RESUMO
There is a wide variation in reported incidence, risk factors and presentation of molar pregnancy. This necessitates population-based studies to determine these parameters at the University Hospital of the West Indies, which is a referral centre for these conditions. The incidence of molar pregnancy at the University Hospital of the West Indies was found to be 2.81 per 1,000, which fell in the range of worldwide values. Partial moles made up 61.1% and complete moles 31.0%. The mean age of the patients was 28.49 years old with 85% of patients aged between 20 and 40 years old. The median gestational age by dates was 12 weeks and vaginal bleeding was the most common presenting symptom (77%). A significant number of cases (52.2%) of molar pregnancy were diagnosed by routine histopathology for failed pregnancy and not by pre-evacuation ultrasound. The practice of routine assessment of tissue from failed pregnancy should therefore be encouraged in our population.
Assuntos
Mola Hidatiforme/epidemiologia , Neoplasias Uterinas/epidemiologia , Adolescente , Adulto , Gonadotropina Coriônica Humana Subunidade beta/sangue , Feminino , Idade Gestacional , Hospitais Universitários , Humanos , Mola Hidatiforme/complicações , Mola Hidatiforme/diagnóstico , Incidência , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos , Hemorragia Uterina/etiologia , Neoplasias Uterinas/complicações , Neoplasias Uterinas/diagnóstico , Índias Ocidentais/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: To determine the rate of recurrence of cervical intraepithelial neoplasia (CIN) in HIV-positive women evaluated at the University Hospital of the West Indies (UHWI). METHOD: A chart review of all non-pregnant HIV-positive women who attended the gynaecologic and colposcopic clinics between January 1994 and December 2004 identified 21 such women. Fifteen of these patients who had CIN and had at least one follow-up Pap smear were the main subjects of this study. These patients were compared to 21 HIV-negative controls who were seen during the same period and who also had at least one follow-up Pap smear. Treatment modalities for the groups included cold coagulation and large loop excision of the transformation zone (LLETZ). Cox proportional hazards analysis was used to determine the effect of HIV status on the time to first recurrence of CIN. RESULTS: The mean ages of the subjects were 32.7 ± 8.0 and 33.2 ± 8.1 years, respectively. With a mean follow-up period of 1.7 years, the rate of recurrence of CIN in patients with and without HIV was 66.24 (95% CI 27.6, 159.1) and 3.0 (95% CI 1.3, 7.3) per 100 person years. The hazards rate ratio for recurrence in subjects with HIV after adjusting for age and CIN stage was 19.1 (95% CI 4.4, 82.1). CONCLUSION: HIV increases the risk of recurrence of CIN.
Assuntos
Infecções por HIV/complicações , Recidiva Local de Neoplasia , Displasia do Colo do Útero/terapia , Neoplasias do Colo do Útero/terapia , Técnicas de Ablação , Adulto , Estudos de Casos e Controles , Estudos de Coortes , Colposcopia , Feminino , Hospitais Universitários , Humanos , Jamaica , Teste de Papanicolaou , Modelos de Riscos Proporcionais , Fatores de Tempo , Resultado do Tratamento , Neoplasias do Colo do Útero/complicações , Esfregaço Vaginal , Adulto Jovem , Displasia do Colo do Útero/complicaçõesRESUMO
OBJECTIVE: To determine the rate of recurrence of cervical intraepithelial neoplasia (CIN) in HIVpositive women evaluated at the University H ospital of the West Indies (UHWI). METHOD: A chart review of all non-pregnant HIV-positive women who attended the gynaecologic and colposcopic clinics between January 1994 and December 2004 identified 21 such women. Fifteen of these patients who had CIN and had at least one follow-up Pap smear were the main subjects of this study. These patients were compared to 21 HIV-negative controls who were seen during the same period and who also had at least one follow-up Pap smear. Treatment modalities for the groups included cold coagulation and large loop excision of the transformation zone (LLETZ). Cox proportional hazards analysis was used to determine the effect of HIV status on the time to first recurrence of CIN. RESULTS: The mean ages of the subjects were 32.7 ± 8.0 and 33.2 ± 8.1 years, respectively. With a mean follow-up period of 1.7 years, the rate of recurrence of CIN in patients with and without HIV was 66.24 (95% CI 27.6, 159.1) and 3.0 (95% CI 1.3, 7.3) per 100 person years. The hazards rate ratio for recurrence in subjects with HIV after adjusting for age and CIN stage was 19.1 (95% CI 4.4, 82.1). CONCLUSION: HIV increases the risk of recurrence of CIN.
OBJETIVO: Determinar la tasa de recurrencia de la neoplasia intraepitelial cervical (NIC) en las mujeres VIH-positivas evaluadas en el Hospital Universitario de West Indies (HUWI). MÉTODO: Una revisión de las historias clínicas de todas las mujeres VIH-positivas no embarazadas que asistieron a la clínica ginecológica y la clínica colposcópica entre enero de 1994 y diciembre de 2004, identificó 21 de estas mujeres. Quince de estas pacientes que tenían NIC y habían tenido al menos una prueba de Papanicolaou de seguimiento, fueron los sujetos principales de este estudio. Estas pacientes fueron comparadas con 21 controles de VIH-negativos que fueron vistos durante el mismo período y que también tuvieron al menos una prueba de Papanicolaou de seguimiento. Las modalidades de tratamiento para los grupos incluyeron coagulación fría y escisión con asa grande de la zona de transformación (LLETZ). El modelo de análisis de riesgos proporcionales de Cox fue utilizado para determinar el efecto del estatus de VIH al momento de la primera recurrencia de CIN. RESULTADOS: Las edades promedios de los sujetos fueron 32.7 ± 8.0 y 33.2 ± 8.1 años, respectivamente. Con un período de seguimiento promedio de 1.7 años, la tasa de recurrencia de NIC en pacientes con y sin VIH fue 66.24 (95% IC 27.6, 159.1) y 3.0 (95% IC 1.3, 7.3) por 100 persona/años. El cociente de tasas de riesgo de recurrencia en pacientes con VIH después de ajustar por edad y etapa de CIN fue 19.1 (95% IC 4.4, 82.1). CONCLUSIÓN: El VIH aumenta el riesgo de recurrencia de la NIC.
Assuntos
Humanos , Feminino , Adulto , Adulto Jovem , Infecções por HIV/complicações , Neoplasias do Colo do Útero/terapia , Displasia do Colo do Útero/terapia , Recidiva Local de Neoplasia , Fatores de Tempo , Esfregaço Vaginal , Estudos de Casos e Controles , Modelos de Riscos Proporcionais , Neoplasias do Colo do Útero/complicações , Estudos de Coortes , Resultado do Tratamento , Displasia do Colo do Útero/complicações , Colposcopia , Técnicas de Ablação , Teste de Papanicolaou , Hospitais Universitários , JamaicaRESUMO
INTRODUCTION: Anal sphincter injuries are uncommon injuries outside of obstetric practice - but they may cause disastrous complications. PRESENTATION OF CASE: We present a case of complete anal sphincter disruption from anal intercourse in a 25 year old woman. Clinical management is presented and technical details of the repair are discussed. She had an uneventful post-operative course and good continence after 154 days of follow up. DISCUSSION: This is one of a handful of reported cases of anal sphincter disruption secondary to anal intercourse. The established risk factors in this case included receptive anal intercourse coupled with alcohol use. We review the pertinent surgical principles that should be observed when repairing these injuries, including anatomically correct repair and appropriate suture choice. There is little evidence to support simultaneous faecal diversion for primary repair of acute perineal lacerations. CONCLUSION: Acute post-coital sphincter injuries should be treated operatively on an emergent basis, without diversion because they are low energy injuries with minimal tissue loss and excellent blood supply. Although repair of each injury should be individualized, the majority of these injuries do not require concomitant protective colostomy creation.
RESUMO
Ovarian lymphomas are rare. We reviewed three cases seen at our hospital to determine any similarities and outcome. The women presented with abdominal discomfort and swelling and were staged as stage I, II and IV. All three cases were B-cell lymphomas confirmed with positive staining with CD45 (LCA), CD20 (L26), CD 45 (4KB) CD45RA (MB1) and MB2 on immunohistochemistry. The two patients with more advanced disease died soon after treatment but the one with stage I (primary ovarian lymphoma) was still alive after 2 years. Ovarian lymphoma when detected late carries a poor prognosis.