Yves Muscat Baron

Intervertebral disc height correlates with vertebral body T-scores in premenopausal and postmenopausal women

Objective To assess the correlation between vertebral body T-score and intervertebral disc height in premenopausal and postmenopausal women. Methods A total of 203 women were recruited from a large bone densitometer directory. The disc heights measured were those between the 12th thoracic and third lumbar vertebra. The discs were assigned the symbols D, whereby D1 applies for the disc between the 12th thoracic and first lumbar vertebra. The disc height of the group of women (n = 38) with osteoporotic vertebral fractures was compared with the disc heights of hormone-treated women (n = 47), untreated postmenopausal women (n = 77) and another group of premenopausal women (n = 41). Bone density measurements were taken by a Norland Bone Densitometer (DEXA 586). Results The lowest disc heights were found in the fracture group. The total disc height in the fracture group was 1.42 ± 0.25 cm, significantly lower (P < 0.0001) than the untreated group (1.82 ± 0.3 cm), which in turn was significantly (P < 0.0001) lower than the hormone-treated group (2.2 ± 0.26 cm) and the premenopausal group (2.11 ± 0.21 cm). The lowest T-scores were also noted in the vertebral fracture group (T-score = −3.1 ± 0.3) (P < 0.0001). The highest T-score recorded for the premenopausal group was −0.38 ± 45, higher than that of the untreated menopausal −1.4 ± 0.32 and hormone treated women −0.65 ± 0.3, all three significantly higher than the fracture group (P < 0.0001). The lowest T-scores were also noted in the vertebral fracture group (T-score = −3.1 ± 0.3) (P < 0.0001). The highest T-score recorded for the premenopausal group was −0.38 ± 45, higher than that of the untreated menopausal −1.4 ± 0.32 and hormone treated women −0.65 ± 0.3, all three significantly higher than the fracture group (P < 0.0001). Bone density across all groups revealed a correlation with disc height (R = 0.29) (P < 0.05). The group with vertebral osteoporotic fractures was the only group to show a negative correlation (−0.21) between disc height and vertebral bone density. Conversely, a significant correlation (R = 0.47) (P < 0.001) between the T-score and the total lumbar intervertebral disc height was noted in the premenopausal group of women. The menopausal group of untreated women also showed a significant correlation between the T-score and disc height (R = 0.25 P < 0.05); however, an insignificant positive correlation was found in the hormone-treated group. Conclusion The fracture group was noted to have the lowest intervertebral disc height and lowest T-scores compared with the other three groups. The hormone-treated and the premenopausal women had the highest disc heights and T-scores recorded. Positive correlations between T-score and disc height were noted for all the groups except for the fracture group. These results suggest a coupling between the vertebral body and intervertebral disc, which if disrupted may lead to increased risk for fracture. The combination of both T-score and disc height may improve the screening sensitivity for vertebral body fracture risk.

Gastro-intestinal symptoms and dietary intolerance in women with endometriosis

Purpose A comprehensive assessment of gynecologic, general, and gastrointestinal complaints of a group of women with laparoscopically confirmed endometriosis compared to another group of women without endometriosis was performed. The possibility of dietary intolerance in relation to the coexistence of endometriosis was also assessed. Methods This was a prospective, comparative study conducted on 57 patients who had had laparoscopies for various gynecologic complaints. These women were recruited sequentially into the study so as to avoid selection bias (age range 20 to 55). Twenty-three patients were diagnosed with endometriosis while the other 34 did not have this pathology. Prior to laparoscopy these patients were asked through a telephone questionnaire about associated long-term gastrointestinal symptoms, dietary intolerance, and general and gynecologic symptoms. Results Twenty-three women were diagnosed as having pelvic endometriosis. The remaining thirty-four patients were noted to suffer from pathology other than endometriosis. Gastro-intestinal symptoms such as dyspepsia (P<.01) and diarrhea (P< .05) were significantly more common in the endometriosis group compared to the other group of women. Women with endometriosis complained of more gastrointestinal symptoms (53% vs. 31%) and food intolerance (26% vs. 14%) than the women without endometriosis. These differences between both groups did not attain statistical significance possibly because the study was not suitably powered to reveal this. No significant differences were noted for most of the other aggregated gynecologic and general symptoms except for shorter menstrual cycles (P<.01) and depression (P<.05) in the women diagnosed with endometriosis. Conclusions Patients suffering from endometriosis in this study complained of significantly more gastrointestinal symptoms. A nonsignificant trend of dietary intolerance was noted in the women shown to suffer from endometriosis. These findings may shed some light on the pathogenesis and the management of endometriosis.

Sentinel Lymph Node Biopsy in the Management of Vulvar Carcinoma: An Evidence-Based Insight

Objective Lymph node metastasis has been shown to represent the most significant prognostic factor in vulvar carcinoma. Because only 25% to 35% of patients with early stage disease have lymph node metastases, a significant 65% to 75% possibly do not benefit from elective inguinofemoral lymphadenectomy considering the related morbidities of wound infection, breakdown, and lower limb lymphedema. This review article aims to present and summarize the evidence available with regard to sentinel lymph node (SLN)–guided management of vulvar carcinoma. Materials and Methods A literature search was performed in MEDLINE resources using the subject headings “vulvar neoplasms,” “sentinel lymph node,” “sentinel lymph node biopsy,” and “lymphatic metastasis.” This search returned 886 articles that were published through January 2017. Prospective studies investigating sentinel node identification techniques and their impact on vulvar cancer management and prognosis were considered. Case reports were excluded from the review. Results Technetium-99-m-labeled nanocolloid with or without blue dye and more recently indocyanine green fluorescence have been the main techniques used for SLN identification in vulvar carcinoma. Radioisotope and near-infrared techniques have been shown to be superior to blue dye particularly with midline lesions that drain bilaterally or that drain directly to a deep pelvic node. Patients with a small unifocal primary tumor (<4 cm) and no obvious preoperative metastasis have been shown to have low groin recurrence rates and excellent disease-specific survival rates with minimal treatment-related morbidity when undergoing SLN biopsy–guided management. Conclusions Sentinel lymph node biopsy–guided management seems to be safe when restricted to International Federation of Gynecology and Obstetrics IB to II cases where tumors are unifocal, less than 4 cm in size, and when there is no evidence of lymph node metastasis on clinical/radiological assessment. This reduces operative morbidity in this cohort of patients.

Iliac vessel wall thickness in menstrual and hormone treated and untreated postmenopausal women

Objective: To assess iliac vessel wall thickness in different groups of women. Method: Three groups of women were menopausal and were classified by hormone replacement therapy (HRT) (n = 32), atherosclerotic risk factors (n = 14) and an untreated group of postmenopausal women (n = 29), two groups of menstrual women, above 35 years (N = 35) and below 35 years (n = 16). In these groups of women, a 3.5 MHz ultrasound was used to assess the combined vessel wall thickness of the right iliac artery inner wall and vein outer wall. Results: The iliac vessel wall thickness was found significantly high in the menopausal group of women possessing high risk factors for atherosclerosis (4.3 ± 0.08 mm) and the untreated menopausal group of women (3.9 ± 0.08 mm) compared to the other three groups (p < 0.0001) (Mann–Whitney U test). The vessel wall thickness of the HRT group was 2.96 ± 0.09 mm, the older menstrual group 2.61 ± 0.07 mm, and 2.0 ± 0.06 mm in the young menstrual group. The HRT group had a significantly thicker iliac vessel wall compared to the young menstrual group (p < 0.001). Conclusion: These results confirm the significant impact of high risk factors, such as smoking, hyperlipidaemia and diabetes, on the vessel wall thickness due to accelerated atherosclerosis. This study also suggests that the oestrogenaemic state of a woman may affect the health of the vessel wall.

Synergistic effect on the treatment of menorrhagia by endometrial biopsy followed by contemporaneous insertion of the levonorgestrel intrauterine system

Objective: To evaluate the efficacy of endometrial biopsy followed by intrauterine system-releasing levonorgestrel (LNG-IUS) insertion in the treatment of women with menorrhagia. Method: This was a retrospective, non-comparative study. Ninety-two patients who had menorrhagia due to non-malignant causes were sequentially recruited into the study over a 3-year period (age range 29–51 years). Patients with a uterine size more than 12 weeks were not included. A LNG-releasing intrauterine system was inserted during the mid-cycle immediately after an endometrial biopsy was taken. One year after the closure of the study period, the women recruited were then contacted by telephone or by direct questioning at the outpatient clinic as to the outcome of the above treatment. Results: The most common (15%) complaint regarding bleeding patterns at 3–6 months after insertion was spotting and intermenstrual bleeding. Following the introduction of the LNG-IUS, six women required a hysterectomy for various reasons. The remaining 86 women (93.5%) continued the use of LNG-IUS. Conclusion: LNG-IUS following an endometrial biopsy is an effective treatment for menorrhagia due to benign causes and could be an alternative to other forms of medical and surgical treatments.