Laparoscopic management of adnexal masses in premenopausal and postmenopausal women

OBJECTIVE: Caffeine is by far the most commonly consumed psychoactive substance. The use and abuse of most other licit and illicit psychoactive drugs have been shown to be substantially heritable. However, the impact of genetic factors on caffeine consumption, heavy use, intoxication, tolerance, and withdrawal is largely unknown. METHOD: Caffeine consumption, in the form of brewed coffee, instant coffee, tea, and caffeinated soft drinks, as well as caffeine intoxication, tolerance, and withdrawal, were assessed by personal interviews of 1,934 individual twins from female-female pairs ascertained from the population-based Virginia Twin Registry. The sample included both members of 486 monozygotic and 335 dizygotic pairs. Twin resemblance was assessed by probandwise concordance, odds ratios, and tetrachoric correlations. Biometrical model fitting was also performed. RESULTS: The resemblance in twin pairs for total caffeine consumption, heavy caffeine use, caffeine intoxication, caffeine tolerance, and caffeine withdrawal was substantially greater in monozygotic than in dizygotic twin pairs. Model fitting suggested that twin resemblance for these measures could be ascribed solely to genetic factors, with estimated broad heritabilities of between 35% and 77%. CONCLUSIONS: Caffeine is an addictive psychoactive substance. Similar to previous findings with other licit and illicit psychoactive drugs, individual differences in caffeine use, intoxication, tolerance, and withdrawal are substantially influenced by genetic factors.     

Diagnosis of adnexal malignancies by using color Doppler energy imaging as a secondary test in persistent masses

In this study we evaluated the histomorphology and ultrastructure of the oviduct of newly hatched chicks, as well as the immunohistochemical expression of progesterone receptor (PR) in this tissue after follicle-stimulating hormone (FSH) treatment on days 13, 15 and 17 of embryonic development. Results indicated a marked difference in the histology of the oviduct of newly hatched chicks treated with FSH. Magnum mucosa from these animals presented a pseudostratified epithelium with evaginations from the lumen into the epithelium and from the latter into the stroma beneath where tubular glands are formed. In contrast magnum mucosa from control animals presented columnar epithelium with no evaginations. In magnum epithelium FSH also induced the formation of cilia and microvilli projections into the lumen as well as an increase in the wall and lumen areas and in the density of nuclei per unitarea. PR immunoreactivity was only observed in the oviduct of FSH treated animals. PR was located in the nucleus of epithelial luminal cells, mucosal stromal cells and smooth muscle cells. These findings suggest that FSH induces an adequate hormonal milieu for the cytodifferentiation and PR gene expression in the chick oviduct.     

Preoperative sonographic evaluation and laparoscopic management of persistent adnexal masses: a 1994 review

Carcinoma of the ovary is a frightening disease because it is a major cause of death due to cancer in women and is the leading cause of deaths from gynecologic malignancies. The disease is associated with a common clinical problem: persistent adnexal masses, most of which are benign. Operative laparoscopy has become an increasingly attractive way of diagnosing and removing adnexal masses. The practicing general gynecologist thus faces two new dilemmas: not to miss an early ovarian cancer or manage an unsuspected one to the patient's detriment, and not to perform extensive major surgery for adnexal masses, most of which can be handled laparoscopically. Fortunately, pertinent data exist on which the resolution of these dilemmas may be based.     

CYFRA 21-1 serum levels in women with adnexal masses and inflammatory diseases

The aim of the present study was to evaluate the clinical usefulness of the cytokeratin marker CYFRA 21-1 as a screening marker for ovarian cancer, as a predictive marker in patients with adnexal masses and as a prognostic marker in women suffering from ovarian cancer. In order to determine the specificity of the CYFRA 21-1 test, we have investigated CYFRA 21-1 serum levels in several benign conditions. This retrospective study comprises 37 patients suffering from ovarian cancer FIGO stages Ia-III. Sera from patients with benign ovarian cysts, endometriosis, pelvic inflammatory disease, inflammatory bowel disease and liver cirrhosis were evaluated in 90, 10, 38, 10 and 20 cases respectively. With a sensitivity of 41% and a specificity of 95%, CYFRA 21-1 was not suitable as a screening marker for ovarian cancer. Although CYFRA 21-1 was able to discriminate between ovarian cancer and benign adnexal tumours (univariate regression model, P = 0.0001), CYFRA 21-1 did not reveal additional information to CA 125 in a multivariate regression analysis (P = 0.06). CYFRA 21-1 serum levels were elevated in benign conditions such as liver cirrhosis, but not in endometriosis and inflammatory diseases. In ovarian cancer patients, elevated CYFRA 21-1 serum levels before therapy were associated with a poor overall and disease-free survival (log-rank test, P = 0.02 and log-rank test, P = 0.005 respectively). CYFRA 21-1, while obviously not suitable for screening or differential diagnosis of adnexal masses, could be useful as an additional prognostic factor in ovarian cancer patients.     

Surgical management of adnexal tumors]

Concerning laparoscopy and tumor dissemination, we know from several multivariate analyses that at laparotomy, if the tumor is entirely and immediately removed, the puncture of a stage I ovarian cancer has no influence on the prognosis. In contrast the inadequate surgical management of an undiagnosed ovarian cancer may worsen the prognosis. The diagnosis is the key step. To be able to immediately and completely treat an ovarian cancer when managing an ovarian tumor surgically, Laparoscopic diagnosis is safe and reliable when used cautiously. The surgical diagnosis may and should probably be performed by laparoscopy whatever the ultrasonographic appearance of the tumor. Masses diagnosed as suspicious at surgery should be treated by immediate laparotomy, since the results of laparoscopic treatment of an ovarian cancer are not known. In young patients, conservative surgery is the main advantage of laparoscopy, and should be achieved in most benign masses. The recent progresses of in vitro fertilization should be taken into account when managing an ovarian tumor in a patient who wishes to become pregnant. Frozen sections are useful, when treating highly suspicious masses, allowing an immediate staging and avoiding the disadvantages of a second surgical procedure. Whenever a malignant tumor has been missed at laparoscopy, restaging is required and should be considered to be an oncologic emergency.     

The mechanism of Na+ transport by rabbit urinary bladder

The mechanism of Na+ transport in rabbit urinary bladder has been studied by microelectrode techniques. Of the three layers of epithelium, the apical layer contains virtually all the transepithelial resistance. There is radial cell-to-cell coupling within this layer, but there is no detectable transverse coupling between layers. Cell coupling is apparently interrupted by intracellular injection of depolarizing current. The cell interiors are electrically negative to the bathing solutions, but the apical membrane of the apical layer depolarizes with increasing Isc. Voltage scanning detects no current sinks at the cell junctions or elsewhere. The voltage-divider ratio, alpha, (ratio of resistance of apical cell membrane, Ralpha, to basolateral cell membrane, Rb) decreases from 30 to 0.5 with increasing Isc, because of the transport-related conductance pathway in the apical membrane. Changes in effective transepithelial capacitance with Isc are predicted and possibly observed. The transepithelial resistance, Rt, has been resolved into Ra, Rb, and the junctional resistance, Rj, by four different methods: cable analysis, resistance of uncoupled cells, measurements of pairs of (Rt, alpha) values in the same bladder at different transport rates, and the relation between Rt and Isc and between alpha and Isc. Rj proves to be effectively infinite (nominally 300 k omega muF) and independent of Isc, and Ra decreases from 154 to 4 omega muF with increasing Isc. In the resulting model of Na+ transport in "tight" epithelia, the apical membrane contains an amiloride-inhibited and Ca++-inhibited conductance pathway for Na+ entry; the basolateral membrane contains a Na+--K+-activated ATPase that extrudes Na+; intracellular (Na+) may exert negative feedback on apical membrane conductance; and aldosterone acts to stimulate Na+ entry at the apical membrane via the amiloride-sensitive pathway.     

Selective bladder preservation by combination treatment of invasive bladder cancer

BACKGROUND: For patients with invasive bladder cancer the usual recommended treatment is radical cystectomy, although transurethral resection of the tumor, systemic chemotherapy, and radiotherapy are each effective in some patients. We sought to determine whether these treatments in combination might be as effective as radical cystectomy and thus might allow the bladder to be preserved and the cancer cured. METHODS: We enrolled 53 consecutive patients with muscle-invading bladder cancer (stages T2 through T4, NXM0) in a trial of transurethral surgery, combination chemotherapy, and irradiation (4000 cGy) with concurrent cisplatin administration. Urologic evaluation of the tumor response directed further therapy: radical cystectomy in the 8 patients who had incomplete responses, additional chemotherapy and radiotherapy (6480 cGy) in the 34 patients who had complete responses or who were unsuited for cystectomy, and alternative care in the 11 patients who could not tolerate either irradiation or chemotherapy. RESULTS: After a median follow-up of 48 months, 24 of the 53 patients (45 percent) were alive and free of detectable tumor. In 31 patients (58 percent) the bladder was free of invasive tumor and functioning well, even though in 9 (17 percent) a superficial tumor recurred and required further transurethral surgery and intravesical drug therapy. Of the 28 patients who had complete responses after initial treatment, 89 percent had functioning tumor-free bladders. CONCLUSIONS: Conservative combination treatment may be an acceptable alternative to immediate cystectomy in selected patients with bladder cancer, although a randomized clinical trial that included a group for simultaneous comparison would be required to produce definitive results.     

The direction and mission of social medicine

The author characterizes briefly the contemporary baseline situation of social medicine. He explains its three aspects--the methodical and cognitive approach, the orientation on values and attitudes and the formative and action component. The author emphasizes the integral concept and the necessity of a purposeful development of the mentioned discipline. The purpose of the article is to provide basic orientation in social medicine for discussion and creative work.     

国内热镀锌钢板镀层发展方向

分析了当前国内外热镀锌镀层钢板的发展情况，简要介绍了铁锌、锌铝、铝锌合金镀层钢板。     

Treatment of adnexal torsion using operative laparoscopy

The aim of this work was to clarify the value and application of operative laparoscopic treatment for adnexal torsion. We included in our study all patients (n = 27) who presented with an intra-operative diagnosis of torsion of the adnexa between January 1989 and May 1995. A total of 28 adnexal torsions were treated. Treatment was carried out by laparoscopic surgery in 75% of cases (21 torsions): in one-half of the cases (14 torsions) it was possible to achieve conservative laparoscopic treatment. The nature of the lesions and the experience of the surgeons are two factors which closely govern the outcome of surgical treatment. For those patients presenting a benign pathology, laparoscopic surgery was used to treat 84% of cases in the series. All the patients presenting a benign pathology and operated upon since 1993 have received laparoscopic surgical treatment. No major complications (peritonitis, thrombotic emboli, coagulation problems) were observed after conservative laparoscopic surgery. These results demonstrate that, provided the surgeons are sufficiently experienced, treatment by conservative laparoscopic surgery for adnexal torsion is both safe and reliable. In the years to come more work must be done to assess the vitality of the adnexa so that as many patients as possible can benefit from conservative treatment.     

Diagnosis and management of the adnexal mass

Adnexal masses are frequently found in both symptomatic and asymptomatic women. In premenopausal women, physiologic follicular cysts and corpus luteum cysts are the most common adnexal masses, but the possibility of ectopic pregnancy must always be considered. Other masses in this age group include endometriomas, polycystic ovaries, tubo-ovarian abscesses and benign neoplasms. Malignant neoplasms are uncommon in younger women but become more frequent with increasing age. In postmenopausal women with adnexal masses, both primary and secondary neoplasms must be considered, along with leiomyomas, ovarian fibromas and other lesions such as diverticular abscesses. Information from the history, physical examination, ultrasound evaluation and selected laboratory tests will enable the physician to find the most likely cause of an adnexal mass. Measurement of serum CA-125 is a useful test for ovarian malignancy in postmenopausal women with pelvic masses. Asymptomatic premenopausal patients with simple ovarian cysts less than 10 cm in diameter can be observed or placed on suppressive therapy with oral contraceptives. Postmenopausal women with simple cysts less than 3 cm in diameter may also be followed, provided the serum CA-125 level is not elevated and the patient has no signs or symptoms suggestive of malignancy.     

The pathogenesis of bladder cancer

Carcinoma of the urinary bladder appears to arise, in at least some cases, from carcinoma in situ developing in a field of atypical epithelial proliferation. There is both a spatial and temporal relationship between invasive and in situ bladder cancer, although the exact relationship between the noninvasive flat and papillary types of tumors is not known. Prenoeplastic bladder lesions are defined as irreversible, although not necessarily progressive, and an experimental animal model of the disease has been developed. The appearance of pleomorphic microvilli on the luminal surface of epithelial cells of the urinary bladders of Fischer rats is correlated with the irreversibility of hyperplastic epithelial lesions induced by feeding N-[4-(5-nitro-2-furyl)-2-thiazolyl] formamide (FANFT) to the test animals. This alteration can be visualized by scanning electron microscopy of cytologic and histologic preparations.     

The soothing effect of rocking as determined by the direction and frequency of movement.

Recent research has revealed that rocking is a potent soother of infant distress, the effectiveness of which is a direct function of frequency and amplitude. The present 2 experiments with a total of 112 2-mo-old infants were conducted because previous studies have not examined the influence of direction per se. In Exp I, Ss were rocked in an up-and-down, side-to-side, or head-to-toe direction at 45 or 60 cycles/min. The direction of rocking was not significantly related to changes in activity. Rocking at 60 cycles/min resulted in a greater reduction in activity than rocking at 45 cycles/min. In Exp II, the influence of up-and-down and head-to-toe movement at 45 cycles/min was compared using a within-Ss rather than a between-Ss design. Again, the effects of rocking were not related to the direction of movement. (French summary) (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differentiation of benign from malignant pancreatic masses by endoscopic ultrasound

BACKGROUND: It is often difficult to determine whether a mass in the pancreas is benign or malignant. The goal was to evaluate whether endoscopic ultrasound (EUS) can reliably establish whether a mass is benign or malignant. METHODS: One hundred five patients with possible pancreatic tumors were referred for EUS. Those who were found to have a lesion suspicious for carcinoma and did not have a known malignancy also underwent EUS-guided FNA. RESULTS: A mass suspicious for cancer was identified in 73 patients, whereas inflammatory changes or a normal pancreas was noted in 32 patients. Four of the latter 32 patients were subsequently found to have cancer. EUS-guided FNA was performed on 47 of the 73 patients with a suspicious mass and was read as cancer in 27 patients, atypia in 10 patients, and benign in 10 patients. All 10 patients with atypia were subsequently confirmed to have cancer, and 6 of the 10 patients with a benign FNA were proved to have a tumor at surgery. EUS could differentiate the lesion as malignant with a sensitivity of 95%, specificity 88%, positive predictive value 95%, and negative predictive value 88%. CONCLUSIONS: Radial array EUS is helpful in supporting or refuting a diagnosis of cancer in a patient with a pancreatic mass. Although EUS-guided FNA can confirm the diagnosis, a negative FNA should not preclude exploration when clinically indicated.