Pain syndrome in gastroenterological practice: potentialities of evaluation

Qualitative and quantitative characteristics of chronic pain syndrome and their possible use in assessing analgetic effects of treatment were studied in 16, 49, 26 and 17 patients with gastric ulcer, duodenal ulcer, chronic pancreatitis, chronic colitis, respectively. Pain was measured with the use of McHill's questionnaire modification and visual-verbal-analog scale. In addition to routine analysis of the data from the respondents, graphic mean profiles of pain for each group have been devised. There were differences in quantitative parameters of pain syndrome depending on nosological unity and profiles of patients. The questionnaire proved rather informative in evaluation and gradation of analgetic effects of therapeutic factors in ulcer patients.     

Our experience with the use of a Bulgarian cyanoacrylate tissue adhesive in obstetrical and gynecologic surgical practice

The effect of somatostatin was tested on gastrin release induced by electrical vagal stimulation in anaesthetized cats. The antral release of gastrin was determined in the gastric venous outflow by simultaneous recording of gastrin concentration and blood flow. Repeated vagal stimulation at the same frequency and duration caused release of similar amounts of gastrin within the same cat. Infusion of somatostatin, at a rate of 0.5 microng/kg/min, reduced the vagally induced gastrin release to about 40%. Similarly, basal gastrin output was depressed to about 40% of the control values.     

Witzel gastrostomy in gynecologic surgery

From 1965 to 1990, 46 cases of malignant nasopharyngeal tumours were diagnosed in Iceland. The incidence rate is as low as in other Western countries, 0.6/100,000 per year. Histo-pathological diagnosis were as follows: Undifferentiated carcinoma 45%; squamous cell carcinoma 30%; non-keratinizing carcinoma 7%; and plasmacytoma 9%; lymphoma 7%; rhabdomyosarcoma 2%. Four per cent were diagnosed at stage I, 13% at stage II, 29% at stage III and 54% at stage IV. The overall crude survival at 10 years from diagnosis was 28.3%. The following factors were found to have a prognostic value: Stage of disease, size of tumour (T-classification) and age at diagnosis. Nodal stage (N-classification) alone and sex were not found to be prognostic factors. There was no difference in survival among the different WHO types of cancer. Patients with carcinoma were all treated with radiotherapy. The survival of those who received more than 60 Gy was better than of those who received 60 Gy or less (p = 0.04).     

Intraepithelial carcinoma of the cervix uteri. 1) Cytologic detection in gynecologic practice. Our exerience with 15,000 smears

The best results in screening for subclinical cancer of the cervix are given by cytological studies. The authors in reviewing their experience in this method of screening studied the result of 15,000 smears which gave a diagnosis of 37 cases of intra-epithelial carcinoma of the cervix, which means 1 case of carcinoma in situ diagnosed in every 400 smears. Although the technique is very simple it has to be carried out according to strict criteria at the time of taking the smear, of fixing it immediately and of staining it. There is a group of patients who are at high risk about the age of forty, when there is a marked influence due to parity. But only a systematic policy will bring about diagnosis of pre-invasive carcinoma in cases where the cervix is clinically healthy. The cytology is usually characteristic, though the diagnosis may be difficult during pregnancy, or when hormone contraception is being used or when there is a trichomonas infection present. This explains why we find false positives in 0.03 per cent of cases in this study and false negatives in 0.03 per cent of cases. Their rarity means that the method is 99.94 per cent reliable. Finally, the cervical smear gives an opportunity for studying the vaginal microbial flora as well as the cyto-hormonal state.     

Fibrinogen degradation products in gynecologic neoplasms

Concentration of fibrinogen degradation products in sera of 12 healthy women and 163 patients with gynecological tumors was determined by Staphylococcal-clumping-test. In sera of healthy women and patients with benign tumors the highest titer was 8. On the other hand in 53 of 97 cases with malign tumors higher concentrations were evaluated.     

Prophylactic ureteral catheterization in gynecologic surgery

OBJECTIVES: To examine the frequency of ureteral catheter usage, its efficacy in preventing injury, and related complications, because the preoperative routine placement of ureteral catheters as a prophylactic measure to prevent ureteral injury is controversial. METHODS: All major gynecologic operations performed between January 1992 and December 1994 were identified. All gynecologic procedures that were preceded by ureteral catheter placement were also identified. A data base maintained by the Department of Quality Management allowed identification of all urinary tract complications and ureteral injuries. Four categories of surgery were analyzed: exploratory laparotomy with catheters, exploratory laparotomy without catheters, operative laparoscopy with catheters, and operative laparoscopy without catheters. The medical records of all patients with urinary tract complications were reviewed. RESULTS: Bilateral prophylactic ureteral catheterization was performed in 469 (15.3%) of 3071 patients. A ureteral injury occurred in 4 (0.13%) of 3071 patients. All four ureteral injuries (0.17%) occurred among 2338 patients who underwent exploratory laparotomy. None of the 733 patients who underwent operative laparoscopy suffered ureteral injury. The incidence of ureteral injury in patients who had ureteral catheters placed before exploratory laparotomy was 2 (0.62%) of 322. Two (0.10%) of 2016 patients who did not have prophylactic ureteral catheters suffered a ureteral injury. There was no statistically significant difference in the incidence of ureteral injury between patients who did and patients who did not undergo ureteral catheterization (P=0.094). CONCLUSIONS: The use of prophylactic ureteral catheters did not affect the rate of ureteral injury in our patients. The very low incidence of ureteral injury among our patients is attributed mainly to meticulous surgical technique.     

Surgery for gynecologic malignancies

At room temperature (23 degrees C-25 degrees C), the induction of long-term potentiation (LTP) in area CA1 of slices from young male Sprague-Dawley rats was depressed by preincubation with the nitric oxide synthase inhibitors NG-nitro-L-arginine (L-NA, 100 microM) and NG-nitro-L-arginine methyl ester (L-NAME, 100 microM). The D isomers were ineffective under the same conditions. Hemoglobin (20 microM) reduced but did not completely block LTP. Neither L-NA (at concentrations up to 1 mM) nor hemoglobin (20 microM) had any significant effect on LTP in slices from adult rats at room temperature, or in young rats at 29 degrees C-30 degrees C. These results suggest that nitric oxide is unlikely to play a role in the induction of LTP under physiological conditions.     

Field-expedient gynecologic examination table

In field operational environments, the gynecologic health needs of women may be difficult to provide because of the lack of a small, lightweight, durable, inexpensive gynecologic examination table. Such a table already exists, in pieces, in the inventory of most field-deploying units of battalion aid station size or larger. Because the table's existence is not commonly known, we describe the assembly and use of this field-expedient gynecologic examination table.     

Surgery for gynecologic cancer

Surgery is an integral part of staging procedures for ovarian, endometrial, and vulvar cancers, with a move toward surgicopathologic rather than clinical staging in cervical cancer. Morbidity can be reduced without compromising patient cure by individualizing surgery for patients with early vulvar cancer, and reproductive potential can be maintained in some women with early ovarian cancer. The place of prophylactic oophorectomy and primary and secondary surgery in ovarian cancer remain controversial and await prospective study. Recent developments in laparoscopic techniques have been applied to a number of problems in gynecologic cancer surgery, and the feasibility of laparoscopic lymphadenectomy and radical pelvic surgery has been demonstrated. Care must be taken, however, to ensure that the tenets of surgical oncology are not sacrificed in order to offer minimal-access surgery to women with gynecologic cancer.     

Obstetric and gynecologic emergencies

This article reviews the pearls and pitfalls of obstetric and gynecologic emergencies occurring in women presenting to the emergency department. Some pitfalls include failure to screen for ectopic pregnancy, tachycardia as an unreliable indicator of a ruptured ectopic pregnancy, and the use of serum hCG as a testing procedure during pregnancy. Updates include serologic markers of ectopic pregnancy, ultrasonography in the emergency department, methotrexate treatment of ectopic pregnancy, traumatic placental separation, and fetomaternal hemorrhage.     

Racial differences in survival from gynecologic cancer

OBJECTIVE: To determine whether survival from gynecologic cancer is different between African-American and white patients at an inner-city hospital with both a large clinic and a private service. METHODS: We studied 538 patients (89 African American, 449 white) diagnosed with cervical, uterine, or ovarian cancer at a single institution from January 1, 1989 through December 31, 1993. Information was obtained on age, stage, site of disease, histology, and type of health insurance (public or commercial). Insurance coverage was used as a proxy for socioeconomic status. Overall survival was estimated by the method of Kaplan and Meier and compared by the log-rank test. Cox proportional hazard modeling was used to evaluate the effects of multiple factors on survival. RESULTS: African-American patients were significantly older and were more likely to have cervical cancer and public insurance than white patients. Overall survival was worse for African-American patients than for white patients (P < .05). However, stage for stage, there was no significant difference in survival between the groups. There was also no difference when patients were grouped by insurance status. African Americans had a significantly worse survival for cervical cancer than whites, and African-American patients older than 65 years had a worse survival than whites of similar age. On multivariate analysis, only stage and insurance coverage were significant predictors of survival. CONCLUSIONS: African-American patients with gynecologic cancer at our institution have worse overall survival than white patients. The survival difference seems to be due predominantly to differences in socioeconomic status and stage at diagnosis.     

The gynecologic examination in children and adolescents

Contraception for adolescents should be considered an important part of prophylactic medicine. Not enough attention has been given to this area, which could mean saving a young person from the destruction of his or her plans, and disruption of their family with an unwanted, unexpected child. This involves greater rapport with adolescents in schools on matters of sexual awareness and education. Noting that 15% of pregnancies between the ages of 12 and 16 are on the first sexual contact, the morning after pill and post coital progestins are thought appropriate as they require only single uses. The most frequently used methods are coitus interruptus (36%), followed by the male condom with vaginalspermicides, and the diaphragm. The use of hormonal contraceptives by adolescents raises questions about their effects on the development of the hypothalamal-hypophysial-ovarian system and the growth of the uterus. The use of intrauterine devices is generally countraindicated, as the uterus grows about 6 cm a month during adolescence and the action of these devices can have dangerous effects on this growth.     

Ultrasound in the study of gynecologic neoplasms

The authors discuss the state-of-the-art of ultrasound diagnosis for pelvic swellings, with special reference to uterine and ovarian cancer. They review the applications of Eco colour Doppler in gynecological oncology and discuss the protocols for the prevention and/or early diagnosis of gynecological tumours.     

Prevention of thromboembolic disease in gynecologic surgery

We presented two groups of patients gynecologically operated and examined in a five year period; the first group of 11536 patients was under thromboembolic protection, whereas the second group of 8532 patients was without thromboembolic protection. Protective measures concerning thromboembolic disease were carried out by applying elastic stockings 24 hours before operation and by early post-operative getting up from bed. Low-molecular dextran was applied before operation as well as during the operation in the amount of 500-1000 ml. In risky patients with varicosities, recidive thrombophlebitis and cardiovascular diseases, we applied small doses of heparin subcutaneously two hours before the operation and after the operation every eight hours five days long. With such prevention of thromboembolic disease in gynecologic surgery, we achieved very favorable effects in reducing mortality to 0.05% concerning the operated, while it amounts to 0.3% in those who were without this kind of protection.     

Treatment of gynecologic cancer in elderly patients

Due to the increasingly elderly population and prolonged life span of women in Japan, population of women older than 75 years of age has become 7.3% of all female population in 1995. According to this change, elderly patients with gynecologic malignancies, such as cervical cancer, endometrial cancer and ovarian cancer have increased markedly. Those patients tend to have progressed disease and therefore treatments should be less invasive and tailored based upon individual conditions to maintain their quality of life.     

Interstitial implantation of gynecologic malignancies

Interstitial implantation is invaluable in the management of patients with extensive or large volume gynecologic malignancies, significant anatomical distortion, or recurrent disease. Such techniques are necessary components of the brachytherapy services available to patients with gynecologic malignancies giving superior results in terms of local tumor control and survival compared to those achieved with external beam alone or inadequate intracavitary applications. Local tumor control with an acceptable risk of complications can be achieved for these challenging disease presentations if these techniques are implemented skillfully through the joint efforts of the radiation oncologist and gynecologic surgeon.