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PubMedDate not supplied

Serum soluble interleukin-2 receptor (sIL-2R) assay in cervical and endometrial cancer. Preliminary data.

Pretreatment serum levels of soluble interleukin-2 receptor (sIL-2R), CA 125, and SCC were measured in 183 patients with malignant or benign uterine diseases. Serum sIL-2R levels were higher in the 46 patients with cervical cancer (p < 0.05) or in the 35 patients with endometrial cancer (p < 0.05) than in the 102 patients with benign uterine diseases. Raised serum concentrations of sIL-2R (> or = 50 U/mL), CA 125 (> or = 35 U/mL) and SCC (> or = 2 ng/mL) were found in 50.0%, 15.0% and 67.5% of 40 patients with squamous cell carcinoma of the cervix, respectively. Serum sIL-2R values were > or = 50 U/mL in 83.3% of 6 patients with cervical adenocarcinoma. Elevated serum levels of sIL-2R, CA 125 and SCC were detected in 51.4%, 11.3% and 14.3% of 35 patients with endometrial cancer, respectively. The sensitivity of SCC for squamous cell carcinoma of the cervix was better than that of sIL-2R. On the other hand, we observed that sIL-2R was the most sensitive antigen for endometrial cancer; therefore it could represent a new tumor marker for the management of patients with this malignancy.

Adenocarcinoma↗
PubMed1990

Physical illness, pain, and suicidal behavior.

The relevant literature on the relationship between physical illness and suicide is briefly reviewed. Some important studies on the relationship between pain from physical illnesses like duodenal ulcer, uterine diseases (dysmenorrhea, dysfunctional uterine bleeding) and suicide are referred to. The Madurai studies reveal that high scores on hopelessness and suicide intent in patients with pain from duodenal ulcer, dysmenorrhea, and other uterine problems are associated with suicidal behavior. The need for assessing the suicide risk in such patients under the care of nonpsychiatric medical personnel is discussed. A simple, easy-to-administer questionnaire is presented.

Abdominal Pain↗
PubMed1997

Telomerase activity in ovarian tumors.

BACKGROUND: Shortening of telomeres occurs with each cell division and eventually results in cell death. The activity of telomerase, an enzyme that catalyzes telomere elongation, has been detected in germ cell lines and cancer cells, and has been detected in immortal cell lines but not in normal somatic cells. The relationship between telomerase expression and ovarian carcinogenesis was investigated. METHODS: Ovarian tissue was obtained from 41 women with ovarian tumors (10 benign, 6 borderline-malignant, and 25 malignant tumors) and 6 with uterine disease (2 with uterine myoma and 4 with uterine carcinoma). These specimens were analyzed for telomerase activity and telomere length by the telomeric repeat amplification protocol and Southern blot hybridization, respectively. RESULTS: Telomerase activity was detected in 23 of 25 malignant ovarian tumors (92%), in 1 of 6 borderline-malignant tumors (16.7%), and in 2 of 10 benign tumors (20%) (both of which were germ cell tumors). Weak telomerase activity was present in the cortex of normal ovaries from premenopausal women, and appeared to be attributable to follicles. Telomerase activity in malignant and poorly differentiated tumors tended to be higher than that in other tumors. Terminal restriction fragment length ranged between 8 and 13 kilobase pairs (kbp) for normal ovaries, and was <8 kbp in 1 of 6 malignant Stage I tumors (16.7%), 1 of 2 Stage II tumors (50%), and 9 of 17 Stage III tumors (52.9%). CONCLUSIONS: Telomerase activity may be a useful marker for the diagnosis of ovarian tumors.

Adult↗
PubMed2001

Accuracy of frozen section for the operative management of endometrial cancer.

OBJECTIVE: To assess the accuracy of intra-operative frozen section reports at identifying the features of high risk uterine disease compared with final histopathology. DESIGN: Retrospective study. METHODS: The records of 460 patients with uterine cancer registered with the Queensland Centre for Gynaecological Cancer between January 1, 1996 and December 31, 1998 were reviewed. Intra-operative frozen section was undertaken in 260 patients with endometrial adenocarcinoma. Frozen section pathology was compared with the final histopathology reports. Inter-observer reliability was assessed using percentage agreement and kappa statistics. Clinical notes were also reviewed to determine if errors resulted in sub-optimal patient care. RESULTS: Respectively, tumour grade and depth of myometrial invasion were accurately reported in 88.6% of cases (expected 61.5%, Kappa 0.70) and 94.7% (expected 53.8%, Kappa 0.89). Errors were predominantly attributable to difficulties with respect to the interpretation of tumour grade. The error resulted in the patient receiving sub-optimal surgical management in only 11 cases (5.3%) CONCLUSION: Frozen section is accurate at identifying the features of high risk uterine disease in the setting of endometrial cancer and can play an important role in directing primary operative management.

Adenocarcinoma↗
PubMed1990

Management of endometrial cancer with suspected cervical involvement.

The 1989 International Federation of Gynecology and Obstetrics (FIGO) staging system for endometrial cancer cells for operative assessment of the extent of uterine disease, grade, and sites of metastasis before assigning a stage to the cancer. In the current study, 70 endometrial cancer patients with suspected cervical involvement based on a positive endocervical curettage or punch biopsy were treated with initial surgery followed by tailored radiation or chemotherapy. Only 37% of the patients had operative findings consistent with the preoperative suspicion of stage II disease. Postoperative therapy was determined by the extent of cervical involvement, depth of myometrial invasion, cell type, tumor grade, and the presence and location of extra-uterine disease. Based upon these parameters, 21 patients were believed to have low risk for pelvic recurrence and received no adjuvant therapy (90% 5-year survival); 38 patients received postoperative pelvic radiation because of high-risk factors for pelvic recurrence or pelvic nodal involvement (65% 5-year survival); and 11 patients received chemotherapy and/or extended radiation because of extrapelvic disease (no 5-year survivors). The approach outlined supports initial surgery for cases of endometrial cancer with suspected cervical involvement. This approach permits accurate surgical staging under the new FIGO system, avoids radiotherapy in many patients whose disease is less extensive than suspected preoperatively, and can accomplish good local control with limited morbidity.

Combined Modality Therapy↗
PubMed2005

Fertility of bitches in which estrus was prevented with implantations of chlormadinone acetate for four years.

The recurrence of estrus and fertility after removal of a subcutaneous chlormadinone acetate implant (CMA-I) administered to prevent estrus for 4 years, was investigated in 8 female dogs and the results compared with those for 4 untreated female dogs (control group). The sex hormones present during the estrous cycle were also investigated. There were no significant differences in the estrous cycle after removal of the implant between the CMA-I-treated group and the control group. However, although conception was achieved after mating and no uterine diseases developed in the control group, only 5 (4 dogs, 41.7%) of the 12 cases (6 dogs) in which mating took place at the second to fourth estrus after the removal of CMA-I resulted in pregnancy in the CMA-I-treated group. Furthermore, 6 (75.0%) of the 8 dogs in the CMA-I-treated group developed uterine diseases including pyometra or hydrometra. There were no significant differences in plasma progesterone, LH and prolactin levels between the non-pregnant and pregnant dogs in the CMA-I-treated group or control group. These results suggest that long-term implantation of CMA-I affects fertility after the implant is removed.

Animals↗
PubMed1992

[Diagnosis of ovarian tumor by measuring tumor markers].

Values of CA125, CA19-9, TPA, CA72-4, BFP and LDH in sera were detected in 148 malignant ovarian tumors, 41 borderline malignant ovarian tumors, 71 benign ovarian tumors and 64 benign uterine diseases. A new cut-off value was determined by ROC graph for distinguishing malignant and borderline ovarian tumors from benign ovarian tumors. CA125 (cut off: 30 U/ml) was a highly sensitive marker for malignant and borderline malignant ovarian tumors, the value being 88.1% (52/59) and 81.8% (9/11), respectively. On the other hand, in 37 benign ovarian tumors, the positive rate was 21.6% and in 21 benign uterine diseases it was 52.4%. CA19-9 (cut off: 150 U/ml) was inferior to CA125, but it was an effective marker for mucinous ovarian tumors. TPA (cut off: 40 U/ml) was also a sensitive (84.7%, 50/59) marker of malignant ovarian tumors. CA72-4 (cut off: 4 U/ml) was a highly specific (87.0%, 60/69) marker of malignant ovarian tumors. Combination assays of CA125/CA19-9, CA125/TPA and CA125/CA72-4 were not effective. Usefulness of BFP for early malignant ovarian tumors was suggested. Seven cases of dysgerminoma showed extremely elevated LDH levels (1,248 +/- 886 IU/1/37 degrees C). Malignancy and histological type of ovarian tumors could be decided by combination assay of these tumor markers, before surgical operation.

Antigens, Tumor-Associated, Carbohydrate↗
PubMed1995

Clinical analysis of pelviscopic classic intrafascial Semm hysterectomy.

STUDY OBJECTIVE: To evaluate the efficacy of pelviscopic classic intrafascial Semm hysterectomy (CISH). DESIGN: Review of hospital records of 90 women undergoing pelviscopic CISH between April 1993 and June 1994. SETTING: Department of Obstetrics and Gynecology at a university teaching hospital. PATIENTS: Sequential sample of 90 women undergoing pelviscopic intrafascial hysterectomies. INTERVENTIONS: All of the hysterectomy procedures were performed in the classic manner with grasping forceps, scissors, ligatures, and sutures. No lasers, electrocoagulation, or stapling devices were used. MEASUREMENTS AND MAIN RESULTS: Indications, associated procedures, surgical outcomes, and complications were analyzed. The most common surgical indication was leiomyomata uteri. No major complications occurred even in patients who had extremely large leiomyomata. The mean uterine weight was 207.49 +/- 104.9 g. The average operating time (169.89 +/- 56.19 min) was consistent with that of other methods. Blood loss (160 +/- 182 ml) was lower than during conventional abdominal hysterectomy. No procedure was converted to laparotomy. CONCLUSIONS: Pelviscopic CISH is truly a minimally invasive and organ-preserving surgery, and in our study was associated with significantly low morbidity and no major complications. Pelvic floor support is maintained and the ureters are not in danger. Coring out the cervix with the calibrated uterine resection tool may prevent the development of cervical cancer. Therefore, we think that CISH may be an acceptable technique for benign uterine disease.

Adnexa Uteri↗
PubMed1989

Pneumoperitoneum and an acute abdominal condition caused by spontaneous perforation of a pyometra in an elderly woman: a case report.

Pyometra, a collection of purulent material in the uterus, is an uncommon gynecologic entity. Spontaneous perforation of the uterus is an infrequent complication of pyometra, most often the result of malignant conditions in the uterus. We report the case of an elderly woman who had an acute abdominal condition and pneumoperitoneum due to a ruptured pyometra resulting from a degenerative and infected leiomyoma. Although uterine disease is a rare cause of an acute abdominal condition and pneumoperitoneum in the elderly, a perforated pyometra must be considered in the differential diagnosis.

Abdomen, Acute↗
PubMed1996

Spontaneous perforated pyometra presenting as pneumoperitoneum.

BACKGROUND: Spontaneous perforated pyometra presenting as pneumoperitoneum is extremely rare. CASE REPORT: An 80-year-old Japanese female with spontaneous perforating pyometra presenting as pneumoperitoneum is reported. The patient came to our institute with severe abdominal pain. Routine abdominal examination showed muscular defense, and plain chest roentgenograms revealed infradiaphragmatic free gas. Subsequent computed tomography also demonstrated pneumoperitoneum. Laparotomy was performed on the basis of a tentative diagnosis of perforation of the gastrointestinal tract but revealed a perforated pyometra. A simple hysterectomy was performed. The histological diagnosis of the surgical specimen was acute endometritis without neoplasm. The present report is the third case of spontaneous perforated pyometra with pneumoperitoneum to date. CONCLUSION: Although uterine disease presenting as pneumoperitoneum is rare in elderly patients with an acute abdomen, the possibility of a perforated pyometra should be considered in the differential diagnosis.

Aged↗
PubMed2003

Selective estrogen-receptor modulators.

Tamoxifen is useful for adjuvant treatment of breast cancer and in some women for the prevention of breast cancer. The risk-benefit ratio in regard to the skeleton and perhaps other organ systems may very well be different for postmenopausal versus premenopausal women. In postmenopausal women, tamoxifen (20 mg/d) increased BMD in the spine and perhaps the hip; however, the effect on fracture risk is unclear. Therefore, for postmenopausal women with osteoporosis, consideration should be given to the addition of an agent that is shown to have efficacy against fractures (such as bisphosphonates), even while these women are on tamoxifen. For women at only modest or moderate risk, with bone density above the osteoporosis range (T score above -2.5) and no major fracture history, tamoxifen is probably adequate for 5 years of use. Potentially serious adverse effects include venous thromboembolism, uterine cancer, benign uterine disease, and cataracts. Raloxifene (60 mg/d) protects against vertebral fractures over 4 years in women with osteoporosis, produces small increases in bone mass of the spine, hip, and total body, and reduces bone turnover in postmenopausal women with or without osteoporosis. No significant effect has yet been demonstrated on nonvertebral fractures after 4 years of treatment. Raloxifene has the additional benefit of substantially reducing the risk of ER-positive invasive breast cancer and does not increase the risk of uterine disease. Raloxifene increases the risk of venous thromboembolic disease to the same degree as tamoxifen and estrogen. Therefore, SERMS and estrogens are generally contraindicated in women with a previous history of venous thromboembolism or those who are at significantly increased risk. Raloxifene is probably most useful in women who have osteoporosis (T score = -2.5) or who are at risk (T score less than -1.5 with clinical risk factors) in the middle menopausal period (age 55-65) or in the early menopausal period in women who have no significant hot flashes. At this stage in life, vertebral fractures are common, but hip fractures are not. Therefore, women who take raloxifene can expect a reduction in the likelihood of having a vertebral fracture, and possibly breast cancer. The lack of definitive efficacy against hip fracture is not a major deterrent to use of this agent in this age group because hip fracture risk is very low. Raloxifene might not be the treatment of choice for elderly women who are at particularly high risk of hip fracture.

Female↗
PubMed1997

Nocturnal urinary 6-sulphatoxymelatonin excretion is decreased in primary breast cancer patients compared to age-matched controls and shows negative correlation with tumor-size.

In previous studies a tumor-size dependent decline of the circadian amplitude of serum melatonin was found in primary unoperated breast cancer patients, which was not due to changes of the hepatic metabolism of melatonin since its main peripheral metabolite, 6-sulphatoxymelatonin (aMT6s), showed similar serum levels. The aim of the current study was to verify these previous results by measurements of the nocturnal excretion of aMT6s in urine. The determination of aMT6s was carried out by radioimmunoassay. 17 primary unoperated breast cancer (BC) patients and 34 age-matched control patients with different types of benign gynecological diseases awaiting operation (breast diseases, n=13; ovarian diseases, n=12; and uterine diseases, n=9) were analysed. The median nocturnal urinary aMT6s excretion (22:00-6:00 hr) was significantly lower (-48%, P = 0.033) in BC patients than in controls. Controls showed a significant negative linear regression with age (r = -0.419, P = 0.014). According to multivariate linear regression analysis, BC revealed no age-dependency but a significant negative effect of increasing tumor-size on aMT6s-excretion (P = 0.036) was detected. These results confirm previous findings of a decreased pineal melatonin secretion in BC patients as well as an inverse relationship with tumor-size excluding a possible distortion due to age. The mechanisms involved are unknown but indicate that BC may lead to an impaired production of pineal melatonin. The clinical relevance of these findings from therapeutic and diagnostic point of view is discussed.

Breast Neoplasms↗