摘要：Objective: The following study was conducted to determine which FSH, recombinant or urinary, works better in older women. Design: We conducted a controlled randomized study in a single university IVF center. Setting: University IVF center. Patient(s): Women (N = 257) over 39 years old undergoing IVF. Intervention(s): The patients were randomized into two study groups at their first IVF cycle: 121 patients were treated with recombinant FSH, and 120 patients were treated with urinary FSH. Both groups were suppressed with a long GnRH analog protocol. Main Outcome Measure(s): Days of stimulation, E2 at the day of hCG, total amount of FSH administered, number of oocytes collected, amount of FSH per oocyte, and number of embryos obtained. Result(s): Patients treated with urinary FSH required a significantly lower total amount of FSH, and a lower amount of FSH per oocyte than women treated with recombinant FSH. The other measures evaluated did not show any statistically significant differences. Conclusion(s): Our study showed that urinary FSH performed better in older women than recombinant FSH when associated with the long protocol.
摘要：Objectives.: To analyze expressions of the EphB2 and EphB4 receptors in ovarian carcinomas and explore their clinicopathological correlations and prognostic value. Methods.: 115 patients with advanced ovarian carcinoma FIGO IIB to IV were involved. RT-PCR and immunohistochemistry were used to examine the expressions of EphB2/B4 receptor mRNA and protein. Correlations between protein expression and clinicopathological factors were also analyzed. Results.: Ovarian carcinoma patients with age elder than 60 years had higher EphB2 expression than younger patients. Expression of EphB2 and EphB4 protein did not significantly correlate with any other clinical variables, including FIGO stage, residual tumor, histological type and differentiation grade. No significant correlation between mRNA and protein expression level for both of these receptors was seen. It was found that patients with strong immunostaining for EphB2(P=0.03) or EphB4(P=0.003) receptors had poorer survival, and patients with strong immunostaining for EphB4 receptor showed poorer response to chemotherapy(P=0.036). Conclusions.: These studies suggest that EphB2 and B4 receptors are of prognostic value and EphB4 receptor may be an independent predictor of chemotherapy response in ovarian cancer patients.
摘要：Objective: To examine an unusual case of Klinefelter’s syndrome. Design: Case report. Setting: An infertility clinic at a private hospital. Patient(s): A patient with nonmosaic Klinefelter’s syndrome who had had a child with his ex-wife without artificial reproductive technologies. Intervention(s): Karyotyping with peripheral blood lymphocytes, microdissection testicular sperm extraction, and intracytoplasmic sperm injection (ICSI). Main Outcome Measure(s): Sperm count and testicular histopathology. Result(s): Semen analysis revealed severe oligoasthenozoospermia. Intracytoplasmic sperm injection using ejaculated spermatozoa was performed, and successful pregnancy and delivery were achieved. Two years later, multiple semen analyses revealed azoospermia. Microdissection testicular sperm extraction was performed, and motile sperm were successfully retrieved. Unfortunately, the first cycle of ICSI using testicular sperm failed. Testicular histopathology was compatible with decreased spermatogenesis. Conclusion(s): This is a case of a man with nonmosaic Klinefelter’s syndrome who exhibited progressive decline of spermatogenesis. This case suggests the merit of early sperm retrieval and cryopreservation for future management of infertility in Klinefelter’s syndrome.
摘要：Objectives. We evaluated the results of surgical insertion of a polypropylene mesh via the vaginal route in young women presenting genital prolapse. Material and methods. Retrospective study concerning 20 women under age 50 who underwent between July 2000 and December 2003 surgical insertion of an anterior (n = 14), posterior (n = 3) or double (anterior and posterior) (n = 3) polypropylene mesh via the vaginal route. A minimum follow-up of 6 months was required for inclusion in the study. Anatomical results were assessed using the Pelvic Organ ProlapseQuantification (POP- Q) according to ICS (International Continence Society) recommendations. To document the functional results, the patients answered 3 validated self-assessment questionnaires related to pelvic symptoms, sexual behaviors and quality of life. Results. Mean follow-up was 21 months (6 to 52 months). A vaginal erosion of the mesh occurred in 2 women (10% ). Cystocele recurred in one woman among the 17 patients who had an anterior polypropylenemesh (GynemeshTM, Gynecare ,Ethicon ). Seventeen women were sexually active before the surgical procedure and 19 post-operatively. Among these women, 5 (26% ) reported alteration of sexual activity after surgery (with dyspareunia in 4 cases (21% ), and 14 women (74% ) reported no changes or improvement in sexual activty. Conclusion. Surgical management of genital prolapse using a polypropylene mesh inserted via the vaginal route has proven its anatomical efficacy in young women. The potential adverse consequences on sexual life would require clinical research concerning the surgical approach (abdominal or vaginal route) and synthetic materials used in prolapse surgery for young women.
摘要：Objectives.: We had previously reported an association between the use of recombinant human erythropoietin(rHuEPO) and thrombosis in patients with cervix and vulvo-vaginal cancer treated with chemotherapy and radiation. We hypothesized that low-dose warfarin would be effective prevention for thromboembolic events in this setting. Methods.: A retrospective analysis of patients with cervical or vulvo-vaginal carcinoma receiving chemoradiation and rHuEpo was performed. Thirty-two patients received rHuEpo alone, and 24 received warfarin(1-2 mg) and rHuEpo. The primary endpoint was objectively proven symptomatic venous thrombosis. Results.: There was no difference in the baseline characteristics(e.g. age, stage, body mass index, mean and peak hemoglobin,WBC and platelet counts, and number of transfusions) between these two groups. The rate of thrombosis also was not statistically different(P=0.62). Nine of 24 patients had a symptomatic deep vein thrombosis(DVT) while receiving warfarin compared to 10 of 32 patients not on warfarin. There was no difference between the two groups in the percentage of patients with upper extremity DVT(P=0.83) or lower extremity DVT(P=0.64). Conclusion.: Daily low-dose warfarin did not alter the incidence of symptomatic DVT in patients with cervical or vulvo-vaginal cancer who received rHuEpo in conjunction with chemoradiation.
摘要：Objective: To establish the nature and extent of difficulties in parenting and child development in families with twins conceived by assisted reproduction. Design: Comparisons were carried out between a representative sample of 344 families with 2-to 5-year-old twins conceived by IVF/intracytoplasmic sperm injection (ICSI) and a matched comparison group of 344 families with singletons from IVF/ICSI. One twin was randomly selected for data analysis to avoid the bias associated with nonindependence of measures. Setting: A general population sample of IVF/ICSI families. Patient(s): Mothers and children. Intervention(s): Mothers completed a questionnaire booklet. Main Outcome Measure(s): Standardized measures of the mother’s psychological well-being (parenting stress, depression, and quality of marriage) and standardized measures of the child’s psychological development (emotional/behavioral problems and cognitive development).Result(s):Mothers of twins showed significantly higher levels of parenting stress and depression than mothers of singletons and were significantly more likely to find parenting difficult and significantly less likely to obtain pleasure from their child. Regarding the children, there was no difference in the level of emotional or behavioral problems between twins and singletons. However, twins showed significantly lower levels of cognitive functioning. Conclusion(s): Greater difficulties in parenting and child development were experienced by IVF/ICSI families with twins than by IVF/ICSI families with singletons.
摘要：Objective.: While panniculectomy has been shown to be a useful technique in obese women undergoing gynecologic surgery, the long-term outcome of these patients has been poorly described. The goal of this study was to determine the long-term outcomes and patient satisfaction of women who underwent panniculectomy at the time of pelvic surgery. Methods.: A retrospective review of patients who underwent panniculectomy at the time of pelvic surgery between 1996 and 2004 was performed. Postoperative complications and long-term trends in weight were evaluated. Patient satisfaction was assessed by telephone survey. Results.: Forty-two patients were identified. The mean EBL was 522 ml, the mean operating time was just over 4 h. Wound complications were noted in 36%of the subjects. Two weeks after the procedure, 86%of the women had a weight that was lower than their preoperative weight. Weight loss peaked 3 months postoperatively, 97%of the subjects had a net lower weight, with a mean loss of nearly 20 lb. Over the ensuing 2 years, weight loss gradually declined. After 2 years of follow-up, 62%of the women were below their preoperative body weights. The mean weight loss at 24 months was 7 lb. Overall patient satisfaction with the procedure was high. Eighty-six percent of the subjects responded that they would undergo the procedure again given their outcome. Conclusions.: Panniculectomy is well tolerated and associated with a high rate of patient satisfaction. Panniculectomy is a valuable component of gynecologic surgery in morbidly obese women.
摘要：Objective. To determine risk factors of failed labor in case of fetal macrosomia. Materials and methods. Medical charts of two hundred and forty six women who delivered macrosomic infants ( > 4,000g) between January 2004 and May 2005 were reviewed. Maternal and obstetrical data were analyzed by mode of delivery. Univariate and multivariate (logistic regression analysis) were performed to identify risk factors of failed labor. Results. Rate of cesarean delivery was 18.3% . Indications for cesarean were: failure to progress in 55.6% , arrest in fetal descent in 22.2% , fetal distress in 6.7% , and other in 8.9% . There was a higher risk of failed labor in nulliparous women (p < 0.001), in case of a symphysio-fundal measurements > 34cm (p = 0.004), in nulliparity associated with symphysio-fundal measurements > 34cm (p < 0.001), in case of previous cesarean delivery (p = 0.004), in cases of maternal height < 1.65m (p = 0.02), and with ocytocin use (p = 0.05). In multivariate analysis, nulliparity associated with symphysio-fundal measurements > 34cm (OR = 5.2; CI 1.5- 18.4), previous cesarean section (OR = 3.7; CI 1.1- 12.4) and maternal height < 1.65m (OR = 2.6; CI 1.2- 5.5) were independent factors of failed labor. Conclusion. Failure of labor in case of macrosomia can be predicted in the event of previous cesarean section, shorter maternal height, and association of nulliparity and symphysio- fundal measurements > 34cm.
摘要：Objective: To evaluate the effectiveness of a practice nurse led strategy to improve the notification and treatment of partners of people with chlamydia infection. Design: Randomised controlled trial. Setting: 27 general practices in the Bristol and Birmingham areas. Participants: 140 men and women with chlamydia (index cases) diagnosed by screening of home collected urine sample or vulval swab specimen. Interventions: Partner notification at the general practice immediately after diagnosis by trained practice nurses, with telephone follow-up by a health adviser; or referral to a specialist health adviser at a genitourinary medicine clinic. Main outcome measures: Primary outcome was the proportion of index cases with at least one treated sexual partner. Specified secondary outcomes included the number of sexual contacts elicited during a sexual history, positive test result for chlamydia six weeks after treatment, and the cost of each strategy in 2003 pounds sterling prices. Results: 65.3%(47/72) of participants receiving practice nurse led partner notification had at least one partner treated compared with 52.9%(39/68) of those referred to a genitourinary medicine clinic (risk difference 12.4%, 95%confidence interval-1.8%to 26.5%). Of 68 participants referred to the clinic, 21 (31%) did not attend. The costs per index case were ￡32.55 for the practice nurse led strategy and ￡32.62 for the referral strategy. Conclusion: Practice based partner notification by trained nurses with telephone follow-up by health advisers is at least as effective as referral to a specialist health adviser at a genitourinary medicine clinic, and costs the same.
摘要：Objective: To determine if goserelin immediately after uterine artery embolization (UAE) affected myoma reduction. Design: Randomized pilot study (level 1). Setting: Teaching hospital. Patient(s): Twenty-six women. Intervention(s): All patients underwent UAE, and then 12 patients received 10.8 mg of goserelin 24 hours later. The treatment group was 5 years older: 43 versus 37.7 years. Uterine and myoma volumes were measured by ultrasound 2 weeks before UAE and at 3, 6, and 12 months. Main Outcome Measure(s): Uterine and fibroid volumes. Result(s): Pretreatment uterine volume was 477 versus 556 cm3, and dominant fibroid volume was 257 versus 225 cm3 in the control versus goserelin groups. Analysis of variance measurements indicated that the change over time did not significantly differ between the two groups. By 12 months, the control group had a mean uterine volume reduction of 58% , while the goserelin group had a reduction of 45% . Dominant fibroid changes over time did not differ between the two groups. At 12 months, the mean fibroid volume had decreased by 86% and 58% in the control and goserelin groups, respectively. Conclusion(s): The addition of goserelin therapy to UAE did not alter the reduction rate or volume of uterine myomas.
摘要：Objective: To describe a case of dramatically improved ovarian reserve in a 42.7-year-old woman who was using the dietary supplement dehydroepiandrosterone (DHEA) as well as acupuncture. Design: Case report. Setting: Private IVF center. Patient(s): A 42.7-year-old patient with initial severely decreased ovarian reserve. Intervention(s): Serial ovulation induction with concomitant use of DHEA dietary supplementation as well as acupuncture. Main Outcome Measure(s): Peak E2 concentration, oocytes retrieved, and cyropreservable embros. Result(s): In her first treatment cycle peak E2 was 1,211 pmol/mL. Afterseven months of DHEA supplementation her peak E2 in cycle 8 was >18,000 pmol/mL. Because of fear of hy-perstimulation we reduced her gonadotropin stimulation by 25%. In the ninth cycle peak E2 was 9,178 pmol/mL, resulting in retrieval of 17 oocytes (16 embryos). In the last 11 months the patient has undergone nine treatment cycles while continuously and dramatically improving her ovarian response and banking of 66 embryos overall. Conclusion(s): This case illustrates the possibility that ovarian function may be salvaged, even in women of advanced reproductive age.
摘要：Background: Vitamin D insufficiency is common in women of childbearing age and increasing evidence suggests that the risk of osteoporotic fracture in adulthood could be determined partly by environmental factors during intrauterine and early postnatal life. We investigated the effect of maternal vitamin D status during pregnancy on childhood skeletal growth. Methods: In a longitudinal study, we studied 198 children born in 1991-92 in a hospital in Southampton, UK; the body build, nutrition, and vitamin D status of their mothers had been characterised during pregnancy. The children were followed up at age 9 years to relate these maternal characteristics to their body size and bone mass. Findings: 49 (31%) mothers had insufficient and 28 (18%) had deficient circulating concentrations of 25(OH)-vitamin D during late pregnancy. Reduced concentration of 25(OH)-vitamin D in mothers during late pregnancy was associated with reduced whole-body (r = 0.21, p = 0.0088) and lumbar-spine (r = 0.17, p = 0.03) bone-mineral content in children at age 9 years. Both the estimated exposure to ultraviolet B radiation during late pregnancy and the maternal use of vitamin D supplements predicted maternal 25(OH)-vitamin D concentration (p < 0.0001 and p = 0.0110, respectively) and childhood bone mass (p = 0.0267). Reduced concentration of umbilical-venous calcium also predicted reduced childhood bone mass (p = 0.0286). Interpretation: Maternal vitamin D insufficiency is common during pregnancy and is associated with reduced bone-mineral accrual in the offspring during childhood; this association is mediated partly through the concentration of umbilical venous calcium. Vitamin D supplementation of pregnant women, especially during winter months, could lead to longlasting reductions in the risk of osteoporotic fracture in their offspring.
摘要：Background: Ovarian choriocarcinoma(CC) is rarely encountered as compared to uterine CC. Furthermore, ovarian CC coexisting with surface epithelial tumor is very rare. Case: A 50-year-old postmenopausal woman, gravida 0, was admitted to our hospital with abdominal pain and distention due to a complex ovarian tumor. The laboratory data showed high serum level of CA125, neuron specific enolase(NSE), and hCG β-subunit C-terminal peptide(hCG-β-CTP). Total abdominal hysterectomy, right salpingoophorectomy, and lymph node dissection were performed. The right ovary revealed a cystic tumor with two solid parts: larger part, endometrioid adenocarcinoma and small cell carcinoma; smaller part, predominantly CC and focally clear cell adenocarcinoma. CA125 was rapidly decreased after first operation, but hCG-β-CTP levels repeated distinctive fluctuations and NSE abruptly increased during the last few months before death. The patient died 10 months after the first operation. Conclusion: Only four cases of ovarian nongestational CC coexisting with surface epithelial tumor have been reported. This is the first reported case of admixture of CC with three epithelial malignancies. We assume that endometrioid and clear cell adenocarcinomas arose at different sites as tumorigenic factors in association with endometriosis, and the former may have been dedifferentiated into small cell carcinoma and the latter to CC. Coexistence of CC with small cell carcinoma is considered to be responsible for relative chemoresistance leading to poor prognosis.
摘要：Objective: To determine the effect of luteal-phase acupuncture on the outcome of IVF/intracytoplasmic sperm injection (ICSI). Design: Randomized, prospective, controlled clinical study. Setting: University IVF center. Patient(s): Two hundred twenty-five infertile patients undergoing IVF/ICSI. Intervention( s): In group I, 116 patients received luteal-phase acupuncture according to the principles of traditional Chinese medicine. In group II, 109 patients received placebo acupuncture. Main Outcome Measure(s): Clinical and ongoing pregnancy rates. Result(s): In group I, the clinical pregnancy rate and ongoing pregnancy rate (33.6% and 28.4% , respectively) were significantly higher than in group II (15.6% and 13.8% ). Conclusion(s): Luteal-phase acupuncture has a positive effect on the outcome of 5 IVF/ICSI. .
摘要：Recall the clinical signs and personal and family medical history suggestive of Elhers-Danlos syndrome, mainly type IV. Review of literature and presentation of a clinical case observed in a female patient with Elhers-Danlos disease type IV who developed dissection of a renal artery during pregnancy. The prevalence of the syndrome is increasing, reaching, according to the latest publications 1/5000 births. It is important to determine the type of syndrome to assess prognosis. In the classic type and in the hyper mobile type, pregnancy is generally well tolerated although certain complications linked to connective tissue dysfunction such as pelvic instability, premature delivery, bleeding postpartum and perineal lacerations, may develop. Ehlers-Danlos syndrome can be associated with serious and even fatal complications for these patients: vascular dissection or uterine rupture. It is important for obstetricians to be aware of the clinical signs and symptoms suggestive of Elhers-Danlos syndrome in a pregnant patient and to know the diagnostic possibilities and potential risks. If a type IV syndrome is diagnosed, it is very important to inform the patient about the potential implications for pregnancy and maternal health, as well as the risk of transmission to the child and the possibility of antenatal diagnosis.
摘要：Objective: To describe a case of twin gestation that occurred in both horns of a bicornuate uterus after the administration of clomiphene citrate and bromocriptine. Design: Case report. Setting: Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Korea. Patient(s): A 34-year-old woman presented with secondary infertility and hyperprolactinemia. Intervention(s): Bromocriptine, 2.5 mg/day, was administered immediately, and clomiphene citrate, 150 mg/day, was started from menstruation day 5 for 5 days. Main Outcome Measure(s): The establishment of pregnancy and obstetric outcome. Result(s): A nonidentical twin pregnancy occurred but ended in preterm delivery at 24 weeks. One baby has survived for over 3 months. Conclusion(s): Twin gestation can occur in both horns of a bicornuate uterus after clomiphene citrate administration.
摘要：Objectives: To validate and improve an established prognostic index in patients with recurrent ovarian cancer. Methods: A Canadian three-covariate prognostic index (tumour grade at diagnosis, initial performance status, and time to relapse/-primary progression (TRP)) was validated in a well-defined cohort of comparable Danish patients. Potential parameters to be included in an improved prognostic index were revealed by univariate and multivariate analyses in the Danish validation group. Results: The Canadian index validated in the Danish patient population (n = 189) found a statistical significant difference in survival between the prognostic groups good and intermediate (P < 0.0001),whereas therewas no significant difference in survival between the prognostic groups intermediate and poor (P = 0.51). In order to improve the accuracy of the index, the candidate parameters, treatment free interval (TFI), CA125 level and performance status, at time of relapse/primary progression, were added, whereas the parameters, tumour grade, and initial performance status, from the Canadian index were excluded. As the correlation coefficient between TRP and TFI was very high (r = 0.91), TRP was substituted with TFI in the improved prognostic model. The final model was: 0.8 (performance status) +0.33 log (CA125)-1.31 log (TFI). The improved model was a good predictor of one-year survival (AUC 0.85; logistic regression; P < 0.0001). The median survival (with 95%CI) of the four prognostic groups (A-D) was 50.6 (34.0-not available), 25.0 (22.1-33.6), 11.3 (8.5-12.9), and 5.2 (3.5-6.3) months, respectively. Conclusions: A novel prognostic model (the Copenhagen index) for patientswith recurrent ovarian cancer is presented.
摘要：Background.: Central nervous system(CNS) metastases from cervical carcinoma are uncommon events. Leptomeningeal involvement from cervical squamous cell carcinoma has not been extensively described. Case.: A 43-year-old woman with initial diagnosis of stage IB squamous cervical carcinoma at age 30 was treated with hysterectomy and left salpingo-oophorectomy. She recurred with nodal disease at age 39 and went into a clinical com-plete remission after chemotherapy and radiation treatment. Three years later, she presented with symptoms of optic neuropathy. Cerebral spinal fluid(CSF) was positive for squamous cells consistent with primary cervical squamous cell carcinoma. No measurable disease was evident outside of the CNS. Conclusion.: Meningeal carcinomatosis from cervical squamous cell carcinoma involving optic nerves has not been reported. Rapid progression of this patient’s CNS metastatic disease suggests this form of metastases may be more aggressive and carry extremely poor prognosis.
摘要：Objective: To compare uterine tissue concentrations of ethinyl estradiol (EE) and etonogestrel (ENG) after one cycle of use of a contraceptive vaginal ring (NuvaRing;NV Organon, Oss, The Netherlands) or a combined oral contraceptive (COC). Design: Randomized, open-label, pharmacokinetic study. Setting: Obstetrics and gynecology unit. Patient(s): Eight premenopausal women about to undergo hysterectomy but otherwise healthy. Intervention(s): One cycle (17-21 days) of NuvaRing or COC treatment that ended with surgical hysterectomy. Main Outcome Measure(s): Tissue concentrations of EE and ENG in uterine tissue samples taken from the upper myometrium and mid-myometrium, the cervical region, and the endometrium. Result(s): In both groups, concentrations of EE and ENG were similar in uterine tissue taken from the upper myometrium and mid-myometrium and the cervical region. However, compared with the COC group, concentrations of both hormones were markedly lower in tissue samples from the endometrium of women who had been treated with NuvaRing. Conclusion(s): Vaginal administration of hormones with NuvaRing did not produce elevated uterine concentrations of EE and ENG, compared with an oral contraceptive.
摘要：Objective: To determine the response to tamoxifen in a woman with hypogonadotropic hypogonadism induced by hyperprolactinemia resistant to dopamine agonist drugs. Design: Case report. Setting: Academic fertility center. Patient(s): A young woman with persistent amenorrhea, symptomatic hypogonadotropic hypogonadism, and hyperprolactinemia. Intervention(s): Tamoxifen was administered in addition to bromocriptine. Main Outcome Measure(s): Measurements of follicle-stimulating hormone, estradiol, prolactin, and progesterone. Result(s): Recovery of gonadal-hypothalamic-pituitary axis. Conclusion(s): Tamoxifen can revert the effects of chronic hypogonadotropic hypogonadism induced by hyperprolactinemia resistant to dopamine agonists.
摘要：Aim. Comparison of the decision to delivery interval in cases of forceps delivery and in cases of cesarean sections. Material and method. A retrospective analysis was performed on 137 cases of forceps deliver (n = 63) and cesarean section (n = 74) indicated for abnormal fetal heart rhythm. All cases were observed in a level 3 maternity unit between October 2003 and August 2004. Results. The mean decision-to-delivery interval was significantly shorter in the forceps group (14.84min ± 6.54 versus 29.31 min ± 11.79 p < 0.0001). Maternal and neonatal morbidity were comparable. Conclusion. This study suggest that once the fetal head is engaged, forceps delivery can significantly reduced the decision-to-delivery interval.
摘要：Background: Uterine leiomyomas are the commonest tumors of the genital tract. Growth factors seem to be implicated in the development of leiomyoma. Objective: To determine the insulin receptor (IR) tyrosine kinase activity-phosphorylation of exogenous substrate poly(Glu 4: Tyr 1)-and insulin receptor substrate 1 expression in normal myometrium and leiomyoma. Study design: The study group consisted of 12 women with leiomyoma undergoing routine hysterectomy. Samples of leiomyoma and adjacent normal myometrium were obtained at the time of operation. Plasma membrane fractions were prepared and samples were incubated with and without insulin and incubated with exogenous substrate poly(Glu 4: Tyr 1). IRS-1 expression was studied in the whole lysate via Western blotting using specific antibodies. Data were analyzed using Student’s t test. Results: The phosphorylation of the exogenous substrate poly(Glu 4: Tyr 1) in myometrium (1.566 ±0.177) and in leiomyoma (1.98 ±0.612) were similar (P = 0.774). The IRS-1 levels in myometrium(0.190±0.022) and in leiomyoma (0.226 ±0.022) were not different (P = 0.184). Conclusions: There was no difference in IR tyrosine kinase activity (phosphoryla-tion of exogenous substrate) and IRS-1 expression between normal myometrium and leiomyomata. Other steps in the insulin signaling cascade require further study to investigate the role of insulin receptor in leiomyomata.
摘要：Objective: The purpose of this study was to evaluate the outcome of patients with cervical adenocarcinoma and to determine the characteristics and the prognostic factors of this entity. Study design: This retrospective study was done in the Department of Surgical Oncology of the Salah Azaiz Institute of Tunis with 79 cases of invasive adenocarcinoma of the uterine cervix that were collected from 1990 to 1999. Survival was analyzed according to the Kaplan-Meier method. Univariate analysis of prognostic factors was performed with the test of log rank. Cox regression model was used in multivariate analysis of prognostic factors. Results: Mean age was 50 years, and metrorrhagia was mostly revealing in 73%of the cases. Early stages (I, IIa, IIb with 1/3 proximal parametrial invasion) and “pure”type adenocarcinoma were found in 78%and 87%of the cases, respectively. Treatment consisted of a radiosurgical combination in 52 cases; exclusive radiotherapy was practiced with 17 patients. The 5 year-overall and disease-free survival percentages were, respectively, 68%and 72.4%. Poor prognostic factors were age > 50 years, tumor size > 4 cm, advanced stage, tumor grade, and lymph nodes and lymph-vascular space involvement. With the use of multivariate analysis, only stage and lymph node metastases remained significant prognostic factors. Conclusion: This report shows survival and prognostic factors that are similar to those found in previous studies, but unlike the Western countries, our results demonstrate a high rate of early stages and no increase in frequency of cervical adenocarcinoma.
摘要：Primary malignant lymphoma of the ovary is a rare tumor (1,5% of ovarian tumors). Clinically, it occurs as an abdominal mass with pain which can be confused with an epithelial ovary tumor. Most tumors are observed during the fourth decade. Burkitt lymphoma, is sporadic in western countries, usually with abdominal involvement. Diagnosis is guided by biological analysis and imaging. Prognosis depends on medullary and neuromeningeal involvement. Polychemotherapy is required. We report a case of a young woman who developed abdominal Burkitt Lymphoma mimicking advanced-stage bilateral ovarian cancer.
摘要：Objective: This study was undertaken to evaluate the role of secondary cytoreduction in patients with recurrent epithelial ovarian cancer. Study design: Secondarily, cytoreduced patients were retrospectively analyzed with respect to the clinicopathologic variables. Results: A total of 64 patients were evaluated in this report. Multivariable analysis revealed 3 factors to be significant: optimal cytoreduction during primary (P = .003, odds ratio [OR]: 0.30; 95%CI: 0.14-0.66), secondary cytoreduction (P = .04, OR: 0.47; 95%CI: 0.22-0.99), and the endometrioid histologic type (P = .005, OR: 0.09; 95%CI: 0.02-0.48). Intrinsic factors of the tumors (grade, stage, age), size, and number of recurrent tumors were nonsignificant. Conclusion: Secondary cytoreductive surgery should be offered in selected recurrent epithelial ovarian cancer patients. Further prospective randomized series are needed to determine specific recommendations.
摘要：To describe the frequency of maternal and neonatal complications resulting from the use of Thierry’s spatulas. Materials and methods. This retrospective study included 166 patients treated during a 17- month period. Results. For 100% of the patients, the use of the spatulas allowed the extraction of the new born, in 68 cases (41% ) the new born was engaged between one and two centimeters below the spines. A mediolateral episiotomy was performed in 159 patients (96% ). A serious perineal tear (Type 3) occurred for 6 of these patients (3.6% ). A simple perineal tear (Type 1) or vaginal tear occurred in 24 (18% ). Episiotomy was performed in 18 patients and was significantly protective. No case of serious neonatal complication were related to the use of the spatulas. Conclusion. We found that perineal tear rate is similar to that observed with other instruments used for fetal extraction. No case of fetal trauma could be related to the use of the spatulas; this was the goal of Thierry who creation the instrument. The use of Thierry’s spatulas as a reference instrument is warranted, particularly for cases of prematurity, as these spatulas fulfil the modern obstetrics requirements of fetal protection, without maternal risk.
摘要：Objective: To describe the clinical symptoms associated with the diagnosis of pituitary gonadotroph adenoma in premenopausal women. Design: Report of three separate cases. Setting: University medical center. Patient(s): Three patients: a 31-year-old woman with primary infertility, recurrent adnexal masses, and highly elevated estradiol level; a 30-year-old woman with recurrent multicystic ovaries following multiple cystectomies and transvaginal cyst aspirations, and elevated estradiol level; a 43-year-old woman with bilateral complex cystic adnexal masses and an elevated estradiol level, who under-went a total abdominal hysterectomy and bilateral salpingo-oophorectomy for a suspected granulosa cell tumor. Intervention(s): Transsphenoidal resection of a pituitary mass. Main Outcome Measure(s): Serum estradiol, FSH, and LH levels; transvaginal ultrasonography of the ovaries; histologic examination of pituitary tumors. Result(s): Transsphenoidal resection of pituitary adenomas resulted in normalization of serum estradiol and FSH levels and resolution of adnexal masses in two of the women. Conclusion(s): Pituitary gonadotroph adenoma must be considered in the differential diagnosis in reproductive-aged women presenting with the clinical symptom triad of new onset oligomenorrhea, bilateral cystic adnexal masses, and elevated estradiol and FSH levels with suppressed levels of LH; timely diagnosis may prevent unnecessary and potentially damaging surgical procedures.
摘要：Objective. To determine whether perioperative packed red blood cell (PRBC) and fresh frozen plasma (FFP) transfusions during ovarian, tubal, or peritoneal cancer surgery increase the risk of symptomatic postoperative venous thromboembolism (VTE) and adversely affect overall survival. Methods. We conducted a retrospective review of all cases of surgical exploration for resection of stage IIIC-IV adnexal/peritoneal cancer between November 1998 and May 2002 at Memorial Sloan-Kettering Cancer Center. Patients with a history of prior or active preoperative VTE were excluded. Routine intraoperative and postoperative VTE prophylaxis including lower extremity external pneumatic compression with or without postoperative subcutaneous heparin was utilized in all cases. Symptomatic postoperative VTE was diagnosed by lower extremity Doppler or computerized tomography (excluding cases with only ovarian vein thrombosis). Clinical parameters were examined by a logistic regression analysis to identify independent prognostic predictors of postoperative symptomatic VTE, which occurred within 30 days of surgery. Survival was calculated using the Kaplan-Meier method. Results. In all, 174 patients underwent exploratory surgery, and 6 (3.4%) were excluded due to active or prior history of VTE. Of the remaining 168 patients, 71 (42%) received at least one perioperative transfusion of PRBC or FFP. Postoperative VTE was documented in 5 of 46 (11%) patients who received a postoperative transfusion compared to 3 of 122 (2.5%) patients who did not (P = 0.04; odds ratio, 4.8); moreover, VTE was noted in 3:16 (19%)patients who received postoperative FFP compared to 5:152 (3.3%) patients who did not (P = 0.01, odds ratio of 6.78). Age, stage, body mass index, length of the operation, blood loss, presence of ascites, volume of ascites, residual disease status, preoperative hemoglobin level and coagulation profile were not associated with increased risk for VTE. When survival results were stratified by transfusion utilization and controlling for optimal debulking status, perioperative transfusions had no apparent effect on overall survival. Conclusion. In women with stage IIIC-V disease, postoperative blood product transfusions particularly FFP were associated with increased risk of DVT and PE, but transfusions had no impact on overall survival.
摘要：Background.: Bevacizumab has demonstrated activity against a variety of solid tumors, including ovarian carcinoma. However, there have not been reproducible prognostic features associated with its activity. Cases.: One patient each with recurrent, refractory well-differentiated serous-endometrioid ovarian carcinoma, micropapillary serous carcinoma of the ovary, and primary peritoneal micropapillary serous carcinoma were treated with single agent bevacizumab(15 mg/m2 intravenously every 3 weeks). All three have had dramatic sustained responses of 15, 15, and 22 months’duration. Conclusion.: Bevacizumab may have significant activity against well-differentiated ovarian carcinoma and micropapillary serous carcinomas of the ovary or peritoneum. Since these tumors are generally indolent and not responsive to adjuvant therapy, further investigation is warranted.
摘要：Description of acute per-partum feto-fetal transfusion. The risk of twin-twin transfusion syndrome in monochorionic twin pregnancies is well known. This pathology starts in the second trimester and has a chronic course. Acute per-partum feto-fetal transfusion seems to be less frequent and has not been studied. In the study, we described two cases of acute per-partum fetofetal transfusion. The outcomes of the pregnancies were as follows: following a successful delivery, the first set of twins presented hypovolemic shock at birth due to an acute anemia. The second set of twins was polyglobulic, but otherwise healthy at birth. The risk of hypovolemic shock seems to be unpredictable, even if the pregnancy is monitored. Obstetricians and pediatricians must keep this pathology in mind when dealing with this kind of pregnancy. Moreover, it would be interesting to obtain systematically a full blood count of each set of twins of monochorionic pregnancies, in order to detect every case of feto-oetal transfusion.
