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Genital bleeding in premenarcheal children.

OBJECTIVE: The earlier occurrence of secondary sexual development and the advance in diagnostic techniques prompted us to review our recent experience with genital bleeding in childhood. METHOD: We analyzed data for all patients aged less than 10 years who were referred to Gifu University School of Medicine-affiliated hospitals from 1984 through 1993. RESULTS: From a total of 330 girls, 62 (approximately 20%) complained of genital bleeding. The patients were distributed equally between 0 and 10 years of age. In 46 of 62 patients (74%), bleeding resulted from a local lesion of the vagina: 28 due to vulvovaginitis, six to urethral prolapse, six to trauma, three to foreign bodies and three to vaginal tumors. Malignant vaginal tumors were seen in two patients: sarcoma botryoides and endodermal sinus tumor. Both were diagnosed by histopathological examination of an exophytic vaginal tumor, with several weeks' interval from the initial episode of bleeding to diagnosis. The remaining 16 patients (26%), with no demonstrable local lesions, bled as a result of some form of precocious puberty. In six patients, precocious puberty was secondary to a hormonally active ovarian tumor, five of these patients also experiencing advanced breast development. Routine ultrasound and hormonal evaluations promptly detected the presence of tumor. None of three patients with idiopathic precocious puberty presented with secondary sexual development. No specific etiology was established in seven patients. CONCLUSION: Genital bleeding alerts us to the possibility, though rare, of a genital tract tumor. Prompt and precise detection may lead to cure and preservation of future fertility.

Age Distribution↗

Therapeutic hysteroscopy in infertility.

Hysteroscopic treatment was provided for 122 of 139 women complaining of primary or secondary infertility. Hysteroscopy revealed intrauterine lesions and the following treatments were carried out: lysis of intrauterine adhesions (61), removal of large endometrial polyps (47), removal of submucous leiomyomas (4), removal of embedded fragmented IUD (4), division of uterine septa (3) and treatment of other unusual conditions (3). The reproductive outcome included 46 term pregnancies, 28 following the division of intrauterine adhesions, 11 after the removal of endometrial polyps, 2 after correction of a septate uterus, one after removal of a pedunculated intrauterine leiomyoma, and 4 after removal of different foreign bodies. There were 8 spontaneous first trimester abortions, and 1 ectopic pregnancy. Removal of the lesion and restoration of a symmetric uterine cavity was successful in 119 patients; only 3 failures occurred, in patients with severe Asherman's syndrome.

Adult↗

[150 cases of vedio-laparoscopic gynecologic surgery].

From September 1992 to September 1993, 150 patients aged 15-68 years underwent laparoscopic gynecologic surgery. These patients included 63 patients with acute abdominal diseases (46 had ectopic pregnancy, 9 rupture of ovary, and 8 torsion of ovarian cyst), which consisted of 90% of total patients with acute abdomen in corresponding period, 63 patients with mass of adnexa, which made up 72% of total patients with ovarian tumors, and 24 patients with uterine diseases. We successfully performed laparoscopic salpingostomy, fallotomy, removal of ovarian cyst, oophorosalpingectomy, myomectomy and laparoscopy assisted vaginal hysterectomy (LAVH) with 2-4 puncture technic after general anesthesia. The largest ovarian tumor and the enlarged uterus were 14 and 16 cm in diameter respectively. Four patients had laparotomy because of severe pelvic adhesions and the laparotomy rate was about 2.6%. The procedure lasted 20-240 minutes and bleeding was less than 200ml. No major surgical complication was encountered.

Adolescent↗

Vaginal bleeding.

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Adolescent↗

Colour flow Doppler for gestational trophoblastic neoplasia.

Twenty-five consecutive patients referred to the Department of Gynecology and Obstetrics, Karolinska Hospital, Stockholm, because of gestational trophoblastic neoplasia (GTN) had colour flow Doppler performed. The examinations were performed transabdominally in the initial ten patients and transvaginally thereafter. Tumour vessels within the uterus were detected in eighteen patients (72%). A negative colour Doppler finding in patients with persistent disease could imply a diagnosis of choriocarcinoma rather than invasive mole, but all five patients belonging to this group responded promptly to chemotherapy. There seems to be a rough correlation between extent of uterine disease, as judged by colour flow Doppler, and response to chemotherapy.

Antineoplastic Combined Chemotherapy Protocols↗

[Doppler ultrasonic assessment with hemodynamics of gynecologic tumor].

Color and pulsed Doppler ultrasound examinations were done on 11 normal volunteers (NU) and 286 patients that consisted of cervical carcinoma (CC), leiomyoma and/or adenomyosis (M), endometrial carcinoma (EC), trophoblastic disease (TD), benign ovarian tumor (BO), Krukenberg tumor (KT) and ovarian carcinoma (OC). The vascularity was based on the resistance index (RI) and maximum blood flow velocity (Vmax). In uterine disease, there was significant difference (p less than 0.01) among each group, except but one correspondence between NU and CC with RI, and there was significant difference (p less than 0.001) between NU and M, CC and M with Vmax. In ovarian disease, there was significant difference among each group with RI, and there was no significant difference among each group with Vmax. Therefore, Doppler ultrasound is a useful diagnostic tool for assessing gynecologic tumor vascularity.

Blood Flow Velocity↗

Body condition score, health, yield and fertility in diary cows.

The effects of body condition score at drying off and after calving and the rate of loss of body condition score during the dry period on the performance of 2162 cows in eight commercial Israeli Holstein herds were evaluated. The relationships between health, fertility and yield and body condition score were examined by using multiple logistic regressions for measurements with only two outcomes and general linear models for the continuous variables. Herds, parity, season, length of dry period, postparturient diseases, twinning, stillbirth, induction of calving and high somatic cell counts were used as confounding and other exposure variables. Multiparous cows that were underconditioned at calving were culled and exhibited more postparturient uterine diseases. The risk of retained placenta was greater for cows that were underconditioned at drying off, whereas cows that lost more body condition during the dry period suffered more from both retained placenta and metritis; the two effects being independent of each other. An apparent increase in the risk of ketosis associated with over-conditioning at calving could be partly attributed to long dry periods. Cows with a higher condition score at calving were less prone to anoestrus but did not conceive more successfully to first service. A reduction of six open days in primiparous cows was estimated for each additional unit of body condition score at calving. Multiparous cows that lost more body condition during the dry period suffered more from inactive ovaries and were more likely to be open 150 days after calving in the next lactation. Cows calving in a higher body condition score produced more milk, fat and protein in the first 90 days of lactation, the effect being most pronounced on milk fat content.

Animal Husbandry↗

Infectious causes of reproductive loss in camelids.

Reproductive losses in camelids are due to infertility, pregnancy loss, udder diseases and neonatal mortality caused by a variety of infectious diseases. Uterine infection and abortion represent the major complaint in camelid veterinary practice. The major infectious organisms in endometritis and metritis are E. coli and Streptococcus equi subspecies zooepidemicus. Abortion rates due to infectious diseases vary from 10% to more than 70% in some areas. Leptospirosis, toxoplasmosis and chlamydiosis have been diagnosed as the major causes of abortion in llamas and alpacas. In camels, brucellosis and trypanosomiasis represent the major causes of infectious abortion in the Middle East and Africa. Mastitis is rare in South American camelids. The prevalence of subclinical udder infection in camels can reach very high proportions in dairy camels. Udder infections are primarily due to Streptococcus agalactiae and Staphylococcus aureus. Neonatal mortality is primarily due to diarrhea following failure of passive transfer and exposure to E. coli, rotavirus, coronavirus, Coccidia and Salmonella. This paper reviews the etio-pathogenesis of these causes of reproductive losses, as well as the major risk factors and strategies to prevent their occurrence.

Abortion, Veterinary↗

Sonographic findings in adenomyosis of the uterus.

In an attempt to define better the sonographic findings of adenomyosis of the uterus, we reviewed sonograms in seven cases of pathologically proven extensive adenomyosis without associated uterine diseases. In all cases, the uterus was enlarged. In five cases, the posterior wall of the uterus was thickened, and echoes in the endometrial cavity were eccentric. Six cases showed a slight decrease in uterine echogenicity. One case had sonographic findings suggestive of a calcified leiomyoma. The diagnosis of adenomyosis cannot be made conclusively by sonography. However, it can be suggested if the uterus is slightly enlarged and if the posterior portion of the myometrium is anechoic and thickened.

Endometriosis↗

Immunohistochemical localization of tenascin and ki-67 nuclear antigen in human endometrium throughout the normal menstrual cycle.

To elucidate the possible regulation of endometrial growth, we investigated the expression of tenascin, an extracellular matrix protein associated with cell proliferation and morphogenetic events, in relation to the mitotic marker ki-67 antigen in human endometrium throughout the menstrual cycle. The endometrial tissue was obtained from women with regular menstruation undergoing hysterectomy due to benign uterine disease. Cryostat sections were subjected to double immunohistochemistry to detect both tenascin and ki-67. During the proliferative phase, an intense deposition of tenascin fibrils occurred in the extracellular matrix of the stroma immediately subjacent to the uterine epithelium that showed the highest proportion of ki-67 positive cells. In the secretory phase, the amount of tenascin expression and the proliferative index of the epithelium were markedly reduced. The topological immunoreactivity of tenascin, however, was clearly related to ki-67 localization close to the tortuous endometrial gland and spiral artery. Expression of tenascin, showing changes depending on the menstrual phase, appears to be influenced by ovarian steroid hormones, and it might play a role in regulating human endometrial development by interaction with mitotic cells.

Adult↗

Total laparoscopic hysterectomy with laparosonic coagulating shears: a retrospective report of 200 consecutive cases.

Despite 10 years of intensive education and training in Australia only around 14% of hysterectomies are performed with laparoscopic assistance. In particular total laparoscopic hysterectomy (TLH) has a poor penetration rate because of perceived technical difficulties that include instrumentation, prolonged operating times and an increase in complications. We present a series of 200 consecutive cases of TLH with very good results and propose that because of the many advantages that this technique offers that it should become the standard procedure for benign uterine disease.

Adenocarcinoma↗

Uterine activity in diabetes insipidus.

In two nonpregnant women with cranial diabetes insipidus, myometrial activity under different hormonal conditions was studied by intrauterine pressure recording. Recordings were performed when the women were under the influence of their regular treatment with desaminocys1-D-arg8-vasopressin (DDAVP), and when they had fully developed symptoms of their disease. Uterine activity was similar to that found in normal women under the same hormonal conditions, and generally did not change when symptoms of lack of vasopressin appeared. Both DDAVP (15-20 microgram), given intranasally, and lysin vasopressin (0.2 IU), given intravenously, stimulated uterine activity, particularly in late secretory menstrual phase. It is suggested that endogenous vasopressin is of minor importance for the induction of spontaneous uterine activity in nonpregnant women.

Adult↗

Preinvasive and invasive cervical cancer: an ex vivo proton magic angle spinning magnetic resonance spectroscopy study.

The aim of this study was to obtain (1)H MR spectra using magic angle spinning (MAS) techniques from punch biopsies (<20 mg) of preinvasive and invasive cervical disease and to correlate the spectral profiles with sample classification on the basis of histopathology. Tissue samples were obtained at colposcopic examination, during local treatment of cervical intraepithelial neoplasia (CIN) or at hysterectomy. (1)H MAS MRS was performed at 25 degrees C while spinning the sample at 4.5 kHz. After measurement, the tissue was immersed in formalin and the pathology determined. Histological examination after (1)H MAS MRS defined 27 samples with squamous cell carcinoma (SCC), 12 with CIN and 39 with only normal tissue. The standardized integrals of the lipid, choline and creatine regions of the spectra were significantly higher in SCC than in normal or CIN tissue. There was no obvious difference in the standardized integral of the region 4.15-3.5 ppm. The acyl fatty acid side-chain length was longer or less unsaturated in SCC than in normal tissue. Normal tissue from patients with SCC showed significantly higher triglycerides than normal tissue from patients with benign uterine disease but significantly lower triglycerides than SCC tissue. (1)H MAS MRS of the uterine cervix ex vivo may be used to differentiate non-invasive from invasive cervical lesions, increase interpretation of in vivo MRS and provide insights into tumor biology.

Adolescent↗

Intra-uterine infection and cord immunoglobulin M. II. Clinical analysis of infants with elevated cord serum immunoglobulin M.

Cord blood immunoglobulin M was measured in 3474 consecutive newborn infants. A group of 147 infants with elevated IgM values (>/=19.0 mg./100 ml.) were compared with 92 unselected newborn infants with normal IgM values. One infant with clinically unsuspected congenital rubella was detected in the study group while no cases of intra-uterine infection were found among the controls. A greater proportion of mothers in the study group had a history of viral infection. The study group also contained a larger number of mothers who might be considered to be at greater risk of infection with agents known to cause intra-uterine disease. Follow-up studies at 6 months of age revealed no differences between the two groups aside from an increased incidence of minor motor abnormalities in the study group. While it is recognized that infants with cord blood IgM levels truly in excess of 30 mg./100 ml. may represent a high-risk group with respect to proved or subclinical intra-uterine infection, it is concluded that routine cord blood screening for elevated IgM values is not a high-yield procedure for the detection of intra-uterine infection in our population.

Adult↗

[Variable rates of diseases in health survey and family practitioners' registries].

OBJECTIVE: To compare the data from the health survey of the Central Bureau for Statistics (CBS: about episodes of chronic diseases experienced by those questioned) and from general practice registration projects (regarding episodes of care). DESIGN: Descriptive. SETTING: Department of General Practice, Academic Medical Centre, Amsterdam, the Netherlands. METHOD: Frequency figures from the CBS health survey regarding chronic diseases for 1992 were compared with data from three large continuous general practice registration projects: the Amsterdam Transition Project, the Nijmegen Continuous Morbidity Registration and the fourth British National Morbidity Study. From the Transition Project not only one-year data were used but also data referring to a four-year period (1989/'93). RESULTS: Incidence and prevalence figures concerning illness and care were in good agreement regarding cardiovascular diseases, uterine prolapse, diabetes mellitus, thyroid disorders, epilepsy and cancer. The health survey had higher frequencies than the GP registration for respiratory disorders, hypertension (both mostly in the age group 25-44 years) gastrointestinal disorders, articular disorders and migraine. With regard to a number of diseases, the four-year registration was in better agreement with the health survey than the one-year registration (e.g. joint disorders): with other disorders the reverse was true (e.g. stroke). CONCLUSION: There were similarities as well as differences between the frequencies from the health survey and the general practice registration projects. Regarding a number of these differences interpretation was possible by using not only one-year data from the GP practice but also data concerning a longer period (4 years) and by comparing the information for different age groups.

Adult↗

Chromosome analysis of uterine adenomyosis. Detection of the leiomyoma-associated del(7q) in three cases.

Adenomyosis is a uterine disease whose defining characteristic is the presence deep in the myometrium of endometrial glands and stroma. The condition is believed to arise from inordinate downward growth by contiguity from the endometrium rather than from in situ metaplasia or neoplasia. No acquired chromosome abnormalities have been associated with adenomyosis before. We analyzed short-term cultures from three cases and detected in all of them a del(7) (q21.2q31.2), a karyotypic anomaly that has hitherto been found repeatedly only in uterine leiomyomas. The cytogenetic similarity to leiomyoma suggests that the del(7q) was present in the mesenchymal or, more precisely, smooth muscle cells of the adenomyosis lesions. The very fact that clonal chromosome abnormalities were present questions whether the prevailing understanding of adenomyosis pathogenesis is adequate; the cytogenetic data would better fit a model of the disease envisioning the intramyometrial endometrial foci as having arisen through a neoplastic process.

Adult↗