OBJECTIVE:To describe the clinical features of papillary serous carcinoma of the peritoneum followed by a short review of the literature.METHODS:From January 1986 to May 1994, six patients with papillary serous carcinoma of the peritoneum were treated at our institution. Their presenting features, sites of disease at the time of staging laparotomy, subsequent treatment and follow-up were reviewed.RESULTS:The mean age was 53.3 years (range 46-59). The most common presenting features were abdominal pain, distention and the presence of ascites. Common sites of disease at the time of laparotomy were the peritoneal and subdiaphragmatic surfaces, omentum, serosa of bowel and superficial involvement of the ovaries. Patients were treated with cytoreductive surgery and platinum-based chemotherapy.CONCLUSION:Although experience is scant and more data is needed, for the time being, management for primary peritoneal carcinoma is as for ovarian cancer.
OBJECTIVE:To compare LeukoSorb filtration with Percoll centrifugation in preparing sperm.METHODS:Each of 26 human seminal specimens were analyzed before and after two preparation methods.RESULTS:In normospermic specimens (n = 11), LeukoSorb produced higher results than Percoll did with regard to mean percentage of motility (72.7% vs 59.2%), total swollen sperm in a hypo-osmotic swelling test (84.8% vs 59.0%), (g)-type swollen sperm (37.8% vs 23.4%) and tail abnormality (20.4% vs 10.1%). In asthenospermic specimens (n = 15), LeukoSorb produced higher results than Percoll did with regard to mean percentage of motile sperm recovery (22.2% vs 10.1%), motility (46.9% vs 23.2%), viability (75.6% vs 54.7%), total swollen sperm (84.8% vs 59.0%) and tail abnormality (42.2% vs 24.3%), although the mean percentage of head abnormality was lower with LeukoSorb than with Percoll (30.6% vs 40.2%) vs 40.2%). In pyospermic specimens (n = 10), the mean concentration of round cells after LeukoSorb decreased significantly more than with Percoll (p = 0.029). The filtration time correlated with the total sperm concentration.CONCLUSION:LeukoSorb filtration is useful for preparing asthenospermic and pyospermic seminal specimens.
OBJECTIVE:To determine the distributions of the duration of postpartum breastfeeding, amenorrhoea, and contraceptive use, a community-based epidemiological investigation was carried out in Pengxian County, Southwest China in March 1992.METHODS:1,040 women who had given live births during the reference period were interviewed. A current-status life table analysis was used.RESULTS:At 1 month postpartum, 100% infants were breastfed, at 6 months 95%, and at 12 months 82%. The level of amenorrhoea at 1 month postpartum was 90%, at 3 months 74%, at 6 months 62%, and at 12 months 36%. Contraceptive use was initiated at the second month postpartum with 19% of users, at 6 months 48%, and at 12 months 91%.CONCLUSION:The results indicate that at population level advising women to begin using contraceptives in 3 months postpartum is fairly reasonable, and the non-medicated IUD is recommended to be the first choice for the lactating women.
In the 3 cases of intravenous leiomyomatosis presented here, the retroperitoneal, pelvic, and vaginal veins were completely removed. Two of the cases were diagnosed by a gynecologist at surgery, and 1 was diagnosed by the pathologist performing a histological examination on excised tissue. These 3 cases were asymptomatic in spite of the intravenous invasive leiomyomatosis.
A case of twin pregnancy with complete and partial molar disease is presented. Aspects of diagnosis, ploidy studies and management are discussed.
OBJECTIVES:This study was to investigate the adjunctive diagnostic utility of HPV fusion proteins from the sera in the patients with cervical neoplasia. Immunologic researches on host factors in HPV infection could contribute to better understanding of patho-physiologic mechanisms of cervical carcinogenesis, and provide valuable information for HPV vaccine development.METHODS:Prevalence of antibodies against human papillomavirus (HPV) in sera of the patients with carcinoma (n = 81), precancers (n = 25) of uterine cervix and normal controls (n = 40) in Korean women were investigated by Western blot immunoassay using partially purified TrpE fusion recombinant proteins for HPV-6b and HPV-16.RESULTS:In 81 patients with cervical cancer, 15 (19%) and 54 (67%) patients were positive for antibodies to at least one of the tested recombinant proteins related to HPV-6b or HPV-16, respectively. And in 25 patients with HPV-related squamous intraepithelial lesion (SIL) of cervix, 10 were positive for at least one of the tested antibodies for HPV-6b gene products (40%) and 11 were positive for HPV-16 related antibodies (44%). The prevalence rates of antibodies for HPV-6b in the sera of SIL patients were significantly higher than those from the sera of cervical cancer patients (p < 0.05). There was an inverse correlation between increasing the positivity against HPV-16 E6 protein and progression of cervical lesions, but there was no significant correlation between the positivities of the other antibodies to HPV-16 and the severity of disease.CONCLUSION:These results suggest that the recombinant proteins related to HPV-6b and HPV-16 could be useful in evaluation of the patients with HPV-related cervical lesions and these might play an adjunctive role in diagnosis and management of cervical neoplasia.
OBJECTIVE:Preoperative CT or MRI findings were compared with the results of staging the laparotomy to evaluate the accuracy of CT or MRI for detecting pelvic and para-aortic lymph-node metastases.METHODS:In evaluating CTs in 95 ovarian carcinomas, we examined plain and contrast images made in 1- to 1.5-cm-thick slices from the pubis to the xiphoid process. Lymph nodes 1.5 cm or larger were considered to be positive. MRIs of 60 uterine corpus carcinomas utilized T1-weighted contrast, T2-weighted, and short-inversion time inversion-recovery (STIR) images.RESULTS:CT had a sensitivity of 60.9% and a specificity of 93.1%. The positive and negative predictive values were 73.7% and 88.2%, respectively. The diagnostic accuracy of CT for detecting para-aortic lymph-node metastases exceeded that for pelvic node metastases. The results of MRI indicated that the T1-weighted image and STIR image were the most accurate in identifying metastatic nodes.CONCLUSIONS:These results indicate that the most practical approach might be to search for enlarged lymph nodes by CT, and to follow-up with MRI when CT scans are questionable.
OBJECTIVE:To compare early oral hydration versus the conventional intravenous fluid replacement after elective cesarean section. METHODS:Two hundred women performed elective cesarean section were selected and randomized to: Regimen I (n = 100): early oral hydration (sips of fruit juices sweetened with honey once the women felt thirst immediately after the operation, then solid food 24 hours later, the amounts of juice or food were determined by the patient herself, i.e. she would regulate her physiological needs) versus regimen II (n = 100): conventional intravenous hydration (2-3 L of dextrose saline/24 hours and solid food thereafter). Biochemical, metabolic values, postoperative nausea and vomiting, propulsive bowel movements, tolerance of solid food, hospital stay and successful continuation of breast feeding were compared in both groups. RESULTS:The two regimens were equally effective in maintaining fluid balance and normal plasma and urinary electrolytes without any observed differences in biochemical or metabolic values. The return of bowel sounds, first occurrence of flatus and tolerance of solid food were achieved in regimen I at time periods significantly shorter than those attained with regimen II (p < 0.0001). The incidence of nausea and vomiting, ileus and deep vein thrombosis was higher in regimen II than in regimen I but the difference is statistically insignificant (p > 0.05). Patients in regimen II were hospitalized for significantly longer times than those on regimen I (p < 0.0001). Successful continuation of breast feeding was significantly more in regimen I than in regimen II (p < 0.01). CONCLUSION:Early oral hydration after elective cesarean section effectively maintained fluid balance and it was associated with rapid return of propulsive bowel movements, successful breast feeding, less side effects and shorter hospital stay than the conventional intravenous hydration. So, it should be used in most cases after elective cesarean section.
Premature ovarian failure (POF) may be caused by a variety of factors that result in the depletion of responsive ovarian follicles. There is a increasing body of evidence that suggests an autoimmune etiology in some POF patients. Data in support of an autoimmune etiology include: (1) lymphocytic and plasma cell infiltration of the ovary and alteration of T cell subsets; (2) circulating autoantibodies to ovarian antigens; (3) association with other "autoimmune" disorders; (4) recovery of ovarian function after regression of autoimmune status. The mechanism for ovarian autoimmunity is unknown. Genetic or environmental factor might be involved in the stimuli inducing immune response. The possibility that major histocompatibility complex antigen and cytokines are implicated in human autoimmune POF has been proposed. The relative contribution of cell-mediated immunity and antibody-mediated immunity remains obscure in animal models and in POF patients. Currently, in vitro fertilization and/or gamete intrafallopian transfer with donated oocytes are the best therapeutic options to achieve pregnancy although ovulation induction and immunosuppressive treatment might be used in approved experimental protocols. A newly developed double bridged enzyme linked immunosorbent assay (ELISA) might be useful in screening POF patients to identify those for whom temporary treatments may improve fertility.
OBJECTIVE:Investigation of human oocyte chromosomes that fail to fertilize may provide data essential to the assessment of reproductive failure. In view of this, 121 uncleaved human oocytes were analyzed cytogenetically to assess the type and frequency of chromosomal abnormality. METHODS:Oocyte recovery was done from patients undergoing in vitro fertilization (IVE) procedures. Then, these oocytes were preincubated and inseminated in vitro. Karyotyping was attempted in 121 oocytes lacking signs fertilization 50 h after insemination. RESULTS:Sixty-nine oocytes were adequately karyotyped. The overall frequency of chromosomal aberration was 47.6%. Amongst these, 34.8% were aneuploidy, the frequency of which was significantly higher (p < 0.05) in patients > 35 years of age. Diploidy and hyperploidy was noted in 7.2% and 2.8% respectively. Translocation were noted in 2.8% and in 18.8% of human oocytes sperm chromosome condensation appeared prematurely in the G1 phase. No correlation was a found between specific chromosomal aberrations and type of fertility, stimulation treatment or gonadotropin levels. CONCLUSION:The high rate of chromosomal disorders (47.6%) in human oocytes may contribute significantly towards their failure to fertilize in vitro.
Patient presented with an acute abdomen at 18 weeks gestation. Ultrasound and CT scan confirmed single extra uterine gestation. Considering the maternal hazards associated with surgical removal of viable abdominal pregnancy feticide was performed with ultrasound guided intracardial injection of KCl solution. Ten days after the procedure successful removal of pregnancy was achieved with no intra or post operative complications.
OBJECTIVE:To explore the clinical utility of measuring atrial natriuretic peptide (ANP) in the second and early third trimesters of pregnancy in order to predict pregnancy induced hypertension (PIH).METHODS AND MATERIALS:The study was done in a University Teaching Hospital. A prospective study of 200 women in their first pregnancy was conducted. ANP was measured at 2 gestational windows, 20-26 weeks and 30-34 weeks. This was correlated with pregnancy outcomes, in particular PIH. Student's t-test was used to compare ANP levels between women who developed PIH and those who did not. The receiver operator curve (ROC) was used to determine its clinical utility.RESULTS:ANP levels were lower at 20-26 weeks in women who subsequently developed PIH but there was no significant difference at 30-34 weeks between women who had normotensive pregnancies and those who later developed PIH. The character of the ROC would indicate that it is not useful for prediction.CONCLUSION:ANP levels in the second and early third trimesters has limited clinical utility for the prediction of PIH.
OBJECTIVE:Several studies have suggested that nausea and vomiting in early pregnancy are related to the levels of thyroid hormones and human chorionic gonadotropin (hCG). To ascertain this relationship, we investigated 60 pregnant women (30 subjects each with morning sickness and hyperemesis gravidarum) and compared them with 30 control subjects (by enzyme immunoassay method).METHODS:Serum T3, T4 and TSH were determined in all the subjects while serum hCG was assayed in pregnant women only. Group comparison was done by applying Student's t-test and the relationship between various parameters was evaluated by calculating coefficient of correlation, "r".RESULTS:Serum T4 and hCG levels were significantly increased in hyperemesis gravidarum while TSH demonstrated a significant decline in the same group. Correlation analysis showed a direct relationship between serum T4 and hCG and an inverse relationship between serum TSH and hCG in pregnancy with morning sickness.CONCLUSION:Our results are suggestive of the involvement of these variables in the pathogenesis of morning sickness and hyperemesis gravidarum not only because their levels were significantly altered but the extent of increase or decrease in their level correlated well with the severity of symptoms in the study subjects.
Anatomic disproportion gains an increasing interest in obstetrics. Imaging procedures (radiologic pelvimetry, computed or magnetic resonance imaging (MRI) fail to reflect the dynamics of delivery including deformations of the birth channel as well as of fetal structures. To validate findings of imaging procedures in this respect a method has been developed to perform a dynamic, biomechanical postprocessing of the static informations obtained from MRI. Using an especially developed software MRI pixel matrices of maternal pelvis and fetal head were color-codef1p4d--according to the principle of same density--line data were created. After sectional attribution of the resulting polygones a three-dimensional mesh of so called Finite elements (FE) was created, which then can be used for deformation analysis. Fetal head was then moved through the birth channel by means of computed simulation. This allows not only ongoing deformations to be visualized but also resulting forces to be calculated for at any time of the delivery process for any point of the anatomical model. Performing these simulations assuming various anatomic and physiologic conditions an obstetrical-biomechanical data basis could be obtained, that was implemented in a PC-based expert system. This allows interpretation of pelvimetric data with regard to birth dynamics.
For the purpose of determining an objective indicator of bacterial vaginosis (BV), we tried to detect and to identify amines in the vaginal fluid of patients by using the dansyl method (to detect amine in a solution of water). Bacteria isolated from these patients were also analyzed. 1) In BV (n: 32) 7 kinds of amines were detected; and the positive rate of detection of the dansyl method was 90.6%. No specific bacteria was found in BV. 2) The positive rate was 80.0% for the patients with trichomonas vaginitis (n: 5). 3) The positive rate of detection was 20.0% in the candida group (n: 5), and 28.6% in the control group (n: 14). Those amines detected in other than BV-related vaginitis are presumed not to vaporize. For purposes of diagnosis, it would be better to detect vaporized amines instead of detecting amines dissolved in vaginal fluid.
OBJECTIVES:To investigate the localization of manganese superoxide dismutase (Mn-SOD) and copper-zinc superoxide dismutase (Cu, Zn-SOD) in the human ovary and fallopian tube, and to examine the role of superoxide radicals and SODs in the human ovulatory process.METHODS:Using immunohistochemical methods, we studied the localization of SODs in 22 human ovaries, in 18 fallopian tubes, and in aspirated granulosa cells. We measured, by enzyme-linked immunosorbent assay, the concentrations of SODs in follicular fluid taken from 94 IVF patients.RESULTS:Mn-SOD was found in granulosa, in theca and luteal cells and in fallopian tubes. Cu, Zn-SOD was localized in theca and luteal cells. The concentration of Cu, Zn-SOD in follicular fluid in the high-progesterone group (11.3 + 4.2 ng/ml) was significantly less than in the low-progesterone group (24.5 + 19.5) (p < 0.05).CONCLUSION:Mn-SOD and Cu, Zn-SOD have different localizations and actions in human ovaries and fallopian tubes. The superoxide radical-SOD system might play an important role in ovulation and in the luteal function of the human ovary.
OBJECTIVES:This study was performed to investigate whether the TXA2 synthase inhibitor, ozagrel, was effective in the treatment and prevention of pre-eclampsia.STUDY DESIGN:Ozagrel was administrated therapeutically to 4 severely pre-eclamptic women, and prophylactically to 5 pregnant women with histories of severe preeclampsia and complications.RESULTS:The therapeutic administration (TA) of ozagrel improved hypertension and proteinuria. Two patients delivered appropriate-for-date (AFD) infants, whereas the other 2 patients delivered light-for-date (LFD) infants. Mean plasma concentrations of TXB2 (plasma TXB2) decreased, whereas plasma 6-keto PGF1 alpha were almost unchanged. The prophylactic administration (PA) of ozagrel prevented the occurrence of preeclampsia in 3 of the 5 patients. All delivered AFD infants. The duration of pregnancy was prolonged more than that of previous pregnancies in all patients. Plasma TXB2 decreased, whereas plasma 6-keto PGF1 alpha increased.CONCLUSIONS:PA prevented preeclampsia and intrauterine growth retardation, whereas TA improved only maternal symptoms. These results might justify a large prospective study to determine whether ozagrel is an effective prophylactic.
OBJECTIVE:To assess the infectious morbidity associated with prelabour rupture of membranes (PROM) to delivery interval, and the incidence of maternal and neonatal infection in a population managed by either immediate stimulation or by overnight conservatism. METHOD:A retrospective study of 117 women admitted with PROM to the labour ward in the National University Hospital, Singapore, in the period between June 1990 and May 1991, and who were managed by immediate stimulation or by stimulation after overnight conservatism. Statistical analysis was performed using Chi-square and Student's t-test. RESULTS:More than one third of infants whose mothers had ruptured membranes for > 48 hrs had signs of neonatal infection, compared with an incidence of 8.8% and 8.9%, respectively for those with an interval of < 12 hrs and 12-24 hrs between PROM to delivery. Group B streptococcal infection was a major cause of neonatal infectious morbidity. Clinical evidence of maternal infection occurred in 3 of the 117 women; these patients had an interval between rupture of membranes and delivery of between 24-76 hrs. CONCLUSIONS:Prolongation of PROM to delivery interval for > 48 hrs increases the incidence of infection. Conservative policy of management of PROM at term should aim to deliver the babies < 48 hrs after PROM. The difference in maternal and neonatal infection rates were not significant in the group treated with a policy of overnight conservatism compared with the group in whom labour was stimulated immediately on admission.
The purpose of the present study was to clarify the mechanism of the stimulatory effect of melatonin on the secretion of prolactin.Determination was made of the levels of dopamine (DA), 3,4-dihydroxyphenlacetic acid (DOPAC), serotonin (5-HT), and 5-hydroxyindoleacetic acid (5-HIAA) in the median eminence of rats following intravenous melatonin (100 micrograms) administration.Administration of 100 micrograms of melatonin to rats resulted in a significant increase in prolactin secretion (p < 0.01, analysis of variance). Administration of melatonin also resulted in significant decreases in the DOPAC content (p < 0.05) and in the DOPAC/DA ratio (p , 0.05) in the median eminence 1 hour after melatonin administration, at which time serum prolactin was maximal. However, no significant changes were detected in the content of 5-HT or 5-HIAA or in the 5-HIAA/5-HT ratio in the median eminence.These results suggest that the stimulatory effect of melatonin on the secretion of prolactin might be mediated by dopaminergic mechanisms.
A case is reported of a 51-year-old woman who had a hysterectomy and bilateral salpingo-oophorectomy in the same year, following a radical mastoidectomy for breast cancer with metastases to the axillary lymph nodes. Histological examination showed breast cancer metastatic to uterine leiomyoma. The literature about metastasis of extragenital cancer to a leiomyoma is reviewed, and the possible mechanism involved is discussed.
