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PubMed1978

Carcinogenicity of saccharin.

Saccharin is carcinogenic for the urinary bladder in rats and mice, and most likely is carcinogenic in human beings. The neoplasms of the urinary bladder are malignant and invade and metastasize. Male rats are more susceptible to urinary bladder carcinogenesis than female rats. Rats exposed as fetuses develop neoplasms more readily than rats exposed as weanlings. The lesions in the urinary bladder go through the stages of hyperplasia, hyperplastic nodules, and later carcinomas. The male of the human species ingesting saccharin, as for rats, is more susceptible to carcinogenesis of the urinary bladder than the female. Neoplasms of the urinary bladder in rats were not caused by stones, parasites, sodium, or impurities. There is a cocarcinogenic effect between saccharin and methylnitrosurea for the urinary bladder. Even through carcinomas of the urinary bladder are present in rats given the higher doses of saccharin, one was observed in a female rat given 0.5%. Chronic renal disease develops in rats ingesting saccharin. The disease is more advanced at the lower doses than at the higher doses, suggesting that saccharin at the lower doses does not reach the urinary bladder. Early neoplasms are seen in the renal pelvis of rats given the higher doses of saccharin. The risk ratios for urinary bladder carcinomas in human beings increase with both frequency andduration of saccharin usage. Benign and malignant neoplasms at all sites are significantly increased in mice and rats ingesting the higher doses of saccharin. These neoplasms are present in the reproductive and hematopoietic systems, and to a lesser extent in the lungs, vascular system and squamous epithelium. Neoplasms in some organs develop with the lower doses of saccharin. Lymphosarcomas of the lung are significantly increased in rats given 0.01% saccharin. Chronic renal disease in rats given saccharin interferes with the health and life span and consequently with development of neoplasms. Saccharin initiates neoplasms of the skin when its application is followed by croton oil. Epidemiological studies have not been done for neoplasms other than the urinary bladder in human beings.

Animals↗
PubMed1989

Magnetic resonance imaging of the abdomen and pelvis. Council on Scientific Affairs.

Magnetic resonance imaging (MRI) of the abdomen presents greater inherent difficulties than other anatomic regions. However, new techniques now allow imaging comparable in quality to computed tomography (CT). Magnetic resonance imaging offers the advantages of greater tissue contrast, multiplanar imaging, and lack of ionizing radiation or risk of toxic reactions from iodinated contrast media. Its use remains limited by high cost, limited availability, lack of a bowel contrast agent, and long imaging time, which some patients cannot tolerate. In many areas of abdominal imaging, MRI is now comparable to CT, but because of the greater availability and lesser cost, CT remains the procedure of choice. Magnetic resonance imaging is more accurate for staging neoplasms of the liver, adrenal glands, kidneys, bladder, prostate, uterus, and cervix and may aid in diagnosis of hepatic, adrenal, and uterine masses. In selected patients, especially those in whom CT is inconclusive or those who cannot tolerate iodinated contrast material, MRI can provide valuable information. Development of faster scanning techniques and MRI contrast agents and wider availability will probably increase the usefulness of abdominal MRI. At this time, MRI complements other abdominal imaging procedures. In a small number of patients, however, it can provide unique information in a virtually risk-free manner.

Abdominal Neoplasms↗
PubMed1996

Laparoscopic unilateral ovarian transposition prior to irradiation: prospective study of 20 cases.

BACKGROUND: The objective of this study was to evaluate the feasibility, morbidity, and efficacy of unilateral laparoscopic ovarian transposition on the preservation of hormonal function in premenopausal patients requiring pelvic irradiation (external and/or intracavity by brachytherapy). METHODS: This prospective study was based on 20 patients: 17 presenting with cervical cancer, 2 with Hodgkin's disease, and 1 with ependymoma of the cauda equina. The operative technique consisted of releasing the right ovary from its pelvic attachments, and placing it as high and as laterally as possible in the right paracolic gutter, after creating a pedicle on the infundibulopelvic ligament. The follow-up of ovarian function was more than 1 year for 14 patients. RESULTS: The therapeutic protocol was not modified as a result of ovarian transposition. No intraoperative or postoperative complications were observed. The mean dose of irradiation received by the transposed ovary was 1.75 gray (Gy) (range 0.4-3.7). Mean follow-up was 2 years. Two cases of menopause (14.7%), in the only 2 patients older than 40 years, were observed among the 14 patients followed for more than 1 year. The success rate was 100% for patients younger than age 40 years. CONCLUSIONS: Laparoscopic ovarian transposition is a simple and reliable method, which does not complicate subsequent therapeutic protocol. Its short term efficiency is comparable to results obtained by laparotomy, with a lesser morbidity. Although long term evaluation is necessary, laparoscopic surgery should be considered as an alternative to laparotomy for ovarian transposition.

Adult↗
PubMedDate not supplied

[Regional perfusion and oxygenation in the early resuscitation period following prolonged clinical death].

Cardiac output distribution and oxygen supply in the period starting from 15 min after resuscitation to 7 h were studied in 23 dogs exposed to 10 min clinical death caused by blood loss. The ratio of supra- to subdiaphragmatic bloodstream was virtually unchanged. Redistribution of the flow in favor of hind limb muscles was observed in the subdiaphragmatic region only between the 15th and 30th minutes. Reduction of oxygen transport during prolonged hypoperfusion (2-6 h) was associated with increased oxygen utilization in all areas which was expressed most of all in the supra-diaphragmatic region and in limb tissues and the least so in the splanchnic area, with oxygen consumption remaining at the initial level or surpassing it. A close relationship was revealed between oxygen transport and consumption in the supradiaphragmatic sector and posterior limb tissues combined with critical levels of pO2 and HbO2 in outflowing blood. Stably surviving animals differed from those dead in 1 sec by a lesser depression of the bloodstream and oxygen transport in the body on the whole and in the supradiaphragmatic region, a lesser oxygen consumption by the supradiaphragmatic region at the 15th-30th minutes, and a higher O2 consumption in 3-6 h under conditions of more marked spontaneous hypothermia.

Animals↗
PubMed1997

CT appearances of involvement of the peritoneum, mesentery and omentum in Wilms' tumor.

BACKGROUND: Peritoneal involvement by Wilms' tumor indicates stage III disease. CT is the single preferred modality in determining the extent and staging of Wilms' tumor; however, the CT appearances of Wilms' tumor involvement of the peritoneum have not been specifically addressed in the literature. OBJECTIVE: The objective of this study was to demonstrate the CT manifestations when there is involvement of the peritoneum, mesentery and/or omentum in Wilms' tumor. MATERIALS AND METHODS: Four cases of Wilms' tumor form the basis of this report. They were examined on Elscint CT scanners. RESULTS: Masses ("dropped metastases") in the pelvis were present in all four patients. Three patients had masses in the mesentery of the small bowel and sigmoid colon. Infiltration of the greater omentum was identified in two patients as a mantle of tumor separating bowel from the anterior abdominal wall. Ascites was present in two patients. In one patient broad-based solid masses of varying sizes were noted on the parietal and on the visceral surfaces of the peritoneum, and in a different patient a discrete mass was noted in the lesser omentum. CONCLUSION: The peritoneal spaces, recesses, ligaments and folds are invisible unless invaded by disease which is well demonstrated on CT.

Child↗
PubMedDate not supplied

Anatomy of the iliolumbar ligament: a review of its anatomy and a magnetic resonance study.

Data of the postmortem studies of the iliolumbar ligament are controversial because of the number, complexity, and variability of the structures present in the lumbosacral region. The objective of this work was to study the anatomy of the iliolumbar ligament to resolve some clinical problems: (1) do anatomic bases exist that can explain the lumbar painful syndrome termed "iliolumbar syndrome?" (2) do iliolumbar ligament varieties exist that can influence lumbosacral joint stability? Magnetic resonance was used to analyze the anatomic structure of the iliolumbar ligament of live human beings. Thirty iliolumbar ligaments of 15 volunteers were analyzed with magnetic resonance. The images were acquired along the transversal and coronal planes (respectively, superoinferior and anteroposterior). The portion of the iliolumbar ligament originating from the L-5 transverse process is made up of two bands (anterior and posterior). The anterior band is broad and flat and has two different anatomic varieties. Type 1 originates from the anterior aspect of the inferolateral portion of the L-5 transverse process and fans out widely before inserting on the anterior portion of the iliac tuberosity. Type 2 originates anteriorly, laterally, and posteriorly from inferolateral aspect of the L-5 transverse process and fans out before inserting on the anterior portion of the iliac tuberosity. The posterior band of the iliolumbar ligament originates from the apex of the L-5 transverse process and is fusiform. Just before inserting on the anterior margin and apex of the iliac crest it widens, assuming the aspect of a small cone. On the transaxial plane, the anterior band of the iliolumbar ligament was placed along the horizontal line passing through the transverse processes, whereas the posterior band formed an angle of approximately 45 to 55 degrees opened posterolaterally with this line. On the coronal plane, the spatial disposition of the iliolumbar ligament varies greatly with the size of the L-5 vertebra and its position in the pelvis: (1) when L-5 is situated low in the pelvis, the bands of the iliolumbar ligament are longer and oblique; (2) when L-5 is situated high in the pelvis, the bands of the iliolumbar ligament are shorter and horizontal. The insertion manner of iliolumbar ligament posterior band in the iliac crest allows us to confirm the possibility of existence of the lumbar painful syndrome termed iliolumbar syndrome and confirms the possibility of examining its insertional site manually. Being accessible manually, various drugs can be injected directly into it or deep friction can be applied. This posterior band is thinner than the anterior, with a smaller insertional base on the iliac crest, which explains its lesser resistance to torsional overloading and also explains the frequency of this painful syndrome. It is probable that the spatial disposition of the iliolumbar ligament influences its antitorsional role. Further anatomic and biomechanic studies are needed.

Adult↗
PubMed2004

Smooth muscle tumors of the ovary: a clinicopathologic study of 54 cases emphasizing prognostic criteria, histologic variants, and differential diagnosis.

We studied 54 ovarian smooth muscle tumors with an emphasis on histologic criteria for malignancy. Twenty-two leiomyomas were identified, including 7 typical, 11 cellular, 2 mitotically active, 1 with bizarre nuclei, and 1 myxoid. Follow-up ranging from 12 to 240 months (mean, 77.6 months) was available for 14 patients; all were alive with no evidence of disease. Of 26 leiomyosarcomas, including 2 myxoid leiomyosarcomas, most were readily diagnosed by the presence of at least two of the following: moderate or severe cytologic atypia, mitotic rate > or =10 mitotic figures per 10 high power fields, and tumor cell necrosis. Some cytologically atypical tumors demonstrated lesser mitotic activity of 5 to 9 mitotic figures per 10 high power fields, in the absence of tumor cell necrosis. Sixty percent of these were clinically malignant, supporting a diagnosis of leiomyosarcoma in such tumors. Follow-up was available for 21 patients. Seventy-one percent developed recurrent disease at a mean of 19 months, and 62% died of their disease at a mean of 24 months. Four tumors were deemed of uncertain malignant potential, and two that were stage II both recurred in the pelvis. One case of ovarian intravenous leiomyomatosis had a benign outcome at 42 months, as did one case of ovarian leiomyoma with leiomyomatosis peritonealis disseminata at 180 months. Overall, ovarian smooth muscle tumors encompass the same varied histologic spectrum as their uterine counterparts. The main tumors in the differential diagnosis are those in the fibroma/thecoma category, spindle cell carcinomas, and metastatic gastrointestinal stromal tumors.

Adolescent↗
PubMed1978

[Myopathy (terminology, clinical picture, and diagnosis)].

The paper deals with a description of the clinical picture and diagnosis of the main types of myodystrophies taking into account formes of muscular damages and a trend of generalization of a pathological process at the early phase of the disease. The clinical picture of endocrine myopathies was also studied. The authors revealed almost the same formula of muscular damages. Muscles of the pelvic girdle and femurs mainly suffered and to a lesser degree--muscles of the shoulder girdle and shoulders. According to the data of the clinical picture, histopathology and electromyography endocrinic myopathies are phenocopies of hereditary myodystrophies.

Adolescent↗
PubMed2000

Extrapulmonary lymphangioleiomyomatosis (LAM): clinicopathologic features in 22 cases.

We describe the lesions of extrapulmonary lymphangioleiomyomatosis (LAM) affecting the lymph nodes of the mediastinum and retroperitoneum in 22 women (mean age +/- SD, 42.4+/-10.5 years). In most of these patients, the diagnosis of extrapulmonary LAM preceded that of pulmonary LAM, usually by 1 to 2 years. Eleven patients had distinct symptoms, including chylous pleural effusion and/or ascites, abdominal pain, and palpable abdominal masses. In the other 11 patients, the masses caused no symptoms. Well-circumscribed, encapsulated masses, measuring up to 20 cm in size, occurred in the mediastinum in 2 patients, the upper retroperitoneum in 15, extensive areas of the retroperitoneum in 2, and the pelvis in 3. The masses exceeding 3 cm in diameter contained large, multiple cysts filled with yellow-tan chylous fluid. Histologically, the masses were characterized by a proliferation of smooth muscle cells (LAM cells) arranged in fascicular, trabecular, and papillary patterns, which were associated with slit-like vascular channels. The LAM cells varied from small, spindle-shaped cells to large epithelioid cells. Immunohistochemical studies showed a strong reactivity of most LAM cells for alpha-smooth muscle actin and smooth muscle myosin heavy chain and a weak to moderate reactivity of a lesser number of cells for desmin and nonmuscle myosin heavy chain II-B. A reaction for HMB-45 and estrogen and progesterone receptors was observed mainly in epithelioid LAM cells. These patterns of reactivity are similar to those observed in pulmonary LAM. However, the chylous cysts are not a feature of pulmonary LAM and are thought to result from obstruction of lymphatics.

Actins↗
PubMed1996

Hysterectomy in invasive cervical cancer: a national patterns of care study of the American College of Surgeons.

BACKGROUND: As the use of Papanicolaou cytologic screening became widespread in the United States of America, there was a shift toward diagnosis of earlier clinical stages in patients with carcinoma of the cervix. This increase in early stage disease has also resulted in increased use of surgery as the primary treatment. Thus, it seems appropriate to investigate the role of hysterectomy in the modern treatment of patients with invasive carcinoma of the cervix, including survival rates and the role of the gynecologic oncologist. STUDY DESIGN: Approximately 1,800 hospitals were sent invitations to submit data on a standard collection form designed by a multidisciplinary committee of specialists. Cancer registrars at 703 hospitals submitted anonymous data on 11,721 patients with carcinoma of the cervix who were diagnosed or treated, or both, in 1984 and 1990. RESULTS: There were 6,570 (56.1 percent) women who had major operations. An operation with curative intent, either total hysterectomy (TAH) or radical type II or III hysterectomy with pelvic node dissection PND (RHPND), was carried out in 5,105 (43.6 percent) women, constituting 38.9 percent of the patients in 1984, and 48.2 percent of the patients in 1990. Overall (both years), 66.5 percent of patients had squamous cell carcinomas and 21.1 percent had adenocarcinomas. The type of operation performed was judged appropriate in 95.6 percent of the patients who underwent RHPND, but in only 80.0 percent of the patients who underwent TAH. Gynecologic oncologists performed 46.8 percent of the hysterectomies in 1984, and 63.8 percent in 1990. Recurrence and long-term survival data are available for the 1984 patients; five-year survival rates for women who underwent TAH (n = 1,013) and RHPND (n = 1,279) were 89 and 85 percent, respectively. A RHPND with negative nodes resulted in a 90 percent five-year survival rate (n = 916) as compared to 70 percent in those with positive nodes (n = 194). CONCLUSIONS: The use of hysterectomy as definitive therapy increased markedly from 1984 to 1990 and was associated with low complication and high five-year survival rates. Gynecologic oncologists now perform the majority of hysterectomies for this type of carcinoma, with general gynecologists playing a lesser role than in the earlier study year. Guidelines should be developed for the use of TAH in patients with invasive carcinoma of the cervix.

Adenocarcinoma↗
PubMed1988

Bone metaplasia in the urinary tract: a new radiological sign.

We report 7 cases of bone tissue in the upper urinary tract. Routine excretory urography was suspicious for renal lithiasis. However, pathological evaluation of the kidney tissue revealed bone metaplasia in all 7 cases. Retrospective examination of the first 6 cases showed a typical radiological sign, consisting of a radiopaque eccentric halo surrounding an area of lesser radiological density that, in turn, connected with the urothelium. These findings permitted a correct preoperative diagnosis of bone metaplasia in case 7. Accurate preoperative differentiation of bone metaplasia (false calculi) and true renal lithiasis is important owing to the different treatments required.

Adult↗
PubMed1995

Deep veins.

BACKGROUND: The deep veins of the leg and their associated perforating veins provide the major conduits for the return of blood from the legs to the heart. In health intrinsic valves maintain a one-way flow of blood from distal to proximal leg. OBJECTIVE: To describe and illustrate the different deep veins, their relationship to each other, and to the superficial venous system. Of particular interest is the demonstration of the deep plantar plexus and its relationship to the anterior and posterior tibial veins and to the greater and lesser saphenous veins. The valvular system, which protects them from the effects of gravity, is also illustrated. METHODS: The various deep veins as well as their tributaries and perforating veins are described in detail and illustrated with simple line drawings. These depictions help clarify the relationships between the paired veins and the higher single veins. RESULTS: Hopefully this unified approach to the various groups of deep veins will allow a better understanding of their form and function. CONCLUSIONS: The deep venous system is an integrated group of veins beginning in the deep venous plexus of the foot and terminating in the lower pelvis. Following contraction of the foot, calf, and thigh muscles the blood flows from a multitude of high pressure veins to a single low pressure vein.

Foot↗
PubMed1996

Experimental partial ureteric obstruction in newborn rats. VIII. Contralateral kidney weight after release of the obstruction.

In unilateral kidney disease, it has been suggested that the ipsilateral state could be estimated by measuring contralateral kidney size; thus, a contralateral increase should reflect an ipsilateral impairment and vice versa. This could easily be performed using ultrasound. In our experiments with partial obstruction of one ureter (created in 1- to 3-day-old rats), a consistent and stable contralateral kidney hypertrophy occurred. However, after unobstruction, the hypertrophy persisted for at least a 6-week observation period, despite the disappearance of hydronephrosis and presence of a normal weight of the ipsilateral kidney. This would undeniably hamper the diagnostic utility of kidney size determination. To find out whether or not the hypertrophy ever disappears, we have performed studies after 6, 9 and 15 weeks. (1) The weight of the unobstructed kidney was found normal except after 15 weeks. The microstructure was normal except for some minor changes. (2) The contralateral kidney was significantly heavier than controls at all checkpoints (+10, +13 and +6%). No significant regression occurred over the observation period. (3) Furthermore, the weights of both kidneys were interrelated, but the slopes were positive; thus, the contralateral hypertrophy was not greater the lesser the ipsilateral kidney weight. The reasons for the persistence of contralateral hypertrophy are discussed. The present findings do not support the idea of documenting improvement by measuring contralateral kidney size. However, repeat studies in the same individual may prove to be more sensitive and are therefore recommended until further notice.

Age Factors↗
PubMed1960

The fine structure of the epithelial cells of the mouse prostate. I. Coagulating gland epithelium.

The fine structure of the epithelial cells of the anterior lobe, or coagulating gland, of the mouse prostate has been investigated by electron microscopy. This organ is composed of small tubules, lined by tall, simple cuboidal epithelium surrounded by connective tissue and smooth muscle. The epithelial cells are limited by a distinct plasma membrane, which covers minute projections of the cytoplasm into the lumen. The cell membranes of adjacent cells are separated by a narrow layer of structureless material of low density. The cavities of the endoplasmic reticulum are greatly dilated, and the cytoplasmic matrix is reduced to narrow strands, in which the various organelles are visible. The content of the cavities of the endoplasmic reticulum appears as structureless material of lesser density than the cytoplasmic matrix. Material which may be interpreted as secretion products can be seen in the lumina of the tubules. The possible nature of the material inside the cisternal spaces and the secretory mechanisms in these cells is discussed.

Animals↗
PubMed1992

Tobacco and cancer: how to react to the evidence.

Tobacco is a remarkable product when considering the number of diseases to which it can reliably be linked as a causal agent or at least as a factor which is partially responsible for the occurrence of disease. If we only look at cancer, tobacco is responsible for the vast majority of cancers of the lung, trachea and bronchus; a proportion of cancers of the bladder and of the renal pelvis; a considerable proportion of cancers of the oral cavity, lip, pharynx, larynx and oesophagus with, for these sites, a large potentiation of risk when associated with the drinking of alcohol; a proportion of cancers of the pancreas and possibly of renal adenocarcinoma. In addition, among women, tobacco use has been linked with an increased risk of cervical cancer. In order to evaluate the present burden of tobacco-related cancers in the world precisely, one needs to be able to consult precise statistics of cancer occurrence, tobacco use and the relationship between the two. The availability of such data varies greatly across countries. Although mortality, and to a lesser extent, morbidity cancer statistics are collected in many parts of the world, the coverage is far from exhaustive and of uniform quality. Commercial or governmental sources of data on tobacco also exist, but the most important missing link is knowledge of the population-specific risk attributable to tobacco use in various countries for all tobacco-related diseases. Despite imperfect knowledge, the link between tobacco use and cancer is clear enough to demand strong action.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude to Health↗
PubMed1994

Torulopsis glabrata pelvic abscess and fungemia.

BACKGROUND: Serious infections caused by Torulopsis glabrata, once rarely encountered, have become common over the last 3 decades. The most frequent manifestations of serious fungal infections include septicemia, endocarditis, hepatosplenic infections, and meningitis. We report a case of fungemia and pelvic abscess caused by T glabrata following gynecologic surgery. CASE: A 43-year-old woman developed fever, abdominal pain, and abdominal distention following a total abdominal hysterectomy and right salpingo-oophorectomy. Empirical treatment with broad-spectrum antimicrobial agents was not successful. Three sets of blood cultures were positive for T glabrata, and radiologic investigations revealed pelvic and lesser sac fluid collections. Cultures of the pelvic abscess grew T glabrata. Treatment was changed to amphotericin B, with complete clinical recovery. CONCLUSION: Serious T glabrata infections are rare following gynecologic surgery, especially in immunocompetent patients. Given the morbidity and mortality associated with these infections, aggressive treatment with amphotericin B and drainage of abscesses is warranted.

Abscess↗
PubMed1985

Roentgenographic features of the arthropathy associated with CPPD crystal deposition disease. A comparative study with primary osteoarthritis.

We assessed the radiological features of the arthropathy seen in patients with calcium pyrophosphate dihydrate (CPPD) disease or pseudogout. Standard AP projections of the hands, pelvis and knees were evaluated in 74 patients with pseudogout, 68 cases of primary osteoarthritis (OA) and 78 "normal" controls matched by age and sex. A grade from 0 to 3+ was assigned to each of the 4 variables of OA: joint space narrowing, sclerosis, osteophytosis and subchondral cysts. Radiographic findings of OA were more prevalent (p less than 0.005) and severe (p less than 0.001) in the group with pseudogout than in the controls. When the groups with pseudogout and primary OA were compared, no significant differences were found in the overall severity of radiographic changes with only minor differences in its distribution. The pseudogout patients had greater changes in the metacarpophalangeal joints and a lesser involvement of the trapeziometacarpal joints. No radiological differences were observed in patients meeting McCarty's criteria for clinical types A and C.

Aged↗
PubMed1989

[Anomaly of the pyelo-ureteral junction and antenatal ultrasonic diagnosis].

Over a period of five years, 40 cases of anomaly of the pyelo-ureteral junction were diagnosed ante-natally which subsequently required surgical intervention during the first year of life. The indication for the therapy was based on the degree of obstruction (IVU, DTPA scanning, Whitaker test), the thickness of the renal parenchyma (IVU, ultrasound) and, to a lesser extent, on calyceal dilatation. After a period of follow up ranging from 3 to 48 months (mean 16.8 months), good results were noted in 37 cases, there were two permeable junctions with poorly functioning kidneys and one obstruction which was successfully reoperated. These results suggest that intervention is preferable to surveillance at varying intervals for an undetermined period, where the risk of a sudden exacerbation is always possible.

Diagnostic Imaging↗