. Ovarian sex steroids were decreased in the HYST group, whereas DHEA-S and SHBG were unaltered. Sexuality was unaltered in the HYST+BSO group, whereas decreased scores were found in 3 of 14 sexual variables in the HYST group. Psychological well-being was improved in both groups. There were no correlations between the observed changes (data 1 year after surgery, compared with preoperative data) in androgen levels and index and the observed changes in any aspect of sexuality or psychological well-being. CONCLUSION(S): Hormonal changes after oophorectomy in conjunction with perimenopausal hysterectomy do not significantly change postoperative (1-year) sexual or psychological well-being.

[Embolization of uterine arteries yields good results in symptomatic myoma]. / Embolisering av uterusartärer ger god effekt vid symtomgivande myom.

This article summarizes the experience gained so far of uterine artery embolization (UAE) for symptomatic fibroids, reviewing publications related to this issue. More than 10 years have past since Ravina et al started to treat uterine fibroids with UAE. To date thousands of women have been embolized with excellent results and few serious complications. UAE is a successful alternative to hysterectomy for women wishing uterine preservation. Several cases of pregnancy and partus have been reported after UAE, and the method may be considered in women desiring future fertility, if the only remaining surgical option is complicated multiple myomectomy or hysterectomy. So far, recurrence after initially successful UAE has not been reported, but long-term results are yet to be determined.