Ovarian cancer

Ovarian cancer is the leading cause of death in women with pelvic malignancies. Because of the multiple histologic types of malignancy that can arise within the ovary, accurate diagnosis and staging is critical for optimal patient care. The current standard of proper surgical management followed by combination chemotherapy is outlined. In addition, risk factors, screening, prognostic factors, and the approach to the relapsed patient is discussed.     

Psychological Response to Test Results in an Ovarian Cancer Screening Program: A Prospective, Longitudinal Study.

To identify the psychological impact of receipt of an abnormal yet benign screening test result, the authors examined the response to a transvaginal ultrasound screening (TVS) test for ovarian cancer (OC) in asymptomatic women (N=540) undergoing an initial TVS screening test. Interviews were conducted prior to undergoing TVS screening and at 2 weeks and 4 months following this baseline. Women receiving an abnormal yet benign TVS test result (n=33) reported elevated OC-specific, but not general, distress at 2-week follow-up. Distress returned to baseline levels at 4-month follow-up. Consistent with the monitoring process and cognitive-social health information processing models, response to an abnormal TVS result was moderated by a monitoring coping style, low optimism, and a family history of OC. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ovarian vein syndrome

SETTING: A voluntary community health worker programme, in the Western Cape, South Africa, utilizing volunteers to administer directly observed therapy to tuberculosis (TB) patients. OBJECTIVE: This study describes the perceptions of health team members regarding the voluntary community health worker project. DESIGN: A qualitative, participatory research study utilizing focus groups. RESULTS: TB was perceived by the health team to be a stigmatized disease causing some patients to be reluctant to be associated with the TB control programme. Despite the project's dedicated approach to case-holding, volunteers expressed the need to develop skills in providing more comprehensive care. The volunteers appear to administer a more personalized service to TB patients and can bridge the gap between TB patients and the health agency. CONCLUSION: Sustained evaluation and support seem to be a vital tool in integrating a volunteer project into a health team approach. Its effectiveness appears to depend to a large degree on the people involved.     

Ovarian cancer screening

Sperabillin polymers, which have been shown recently to have antitumor activity, are new basic peptidyl polymers composed of a pseudo-peptide antibiotic, sperabillin A. The polymers, HP-2 (MW 9990), AP-2 (MW 20,100) and AB-2 (MW 35,000), were found to potently activate murine peritoneal macrophages. The phagocytosis-dependent respiratory burst and Fc gamma receptor expression of peritoneal macrophages from C57BL/6 mice were enhanced after in vitro cultivation with these polymers. When HP-2, a representative of these polymers, was intraperitoneally injected into mice, the number of peritoneal exudate cells increased and phagocytosis-dependent respiratory burst and class II (I-A) antigen expression of peritoneal macrophages were augmented. These macrophages showed strong inhibitory activity against the growth of murine tumor cell lines such as EL4 lymphoma and B16 melanoma. Nitrogen oxide, tumor necrosis factor (TNF) and interleukin 1 (IL-1) might be required for this inhibitory activity. Moreover, in mice treated with HP-2, splenocyte counts also increased and non-specific killer activity of the splenocytes was augmented. These results indicate that sperabillin polymers are new macrophage activators.     

Ovarian vein thrombosis

A 44 year-old woman was admitted with fever and lower abdominal pain at the right side suggestive of appendicitis. Ovarian vein thrombosis was diagnosed by sonography and confirmed by contrast-enhanced CT scan. After heparinisation the complaints disappeared and fever resolved in less than 72 hours. Repeated radiological investigation showed regression of the thrombus. Ovarian vein thrombosis is an uncommon, potentially fatal disorder that can be adequately treated with medication. The cornerstone of the diagnosis consists in non-invasive radiological investigation.     

Ovarian cancer complicating pregnancy

Ovarian cancer is the second most frequent gynecologic cancer complicating pregnancy. Although uncommon, this is a topic that encompasses multiple aspects of obstetrics and gynecology. The management of the adxenal mass in pregnancy, surgery for ovarian cancer, chemotherapy during gestation, and the use of tumor markers during pregnancy are discussed.     

Ovarian tumors complicating pregnancy

Administration of a sub-Tenon's anesthetic induced an orbital hemorrhage in a patient who underwent strabismus surgery. This report is the first case of this sight-threatening complication after sub-Tenon's infusion anesthesia.     

Ovarian neoplasms in children

OBJECTIVE: To review the clinical presentation, treatment, and outcome in a series of children with ovarian neoplasms. DESIGN: A retrospective review of the medical records in a case series of 29 girls with ovarian neoplasms. The length of follow-up ranged from 6 months to 7 1/2 years and averaged 3.0 years in the girls with malignant tumors. SETTING: The patients were treated at a large referral children's hospital. PATIENTS: Twenty-nine girls with ovarian neoplasms were treated from 1976 to 1992. The average age of the patients was 10 years and ranged from 2 to 16 years. MAIN OUTCOME MEASURES: The principal outcomes examined were mortality and surgical morbidity. RESULTS: The most common presenting symptoms for these ovarian tumors in pediatric patients included chronic abdominal pain, an abdominal mass, or distention. Three girls presented with precocious puberty or hirsutism. In 27 cases, the tumor was a primary ovarian lesion. In two patients, the ovarian mass was the presenting finding for a stage IV non-Hodgkin's lymphoma. Seventeen tumors were benign and 12 were malignant. Tumors originating from the germ-cell line predominated (n = 17). Seven of the 10 ovarian malignant neoplasms were stage I at the time of diagnosis. All but one of the girls with malignant tumors received either adjunctive radiation therapy or multiple-agent chemotherapy. Two girls with sex cord/stromal cell tumors who presented with stage I disease ultimately developed widespread metastases. Both girls with large epithelial tumors survived. All of the girls with benign tumors and seven (70%) of 10 with malignant lesions survived. CONCLUSION: Ovarian tumors are unusual lesions in the pediatric population. Unlike in adults, such neoplasms generally originate from the germ-cell line. Whereas most ovarian tumors in girls are benign, some children have malignant tumors that are very aggressive and do not respond well to adjuvant therapy. In particular, malignant sex cord/stromal cell tumors, even when they present at an early stage, may behave unpredictably.     

Ovarian tumors and pregnancy

Ovarian tumors during pregnancy are a rare event. In most cases the tumors are detected accidentially during routine examination, ultrasound or a caesarean section at term. The incidence of malignant ovarian tumors is about 1:10,000 to 1:40,000 pregnancies. Histologic subtypes and prognosis do not differ from tumors not associated with pregnancy, it seems however, that there are more lesions of borderline malignancy and of low grade. Therapy depends mostly on the age of gestation and tumor stage. Conservative surgery is recommended only in stage IA disease. Radical surgery and if necessary adjuvant therapy is recommended during the first trimester. In the third trimester a caesarean section can be followed by radical surgery, provided that there is a close cooperation between gynecologists and pediatricians. In the second trimester this regimen is possible only as an exception which includes a critical maternal risk-benefit assessment.     

Ovarian Leydig cell tumor

A case report on a 73 year old woman with an Leydig cell tumor of the right ovary accidentally discovered after hysterectomy with bilateral salpingo-oophorectomy is given. Signs of virilization existed for many years, but no diagnostic investigations had been performed. Histologically a well-differentiated Leydig cell tumor was found as the reason of the androgenic changes which regressed after extirpation of the tumor.     

Ovarian cancer and borderline tumors

Long-term trends in the incidence, prognosis, and mortality of patients with ovarian cancer and borderline tumours in Norway were examined based on data from the population-based Cancer Registry of Norway. The incidence of ovarian cancer rose continuously from the mid-1950s to the mid-1980s. There was also an increasing trend in the incidence of borderline tumours from the early 1970s to the early 1990s. The prognosis for patients with ovarian cancer has improved since the 1950s. In 1989-93 the five-year relative survival rate was 37%. The prognosis for patients with borderline tumours was very favourable, with a five-year relative survival rate of 93% (1970-93). The mortality from ovarian cancer has been almost constant since the 1960s.     

Ovarian hyperstimulation syndrome--prevention and treatment

Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic, potentially life-threatening condition associated with ovulation induction. With increasing numbers of women receiving various ovarian stimulation protocols as part of different infertility treatments, the number of cases is likely to increase. The syndrome has a wide spectrum of clinical and laboratory findings, and is classified into mild, moderate and severe OHSS. The pathophysiology of this syndrome is unclear, and medical management has traditionally been conservative and supportive consisting of bedrest, volume expanders and replacement of fluid. When ascites is present, paracentesis under ultrasound guidance has been found to improve the condition of the patient by reducing the hydrostatic pressure. Prevention is very important, but at present it is doubtful if OHSS can be completely avoided due to the existence of a relatively small margin of safety between successful induction of ovulation and the development of OHSS.     

Ovarian neoplasia and subfertility treatments

OBJECTIVE: This study examines three specific questions about obesity and overweight, using a nationally representative sample of Canadians. Are sociodemographic and lifestyle behaviors associated with body weight? Is body weight correlated with specific health outcomes? Has the prevalence of obesity in Canada changed since 1978? METHODS: Secondary data analysis of a cross-sectional survey. SAMPLE: This study uses the 1994 National Population Health Survey (NPHS) by Statistics Canada. It is a stratified random sample of 19600 Canadians across all provinces. RESULTS: The results show that age, gender, education, birth place and region, are significantly associated with obesity. When a lower criterion is used for overweight and obesity (body mass index, BMI > or = 25), dummy variables for marital status and occupation are also significant. Second, obesity is associated with poorer self-rated health, high blood pressure, heart disease, diabetes, arthritis, respiratory and stomach problems. For those respondents who have a BMI score of 25 or greater, there is also an association with stroke. Finally, it is unclear whether the prevalence of obesity has changed. However, there appears to be a systematic difference between studies using actual height and weight measurements (anthropometric) vs self-reported measurements. CONCLUSIONS: Weight can be considered a modifiable risk factor and reductions in the prevalence of obesity should reduce the risk of specific chronic conditions. Provincial variations in the prevalence of obesity (BMI > or = 27) and overweight and obesity (BMI > or = 25) suggest that collapsing provinces into regions may obscure important inter-provincial differences in body weight. More research is required to assess whether or not obesity is decreasing in Canada. Some of the limitations of self-reported data are discussed.     

Ovarian cancer in infertility patients

The possibility that ovulation induction increases the risk of ovarian cancer remains unproven. However, recent studies suggest that both infertility and endometriosis may be independent risk factors. Despite the various case reports and epidemiological studies performed the association between the use of infertility drugs and ovarian cancer remains weak. The fact that the women who were the first to use ovulation agents are now reaching mid-life means that future studies should show whether any association exists. Hence, there is a need now for large prospective trials to be performed to establish whether an association between ovulation induction agents and ovarian cancer truly exists.     

Ovarian surgery in premenarchal girls

OBJECTIVES: Evaluate causes of surgical failure at time of revision endoscopic sinus surgery. STUDY DESIGN: Prospective review of 682 cases that had endoscopic sinus surgery performed between 1991 and 1995. METHODS: In all cases, variables of age, sex, asthma, allergy, computed tomography stage, associated procedures, complications, and operative findings were collected. Those cases that had a failure after a previous endoscopic sinus procedure and not an intranasal procedure or an external procedure were evaluated. RESULTS: Fifty-two patients (7.6%) were identified. The age range was 24 to 70 years. The most common cause of failure was residual air cells and adhesions in the ethmoid area (30.7%), followed by maxillary sinus ostium stenosis in 27%, frontal sinus ostium stenosis in 25%, and a separate maxillary sinus ostium stenosis in 15% of the cases. CONCLUSION: Review of surgical causes of failure in endoscopic sinus surgery patients revealed that residual air cells and stenotic maxillary or frontal sinus ostium were the most common causes of failures.