Fertility results after ovarian transposition for pelvic malignancies treated by external irradiation or brachytherapy

The spontaneous recovery of nigrostriatal dopaminergic neurons was quantitatively analyzed with tyrosine hydroxylase (TH)-immunocytochemistry in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-treated C57BL/6 young mice. A substantial reduction of striatal dopamine (DA) level was observed until 24 days following MPTP treatment. The TH-immunoreactive (IR) fibers and number of TH-positive cell bodies were also markedly reduced at 3 days after the toxin treatment. Thereafter, TH-IR fiber densities showed to progressively recover through the examining period. The number of TH-positive cell bodies in substantia nigra pars compacta were not changed during the recovery period. These results indicate that MPTP-treated mice have a potential for spontaneous regenerative sprouting in nigrostriatal dopaminergic system.     

Persisting cyclic ovarian activity in cervical cancer after surgical transposition of the ovaries and pelvic irradiation

The effect of surgical transposition of the ovaries on gonadal function was investigated in ten young women with carcinoma of the uterine cervix, stages I and II. Gonadotrophin-, oestradiol- and progesterone-levels were determined before and during pelvic irradiation. A control group consisted of seven patients with cervical cancer who did not undergo ovaria transposition. In the control group gonadotrophins began to rise after radiation doses of 560-2400 rad (FSH) and 1130-2600 rad (LH) respectively. The excessive secretion was not seen in patients who had ovarian lifting. Ovulatory cycles occurred during or after pelvic irradiation in seven women of the study group, either spontaneously or induced by clomiphene treatment. This indicates that transposition preceding radiotherapy is an effective means of preserving ovarian secretion in young women in whom malignancies of the pelvic region demand irradiation.     

Laparoscopic surgery of adrenal glands: indications and limits

Over the last four years it has been demonstrated that laparoscopy can be used successfully for adrenalectomy, providing certain advantages over conventional open surgery. The aim of this study was to determine the indications for laparoscopic approach in adrenal surgery. From June 1994 to June 1996 laparoscopic transabdominal flank approaches were proposed in patients with a unilateral 8 cm or less, non-malignant tumors of the adrenal gland. For tumors under 4 cm in diameter only secreting tumors were removed. Among 77 patients requiring ablation of the adrenal gland, 50 (65%) underwent a laparoscopic procedure: 29 Conn adenomas, 10 Cushing adenomas, 6 Pheochromocytomas, 4 incidentalomas. One patient had Cushing's disease and underwent bilateral resection. Mean tumor size was 26 mm (7-75 mm). Malignancy was demonstrated in 2 tumors: one cortisone secreting tumor and one leiomyosarcoma. Conversion was required in 4 cases (8%). Mean operative time for unilateral adrenalectomies was 147 minutes (50-300'). There were no deaths. Morbidity included: one hemorrhage via the trocar orifice requiring reoperation, one infarction of the spleen which regressed spontaneously, one parietal hematoma, and one case of phebitis of the lower limb. The endocrinopathy was successfully cured in all patients with secreting tumors. The 27 other patients underwent open adrenalectomy. Laparoscopic approach was not proposed due to suspected malignancy in 13 cases, previous surgery in 8 cases and multiple, bilateral and/or extra adrenal tumors in 6 cases. Laparoscopic approach to the adrenal gland is the procedure of choice in patients with Conn adenomas, Cushing adenomas and in most cases of pheochromocytomas. It is not indicated for malignant and large tumor (> 8 cm). Currently two-thirds of our patients requiring and adrenalectomy are operated laparoscopically.     

Surgery for primary hyperparathyroidism 1962-1996: indications and outcomes

Twenty-two cases of ameloblastoma and ten cases of adenomatoid odontogenic tumour (AOT) were analyzed comparatively by the AgNOR technique. Ameloblastomas were distributed into three groups according to their clinical behaviour: primary lesions without recurrences (PLWTR), 5 cases; primary lesions with recurrences (PLWR), 4 cases; and recurrences, 13 cases. The cases were also regrouped according to their histological pattern: follicular (9 cases), plexiform (7 cases), acanthomatous (4 cases) and unicystic (2 cases). Considering histological patterns, there was a significant statistical difference only between follicular and plexiform types. There were no significant differences between the group of ameloblastomas and the group of AOTs or between the three groups of ameloblastomas with different clinical behaviour. Our results strongly suggest that the distinct clinical behaviour of ameloblastomas and AOT is not correlated with their cellular proliferation ratio. Thus, the infiltrative ability of the ameloblastomas is probably not related to the cellular proliferation index of these tumours.     

Laparoscopic cholecystectomy in cirrhotic patients: expanding indications

Cirrhosis, portal hypertension, and bleeding disorders are being considered as relative or absolute contraindications to laparoscopic cholecystectomy (LC). This report describes four cirrhotic patients with clinical portal hypertension in three and mild to severe bleeding tendency in all. Laparoscopic cholecystectomy was uniformly successful in these patients with no complications. If the surgeon exercises extreme caution in securing hemostasis and does not overlook some details concerning patient management, LC can be efficiently and safely performed in cirrhotic patients. Compared with open cholecystectomy, LC may be even more advantageous concerning the virtual elimination of incision-related complications. Our preliminary experience is encouraging and suggests more liberal use of LC in cirrhosis-portal hypertension-bleeding tendency disease complex.     

Laparoscopic excision and marsupialisation of bilateral pelvic lymphocysts following extended hysterectomy and pelvic lymphadenectomy for endometrial carcinoma

The second polar body (2PB), extruded from metaphase II oocytes after fertilization or oocyte activation, has a haploid set of female chromosomes like its sister, the fertilized (activated) oocyte. In the present study, the female pronucleus of fertilized mouse oocytes (zygotes) was replaced with the 2PB nucleus from the same or different oocytes to examine the developmental potential of the 2PB nucleus. When the female pronucleus (FPN) was synchronously (FPN and 2PB were same age) replaced with the 2PB nucleus, the rate of reconstructed zygotes developing to blastocysts decreased with the age of donors and recipients (from 70% at 20-21 h to 15% at 26-27 h after hCG injection). When nuclei were replaced asynchronously (FPN and 2PB were of different ages), a higher developmental rate to blastocysts was obtained with young recipient zygotes (20 h after hCG injection) than with aged recipient zygotes (24 h after hCG injection) (64% versus 20%, P < 0.01) irrespective of the age of the 2PB. In this second group of embryos, in which nuclei were replaced asynchronously, the 2PB nuclei were prematurely condensed at the time of first mitosis. These findings indicate that after being extruded from the oocytes the cell cycle of the 2PB progressed more slowly than did that of the zygote. After the transfer of reconstructed embryos into pseudopregnant females, normal pups with an expected coat colour were born, indicating the competence of the 2PB chromosomes for full embryo development.     

Gonadoblastoma: an ovarian tumor with characteristic pelvic calcifications

Typical circumscribed mottled calcifications in the pelvis are a frequent finding in gonadoblastomas. Six patients with this tumor are reviewed. Radiologically visible calcifying gonadoblastomas were found in three cases.     

Chronicle of functional pain: chronic pelvic pains

Chronic pelvic pains are one of the most frequent complaints in our daily gynecological practice, motivating at least a quarter of our consultants. As it usually puts the practitioner ill at ease in a difficult situation, we will try to understand the meaning of those particular pains, thus defined: a duration outlasting 6 months and the absence or the ineffective suppression of any organic--somatic--substratum. But every alleged pain is real and true, and we must work on that. To validate such suffering, to accept such repetitive complaints, can also be a therapeutic medical approach, even if it is less gratifying for the gynecologist, and certainly less customary.     

Assessing functional outcomes: an overview

Assessment of functional outcomes requires, first, a good working definition and, second, sufficiently reliable and valid measures from which to choose. With the advent of new or refined conceptualizations of patient outcomes, the functional domain has expanded to address not only routine activities of daily life but also the richly diverse aspects believed to constitute quality of life. This article defines and places the concept of functional outcomes within a context of various published and proposed classification schemes, and supports an expanded definition on the basis of these schemes, emerging models of health care that combine biomedical with social science approaches, and the visionary contributions of respected colleagues in the field.     

Laparoscopic pelvic lymph node dissection for prostate cancer: comparison of the extended and modified techniques

PURPOSE: We compared the results of extended (obturator, hypogastric, common and external iliac nodes) to modified (obturator and hypogastric nodes only) laparoscopic pelvic lymph node dissection in patients with clinically localized prostate cancer. MATERIALS AND METHODS: A total of 189 patients with stage T1 to T3 prostate cancer underwent modified (150) or extended (39) laparoscopic pelvic lymph node dissection for pelvic nodal assessment before definitive treatment. RESULTS: Twice as many lymph nodes were removed via extended than modified laparoscopic pelvic lymph node dissection (mean 17:8 versus 9.3). The overall positivity rate was 23 of 189 lymph nodes (12.2%), including 14 of 150 (7.3%) for modified and 9 of 39 (23.1%) for extended dissection (p = 0.02). Two patients (22%) who underwent extended dissection had positive lymph nodes in the external iliac area. Patients who presented with the high risk features of prostate specific antigen (PSA) greater than 20 ng./ml., Gleason score 7 or greater, or stage T2b disease or greater had a 26.5% (p = 0.0002), 22% (p = 0.0006) or 16.4% (p = 0.003) likelihood of positive lymph nodes, respectively. For extended versus modified laparoscopic pelvic lymph node dissection node positivity in high risk patients was 27% versus 18.8% (p = 0.4), 30 versus 26.4% (p = 0.8) and 25.4 versus 14.6% (p = 0.17) for Gleason score 7 or greater, PSA greater than 20 ng./ml. and disease stage T2b to T3a, respectively. Patients who underwent the extended procedure had a higher complication rate (35.9 versus 2%, p < 0.0001). No laparotomy was required. CONCLUSIONS: Despite yielding a 2-fold higher node count and higher node positivity rate, extended laparoscopic pelvic lymph node dissection offers no advantage over modified laparoscopic pelvic lymph node dissection for diagnosing positive lymph nodes when results are analyzed by prognostic factors. The extended procedure is associated with a much higher complication rate. In patients with the high risk features of PSA greater than 20 ng./ml., Gleason score 7 or greater and stage T2b to T3a disease modified laparoscopic pelvic lymph node dissection can be performed safely and effectively to help identify those who may benefit most from curative therapy.     

Systematic pelvic and paraaortic lymphadenectomy for advanced ovarian cancer: prognostic significance of node metastases

A retrospective study of 488 patients with untreated advanced ovarian cancer is presented. Systematic pelvic and paraaortic lymphadenectomy was performed in 248 cases (50.8%). Selective sampling and node biopsy was performed in 33 (6.7%) and 47 (9.6%) patients, respectively. Node metastases were found in 194 of 328 patients (59.1%). The incidence of metastatic nodes significantly increased with more advanced stages, with serous histology, and with a greater amount of residual tumor. Node status appeared to be related to pathology findings at second-look. A complete pathologic response was documented in 26 of 31 (83.8%) patients with negative nodes and in 38 of 59 (64.6%) with positive nodes at first surgery. Patients with negative nodes survived significantly longer (5-year survival, 46%; median, 60 months) than those who had node metastases (5-year survival, 25%; median, 36 months). Using multivariate analysis, lymph node status, together with the stage of disease and residual tumor, still had a significant impact on 5-year survival. Moreover, among patients with optimal cytoreduction, 5-year survival was 46% (median, 56 months) and 30% (median, 41 months) for patients who did and did not undergo lymphadenectomy, respectively (P = 0.05). Likewise, when suboptimal cytoreduction was considered, a median 5-year survival of 24 months was obtained in patients who underwent lymphadenectomy compared with 14 months in patients who did not (P < 0.005).     

Taxanes in the treatment of breast and ovarian cancers: current indications and results

Since the last years, taxanes are among the most active molecules in the treatment of advanced breast and ovarian cancers. Concerning the ovarian cancer, Paclitaxel in association with Cisplatinum is about to become the first line reference protocol. Studies are going on in order to define the association and the optimal way of administration. Concerning breast cancer, Docetaxel seems to provide the most interesting response rates after failures of anthracyclines. In France, randomised studies in adjuvant situation have started with this molecule.     

Laparoscopic pelvic lymph node dissection for clinical staging of prostate cancer: encouraging preliminary results

OBJECTIVE: To evaluate the results of the first 72 laparoscopic pelvic lymph node dissections in patients with prostate cancer. DESIGN: Retrospective study of records. SETTING: Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands. METHOD: A retrospective study of records provided data on 72 patients with prostate cancer staged by laparoscopic lymph node dissection in the period 1993-1997. Per- and postoperative complications, operation time, number of removed lymph nodes, pathology result and duration of hospital stay were assessed. A comparison was made between the first series of 36 patients and the second series. RESULTS: In 9 patients the laparoscopic approach was converted to a laparotomy. This occurred six times in the first series of 36 patients and three times in the second series. The postoperative course was complicated six times in the first and four times in the second series. With increasing experience the mean operation time decreased from 140 min to 114 min in the second series (p < 0.0001). The mean number of nodes removed was equal in both series (7.5). Lymph node metastases were found in 20 patients (28%). Hospital stay was 2.9 days in the first series and 2.2 days in the second series (not significant). CONCLUSION: Laparoscopic pelvic lymph node dissection is a minimally invasive method for staging patients with prostate cancer. This staging procedure is of great benefit in patients scheduled for treatment with curative intent because of its accuracy and low morbidity. With increasing experience operation time, hospital stay and number of complications decrease.     

The principal functional appliances. Characteristics and clinical indications

The author present a review of the six most important functional appliances available now, showing the way of construction, his working and clinical applications. Appliances are extremely valid to rectify skeletric malocclusion of I, II, III class, with ipertonic perioral musculature and with a wrong position of the tongue in growing patient with the FMA under 25 degrees; must be done a correct diagnosis based on patient clinical exam, observation of the model of study and finally on the observation of radiographic exam.     

Intratumoral aromatase in human breast, endometrial, and ovarian malignancies

In human estrogen-dependent neoplasms such as breast, endometrioid endometrial, and surface epithelial-stromal ovarian carcinomas, intratumoral aromatase is considered to play important roles in converting circulating androgens derived from adrenal cortex and/or ovary to estrogens, possibly in association with 17 beta-HSD type 1 and estrogen sulfatase. Analysis of intratumoral aromatase in these estrogen-dependent neoplasms is important not only in understanding the development and biological behavior of these tumors, but also in the clinical management of these patients, because suppression of intratumoral aromatase by newly developed aromatase inhibitors may provide new potentials in endocrine therapy of these patients.     

Laparoscopic resection of ovarian benign cystic teratomas: experience with 84 cases

Laparoscopic treatment of benign cystic teratoma of the ovary has been recommended following the study of relatively small numbers of patients. We reviewed our experience with a prospective ongoing protocol for the treatment of benign ovarian teratomas, between January 1990 and December 1996. Sonography established the diagnosis, and biochemical markers were used to screen for possible malignancy. Surgery consisted of resecting the cyst and conserving the ovary if appropriate. The resected cyst was aspirated of its contents following insertion into an EndoCatch bag. Removal was accomplished via the narrowest incision possible by pulling the bag's margins through the incision and grasping the solid parts with conventional surgical instruments. The diameter of the cysts ranged from 2 to 15 cm. Cystectomy was performed in 47, and oophorectomy in 37, patients. Spillage occurred in 11 cases, but none developed peritonitis or fever. The mean duration of post-operative stay was 0.9 days (range 0.5-2). We conclude that laparoscopic resection of benign teratomas of the ovary is safe, well tolerated, and shortens hospital stay.