Follow-up of women after a first episode of postmenopausal bleeding and endometrial thickness greater than 4 millimeters

OBJECTIVE: To estimate the incidence of recurrent postmenopausal bleeding among women who were diagnosed with an endometrial thickness greater than 4 mm. METHODS: We designed a prospective cohort study and included consecutive women not using hormone replacement therapy, presenting with a first episode of postmenopausal bleeding. We evaluated patients who had an endometrial thickness greater than 4 mm at transvaginal ultrasonography and benign endometrial sampling; presence of carcinoma was ruled out by office endometrial sampling, hysteroscopy, and/or dilation and curettage. Time until recurrent bleeding was measured, and diagnosis at recurrent bleeding was recorded. RESULTS: Among 318 patients who had an endometrial thickness greater than 4 mm, 222 patients had benign histology results and were available for follow-up. During follow-up, 47 (21%, 95% confidence interval 16-27%) patients had recurrent bleeding, with a median time to recurrent bleeding of 49 weeks (interquartile range 18 to 86 weeks). There was no difference with respect to recurrence rate between patients with polyp removal, patients with a normal hysteroscopy, and patients with office endometrial sampling alone at the initial workup. Two patients were diagnosed with atypical endometrial hyperplasia upon recurrent bleeding. CONCLUSION: The recurrence rate of postmenopausal bleeding in women with endometrial thickness greater than 4 mm is 20%. This recurrence rate is not related to incorporation of hysteroscopy or polyp removal at the initial workup. LEVEL OF EVIDENCE: II.     

History of induced abortion and the risk of tubal pathology

Tubal pathology is a common cause of subfertility. Identifying risk factors for tubal pathology in the medical history is important to distinguish between those couples who benefit from early tubal patency tests and those in whom presence of tubal pathology is less likely and delaying tubal tests is justified. This study evaluated whether a medical history of induced abortion is associated with an increased risk of tubal disease among subfertile couples. The reproductive history was determined for each couple. Tubal disease was diagnosed by hysterosalpingography and/or diagnostic laparoscopy. The association between reproductive history and the presence of tubal disease was assessed by calculating odds ratios (OR) and 95% confidence intervals (CI). Data from 6149 couples were available for analysis. The OR for tubal pathology after a previous induced abortion was 1.6 (95% CI 1.3 to 1.9), after a previous ectopic pregnancy, 8.4 (95% CI 6.3 to 12), after a previous spontaneous miscarriage, 1.1 (95% CI 0.87 to 1.3), and after a previous live birth, 1.0 (95% CI 0.88 to 1.2). A history of induced abortion is associated with an increased risk of tubal pathology in subfertile couples. As a consequence, in subfertile women with a history of induced abortion, tubal patency tests should be considered early in the diagnostic work-up.     

Live function in hepatic and extrahepatic diseases

The American Journal of Digestive Diseases - In our patients with acute hepatitis, as a group, the Rose Bengal test was positive in 94 per cent, and the modified glucose tolerance test in 93 per...     

Fractures de type III : attitudes thérapeutiques,complications, résultats

Résumé La série comprend 47 fractures de type III dans la classification de Johansson, dont 36 femmes et 11 hommes d’age moyen 73,4 ans. 6 furent traités orthopédiquement avec 66 % de complications. 34 ostéosynthèses ont donné un taux de complications de 50 %, alors qu’il n’y a eu aucune complication mécanique pour les 6 patients traités par reconstruction prothétique. Présenté à la 38ème Réunion S.O.T.EST à Lons-le-Saunier du 17 au 18 juin 1994     

Late onset subgaleal hemorrhage infection with <Emphasis Type="Italic">Streptococcus pneumoniae</Emphasis>?

We report a case of an infected subgaleal hematoma caused by an unusual micro-organism in a previously healthy 11-month-old girl. Our patient presented at the emergency department with an increasing scalp swelling for 2 weeks, and culture of the evacuated fluid yielded Streptococcus pneumoniae. Although she was born after vacuum delivery and a scalp swelling was noticed from the third day of life, this swelling disappeared completely at the age of 3 months. Parents were thoroughly questioned but we could not find out a new traumatic head event. We postulate that in our patient, a subgaleal hemorrhage developed after vacuum delivery and possibly infected 11 months later, presumably from hematogenous seeding of an acute otitis media. The patient recovered well after surgical drainage and antimicrobial therapy.