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PubMed2006

Giant hepatocellular adenoma presenting with chronic iron deficiency anemia.

Hepatic adenomas are benign liver tumors found mostly in young women with a history of oral contraceptive usage. They commonly present with abdominal pain from the tumor mass effect, bleeding, or rupture. We report a case of a young woman with a giant hepatic adenoma presenting with chronic iron deficiency anemia, requiring repeated blood transfusion. The mass was an incidental finding with typical features of a hepatic adenoma. Resection was performed and the hemoglobin remained stable up to the present fourth year of follow-up. This is an unusual presentation for which an association is investigated here. There was no evidence of intra-tumoral bleed but reverse-transcribed real-time PCR revealed higher tumor hepcidin RNA expression. Chronic iron deficiency anemia can be an initial presenting problem in patients with hepatic adenomas. Its cause may be multifactorial but the role of hepcidin-mediated anemia needs further evaluation in future cases.

Adenoma, Liver Cell↗
PubMed1995

Deep venous thrombosis in Assir region of Saudi Arabia. Case-control study.

In a five-year case-control study (1988 to 1993) at Assir Central Hospital (ACH), Abha (8,000 feet above sea level), Saudi Arabia, 92 of 129 patients suspected of deep venous thrombosis (DVT) were studied with ascending contrast venography (CV) (74 patients, 80.4%) or Doppler ultrasonography (DUS) (18 patients, 19.6%). Female-to-male ratio was 2.3 to 1. Age range of patients was twelve to ninety years; mean age was 44.45 yrs +/- 17.38 years. DVT hospital incidence was 18 per 10,000 admissions. The most common associated factors included immobilization due to chronic diseases (21.7%), trauma and surgery (19.6%), and pregnancy and oral contraceptives usage (16.3%). The most common symptom and sign were limb pain and tenderness (95.6%). Limb swelling was noted in 93.5% of patients. The left lower limb was more commonly affected than the right. There was a definite increase of DVT during the winter months. Altitude was not a contributory factor. Pulmonary embolism was the greatest complication.

Adolescent↗
PubMedDate not supplied

Risk factors in central retinal vein occlusion and activated protein C resistance.

INTRODUCTION: Central retinal vein occlusion (CRVO) tends to be a disease of older individuals, with some known major risk factors, and activated protein C resistance seems to be one of the causes in younger patients. In this study, we reviewed risk factors including activated protein C resistance in a series of patients with CRVO. METHODS: Twenty-four patients with a diagnosis of CRVO presenting either acutely or for a follow-up visit during the study period, were enrolled. Ages ranged between 31 and 83 years (mean 59.7). The risk factors, presence of ischemia, the results of biochemical serological and hematological tests, especially activated protein C resistance (APC-R), were analysed. RESULTS: In 17 patients (71%) one or more of the following risk factors existed: hypertension, diabetes, oral contraceptive usage, family history of thrombosis, and previous operation. In 40% of the eyes, there were ischemic changes. Serum triglycerides were high in 4 of 21 patients (19%) and cholesterol and urea were high in 10 of 21 patients (19%). APC-R was found in 6 out of 24 patients (25%). CONCLUSIONS: Besides known predisposing factors like hypertension, diabetes, glaucoma and hyperlipidemia, APC-R seems to be a risk factor for CRVO at all ages.

Activated Protein C Resistance↗
PubMed1981

Verbal judgments of Taiwanese family planning field workers about induced abortion.

Four hundred female governmental family planning field workers in Taiwan were asked by questionnaire whether women should or should not have an induced abortion under certain circumstances. Major findings were that although most workers were favorable to induced abortion under most circumstances, many were unfavorable when marital status, parity, and contraceptive usage of the woman were considered. Furthermore, cumulative judgment scales were shown to exist which have important implications for program approaches elsewhere.

Abortion, Induced↗
PubMed1984

Tubal sterilization. A prospective long term investigation of 218 sterilized women.

The present study is a long-term investigation of 218 consecutively sterilized women in Akershus County, Norway. The operations were performed in 1973-74, when the access to sterilization was regulated by a legislation from 1934. The women were interviewed personally, and a clinical examination was performed before sterilization, at discharge from hospital, three months, one and six years later. At each occasion the participation was about 95%, and only one woman was lost to follow-up. The women in this series lived in stable social conditions, their average age was 33.7, their parity 2.8. They were not socially distinguishable from women of the same age in the county at large, but there were important socially and age related differences within the series. Their contraceptive usage was widespread, but inconsistent. Family planning was the all-dominant motive. Forty per cent of the women had been suggested the sterilization by a doctor, 30% at abortion application. The operations were performed as laparoscopic electrocoagulation of the tubes or as a Pomeroy resection. Five pregnancies were recognized in the study period, four of these in the laparoscopy group. There were few serious complications, but 20% had a diversity of complaints at the three month interview. At six years seven women had complaints attributed to the operation. The large majority of the series was satisfied with the sterilization. Almost half the women would have preferred an even earlier operation, and six years after the sterilization 85% of the women had told friends about it, and 71% of these had directly recommended sterilization to someone. Six years after the sterilization 74% said the operation should be more widespread, 69% believed postoperative regret was uncommon, and the impact on postoperative marital life was mainly positive. However, during the study period, 18% of the women had experienced regret, ambivalence or periodic depression because of their sterilization. The rate of, and reasons for regret varied with time. The rate increased; at six years 6% of the women would have preferred the sterilization undone, and in 10% of the couples at least one of the partners held that view. At one year, the primary reason for regret was a feeling of having been persuaded by the doctor at abortion application. Six years after the sterilization the desire for a child with a new spouse was the principle reason. There was no association between regret and age or parity at operation.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMedDate not supplied

[Health aspects of population policies].

In developing countries family planning programmes are the main instrument of the populational policy and an important element of social influence in the domain of the population fertility policy in developed countries. The National Family Planning Programme in the Republic of Serbia was accepted by the Government and established in February, 1998. It is directed towards the improvement of reproductive health through promotion of family planning. The main objectives of the programme are: reduction of maternal, perinatal, neonatal and infants mortality, decrease of the number of unwanted pregnancies and abortions, promotion of contraceptive usage, efforts in prevention of sexually transmitted diseases, and meeting the needs of adolescents in relation to sexuality and reproduction. The first phase of realization of the Programme involves effective educative seminars for the primary health care workers--physicians of various specialties which are professionally engaged in family planning. Results of this Programme should provide improvement of reproductive health, as well as positive effects on demographic trends in Serbia in future.

Family Planning Services↗
PubMed1998

[Thrombophilic states].

Thrombophilia is defined as an increased tendency to thrombosis and can be inherited or acquired. The thrombotic events in patients with inherited thrombophilia tend to occur at a young age, are often idiopathic, recurrent and may occur at unusual sites (e.g. mesenteric, portal and cerebral veins and in inferior vena cava). The most common of the hereditary defects appear to be antithrombin, protein C, protein S deficiency, which account for 10% of individuals presenting with venous thromboembolism, resistance to anticoagulant effect of activated protein C (APC-R), which is present in 17 to 64% of patients with thrombosis and prothrombin 20210 G-->A variant with 6% prevalence in patients with thrombosis. APC-R is due in 90% to the presence of factor V Leiden. Rarer defects include heparin cofactor II (HC II), plasminogen or tissue plasminogen activator deficiency (TPA), elevated plasminogen activator inhibitor-1 (PAI-1) and dysfibrinogenemia. The most common acquired defects are antiphospholipid antibodies (lupus anticoagulant and anticardiolipin antibodies). Hyperhemocystinemia is responsible as well for arterial as venous thrombosis. A substantial proportion of venous thrombotic events occurs spontaneously, i.e. without a precipitating event. Risk factors for thrombosis include surgery, trauma, immobility, congestive heart failure, pregnancy including puerperium and oral contraceptive usage. The thrombotic risk is increased in patients who are homozygous for factor V Leiden and markedly increased in patients with combined defects.

Female↗
PubMed1992

Epidemiology of cervical cancer--overview.

Numerous studies of the epidemiology of cervical cancer have shown strong associations with religious, marital and sexual patterns. Although it is well established that women with multiple partners and early ages at first intercourse are at high risk, less is known about how these factors interact or how risk is affected by specific sexual characteristics. Recent studies indicate that number of steady partners and frequent intercourse at early ages may further enhance risk, supporting hypotheses regarding a vulnerable period of the cervix and a need for repeated exposure to an infectious agent. It is now widely accepted that HPV is the major infectious etiological agent, but whether other infectious agents play supportive or interactive roles is unclear. Of specific interest is the independent effect of HSV 2 on risk, especially given some evidence that this viral agent may interact with HPV. Other speculative risk factors for cervical cancer include cigarette smoking, oral contraceptive usage and certain nutritional deficiencies, but again it is not clear whether these factors operate independently from HPV. Although cervical cancer incidence trends correlate with the population prevalence of various venereally transmitted agents, it is not certain how disease rates are affected by other potential risk factors which have changed during recent time (e.g., exposure to HPV, sexual behaviour, cigarette smoking). In addition, a number of recent studies highlight the need for considering not only female influences on risk of cervical cancer, but also male factors, since the sexual behaviour of the male consort appears to play an important role.

Europe↗
PubMed1978

Erythrokeratodermia variabilis. A family study.

Erythrokeratodermia variabilis is a rare genodermatosis; American authors have reported only four previous cases. It had been a problem to obtain a large pedigree for clinical investigation. We studied a family with 12 involved members in five generations. Symmetrically distributed migratory patches and scaling plaques are characteristic and were found to involute with a combination of keratolytic agents and topical steroids. Exacerbations of these patches and plaques were noted in our female patients during such high estrogen states as pregnancy or oral contraceptive usage.

Adult↗
PubMed1992

Factors influencing serum CA 125 levels in normal women.

Serum CA 125 levels were studied in 2544 healthy women. Menopausal status and a history of hysterectomy were both highly significant influences on the CA 125 level (P less than .0001 for both factors). A history of hormone replacement therapy was also highly significant in reducing CA 125 levels (P = .002) in postmenopausal women. Other factors such as parity, history of unilateral oophorectomy or oral contraceptive usage, or family history of ovarian cancer were not significant influences when analysis of covariance was performed. When premenopausal women were assessed separately, age was significant (P = .04). The number of years since menopause did not influence CA 125 levels. Both hysterectomy and menopausal status have a clear effect on serum CA 125 levels and must be considered if serum CA 125 is to be used as a screening test.

Adult↗
PubMed2005

[Laparoscopy in chronic pelvic pain--a prospective clinical study].

OBJECTIVE: The aim of this study was to analyze the incidence, causes and management in women with chronic pelvic pain and to evaluate the role of laparoscopy. DESIGN: A prospective non-randomized clinical trial on 86 women with chronic pelvic pain. SETTING: Clinic of Gynecology and Obstetrics, JMF CU Martin, Slovak Republic. METHODS: A prospective clinical trial was performed on 86 patients with chronic pelvic pain, who have undergone laparoscopy from March 2003 to March 2004. Only patients with a pain history of at least 6 month were enrolled into this trial. Specific patient's history characteristics, laparoscopic and cytologic findings were reviewed and analyzed (pain interval, organic findings, preoperative ultrasound examination, previous surgical intervention, oral contraceptive usage, patient's medical history, menstrual cycle regularity, age, presence of dysmenorrhea). In all women, laparoscopy was performed under general anesthesia. RESULTS: During the study we have performed 309 diagnostic laparoscopic examinations, from which 86 (27.8%) were done due to chronic pelvic pain. The mean patient's age was 35.8 years (19-56). The mean parity was 1.6, ranging from 0-5. Pelvic organ pathology was present in 88.4% of the patients. The most frequent finding was endometriosis (31.4%). According to revised criteria of the American Fertility Society the presence of first, second, third and fourth stage of endometriosis was 55.6, 25.9, 11.1 and 7.4%, respectively. The most frequent occurrence of endometriotic lesions were on ligamenta sacrouterina (21.4%) and plica vesicouterina (19.0%). Pelvic adhesions, myomas, pelvic varicosities and chronic inflammatory process were present in 25.6, 15.1, 9.3 and 3.5% of the cases, respectively. No somatic origin of pain was identified at laparoscopy in 11.6% of patients. Preoperative ultrasonic examination with pelvic pathology findings were performed in 36 patients, and laparoscopy correlated with ultrasonographic findings in 31 (86.1%) cases. The average pain duration was 11.5 months (6-28) with the majority among women with history of previous surgical intervention (48.8%) and parturated women. Presence of pain was most common among women after 31 years of age. Predominantly, cytology examination of biological materials (peritoneal fluid, cyst fluid) revealed an increased histiocytic reaction in coincidence with chronic inflammation process in 31.6%. CONCLUSION: Invasive laparoscopy in chronic pelvic pain pertains to one of the most important examination procedures for its high specificity and sensitivity. Laparoscopy can reveal organic causes of pelvic pathology in 60% of cases with the possibility of following treatment. Our combined effort should stop the progression of such pathology leading to possible morphologic, functional and psychological alteration, especially among young women in fertile age. Today, endometriosis still remains the main cause of chronic pelvic pain in high percentage rate.

Adult↗
PubMed1991

A comparison of adenocarcinoma and squamous cell carcinoma of the cervix.

A comparison and survival analysis of 203 patients (21%) with adenocarcinoma and 756 (79%) with squamous cell cancer of the cervix for the time period 1970-1985 is reported. The mean number of new cases of adenocarcinoma (N = 12) remained the same, while squamous cell cases decreased from 57 to 32. The clinical features were compared; oral contraceptive usage, node status, diabetes, and symptoms of bleeding were not related to cell type. Nulliparity was more frequent in patients with adenocarcinoma, whereas obesity and smoking were more frequent in patients with squamous cell cancer. Survival in stage I was significantly influenced by the cell type. Patients with stage I squamous cell disease had a 90% 5-year survival, compared with 60% for adenocarcinoma (P less than .0001). Other features that influenced survival included node status (P = .001), poor differentiation of tumor histology (P = .001), diabetes (P = .001), and Papanicolaou smear interval (P = .001). Patients undergoing radical hysterectomy were analyzed separately, and adenocarcinoma cell type significantly influenced survival (P = .0008). Patients with stage II squamous cell disease had a 62% survival, compared with 47% for adenocarcinoma (P = .01); patients with stage III squamous cell disease had a 36% survival, compared with 8% for adenocarcinoma (P = .002). The percentage of adenocarcinoma has increased because of the decreased number of patients with squamous cell disease. Stage-for-stage survival is significantly decreased for patients with adenocarcinoma as opposed to squamous cell disease.

Adenocarcinoma↗
PubMed1985

Dietary influences upon colon carcinogenesis.

A succession of case-control studies of diet and colon cancer, predominantly in developed countries, has produced varied and generally inconsistent findings. The somatic mutation theory of carcinogenesis has dominated much of cancer research for the past 30 years, encouraging emphasis on exogenous genotoxic agents capable of inducing malignant transformation via heritable damage to DNA. Increased risks of human cancers due to various potent chemical carcinogens (found in certain occupations), ionizing radiation, and sunlight have corroborated this "toxicological" view of cancer. Recently, however, greater emphasis has been paid to cancer as a disorder of growth control. The stimulation or derepression of cell growth, via hormones or proto-oncogene activation respectively, is likely to reflect "metabolic" disturbances--such as can be caused by diet. If diet influences large bowel carcinogenesis via mediating metabolic or biochemical factors such as intracolonic pH, production of bile acid metabolites, and fermentative production of volatile fatty acids (which appear to influence mucosal cell stability), then a variety of configurations of diet may have an equivalent net effect upon bowel carcinogenesis. Further, non-specific aspects of diet (such as total energy intake and frequency of eating) may be important; indeed, those two factors were found to be positively and independently associated with large bowel cancer (LBC) risk in our Adelaide case-control study. The accumulating evidence that other factors that alter sex hormonal status and/or hepatobiliary metabolism, and physical aspects of bowel function, are also associated with altered risk of LBC adds further credence to this metabolic model. Such factors are: gender, reproductive history and oral contraceptive usage in women, cholecystectomy, and physical activity.

Bile Acids and Salts↗
PubMed1982

Treatment of acute salpingitis--with special reference to Chlamydia trachomatis.

Conservative treatment of acute salpingitis should be the rule, surgery the exception. Neisseria gonorrhoeae, Chlamydia trachomatis, and Mycoplasma hominis, are common etiological agents in pelvic inflammatory disease, particularly in women below the age of 25 years. In women above that age as well as in those with two or more episodes of acute salpingitis, there is a higher proportion of tubal infections caused by aerobic and facultatively anaerobic bacteria. Apart from some resistant strains, tetracycline generally has an effect on all three of the above-mentioned agents of sexually transmitted diseases (STD). We recommend that this drug be chosen if the results of etiological studies are not known when therapy is started. If there is reason to believe that anaerobic bacteria may be involved, tetracycline may be combined with nitroimidazole. The short-term effects of various antibiotic drugs in acute salpingitis suggest that women with gonococcal salpingitis will respond sooner than will women with non-gonococcal salpingitis, regardless of which antibiotic regimen is given. The long-term effect of several different antibiotics on the post-salpingitic fertility does not differ. Glucocorticosteroids do not seem to positively influence the prognosis for fertility. To help prevent salpingitis, it is important to advise patients on appropriate contraceptive usage and to examine and treat both patients and consorts for STD.

Acute Disease↗
PubMed1981

Uterine actinomycosis. A case report and review.

Current literature documents an association between intra-uterine contraceptive usage and genital tract colonization or infection with actinomycosis. Uterine involvement, however, is extremely rate. A case of severe pelvic infection with uterine perforation due to an actinomycosis fistula as confirmed by tissue is presented. The condition of actinomycosis is reviewed with special attention to involvement of the female pelvic organs and the difficulties in diagnosis.

Actinomyces↗
PubMed1995

Prevalence of antibodies to hepatitis C virus in patients with nonalcoholic fatty liver.

BACKGROUND: Nonalcoholic fatty liver can be caused by obesity, diabetes mellitus, hyperlipidemia or nonalcoholic steatohepatitis. Hepatitis C viral infection can also cause macrovesicular steatosis and such inflammation of the liver as nonalcoholic steatohepatitis. To determine whether the prevalence of anti-HCV is higher in patients with nonalcoholic fatty liver, this clinical study was undertaken; we also tried to detect which factors predict the presence of anti-HCV in these patients. METHODS: The study included 205 nonalcoholic fatty liver patients (122 males and 83 females) with a mean age of 46.5 years, diagnosed by ultrasonic examination, on whom anti-HCV antibody tests were then done. RESULTS: Eleven cases (5.4%) were anti-HCV positive with a higher mean age of 56.4 +/- 11.1 years (p < 0.05). Anti-HCV positive patients had higher serum AST and ALT levels than negative patients (95 +/- 59 U/L, 166 +/- 116 U/L vs. 34 +/- 26 U/L, 51 +/- 43 U/L; p < 0.05), while anti-HCV negative patients had higher mean body weight (124 +/- 15% vs. 114 +/- 11% of IBW) and serum cholesterol levels (202 +/- 41 mg/dl vs. 159 +/- 45 mg/dl). There was no statistical difference between anti-HCV positive and negative groups in clinical parameters including gender, presence of HBsAg, history of DM, operation, blood transfusion, oral contraceptive usage, and cancer with or without chemotherapy. The prevalence of anti-HCV increased with age from 1.8% in the fourth and fifth decades to 25% in the eighth decade. The prevalence of anti-HCV was 1.4% (1 case) in 72 fatty liver with normal biochemical tests and 7.5% (10 cases) in 133 cases with abnormal biochemical tests, a difference which was statistically marginally significant (p = 0.055). Those with ALT levels greater than three-fold the normal limit had a significantly higher anti-HCV prevalence rate (25.9%) than those with normal (1.4%) or mildly (2.8%) elevated ALT levels (p < 0.001). Logistic regression analysis revealed that only age and serum ALT levels were independent predictive factors for the presence of HCV infection. CONCLUSIONS: Results revealed that the prevalence of anti-HCV in patients with nonalcoholic fatty liver was 5.4%, slightly higher than in the general population. Age and serum ALT level were the predictive factors for the presence of HCV infection.

Adult↗
PubMed1995

[Estrogen treatment caused acute attacks of porphyria].

Two female patients with acute intermittent porphyria, who received oestrogen skin pads as supplementary treatment for postmenopausal discomfort, developed severe psychiatric disorders with persistent confusion, aggression and paranoid reactions. Some decades earlier they had reacted with symptoms of acute porphyria following oral contraceptive usage. There is well documented evidence of the advisability of restrictiveness in the use of oestrogens in conjunction with acute porphyria, particularly in cases of patients with a history of hormone-related symptoms of acute porphyria. The putative mechanisms by means of which oestrogens may exert effects on neurotransmitters and peptides are discussed in the article. The authors would be grateful to hear from colleagues abroad who have treated patients with similar symptoms following postmenopausal treatment with oestrogens.

Estradiol↗
PubMed1995

Some determinants of whole-gut transit time: a population-based study.

Slow whole-gut transit time may be associated with an increased risk of gallstones, and possibly bowel cancer, but its determinants are unknown. We looked for these determinants in a community-based study of 884 women aged 25-69 years and 677 men aged 40-69 years. Transit time was estimated using prospective examination of three stools and a questionnaire about bowel habit. Diet and alcohol intake were assessed using a validated food frequency questionnaire. In women < 50 years not taking oral contraceptives, mean transit time was relatively constant across 10-year age bands (62 to 63 h). In older women it was also relatively constant, but was significantly shorter (58 to 59 h), suggesting an effect of female sex hormones. In women taking oral contraceptives, mean transit-time was 6 h longer than in women of the same age not taking them (95% CI 1.4 to 10.6 h). In men drinking > 40 g alcohol/day, mean transit time was 49 h compared with 54 h in those drinking < 20 g/day (p < 0.0001). In alcohol-abstaining men, an effect of dietary NSP (non-starch polysaccharide or fibre) intake was clearly apparent. Alcohol consumption quickened transit in both sexes; oral contraceptive usage slowed it in women. Body mass index in both sexes, soluble NSP in men, and insoluble NSP in women also significantly and negatively affected transit time. The food groups which were related to transit time were potatoes and cooked fruit in men, and pulses and bread in women.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗