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Introduction: High prevalence of gynecological conditions in women of Middle Eastern origin is reported, likely due to regional risk factors and mediators. The objective of this systematic review and meta-analysis is to investigate the prevalence of polycystic ovary syndrome (PCOS), endometriosis, uterine fibroids, and adenomyosis in women of Middle Eastern origin. Methods: MEDLINE, EMBASE, PsycINFO, Global Health, and Google Scholar databases were searched from database inception until 14 February 2021 to identify relevant studies. Peer-reviewed research articles that reported the prevalence of PCOS, endometriosis, uterine fibroids, and adenomyosis in the Middle Eastern population were written in English or Arabic. The primary outcome was the estimated pooled prevalence of PCOS, endometriosis, uterine fibroids, and adenomyosis in the Middle Eastern populations. The secondary outcome was to assess the evidence in the data for the presence of heterogeneity, by conducting subtype-pooled analysis of prevalence estimates of the conditions. Total weighted prevalence was calculated via Freeman-Tukey arcsine transformation and heterogeneity through the I 2 statistic. Quality control was performed using GRADE criteria. Results: A total of 47 studies, 26 on PCOS, 12 on endometriosis, eight on uterine fibroids, and seven on adenomyosis, were included. The pooled prevalence of PCOS diagnosed according to the NIH criteria was 8.9% (95% CI: 6.5-11.7; prevalence range: 4.0-27.6%), with a higher prevalence from the Gulf Arab states (18.8%, 95% CI: 9.5-30.3; range: 12.1-27.6%). According to the Rotterdam criteria, the pooled prevalence of PCOS was 11.9% (95% CI: 7.1-17.7; range: 3.4-19.9%) with studies limited to the Persian and Levant regions. Endometriosis was diagnosed in 12.9% (95% CI: 4.2-25.4; range: 4.2-21.0%) of women undergoing laparoscopy, for any indication. Uterine fibroid and adenomyosis prevalence of women was 30.6% (95% CI: 24.9-36.7; range: 18.5-42.6%) and 30.8% (95% CI: 27.1-34.6, range: 25.6-37.7%), respectively. Heterogeneity was present between studies due to statistical and methodological inconsistencies between studies, and quality of evidence was low due to sample size and unrepresentative participant selection. Conclusion: This is the first review that has reported the prevalence of gynecological diseases in the Middle Eastern population, suggesting that gynecological morbidity is a public health concern. Due to the health disparities in women, further research is required to understand the relative roles of environmental and genetic factors in the region to serve as a benchmark for evaluation and comparative purposes with other populations., Competing Interests: SM has been a member of advisory/scientific boards for AbbVie. CB reports grant from Bayer AG, others from AbbVie Inc., grants from Volition Rx, grants from MDNA Life Sciences, grants from Roche Diagnostics Inc., nonfinancial support from Population Diagnostics Ltd, others from ObsEva, and others from Flo Health, outside the submitted work. KZ reports grants from Bayer Healthcare, MDNA Life Sciences, Roche Diagnostics Inc., Volition Rx, and Evotec (Lab282 - Partnership program with Oxford University), nonfinancial support from AbbVie Ltd, all outside the submitted work, and is a Board member (Secretary) of the World Endometriosis Society and World Endometriosis Research Foundation. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Mousa, Al-Jefout, Alsafar, Kirtley, Lindgren, Missmer, Becker, Zondervan and Rahmioglu.)

Minimally invasive surgery represents the gold standard for benign and malignant gynecological disease. Laparoendoscopic single-site surgery has emerged as a new technical concept to decrease parietal trauma and improve body image. Laparoendoscopic single-site surgery is not a new essay, but recent developments in surgical technology have resulted in an exponential enlargement of indications. Recently published data showed feasibility, safety, and reproducibility of single-port hysterectomy for benign and malignant gynecological diseases. This approach represents a new challenge in minimally invasive surgery and appears to be feasible and safe to perform in a variety of gynecologic diseases. The aim of this chapter is to show the needed instruments, the main surgical step of single-site hysterectomy according to our surgical experience starded on 2008.

Background. Endometriosis is a common but bothersome gynecological disease, and Chinese herbal medicine (CHM) is used for treating endometriosis. The aim of this study is to explore CHM network and core treatments for endometriosis by analyzing nationwide CHM prescription database. Methods. From 1998 to 2013, the CHM prescriptions made primarily for endometriosis among women diagnosed with endometriosis (ICD-9-CM code: 671) by gynecologists during their reproductive age were collected. CHM network analysis was then carried out by using association rule mining and social network analysis. Results. A total of 12,986 CHM prescriptions made for endometriosis were analyzed. There were 556 kinds of CHM ever used, and, in average, each prescription was composed of 6.2 CHMs. Gui-Zhi-Fu-Ling-Wan (GZFLW) was used most frequently, followed by Cyperus rotundus (28.1% and 18.8% of all prescriptions, resp.). Additionally, the combination of Cyperus rotundus with GZFLW (8.0%) was the most frequently used combination of two CHMs. CHM network showed that GZFLW was the core CHM for endometriosis and graphically demonstrated the extensive coverage of TCM syndromes and pathogenesis of endometriosis. Conclusions. CHM network provides graphical demonstration and summary of commonly used CHMs for endometriosis, and further studies are warranted based on these findings.

Endometriosis is a gynecological disease that affects up to 10%-15% of all reproductive-age women worldwide. It is characterized by the presence of endometrial tissues outside the uterine cavity. Endometriosis is a complex disease; its pathogenesis includes altered steroid metabolism and immune system abnormalities such as inflammation, increased angiogenic activity in the peritoneal fluid and impaired recognition of ectopic endometrial cells. The development of endometriosis also depends on genetic, anatomical and environmental factors. Numerous surgical and medical approaches to treat endometriosis have been developed to date. However, complete resolution of the problem has not been achieved so far. Gene therapy holds exciting promise for the treatment of numerous disorders and current studies have indicated it can also be applied to endometriosis. The focus of this review is to summarize the pathogenetic background of the disease and to highlight current gene therapy approaches for this common gynecological disorder.

Objective The aim of this study is to clarify the conditions under which female medical personnel receive Pap tests and the influencing factors associated with not receiving Pap tests. Methods Data from the Taiwanese National Health Insurance Research Database (NHIRD) in Taiwan were analyzed. There were a total of 142,123 subjects: 5,196 physicians, 13,366 pharmacists, and 123,561 nurses. Results Of the subjects, 57.7% had received a Pap test in 2008–2010. Pap-test rates were highest for pharmacists (58.1%) and nurses (58.0%) and lowest for physicians (48.6%). After adjustment for age, having visited an obstetrics/gynecology clinic, gynecological disease, chronic disease, major illnesses, occupational diseases/injuries, and cancer, subjects were less likely to have received a Pap test if they were older, had visited an obstetric/gynecological clinic, or had gynecological diseases or major illnesses. Pharmacists and nurses who had occupational diseases/injuries and chronic diseases and nurses who had had cancer were less likely to have received a Pap test. Conclusion Hopefully, by highlighting the factors associated with lower likelihood of receiving Pap tests, the study findings will increase self-awareness among female medical personnel, improving their rate of Pap-test participation.

Introduction: Polychlorinated biphenyls (PCBs) are a class of persistent organic pollutants found in the environment. Endometriosis, an estrogen-dependent gynecological disease, affects about 15% o...

Este artigo discute o sensacional processo de 1892 entre o jornal Eagle, Do Brooklin, Nova Iorque, e uma conhecida cirurgiã ginecologista, Dra. Mary Amanda Dixon Jones. Sugiro que o evento confirmou e ajudou a mudar a compreensão sobre o corpo feminino e as doenças ginecológicas para as pacientes, os espectadores do julgamento e o público mais amplo. O desenvolvimento da cirurgia ginecológica alterou as relações entre médico e paciente, permitindo que mulheres pobres e de classe média falassem no tribunal sobre sua penosa experiência da doença. O julgamento proporcionou um canal público incomum para a divulgação das reclamações quanto à condição feminina, assim como para discussão sobre a prática médica.Abstract This article examines a sensational public libel trial that took place in 1892 between the Brooklyn, New York, Eagle newspaper and a well-known female gynecological surgeon, Dr. Mary Amanda Dixon Jones. I suggest that the event both affirmed and helped authorized changing understandings of women’s bodies and gynecological disease for female patients, trial spectators, and the larger public. It suggests that the development of gynecological surgery altered doctor-patient relationships which enabled middle class and even some poor women to speak in the courtroom about the burdensome experience of illness. The trial provided an unusual public venue for airing disappointments and complaints about the female condition, as well as the discussion about medical practices.Key words: Gynecology. Female Bod. Sickness. Gender. Agency

Cervical cancer is a malignant gynecological disease with high morbidity and high mortality. Due to the limited diagnostic tools at present, some kinds of cervical cancers cannot be timely and precisely detected, so that the optimal treatment opportunities for the patients might be missed. In this paper, we propose photoacoustic imaging, a method with high sensitivity, deep penetration depth, low cost and non-destruction for the cervical cancer detection. A dual-wavelength photoacoustic imaging system of 532nm and 1064nm was designed and built, and experiments of cervical cancer scans on nude mice model were carried out. Results show that under both the two wavelengths, the in depth structure of the tumor can be distinguished with complementary information, which proves the potential of photoacoustic imaging in cervical cancer diagnostics.

Endometriosis is a gynecological disease, which causes significant physiological pain but also psychological distress leading to decreased quality of life for those afflicted with the disease. Though researchers have investigated this disease for over 90 years, there is still much information unknown about its pathophysiology, hence impeding the development of effective treatment options. In addition, the difficulty to diagnose the disease using non-invasive measures increases the prevalence of this disease among reproductive aged women. This review discusses the challenges that the scientific and medical communities endure combating endometriosis along with the social and financial burdens of patients whom suffer from endometriosis. Finally this review highlights the positive and negative side effects of current treatment options, discusses some alternative treatment and new potential treatment options that have shown variable success in reducing the symptoms associated with endometriosis.

ObjectiveHuman epididymis protein 4 (HE4), a precursor of human epididymis protein, has been recently identified as a new promising serum biomarker for ovarian carcinoma. We performed a systematic review of studies that investigated the use of HE4 in the diagnosis of ovarian cancer in patients with pelvic or gynecological masses. We also evaluated the diagnostic performance of HE4 for differentiating between patients with benign gynecological disease and those with ovarian cancer.MethodsWe searched PubMed database (1990–2011) to collect articles in English that evaluated the diagnostic value of HE4 in patients with gynecological or pelvic masses. Two reviewers independently assessed the methodological quality of each study using the quality assessment of diagnostic accuracy studies tool. The data were analyzed using Meta-Disc1.4 software. Meta-analysis of the reported sensitivity and specificity of each study and summary receiver operating characteristic (SROC) curve were performed.ResultsA total of 9 studies involving 1807 women were included. When the control group was composed of healthy women, the pooled sensitivity and specificity for HE4 in diagnosing ovarian cancer were 83% (95% confidence interval [CI], 77%–88%) and 90% (95% CI, 87%–92%), respectively. The area under the SROC curve was 0.9271. When the control group was composed of women with benign disease, the pooled sensitivity and specificity for HE4 were 74% (95% CI, 69%–78%) and 90% (95% CI, 87%–92%). The area under the SROC curve was 0.8853.ConclusionThe current analysis indicated that HE4 may be a valuable marker in the diagnosis of ovarian carcinoma. Serum HE4 detection is not only a useful preoperative test for predicting the benign or malignant nature of pelvic masses but has a potential to be used as an initial step in ovarian cancer screening strategy.

Endometriosis is a benign sex hormone-dependent gynecological disease, characterized by the presence and growth of endometrial tissue outside the uterus; it affects 10% of women of reproductive age and is associated with infertility and pain. Treatment of endometriosis involves conservative or radical surgery, or medical therapies. The goals for endometriosis treatment may be the relief of pain and/or a successful pregnancy achievement in infertile patients. Treatment must be individualized with a multidisciplinary approach. The classical treatments carry adverse side effects and in some cases a negative impact on quality of life. New agents promise a distinct perspective in endometriosis treatment.The aim of this paper is to systematically review the literature evidence of new medical treatments for endometriosis, defined as pharmacological treatments not yet commonly available and currently under investigation.These new medical therapies would be used associated with surgical treatment and, in the future, will render possible the association of hormone therapy with non-hormonal treatment for endometriosis.

Objectives We aimed to characterize HPV infections and cervical lesions in Western Algeria. Patients and methods A total of 96 cervical samples obtained from women at risk of HPV infection (HIV-1-infected or presenting with a gynecological disease) were analyzed to characterize this infection and search for cytological abnormalities. Results A total of 60% of women at risk had an HPV infection. The rate of high-risk HPV (HR-HPV) infection among these women was 84.5% and that of intraepithelial lesions was 29.3%. The frequency of HPV infection was significantly higher among HIV-1-infected patients. An association between the presence of HR-HPV and the polygamy of the partner was observed. An association between cytological abnormalities and the use of oral contraceptives was observed among HIV-1-infected women. Conclusion Given the high frequency of HPV infection in this at risk population, close monitoring and regular gynecological screening are essential.

Aim: To evaluate the feasibility, efficacy, and safety of laparoscopic surgery for benign gynecological disease in women over 70 years old. Materials and Methods: Fifty-four women over 70 years old underwent surgery for benign gynecological disease from January 2003 to December 2009. Each woman was matched with two subjects of 30–50 years old in the younger group; the matching with patients undergoing a similar surgical technique was retrospective from December 2009. We evaluated body mass index, comorbidities, number of previous abdominal surgeries, operating time, hemoglobin change, postoperative complications, hospital stay, and return of bowel activity. The χ2-test and t-test were used to compare the results of the elderly group and the younger group. Results: There were no significant differences between the elderly group (over 70 years old) and a matched younger group (aged 30–50 years old) in body mass index, number of previous abdominal surgeries, operating time, hospital stay, and postoperative complications. Conclusion: Laparoscopic surgery in elderly women for benign gynecological disease is feasible, efficient, and safe. However, a large prospective randomized study is needed to confirm the conclusion.

The uterine mobilization is important to expose correctly the vesico-uterine plane, the adnexae, and the posterior cul-de-sac. Several studies compared different types of uterine manipulator and their maneuvrability, underlining the limitations or advantages related to the head and shaft when they are fixed together, limiting exposition or in the other, once there is dye injection capability. A new model of uterine manipulator by suction of endometrial cavity has been studied. Patients were not selected by uterine dimension or by gynecological disease; only the cases of endometrial cancer were excluded. In ten patients, we performed an hysteroscopic study associated to an endometrial specimen before installing the uterine device. No endometrial modification was found between normal endometrial specimen before surgery and after surgical treatment. The Vectec uterine manipulator has been demonstrated to be easy and safe to use.

Endometriosis is one of the most common gynecological disease affecting 6-10% of women of reproductive age. There is no cure for endometriosis-except a few methods of reducing the symptoms; both medical and surgical. Prolonged medical treatments to suppress the symptoms alone is not beneficial. The transformation of endometriosis to malignancy is always a possibility and the need for proper follow up and complete surgical clearance should be explained to the patient.

OBJECTIVE: It is postulated that the establishment of specialized centers with certification can be used as a marketing tool, in addition to its quality-assurance effect, and that it influences patients' choice of a hospital. One prerequisite for this, however, must be an awareness on the part of patients about both the purpose and the availability of a specialized center. The present study investigated the extent to which patients are familiar with specialized centers. METHODS: The data were gathered from 1073 patients of the Department of Gynecology, the University Breast Center Franconia (UBF; certified in accordance with DIN EN ISO 9001, DKG, DGS, EUSOMA, ESGO, EBCOG), and the University Perinatal Center Franconia (UPF; certified in accordance with DIN EN ISO 9001; level 1, defined by GBA regulations) by means of questionnaire. Of these patients, 46.7 % (n = 501) had breast cancer. The reason for presentation was obstetric in 31.9 % (n = 342) of cases, while 18.5 % of the patients (n = 198) had benign gynecological disease. Topics investigated included whether each patient knew she would be treated in a specialized center and whether there were any differences between obstetric patients and those with breast cancer. Moreover, they were asked about whether specialized certified centers were important to them. RESULTS: Out of all the patients questioned, 34.4 % did not know what the definition of a specialized center is; 37.7 % stated that they did know, and 27.9 % stated that they knew “a little”. A total of 289 patients provided specific descriptions. While only 46.1 % of the obstetric patients knew precisely or to a minor degree what a certified specialized center is, 78.2 % of the patients at the breast center knew what it was (p < 0.001). Prior to presentation, 52.3 % of all patients knew that it was a specialized center, although only 37.5 % of the obstetric patients had this prior information, compared with 65.8 % of patients with breast cancer (p < 0.001). When compared directly, the probability of having prior information was more than three times higher among oncology patients (HR 3.19 [95 % CI 2.35 to 4.34]). When asked about importance of receiving care at a specialized certified center, this was found to be very significantly more important for patients with breast cancer (HR 6.82 [95 % CI 3.09 to 15.04]). CONCLUSION: This survey shows that obstetric patients are often unaware of the definition of a specialized certified center. Oncology patients with breast cancer are much better informed about the definition and availability of a specialized center. While the establishment of centers currently appears to be inappropriate as a marketing tool for obstetric patients, the specialization and certification of a breast center can be used for oncology patients.

Vesicovaginal fistulae (VVF)represents one of the most frequent complications of various gynecological and obstetric procedures. In presence of a gynecological malignant tumor, fistula could be the outcome of surgical complications, radiotherapy or consequence of the tumor process. Reparation of these fistulae is a very complex problem. Our aim was to analyze the results of surgical care VVF-s occurred in women with malignant gynecological disease which was treated surgically or with radiotherapy. Out of the 48 surgically treated patients with primary VVF, in 28 of them fistula occurred after hysterectomy, and in 20 patients after radiotherapy. In 15 patients (31.25%) transvaginal approach was applied, and in 33 patients (68.75%) abdominal approach was applied, with the interposition of a well vascularized lobe being used in 25 patients. All the VVFs that occurred after radiotherapy were repaired by using the abdominal approach. The efficiency of surgical treatment of VVFs after hysterectomy due to a malignant disease was 78.5%, and after radiotherapy 65%. In patients that have not been subjected to radiotherapy, depending on the characteristics of the fistula, transvaginal or abdominal approach is applicable in VVF reparation, while the abdominal approach remains a golden standard in post-radiation fistula treatment, despite the fact that it has not solved the problem after the first medical treatment in as far as 35% of patients.

Objective To analyze the occurrence of atypia in the cytology/histology examinations of young women under the age of 25 years and of elderly women aged over 64 years, in the Xingu Indigenous Park and to evaluate, in a subjective manner, if the age range for screening established by the Ministry of Health and the Instituto Nacional de Câncer is appropriate for this population. Methods The Xingu/UNIFESP Project, in partnership with the Center for Gynecological Disease Prevention, develops programs to prevent cervical cancer. The exploratory, retrospective and descriptive study of cytological and histopathological examinations of young (12-24 years) and elderly (aged 64 and over) women of the Xingu Indigenous Park, between 2005 and 2011. Results There was low occurrence of cytological atypia in the elderly female population, but there were occasional high-grade lesions in the indigenous youth. Conclusion Interrupting screening at the limit age of 64 years, as established by the Ministry of Health and the Instituto Nacional de Câncer is justified. However, screening of young women should begin at an earlier age. Objetivo Analisar a ocorrência de atipias nos exames citológicos e histológicos de jovens e idosas indígenas, e também avaliar se a faixa etária preconizada pelo Ministério da Saúde e pelo Instituto Nacional de Câncer em rastreamento do câncer de colo uterino é adequada para essa população. Métodos O Projeto Xingu/UNIFESP, em parceria com o Núcleo de Prevenção de Doenças Ginecológicas, desenvolve programas de prevenção do câncer do colo de útero. Foi realizado estudo exploratório, retrospectivo e descritivo de exames cito/histopatológicos em jovens do Parque Indígena do Xingu de 12 a 24 anos e em idosas a partir dos 64 anos, no período de 2005 a 2011. Resultados Em idosas, houve baixa ocorrência de atipias citológicas, mas nas jovens indígenas, ocorreram casos eventuais de lesão de alto grau. Conclusão Justifica respeitar o limite de 64 anos para a interrupção do rastreamento, como o estabelecido pelo Ministério da Saúde/Instituto Nacional de Câncer, mas, nas jovens, seria importante iniciar o rastreamento mais precocemente.

Copyright: © 2015 Djokovic and Calhaz-Jorge. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms., Emerging evidence indicates that somatic stem cells (SSCs) of different types prominently contribute to endometrium-associated disorders such as endometriosis. We reviewed the pertinent studies available on PubMed, published in English language until December 2014 and focused on the involvement of SSCs in the pathogenesis of this common gynecological disease. A concise summary of the data obtained from in vitro experiments, animal models, and human tissue analyses provides insights into the SSC dysregulation in endometriotic lesions. In addition, a set of research results is presented supporting that SSC-targeting, in combination with hormonal therapy, may result in improved control of the disease, while a more in-depth characterization of endometriosis SSCs may contribute to the development of early-disease diagnostic tests with increased sensitivity and specificity. Key message: Seemingly essential for the establishment and progression of endometriotic lesions, dysregulated SSCs, and associated molecular alterations hold a promise as potential endometriosis markers and therapeutic targets.

Gene transfer presents a potentially useful approach for the treatment of diseases refractory to conventional therapies. Various preclinical and clinical strategies have been explored for treatment of gynecological diseases. Given the direst need for novel treatments, much of the work has been performed with gynecological cancers and ovarian cancer in particular. Although the safety of many approaches has been demonstrated in early phase clinical trials, efficacy has been mostly limited so far. Major challenges include improving gene transfer vectors for enhanced and selective delivery and achieving effective penetration and spread within advanced and complex tumor masses. This review will focus on current and developmental gene transfer applications for gynecological diseases.

Danshen is a drug with a long history of clinical application, recorded as early as in the Eastern Han dynasty’s Shen Nong’s Classic of the Materia Medica, in which it was called “Xichan Cao.” Danshen was called “Chishen” and “Mu Yang Ru” in Wu Pu’s Materia Medica, “Zhu Ma” in Collective Commentaries on the Classic of Materia Medica, and “Shanshen” in Ri Hua-zi’s Materia Medica. In modern times, Danshen has the names of Zi Danshen, Hong Gen, Huoxue Gen, Da Hong Pao, Xueshen Gen, Hong Danshen, etc. in various botanical and materia medica records.

The evolution of diagnostic and interventional procedures for gynecologic disease has led to organ, sexual and reproductive sparing treatments. Photodiagnosis (PD) and photodynamic therapy (PDT) may play a great role for gynecological patients as both offer the potential to achieve these goals. PD/PDT for a wide variety of diagnostic and therapeutic interventions have shown potential for excellent clinical outcomes. However, significant limitations remains, both clinically and dosimetrically, that prevent consistent results. When those limitations are resolved PD/PDT could move to the forefront of gynecological therapy. This clinical review highlights the outcomes and shortcomings of PD/PDT through the peer reviewed literature for gynecological sites.

Purpose of review The goal was to evaluate the safety, feasibility, and reproducibility of total and radical single-site hysterectomy. Recent findings Minimally invasive surgery represents the gold standard for benign and malignant gynecological disease. Laparoendoscopic single-site surgery has emerged as a new technical concept to decrease parietal trauma and improve body image. Laparoendoscopic single-site surgery is not a new essay, but recent developments in surgical technology have resulted in an exponential enlargement of indications. Recently published data showed feasibility, safety, and reproducibility of single-port hysterectomy for benign and malignant gynecological diseases. Summary Laparoendoscopic single-site surgery represents a new challenge in minimally invasive surgery and appears to be feasible and safe to perform in a variety of gynecologic diseases. The aim of this review is to critically analyze the recent literature about single-site hysterectomy.

In medical diagnosis, the descriptions of disease entities use linguistic expressions that are inherently imprecise/vague/ fuzzy/ambiguous which form the scaffold of the medical knowledge of a physician. In our view, overall approach in gynecological disease diagnosis could be divided in three distinct stages. Stage 1 refers to initial screening process in order to arrive at a single disease diagnosis for the patients, and based only on the subjective information provided by patients to the physician. In stage 2, the patient who has not received a single diagnostic label in stage 1, is further investigated for single disease diagnosis using the parameter past history. If stage 2 fails to arrive at a single disease diagnosis for a patient then physical examination and various tests like imaging tests, blood tests, etc. are conducted and the test results are processed in stage 3. The paper presents the research findings with a case study focused only on stage 2 using type 1 fuzzy inference system. We have identified 29 out of 226 patients satisfying past history criteria to achieve single disease diagnosis wherein in stage 1, 50 patients were correctly diagnosed.

Primary dysmenorrhea is a common gynecological disease garnering increasing attention and research. To investigate the clinical therapeutic effects of Jingqian Zhitong Fang (JQF) and the differences in serum sex hormone levels during the treatment of primary dysmenorrhea, we selected 30 healthy volunteers and 60 individuals with primary dysmenorrhea. On the third day of the menstrual cycle, we used ELISA to determine the levels of serum prolactin (PRL), follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone (TEST), progesterone (PROG), and estradiol (E2) compared with normal levels and levels in the JQF group, the Western medicine group receiving continuous treatment during the first and third menstrual cycles, and the group followed up after the drug was stopped. We observed that after JQF treatment, the levels of the following hormones changed significantly: PRL, LH, TEST, and E2levels decreased significantly and the PROG level increased significantly after treatment. After treatment with Western medicine, the serum levels of FSH, LH, PROG, and E2showed no significant change. We conclude that the long-term effect of JQF treatment was better than that of Western medicine. JQF treatment of primary dysmenorrhea is related to adjustment of PRL, LH, TEST, and E2 hormone levels in the human body.

Frequently, a fixed pelvis is encountered that is caused by a benign disease, either severe endometriosis or severe adhesions with or without fibroid uterus. We present two cases of nulligravida and multiparous women who had absolute frozen pelvises with no motion whatsoever of their pelvic structures on bimanual examination. Conventionally, these patients would have been approached by open hysterectomy only. We do not consider a frozen pelvis from what appears to be a benign case a contraindication to the laparoscopic approach.

Laparoscopic cholecystectomy is the most common laparoscopic operation in the world and is accepted as the standard procedure for cholecystectomy. Although use of miniendoscope in diagnosis of gynecological disease has been performed for decades, using a 2-mm mini-laparoscope for cholecystectomy is new. From November 1996 to January 1997, 14 patients (6 men, 8 women; mean age 47 years) with gallbladder stone disease were treated by mini-laparoscopic cholecystectomy at National Taiwan University Hospital, Taipei, Taiwan. The entire procedure was done through four ports (an 11-mm subumbilical working port, a 2-mm subxiphoid video port, one 2-mm mid-clavicular retraction port, and one anterior axillary retraction port). The operative time for these patients ranged from 30 to 150 min, with an average time of 79.29 min. Suturing was not necessary for the three 2-mm wounds. The estimated blood loss was minimal, and no intraoperative transfusions were required. All patients were able to tolerate feeding within 8 h. The average postoperative hospital stay was 1.57 days. Neither complications nor operation-related mortality were seen. In conclusion, mini-laparoscopic cholecystectomy is a feasible and safe procedure with nearly scarless wounds with a much better cosmetic effect, especially for young female patients.

Objectives. A prospective study was carried out to compare vaginal hysterectomy (VH) and robotically assisted hysterectomy (RH) for benign gynecological disease.Materials and Methods. All patients who underwent hysterectomy from March 2010 to March 2012 for a benign disease were included. Patients’ demographics per and post surgery results were collected from medical files. A questionnaire was also conducted 2 months after surgery.Results. Sixty patients were included in the RH group and thirty four in the VH one. Operative time was significantly longer in the RH group ( versus min; ). Blood loss and length of hospital stay were significantly reduced: versus ml; , and versus days; , respectively. Less pain was reported at D1 and D2 by RH patients, and levels of analgesia were lower compared to those observed in the VH group. No differences were found regarding the rate of conversion to laparotomy, intra- or postoperative complications.Conclusion. Robotically assisted hysterectomy appears to reduce blood loss, postoperative pain, and length of hospital stay, but it is associated with longer operative time and higher cost. Specific indications for RH remain to be defined.

Introduction. Vesicovaginal fistulas (VVF) are the most common and the most frequent type of urogenital fistulas. They may have a different etiology. In most cases, surgery is required for treatment. Objective. The aim of the study was to analyze the results of surgical therapy of VVF in a tertiary level institution over the last decade. Methods. The retrospective study of results was conducted involving a total number of 99 women who were surgically treated for VVF at the Clinic of Urology of the Clinical Center of Serbia in Belgrade in the period from 2001–2010. Results. Over the past ten years VVF occurred after hysterectomy in 74.7% of cases, and almost twice more frequently after hysterectomy for a benign gynecological disease. In the surgical treatment of primary VVF transvesical approach was used in 53.53% (52/99) of cases. Relapses were treated surgically using transperitoneal approach in all cases. No significant difference was found in respect to the applied approach in the surgical treatment of primary fistulas. In even 94% (93/99) of cases the problem of VVF was solved by a single surgical intervention only. In total, in 107 interventions 8 (7.4%) relapses were recorded. Conclusion. The study showed that VVF occurred after hysterectomy in three quarters of cases, more frequently after hysterectomy due to a benign gynecological disease. Early detection with timely and appropriate treatment of gynecological diseases will reduce the number of conditions that may lead to VVF. Surgical treatment of VVF yielded satisfactory results; it was shown that even in 94% of cases the problem of VVF was solved by a single surgical intervention only, however further improvement is certainly necessary.

Background: Endometriosis is defined as the presence of functional endometrial glands and stroma outside the uterine cavity. It’s classified in a primary and a secondary form. The endometriosis is a common gynecological disease with a prevalence estimated between 8-15%, it usually occurs in women during the reproductive years, with the maximum incidence between 30 and 40 year old women. The primary endometriosis form of the rectus abdominis muscle includes lesions that are not a result of a previous surgical procedure. This is an exceptional occurrence and only 18 cases have been described in Literature from 1984 to 2004. The incidence of the secondary form has been estimated around 0,003%-4%.

As a consultant in obstetrics and gynecology, with Western medical training in a surgical orientation, but also as a practitioner of acupuncture, one can obtain great satisfaction from acupuncture study and practice. When used in the treatment of functional gynecological diseases, acupuncture can be an effective alternative or adjuvant therapy. Careful selection of patients and establishing a precise diagnosis are indispensable in order to obtain good results.

Endometriosis is serious gynecological disease affecting millions of women world- wide. Despite long periods of intensive studies, the exact mechanisms are still unclear and no cure is in sight. Recently, the theory of

Background A tumor necrosis factor-alpha is a multifunctional pro-inflammation cytokine, which has been considered as one of pathogenic factors for various diseases. The promoter -1031(T/C) polymorphism in the tumor necrosis factor-alpha gene was reported that it plays a part in reproduction-related diseases. Among these, polycystic ovary syndrome (PCOS) is known to be a common gynecological disease of women in reproductive age women. Here, we performed a comparative study of -1031(T/C) polymorphism of TNF-alpha gene with PCOS in a Korean population. Methods The -1031(T/C) polymorphism of TNF-alpha gene was analyzed by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) in a total of 217 PCOS patients and 144 matched female controls of healthy women. And statistical analysis was performed using HapAnalyzer. X 2 test and logistic regression were utilized analyze the association between two groups. A p-value under 0.05 was considered statistically significant. Results The genotype and allelic frequencies were in Hardy-Weinberg equilibrium (HWE). There was strong association between the -1031(T/C) polymorphism in the promoter region of TNF-alpha gene and PCOS (p-value = 0.0003, odd ratio (OR) = 2.53). In addition, the frequency of C allele was significantly higher in PCOS patients compared with controls. Sequence analyses also showed the -1031(T/C) polymorphism of TNF-alpha gene. Conclusion This is the first study on the -1031(T/C) polymorphism of TNF-alpha gene in PCOS. We concluded that the -1031(T/C) polymorphism of TNF-alpha gene is associated with PCOS in a Korean population. Therefore, it is possible that it may be considered as a clinical biomarker to diagnose for PCOS, and is helpful in understanding the etiology for the pathogenesis of PCOS.

Purpose: To explore the optimal b value in diffusion-weighted (DW)-MRI for differentiation of benign and malignant gynecological lesions. Materials and Methods: Consecutive 58 patients (66 lesions) with pathologically confirmed diagnosis of gynecological disease were included in the study. Routine pelvic MRI sequences were used for defining the lesions and reviewed independently for benignity/ malignity. Single-shot echoplanar imaging (SH-EPI) DW-MRI with eight b values and nine apparent diffusion coefficient (ADC) maps were obtained. The lesions were analyzed qualitatively on DW-MRI for benignity/malignity on a five-point-scale and quantitatively by measurement of apparent diffusion coefficient (ADC) values. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic accuracy of ADC values for differentiating between benign and malignant lesions. Pathology results were the reference standard. Results: Differentiation between benign and malignant gynecological lesions using visual scoring was found to be successful with b values of 600, 800, or 1000 s/mm2. The mean ADC values of malignant lesions were significantly lower than those of benign lesions for all b value (P < 0.005). The ADCs with b = 0 and 600, 0 and 1000 s/mm2, 0, 600, 800 and 1000 s/mm2, and all b values were more effective for distinguishing malignant from benign gynecological lesions (Az = 0.851, 0.847, 0.848, 0.849, respectively). Using ADC with b = 0, 600, 800, and 1000 s/mm2, a threshold value of 1.20 × 10−3 mm2/s permitted this distinction with a sensitivity of 83%, a specificity of 81%. Conclusion: DW-MRI is an important method, and the optimal b values are between 600 and 1000 s/mm2 for differentiation between benign and malignant gynecological lesions. J. Magn. Reson. Imaging 2012;35:650-659. © 2011 Wiley Periodicals, Inc.

Objectives To describe the clinical history and ultrasound findings in women with struma ovarii. Methods Women with a histological diagnosis of struma ovarii who bad undergone preoperative ultrasound examination were identified front the databases of five ultrasound centers. The tumors were characterized on the basis of ultrasound images,, ultrasound reports and research protocols (when applicable) using the terms and definitions of the International Ovarian Tumor Analysis (IOTA) group. In addition, four authors reviewed all ultrasound images and described them using pattern recognition. Results Of 31 patients identified, 16 bad pure struma ovarii (one malignant), whereas in 15 patients the struma ovarii were 'impure', constituting the major part of a dermoid cyst (all benign, bilateral in one case). Median age was 40 (range, 18-80) years and 22 (71%) patients were of fertile age. Thirteen patients (42%) were asymptomatic, nine (29%) presented with pain, six (19%) with bloating, two (6%) with irregular bleeding and one (3%) with thyreotoxicosis. Most pure struma ovarii (11/16 cases, 69%) contained solid components, but cystic components were always present. The color content at Doppler examination varied front none to abundant. Four patients had ascites. Using pattern recognition the most specific feature of pure struma ovarii was the 'struma pearl', i.e. a smooth roundish solid area, similar, but not identical, to the 'round white ball' seen in dermoid cysts. 'Struma pearls' were present in six cases of Pure struma ovarii. Most (10116, 63%) cases of impure struma ovarii manifested ultrasound features compatible with a dermoid cyst, but six manifested ultrasound features similar to those of pure struma ovarii, 'struma pearls' being seen in three of these. Conclusions The sonographic features of struma ovarii vary. Struma ovarii may be suspected when a 'struma pearl' is seen. Whether 'struma pearls' are indeed a specific ultrasonographic feature of struma ovarii needs to be determined in a prospective study. Copyright (C) 2008 ISUOG. Published by John Wiley & Sons, Ltd. (Less)

Endometriosis is a benign gynecological disease with an unclear pathophysiology characterized by ectopic endometrium causing endometrium-like inflammatory lesions outside the uterine cavity. Recently, a number of studies have investigated genetic polymorphisms as a possible factor contributing to the development of endometriosis. In this review, we have summarized current data regarding genes with nucleotide polymorphisms investigated with regard to endometriosis. We searched PubMed for publications on endometriosis and polymorphism and found 108 publications between January 1979 and September 2005. These were classified according to the type of genetic polymorphism investigated and whether the result favored or did not favor association with endometriosis. We found a strikingly large amount of conflicting results. About 50% of the reviewed studies demonstrated positive correlations between different polymorphisms and endometriosis. This relation is most clearly seen in groups 1 (cytokines and inflammation), 2 (steroid-synthesizing enzymes and detoxifying enzymes and receptors), 4 (estradiol metabolism), 5 (other enzymes and metabolic systems), and 7 (adhesion molecules and matrix enzymes). Group 8 (apoptosis, cellcycle regulation, and oncogenes) seemed to be negatively correlated with the disease, whereas group 3 (hormone receptors), 6 (growth factor systems), and especially 9 (human leukocyte antigen system components) showed a relatively strong correlation. The review indicates that polymorphisms may have a limited value in assessing possible development of endometriosis.ObstetriciansGynecologists, Family Physicians.After completion of this article, the reader should be able to recall the complexity of attempting to link endometriosis to single nucleotide polymorphisms (SNPs), explain that the literature is varied on results and recommendations and is population specific, and state that there are some SNP relationships that are clinically stronger than others.

In January 1990, we began working with Moni Nag and Pertti Pelto on a Ford Foundation-funded project entitled "Increasing Social Science Research Capacity for Women's Reproductive Health in India." Little research had been carried out on women's reproductive health in India, and the majority of studies that had been done were clinic-based. The one community-based epidemiological study of gynecological disease that had been published found that 92 percent of rural Indian women (in a sample of 650) had one or more gynecological or sexually transmitted diseases, with an average of 3.6 diseases per woman (R. A. Bang, A. T. Bang, M. Baitule, Y. Choudhary, S. Sarmukaddam, and O. Tale, "High Prevalence of Gynecological Diseases in Rural Indian Women," The Lancet [January 14, 1989]). In addition to the lack of epidemiological data, there was a paucity of sociocultural information on how women perceive their own health and morbidity and what factors influence care seeking by and for Indian women.

Tumor-associated trypsin inhibitor (TATI) was assayed in healthy subjects and in women with benign and malignant gynecological diseases. Significantly lower levels were found in boys than in healthy adult subjects. No variations in level were evident over the course of a 24 h period. At a cut-off level of 20 micrograms/l elevated concentrations were found in 42%, 11.4% and 19% of women with ovarian, endometrial and cervical neoplasia, respectively. In patients with ovarian tumors TATI level were elevated both in mucinous and serous tumors. TATI does not seem to be useful for diagnosis of uterine tumors, but could have a specific place in the study and management of ovarian tumors, in which serum concentrations can reach levels 100-200 micrograms/l. In the other gynecological diseases maximum levels of 30-40 micrograms/l were observed.