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Diagnostic accuracy of sonohysterography, transvaginal sonography, and hysterosalpingography in patients with uterine cavity diseases.

OBJECTIVE: To evaluate the diagnostic accuracy of sonohysterography (SHG) in uterine cavity diseases in infertile patients, comparing its results with those of hysterosalpingography (HSG) and transvaginal sonography (TVS). Hysteroscopy was the gold standard. DESIGN: Descriptive, prospective study. SETTING: A tertiary university referral center. PATIENT(S): Sixty-five infertile women 19 to 43 years of age. INTERVENTION(S): Patients underwent SHG, conventional TVS, HSG, and hysteroscopy. MAIN OUTCOME MEASURE(S): The results of each examination were compared with those obtained by the gold standard. The following diagnoses were considered separately: polypoid lesions, uterine malformations, intrauterine adhesions, and endometrial hyperplasia (EH). Sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively), and 95% confidence intervals were calculated. RESULT(S): Sonohysterography had the same diagnostic accuracy as the gold standard for polypoid lesions and EH, with no equivocal diagnosis. Hysterosalpingography showed a sensitivity of 50% and a PPV of 28.6% for polypoid lesions and a sensitivity of 0% for EH. Transvaginal sonography had both sensitivity and PPV of 75% for polypoid lesions and EH. For uterine malformations, SHG had a sensitivity of 77.8%, whereas TVS and HSG both had a sensitivity of 44.4%. Sonohysterography and HSG had a sensitivity of 75% in the detection of intrauterine adhesions and respective PPVs of 42.9% and 50%. Transvaginal sonography showed sensitivity and PPV of 0% for this diagnosis. CONCLUSION(S): Sonohysterography was in general the most accurate test. Its diagnostic accuracy was markedly superior for polypoid lesions and EH, with total agreement with the gold standard. In diagnosis of intrauterine adhesions, SHG had limited accuracy, similar to that obtained by HSG, with a high false-positive diagnosis rate.

Adult↗

Serum CYFRA 21-1 assay in squamous cell carcinoma of the cervix.

Squamous cell carcinoma antigen (SCC) is the best known marker for squamous cell carcinoma of the cervix as well as of the lung, oesophagus, head and neck and anal canal. Elevated levels of cytokeratin 19-fragments (CYFRA 21-1) have recently been detected in a large proportion of patients with non small cell cancer of the lung, and in particular of those with squamous cell carcinoma. Serum levels of CYFRA 21-1 (cut-off = 1.06 ng/mL) and SCC (cut-off = 2 ng/mL) were measured in blood samples collected before treatment from 15 patients with cervical intraepithelial neoplasia (CIN), 56 patients with cervical cancer, 48 patients with endometrial cancer, and 361 patients with benign uterine diseases. Serum CYFRA 21-1 values in patients with CIN were superimposable on those detected in patients with benign uterine diseases. Conversely, serum CYFRA 21-1 levels were higher in patients with cervical cancer (p < 0.05) and in patients with endometrial cancer (p < 0.05) than in those with benign uterine diseases. There was no significant difference in serum CYFRA 21-1 levels between cervical and endometrial cancer, and, as regards cervical cancer, there was no significant difference in antigen values between squamous cell carcinoma and adenocarcinoma. Among patients with squamous cell carcinoma of the cervix, CYFRA 21-1 values correlated with FIGO stage (stage IIb-IV vs stage Ib-IIa, p = 0.0303). Elevated CYFRA 21-1 levels were found in 20.0% of patients with CIN, in 41.7% of patients with squamous cell carcinoma of the cervix, in 62.5% of patients with adenocarcinoma of the cervix, in 45.8% of patients with endometrial cancer, and in 13% of patients with benign uterine diseases. Serum SCC was more sensitive than serum CYFRA 21-1 for both early and advanced squamous cell carcinoma of the cervix; these preliminary data seem to show that serum CYFRA 21-1 is of limited value for the management of patients with this malignancy.

Adenocarcinoma↗

Placental form of glutathione S-transferase in normal and diseased human uterine cervical mucosa.

Expression of the human placental form of glutathione S-transferase (GST-pi), an enzyme proposed as a marker for human and experimental neoplasia, was immunohistochemically evaluated in 51 samples of 'normal' and diseased adult human uterine cervix. Five fetal uteri were also studied. GST-pi positivity was detected in 54, 92, 95 and 83% of the 'normal', non-neoplastic, cervical intra-epithelial neoplasia (CIN) and cancer cases respectively. All five fetal uteri and the positive 'normal' adult cases presented cells immunostained for GST-pi throughout the thickness of the mucosa, including the basal layer. Some non-neoplastic conditions like inflammation, repair and metaplasia and some dysplastic and neoplastic lesions showed areas of positively stained cells within an otherwise negative tissue, indicating a phenotypic heterogeneity regarding the enzyme expression. Our results confirm that GST-pi has a fetal character and indicate that it may appear in the adult cervical squamous epithelia under 'normal' or pathological conditions not necessarily linked to the process of carcinogenesis. Therefore it cannot be used as a marker for cervical epithelial neoplasia.

Biomarkers↗

Use of corticosteroids alone or combined with glucose to treat ketosis in dairy cows.

OBJECTIVE: To compare relative efficacy of dexamethasone and flumethasone alone or in combination with rapid IV infusion of glucose for treatment of ketosis in cattle. DESIGN: Clinical trial. ANIMALS: 127 cows with urine acetoacetate concentration > or = 60 mg/dl. PROCEDURE: Cows were treated with 500 ml of 50% glucose solution. IV, and 40 mg of dexamethasone, IM (group 1), 40 mg of dexamethasone, IM (group 2), 5 mg of flumethasone (group 3), or 500 ml of 50% glucose solution, IV, and 5 mg of flumethasone (group 4). Treatment success was defined as recovery after a single treatment without relapse during the same lactation. Uterine disease (retained placenta or metritis), parity, and pretreatment plasma glucose, serum beta-hydroxybutyric acid, and urine acetoacetate concentrations were evaluated as possible confounding factors affecting recovery. RESULTS: Only uterine disease was found to have a significant effect on recovery. Treatments 1 and 4 were significantly more efficacious than was treatment 2, but efficacy of treatment 2 was not significantly different from that of treatment 3. Regardless of treatment, cows with uterine disease were less likely to have a successful outcome than were cows without uterine disease. In all treatment groups, plasma glucose concentration increased and serum beta-hydroxybutyric acid and urine acetoacetate concentrations decreased following treatment. CLINICAL IMPLICATIONS: In this study, treatment of ketosis in dairy cattle with a corticosteriod alone was less efficacious than treatment with glucose and a corticosteroid.

3-Hydroxybutyric Acid↗

The isolated finding of histiocytes in Papanicolaou smears from postmenopausal women.

The effectiveness of uncovering uterine disease by drawing special attention to increased histiocytes on Papanicolaou smears from postmenopausal patients was evaluated during a 22-month period. Of the 95,593 screened, 478 had increased histiocytes. Half the patients did not have specific follow-up during the study period. One-third had repeated Papanicolaou smears, which were usually unremarkable and free of increased histiocytes. Seventy-eight patients had subsequent endometrial sampling, hysterectomy or both; 41 of these samples failed to disclose pathology. Thirty-seven cases did yield abnormal tissue. However, when the clinical records of those patients were analyzed, it appeared that most had postmenopausal bleeding or an abnormal physical finding. Of five cases in which the finding of increased histiocytes apparently led to uncovering significant uterine disease, two had endometrial cells reported on the Papanicolaou smear in question. There remained only three cases in which the isolated presence of increased histiocytes led to the discovery of disease; they included one instance of adenomatous endometrial hyperplasia and two of endometrial polyp. We conclude that the isolated finding of increased histiocytes in the absence of postmenopausal bleeding or endometrial cells in a postmenopausal patient is a poor indicator of uterine disease. Such a finding, on its own, is insufficient justification for recommending a diagnostic tissue biopsy.

Adenocarcinoma↗

Relationship between overfeeding, metritis and ketosis in high yielding dairy cows.

The association between overfeeding before calving, metritis and ketosis in seven dairy herds was investigated. The overall rate of ketonuria in 695 adult cows tested routinely between seven and 14 days post partum was 18 per cent and that of post parturient uterine diseases was 56.5 per cent. Eighty per cent of all cows with ketonuria concurrently suffered from post parturient uterine diseases. Ketonuria was found by a retrospective analysis to be independently associated with both overfeeding before calving and post parturient uterine diseases. In view of the additional risks of both metritis and ketonuria associated with overfeeding before calving and the fact that the risk of ketonuria in cows which had metritis was also found to be associated with overfeeding, it is argued that the term 'complicated' rather than 'secondary' ketosis should be applied to such cases, and that appropriate therapeutic measures should be taken accordingly.

Acidosis↗

Serum interleukin-6 levels in uterine malignancies. Preliminary data.

Interleukin-6 (IL-6) was measured with an enzyme-immunoassay in blood samples drawn at diagnosis from 37 patients with endometrial cancer, 36 with cervical cancer, 9 with cervical intraepithelial neoplasia (CIN) and 68 with benign uterine disease. The minimal detectable dose of IL-6 was 3 pg/mL. Detectable serum IL-6 levels were found in 9% of patients with benign uterine diseases, 11% of patients with CIN, 44% of patients with cervical cancer and 11% of patients with endometrial cancer. As regards cervical cancer, serum IL-6 levels > 3 pg/mL were found in 36.0% of 25 patients with stage Ib-IIa disease and in 64% of 11 patients with stage IIb-IV disease. As regards endometrial cancer, serum detectable IL-6 levels were observed in 0% of 30 patients with stage I-II disease and in 57% of 7 patients with stage III-IV disease (p = 0.0005). These preliminary data suggest that IL-6 may be involved in the progression of uterine malignancies.

Adult↗

Randomised controlled trial of total compared with subtotal hysterectomy with one-year follow up results.

OBJECTIVE: To compare total abdominal hysterectomy and subtotal abdominal hysterectomy performed for benign uterine diseases. DESIGN: Randomised, controlled, unblinded trial with central, computer-generated randomisation. SETTING: Danish trial performed in 11 departments of gynaecology. POPULATION: Women referred for benign uterine diseases were randomised to total abdominal hysterectomy (n = 158) or subtotal abdominal hysterectomy (n = 161). One-year follow up questionnaires had a response rate of 87%. METHODS: Patients were followed by strict data collection procedures, including postal questionnaires. The results after one year of follow up were analysed by intention-to-treat analyses. MAIN OUTCOME MEASURES: (1) Primary: urinary incontinence and (2) secondary: post-operative complications, quality of life (SF-36), constipation, prolapse of the vaginal vault/cervical stump, satisfaction with sexual life, pelvic pain and vaginal bleeding. RESULTS: A significantly (P = 0.043) smaller proportion of women had urinary incontinence one year after total abdominal hysterectomy compared with subtotal abdominal hysterectomy [9% vs 18% (OR 2.08, 95% CI 1.01-4.29)]. The lower proportion of incontinent women in the total abdominal hysterectomy group was a result of a higher proportion of symptom relief (total abdominal hysterectomy: 20/140, subtotal abdominal hysterectomy: 14/136) as well as a lower proportion of women with new symptoms (total abdominal hysterectomy: 3/140, subtotal abdominal hysterectomy: 10/137). Twenty-seven women (20%) from the subtotal abdominal hysterectomy group had vaginal bleeding and two of them had to have their cervix removed. No other clinically important differences were found between the two hysterectomy methods. CONCLUSIONS: A smaller proportion of women suffered from urinary incontinence after total abdominal hysterectomy than after subtotal abdominal hysterectomy one year post-operatively.

Female↗

A case of Raynaud's disease with uterine cancer producing interleukin-6.

A case of cervical cancer of the uterine producing interleukin-6(IL-6) in a patient who suffered from Raynaud's phenomenon is described. Her serum contained anti SS-A antibody. The cancer was removed surgically. High level of IL-6 activity was detected in the culture supernatant of the resected cancer cells. After operation, Raynaud's phenomenon had improved and anti SS-A antibody had disappeared. This case shows us that IL-6 produced by malignant tumour might induce autoimmune connective tissue disease-like symptoms.

Aged↗

Patients with uterine papillary serous cancers may benefit from adjuvant platinum-based chemoradiation.

OBJECTIVE: The coexistence of minimal uterine disease and extrauterine metastases is common in patients with uterine papillary serous carcinoma (UPSC). Only complete surgical staging accurately depicts the extent of this disease. The purpose of this study was to evaluate different therapeutic options in surgically staged patients. METHODS: We retrospectively reviewed all patients with UPSC histologically limited in the uterus to the endometrium treated at our institution between 1987 and 2002. RESULTS: Twenty-three (45%) cases were International Federation of Gynecology and Obstetrics (FIGO) stage IA, seven (15%) were stage IIIA, one (2%) was stage IIIC, and nine (18%) stage IV. Additionally, 11 of these 51 patients (21%) were diagnosed with two cancers: a stage IA UPSC and concomitant advanced stage serous cancer of the ovary, fallopian tube, or peritoneum. Stage IA patients with no cancer in the hysterectomy specimen (defined as no residual uterine disease) had no recurrences (n = 10) regardless of treatment. There was a trend toward increased survival in stage IA patients with residual uterine disease who were treated with chemoradiation (concomitant vaginal brachytherapy and platinum-based chemotherapy). There were no recurrences in patients with locoregional disease (stages IA-IIIA) who received chemoradiation. All patients with advanced stage UPSC (stage IIIC or IV or two primary cancers) did poorly regardless of treatment. CONCLUSION: Our findings suggest that stage IA patients with no residual uterine disease may be observed. Stage IA patients with residual uterine disease may benefit from chemoradiation. More effective treatment needs to be identified for advanced stage UPSC.

Aged↗

[Electrophoresis of sulphide mud extract in combined therapy of chronic inflammatory diseases of uterine appendages (an experimental and clinical study)].

On the original experimental model of chronic inflammation of the ovaries and oviducts in white rats it was established that electrophoresis of 1% esobel solution prevents an increase in the specific volume of interstitial connective tissue, development of fibrosclerotic alterations and adhesive process. Peloidophysiotherapy normalizes growth and atresia of the ovarian follicular system. Thus, electrophoresis of 1% esobel solution is highly effective in combined treatment of chronic inflammatory diseases of the uterine appendages.

Adult↗

Human papillomavirus infection in non-neoplastic uterine cervical disease in Hong Kong.

The polymerase chain reaction (PCR) was used to detect and identify human papillomavirus (HPV) in 108 cases of formalin-fixed, paraffin-embedded, non-neoplastic uterine cervical biopsy tissue retrieved from the surgical pathology archives of the Department of Pathology, Caritas Medical Centre, Hong Kong. After DNA extraction, HPV L1 gene primers were used to detect the presence of HPV, and type-specific primers (to HPV types 6, 11, 16, 18, 31 and 33) were used to identify the specific HPV type on HPV L1-positive cases. PCR amplification of the beta-globin gene was used to ensure the quality of amplifiable DNA extracted. Of 94 cases that yielded sufficient good-quality DNA for PCR analysis, three (one endocervical polyp, one chronic inflammation with erosion, and a normal biopsy) had detectable HPV infection. Two of these had high-risk HPV type 16; the other had an uncommon HPV type. In view of the low incidence of HPV found in these patients, large-scale population screening of clinical samples using PCR to detect the presence of HPV and identify high-risk asymptomatic patients would not be cost-effective.

Adult↗

CO2-hysteroscopy today.

A survey of intra-uterine endoscopy over the last years is given showing the increased demand for hysteroscopy for diagnosis and therapy of intra-uterine diseases. Its indications include the search for unknown causes of uterine bleeding or sterility. It is also applied for various therapeutic reasons such as for example the search and removal of lost or embedded intra-uterine devices. The different methods of hysteroscopy--particularly the CO2 hysteroscopy, which we developed, are described. The new examination procedures such as for example the extensive penetration test applied in cases of sterility and others, which through the advances made in technology are now possible, are also discussed.

Adolescent↗