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K L Reuter

Publications and source records attributed to K L Reuter.

At least 19 recordsLinked to original sources
PubMed1996

Thickened endometrial stripe and/or endometrial fluid as a marker of pathology: fact or fancy?

OBJECTIVE: To evaluate the implication of a thickened endometrial stripe (ES) and endometrial fluid (EF) in postmenopausal women. METHODS: Between 1991 and 1995, 897 consecutive postmenopausal patients underwent pelvic ultrasound at our institution. Clinical and ultrasound data were reviewed for the 624 patients in whom a comprehensive evaluation of the uterus and adnexae was performed. Of this study group, 495 had normal ES thickness. Nine patients with a thickened ES were excluded due to immediate hysterectomy or history of cervical cancer. This resulted in 120 subjects comprising the group with EF, or a thickened ES > or = 5 mm for patients not on hormone replacement therapy (HR-) and > or = 8 mm in patients receiving hormone replacement therapy (HR+)]. Symptoms were defined as bleeding. Statistical analysis was performed by use of Fisher's exact test. RESULTS: 184/ 495 patients with normal ES thickness underwent biopsy. In this group, 7 cases of simple hyperplasia, 4 cases of atypical hyperplasia (AH), and 4 cases of endometrial cancer (CA) were detected. All of these subjects who were found to have either AH or CA were symptomatic. Of the subjects with a thickened ES, 54 had symptoms and 66 were asymptomatic with 51/54 and 52/66 undergoing endometrial sampling, respectively. Initial sampling in the symptomatic group with thickened ES revealed 7 cases of simple hyperplasia and 2 cases of AH. There were 6 cases of simple hyperplasia in the asymptomatic group (P = NS). Initial biopsy results were either negative or nondiagnostic in 42 symptomatic patients and 46 asymptomatic patients with 40/42 and 19/46 undergoing repeat sampling, respectively. Repeat sampling further identified 9 cases of endometrial hyperplasia or cancer in the symptomatic group while in the asymptomatic group, 2 cases of simple hyperplasia were detected. For symptomatic and asymptomatic patients, analysis of combined initial and second biopsies performed within 1 year was undertaken. This combined analysis revealed a significantly greater rate of detection of endometrial hyperplasia or carcinoma in the symptomatic group vs the asymptomatic group (P = 0.0229, Fishers exact test, [Mantel-Haenszel odds ratio 3.094, confidence interval 0.4799-25.7]). Indeed, the observed detection of hyperplasia or cancer doubled in the symptomatic group, increasing from 9 to 18%, but did not increase significantly in the asymptomatic group. A subpopulation of 21 patients with a thickened ES were HR+ and underwent biopsy, while 72 patients with a thickened ES who were HR- underwent biopsy. 43% of HR+ patients manifested endometrial hyperplasia vs 8% in the HR- group (P = 0.0022). Endometrial fluid was present in 23 patients. The one patient with EF who was determined to have endometrial hyperplasia also had a thickened ES, was symptomatic and HR+. CONCLUSIONS: In the absence of symptoms, repeat sampling is not warranted in patients with a thickened ES and negative findings at initial abnormal biopsy. The presence of symptoms with a thickened ES warrants further diagnostic evaluation to determine an etiology. There was an association with hyperplasia in patients with a thickened ES who were HR+.

Adult↗
PubMed1996

Ovarian Burkitt lymphoma: pelvic pain in a woman with AIDS.

BACKGROUND: Non-Hodgkin lymphomas, a common AIDS-defining manifestation of human immunodeficiency virus (HIV), are aggressive, advanced at diagnosis, and tend to involve extranodal sites. Burkitt lymphoma comprises approximately 20% of AIDS-related non-Hodgkin lymphomas. Sites frequently affected by the disease include the central nervous system, bone marrow, gastrointestinal tract, and mucocutaneous tissue. Gonadal involvement is less common; reports of testicular lymphomas in adult males with AIDS have been sporadic. Ovarian involvement in AIDS-related lymphoma is exceedingly rare and usually involves pediatric patients. CASE: We report an unusual case in which disseminated Burkitt lymphoma presented as pelvic pain in a 32-year-old woman with AIDS. At laparoscopy, the ovaries were unremarkable in appearance but at the upper limits of normal size. However, extreme friability of the left ovary led to hemorrhage and oophorectomy. Pathologic evaluation of the ovary resulted in the diagnosis of Burkitt lymphoma. CONCLUSION: With improved survival because of antiretroviral therapy, the incidence of AIDS-related lymphomas is expected to rise. Lymphoma should be considered in the differential diagnosis of women with AIDS with perplexing abdominal or pelvic symptoms.

Adult↗
PubMed1996

Sonographic appearance of the endometrium and ovaries during cycles stimulated with human menopausal gonadotropin.

OBJECTIVE: To determine the measurable factors that correlated with a higher conception ratio in one of our subpopulations of infertility patients. STUDY DESIGN: We analyzed 58 menstrual cycles in 24 consecutive infertility patients treated only with human menopausal gonadotropin (hMG) and intrauterine insemination between January 1992 and February 1993 to compare those cycles leading to conception with those that did not with regard to certain factors: endometrial thickness, endometrial layering, number of follicles > or = 15 mm in diameter, peak estradiol level and number of cycles prior to conception. RESULTS: All conceptions occurred in cycles that showed endometrial layering. No patient conceived if the endometrial thickness was < 8 mm. The incidence of conception increased with the number of follicles (one to three) measuring > 15 mm in average diameter. No patient conceived if the serum estradiol was < 192 pg/mL. No conceptions occurred after three successive cycles of treatment. CONCLUSION: Endometrial layering, endometrial thickness of at least 8 mm, a higher number of follicles (up to three) with an average of 15 mm and a serum estradiol level of at least 192 pg/mL correlated with a higher rate of conception.

Adult↗
PubMed1994

The role of magnetic resonance imaging in problematic gynecologic diagnoses.

MRI is a modality that provides excellent anatomic detail, especially of soft tissue and bone. Comparison of T1-weighted and T2-weighted images offers significant diagnostic information of pelvic pathology. In five problematic gynecologic cases, magnetic resonance imaging (MRI) provided key information for optimal treatment planning or a definitive diagnosis for the gynecologist.

Adult↗
PubMed1992

Risk factors for breast cancer in women undergoing mammography.

To determine risk factors for carcinoma of the breast, we compared women with cancer on screening and diagnostic mammography with those in whom cancer was not detected. For 39 months, medical histories were collected by mammography technologists on 3492 women having routine screenings or diagnostic mammograms at our institution. Potential risk factors of women with biopsy-proved breast cancer were compared with those in women who had normal findings on mammograms or negative biopsy results (control subjects). Of the 3492 women, 49 had biopsy-proved breast cancer. There were 3361 patients in the control group, including those women with normal findings on mammograms (3294) and those with negative biopsy results (67). Eighty-two women had incomplete questionnaires or were lost to follow up. Nearly all of the patients with breast cancer were postmenopausal compared with 68% of the control subjects. The mean length of lactation for breast cancer patients was significantly less than for control subjects: 5.6 vs 7.5 weeks (p = .015). This was true also for the postmenopausal patients: 8.1 vs 6.1 weeks (p = .041). Postmenopausal breast cancer patients had menstruated significantly more years (p = .016) than the postmenopausal control subjects: 34 vs 31 years, although the mean age at menarche was not different. When corrected for age, there was no significant difference in the total duration of menstruation in the postmenopausal cancer patients compared with the postmenopausal control subjects. Postmenopausal breast cancer patients had a significantly greater (p = .021) average body weight than postmenopausal control subjects: 71.7 vs 66.7 kg, although body weight was the same when all patients were considered. Similar results were found when Quetelet's index for obesity (weight in kg/height in cm2) (p = .004) was calculated for postmenopausal patients: 28 for cancer patients and 26 for control subjects. There was no significant difference in height between the cancer patients and control subjects when all patients or just the postmenopausal patients were considered. History of oral contraceptive use was significantly less common among postmenopausal breast cancer patients than among postmenopausal control subjects: 9% vs 20%. Patients with breast cancer had lower parity than the control subjects. In our series of patients, women in whom breast cancer was detected on mammography lactated less, showed no significant difference in years of menstruation when corrected for age, had a greater average body weight, used oral contraceptives less often, and had fewer children than women in whom no cancer was detected on mammography.

Body Height↗
PubMed1991

Vaginal fibromyomata: two cases with preoperative assessment, resection, and reconstruction.

Vaginal fibromyomata are rare benign neoplasms; approximately 300 have been reported in the world literature. The clinical presentation is variable and the consistency of the mass on pelvic examination may be misleading. A mass may occur anywhere along the vaginal tube and is usually localized, mobile, nontender, and circumscribed. Its consistency, however, may range from solid to cystic. These lesions may be asymptomatic or may cause pain or urinary tract symptoms. Transabdominal and intravaginal sonography along with needle biopsy are valuable in making the preoperative diagnosis of a benign smooth-muscle tumor. Vaginal enucleation is the treatment of choice. Operative management should include evaluation of urethrovesical support and possible reconstruction, eg, pubourethral ligament plication.

Adult↗
PubMed1989

Comparison of abdominopelvic computed tomography results and findings at second-look laparotomy in ovarian carcinoma patients.

In 35 women with epithelial carcinoma of the ovary, the results of restaging laparotomy were compared with the preoperative abdominopelvic computed tomography (CT) findings to evaluate the accuracy of CT for determining tumor status. In the 36 studies performed, enhanced CT scans at 10-mm to 15-mm intervals had a sensitivity of 84% and a specificity of 88%; in addition, there was 86% agreement between the CT and surgical findings. These results suggest that although CT is not accurate enough to completely replace the restaging laparotomy, its high accuracy in determining residual disease after treatment is helpful for patient management.

Adenocarcinoma↗
PubMed1989

Septate versus bicornuate uteri: errors in imaging diagnosis.

Since two müllerian defects, the septate and bicornuate uteri, are no longer repaired by means of the same operative approach, an accurate preoperative diagnosis of these anomalies is now critical. A septum can be removed by means of hysteroscopic metroplasty. However, repair of a bicornuate uterus still requires abdominal surgery. Hysterosalpingography (HSG) has been the primary diagnostic modality for müllerian defects. On the basis of 63 patients, HSG findings alone, as interpreted by the radiologist, had a diagnostic accuracy of 55%. When this was supplemented with a gynecologic evaluation, the diagnostic accuracy improved to only 62.5%. However, when a diagnostic protocol that include ultrasound (US) examination with HSG was used for evaluating müllerian defects, the diagnostic accuracy improved to 90%, with all errors being noncritical. Therefore, it is concluded that HSG alone is not adequate to make the distinction between a septate and a bicornuate uterus unless the angle of divergence of two straight uterine cavities is 75 degrees or less, indicating a septate uterus. Luteal-phase US is frequently necessary to distinguish between these anomalies or to diagnose them in combination.

Adult↗
PubMed1988

Vasa previa.

Explore the source record for details and available documents.

Adult↗
PubMed1988

Dipstick evaluation of hematuria in abdominal trauma.

Urine microscopic evaluation of hematuria has traditionally been used to determine the need for an intravenous pyelogram (IVP) in individuals with blunt abdominal trauma. An IVP is generally advocated in cases where greater than 5-10 red blood cells per high power field (RBC/HPF) are identified. Various laboratories have advocated the use of dipstick examination of these urine specimens as a replacement for microscopic examination. Urine specimens from 178 consecutive patients with blunt abdominal injury were evaluated by dipstick (Chemstrip 9, Cat. No. 417190, Boehringer Mannheim Diagnostics) and microscopic examination. Sensitivity of dipstick testing for microscopic hematuria was 100% as compared to microscopic examination (positive greater than or equal to 5RBC/HPF); specificity was 58.6%. Predictive value of a positive test (PVP) was 60.8%; predictive value of a negative test (PVN) was 100%. Evaluation of proteinuria performed as an additional means of assessing renal integrity was found to be less sensitive, but more specific than, dipstick evaluation of hematuria. Poor correlation was seen between the degree of positivity by dipstick testing and the actual degree of microscopic hematuria. It is concluded that specimens which are negative for hematuria by dipstick do not need further testing by microscopic examination. All specimens which contain blood by dipstick evaluation need to be examined microscopically to predict the need for IVP.

Abdominal Injuries↗