Malrotation of the gut is rare in adults. We discuss the case of a 30-year-old primiparous woman who presented to the acute gynecology ward at 19-weeks’ gestation with ongoing nausea and vomiting throughout pregnancy. She attended on a number of occasions with the same symptoms and was trialed on a number of different antiemetics. Initial biochemical investigations were unremarkable, however, the patient started to develop signs of ‘abdominal obstruction’. A magnetic resonance image (MRI) of the pelvis showed evidence of duodenal obstruction secondary to malrotation which may be secondary to a fibrous (Ladd’s) band. She was treated laparoscopically via a Ladd procedure and had an uneventful recovery. Interestingly, the patient presented again in her second pregnancy with very similar symptoms and underwent another Ladd procedure, but via a laparotomy. This is an interesting, rare and unusual case of nausea and vomiting in pregnancy.

Keywords

Ladd bands; Pregnancy; Nausea; Vomiting; Hyperemesis; Volvulus.

Objective

The study sought to evaluate the historical surgical-pathological trends in Gynecologic Oncology Group (GOG) 33 in a cohort of patients who underwent robot-assisted staging of uterine carcinomas.

Materials and Methods

This is a retrospective study from June 2016 through December 2018 at Catholic Health Services Hospitals in Long Island (CHSLI), NY, USA. All patients underwent robotic surgical staging with hysterectomy, bilateral salpingo-oophorectomy, and pelvic and para-aortic lymphadenectomy. Fifty patients were included, and patients were separated into cohorts with endometrioid or non-endometrioid histology for analysis. Patients were staged using the International Federation of Gynecology and Obstetrics (FIGO) 2009 classification.

Results

For all patients undergoing surgical staging, the rate of pelvic and para-aortic nodal metastases occurred at 10% and 8%, respectively. Sixty percent of the grade 1 endometrioid tumors had less than 50% myometrial invasion. No patients had positive paraaortic lymph nodes in the absence of pelvic node involvement. High-risk histologies were associated with nodal disease thirteen percent of the time. A correlation between increasing depth of invasion and positive lymph nodes was demonstrated. Increasing grade of tumors was correlated with the frequency of nodal metastasis. Intraperitoneal spread was highly correlated to metastatic lymph nodes. Deep invasion was positively correlated with nodal disease.

Conclusion

The results of this study validate the trends previously known from GOG 33 in a population undergoing robot-assisted surgical staging for uterine carcinomas.

Keywords

Gynecologic Oncology Group (GOG) 33; Robotic; Surgery; Uterine cancer; Lymph nodes; Trends.

Objective

To gain insight into the areas that impact women with endometriosis.

Design

A qualitative content analysis of an online survey.

Setting

Online questionnaire via Endometriosis UK.

Population

Women diagnosed with endometriosis of any age range.

Methods

Free-text online questionnaire through Endometriosis UK completed by women. Results were analysed using NVivo version 9, qualitative analysis software. The software creates links between common words (codes), and these links allow data to be placed in nodes (called themes) which are then developed into categories. Content analysis was used to understand this data.

Main outcome measures

Impact of endometriosis on women’s lives.

Results

In total, 1872 questionnaires were returned but not everyone was able to identify ten separate features that affected them. As such, 1872 women provided at least one area that affected them, 1800 provided two areas, 1770 provided three areas and 1600 provided four areas. The results show that the main areas of concern for these women were pain (53%), heavy menstrual bleeding (11%), low mood (8%) and the perceived lack of understanding displayed by other people (7%). Other important factors were fertility concerns, impact on employment, problems with the medical team and uncertainty. These then impacted on their daily life whereby some women felt “guilty” for not ‘being a normal mother’. A key term that resonated was that endometriosis is an “invisible disease”.

Conclusion

This analysis provides us with insight into the complex psycho-social factors that interact with bio-physical symptoms. Further research is required in sub-population groups such as teenagers and ethnic minority women to explore any differences in impact and how care can be guided accordingly.

Keywords

Endometriosis; Impact; Qualitative methods; Quantitative methods; Online survey.

Introduction
Cancer is one of the leading causes of death in people with human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS), due to behavioral choices and overlapping risk factors.

Aim
The purpose of this report is to determine the long-term incidence of human papilloma virus (HPV)-associated cancer in women with pre-invasive cervical neoplasia, and compliance with medication and cancer screening recommendations.

Methods
HIV-infected women diagnosed with pre-invasive cervical neoplasia and an HPV-associated malignancy between 1995-2008 were identified. Data collected includes: demographics, HIV treatment/response, malignancy treatment/response, other healthcare utilization, use of health navigators, and compliance.

Results
Seventy-one subjects were identified with HIV infection, cervical dysplasia, and at least ten years’ follow-up. 17/71 (24%) were identified with an HPV-related malignancy. The mean age of those diagnosed with HPV-related malignancy was 39-years. Malignancies included: Cervix-9, Vulva-7, Anal-4, Vagina-3, Uretha/Bladder-2, Oropharyngeal-3. Eight also had in-situ neoplasms: Cervix-4, Vulva-3, Oropharyngeal-1. Four subjects had 3 separate malignancies, and two others had 2 malignancies. Compliance with HAART correlated strongly with immunocompetence, response to therapy, use of patient navigators, and survival. Sixty out of saventy one (84.5%) subjects underwent screening mammography, 57/71 (80.3%) underwent colonoscopy, and 67/71 (94.3%) underwent pap smear testing. Compliance with screening compared favorably with the general population, and overall survival was similar.

Discussion and Conclusion
The long-term incidence and mortality from cancer in women with HIV and cervical dysplasia appears to be comparable to that seen in the general population, with the possible exception of oropharyngeal cancers. Compliance with cancer screening recommendations appears to be higher than in the general population. This suggests that structured primary care programs for HIV-infected women are effective in prevention/early diagnosis of cancer. Standardized screening programs for oropharyngeal cancers should be considered in this population.

Keywords
Human immunodeficiency virus (HIV); Cancer; Human papilloma virus(HPV); Women; AIDS;
Highly active anti-retroviral therapy (HAART).