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[Behçet's disease of the uterine cervix--a case report].

Behçet's disease is a chronic disorder of unclear pathogenesis defined by multiple genital and oral ulcers, as well as ophthalmic changes. The patient described in this case report presented clinically with recurrent genital discharge, recurrent mild genital pain and a cervical ulcer. The diagnosis of Bechet's disease was established by the presence of cervical ulceration, two minor aphthous lesions in the vestibulum oris and a positive pathergy test. Although rare, Behcet's disease should be considered in the differential diagnosis of genital ulceration of unknown etiology.

Adult↗

Estrogen-associated genes in uterine leiomyoma.

Uterine leiomyomas or fibroids are classified as a benign uterine disease in that the polyps display no malignant growth. However, uterine leiomyomas are a leading cause of morbidity, infertility, and hysterectomy in women. Since leiomyomas are known to be sensitive to estrogen for their growth, we have examined uterine genes known to be estrogen responsive in affected and unaffected uterine tissue. This information will be useful in determining the contribution, if any, of hormonally active environmental chemicals to this highly prevalent reproductive disorder.

Animals↗

Clinical and technical evaluation of the ACS:OV serum assay and comparison with three other CA125-detecting assays.

BACKGROUND: In this study the clinical and technical performance of the CA125- detecting Bayer ACS:OV immunoluminometric serum assay was compared with three other well-established CA125-detecting assays. METHODS: A total of 1112 serum samples was included in this evaluation: 462 from apparently healthy women, 153 from patients with benign ovarian disease, 163 from patients with malignant ovarian disease, 10 from patients with borderline ovarian malignancies and 78 samples from 12 ovarian cancer patients during monitoring of disease. Serum samples from women with malignant endometrial (n = 68) and colon (n = 32) diseases were also included. Moreover, serum samples from women with benign uterine disease and endometriosis (n = 136) plus 10 serum samples from men (n = 7) and women (n = 3) with human anti-mouse antibodies (HAMA) after immunoscintigraphy were included. All samples were tested in duplicate with the Bayer ACS:OV, the Centocor CA125 II, the Abbott IMx CA125 and the Roche (formerly Boehringer Mannheim) Enzymun-Test CA125 II assays. RESULTS: The clinical performance of the Bayer ACS:OV assay, assessed in various patient groups, was similar to that of the two other automated assays. In serum from patients with benign diseases the highest values were found in patients with benign ovarian tumours. In the ovarian cancer patients followed during the course of disease we found similar marker patterns with all four assays. In contrast to the Roche Enzymun-CA125 II assay and to a lesser extent the Centocor CA125 II assay, the Bayer ACS:OV assay was less sensitive to interference from HAMA. CONCLUSION: The Bayer ACS:OV assay is a precise and reliable test for the quantification of CA125 in serum.

Biomarkers, Tumor↗

[Histological analysis of spontaneous adenomyosis-like changes in recombinant inbred mouse uterus (SMXA mouse)--a novel animal model for adenomyosis].

The etiology and the pathogenesis of adenomyosis, which is a benign uterine disease featuring the ectopic proliferation of endometrial tissues and glands into the myometrium and the serosa in the uterus, are still unknown. A novel mouse strain, which showed signs of a condition resembling adenomyosis, was found and the localization of alpha-actin and tenascin was analyzed in order to characterize the histological features of this disease. 1. The uteri of recombinant inbred SMXA mice were shown to have undergone spontaneous histological changes similar to adenomyosis. 2. Compared with SMXA mice, the uteri of F1 mice between the SMXA and NJL strains showed further prominent changes resembling human adenomyosis, which suggests that some hereditary factors may be involved in the pathogenesis of adenomyosis. 3. In a normal mouse uterus, the regions in which tenascin was expressed change with the estrus cycle. In SMXA mice, tenascin was expressed around the dysplastic and cystic uterine glands, and in the myometrium. These results indicated that tenascin is an important marker of the histological changes in adenomyosis. 4. SMXA mice, which are recombinant inbred mice, are shown to be a useful animal model to use in analyzing the pathogenetic mechanisms of adenomyosis.

Animals↗

Total and partial ovariohysterectomy in seven mares.

REASONS FOR PERFORMING STUDY: Ovariohysterectomy appears to have a low mortality rate in mares, but the procedure needs to be reviewed because of the high risk of life-threatening complications. HYPOTHESIS: That ovariohysterectomy can be effective treatment for a variety of uterine diseases in mares and carries a good prognosis. METHODS: Diagnosis, clinical data, surgical technique, post operative care, complications and outcome were recorded from medical records of 7 mares that underwent total (6) and partial (1) ovariohysterectomy at the University of Illinois from 1994 to 2001. RESULTS: The indications for ovariohysterectomy were chronic pyometra (4 mares), chronic uterine torsion (n = 2) and chronic intramural haematoma (n = 1). Surgical exposure was difficult but was improved by traction on stay sutures and right-angled clamps. In some cases, application of the TA-90 autosuture instrument as a right-angled clamp to the caudal part of the uterus improved access to the uterine stump. The most common post operative complications were decreased faecal output, decreased intestinal sounds (4 mares) and mild abdominal pain (2). Two mares had mild to moderate incisional infections. Other previously reported complications, such as haemorrhage, septic peritonitis, uterine stump infection or necrosis, and diarrhoea, did not occur. All mares survived over follow-up periods of 6 months to 5 years and were used for riding (6 mares) and embryo transfer (1 mare, after partial ovariohysterectomy). CONCLUSIONS AND POTENTIAL RELEVANCE: According to this study, the prognosis for mares after ovariohysterectomy appears to be good, despite the technical difficulties of the procedure. The prevalence of life-threatening complications can be lower than reported.

Animals↗

ECC-1 human endometrial cells as a model system to study dioxin disruption of steroid hormone function.

ECC-1, an established epithelial cell line derived from an adenocarcinoma of human endometrial lining, was examined for growth optimization, steroid hormone receptor- and Ah receptor content, and dioxin modulation of estrogen receptor function. Proliferation of ECC-1 cells was accelerated by growth on a lethally irradiated feeder layer of murine 3T3 fibroblasts. Immunoblot analysis demonstrated the presence of Ah receptor an intracellular protein that binds and regulates the toxic action of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). The Ah receptor was functional in these cells as assessed by concentration and kinetic patterns of CYP1A1-mediated 7-ethoxycoumarin O-deethylase (ECOD) induction. The half-maximal effective concentration (EC50) for TCDD was 0.2 nM, and maximal activity appeared after 24-h exposure. A limited structure-activity examination of ECOD activity provided additional evidence for Ah receptor involvement. Competitive binding assays were performed to examine kinetic parameters for estrogen, progesterone, and glucocorticoid receptors. Binding parameters of dissociation constant (Kd) and number of binding sites (Bmax) derived from Scatchard analysis were: estrogen, Kd = 0.67 nM; Bmax = 321 fmol/mg cytosolic protein; progesterone, Kd = 1.31 nM; Bmax = 258 fmol/mg cytosolic protein; dexamethasone, Kd = 1.75 nM, Bmax = 128 fmol/mg cytosolic protein. Exposure of ECC-1 cells to TCDD reduced the estrogen receptor level by 40% without affecting the Kd value, and reduced estrogen receptor-mediated transcription by 50% assessed by transient transfection of an estrogen-responsive reporter plasmid. These data suggest that the ECC-1 cell line is a useful model system for examining the action of dioxin in human endometrial tissue. Both the estrogen receptor and Ah receptor have been implicated in diseases of the endometrium, and examining their interactions may elucidate mechanisms of uterine disease etiology, as well as potential targets for disease prevention.

Cell Division↗

Morbidity and mortality in the city of Zagreb, Croatia--health needs and demands.

The aim of the study was to assess health indicators in the city of Zagreb in order to evaluate the population health status and health needs. A descriptive method was used to analyze data from regular health statistics. In the population of Zagreb, the life expectancy at birth is longer than the European average but shorter than that recorded in Austria and Slovenia. The standardized mortalitay rates of tracheal, bronchial and lung cancer, and of malignant diseases in the Zagreb population exceed the European average, whereas those of ischemic heart disease, cerebrovascular disease, uterine cervix carcinoma and breast cancer are lower than the European average. Circulatory diseases and neoplasms, the two most important groups of death causes, showed a constant rise during the 30-year period (1971-2001). The highest index of primary health care utilization (98.8%) was recorded for the > or = 65 age group, with a mean of 7.5 primary health care visits per capita. The prevalence of hypertensive disorders and of intervertebral disk diseases and other dorsopathies was significantly higher in the oldest population group (chi2 = 27.3 and chi2 = 13.43, respectively, p < 0.05 both). Considering the predominance of chronic widespread diseases that substantially influence the patient's quality of life, public health actions should primarily be focused on preserving personal autonomy of the old and sick man for as long as possible. As the standardized mortality rates of ischemic heart disease, cerebrovascular diseases, tracheal, bronchial and lung cancer, and malignant diseases exceed those reported from some neighboring countries, the highest priority and needs are now related to coping with unhealthy behavior of the population such as smoking, physical inactivity, and dietary issues that should be modified and controlled through implementation of preventive programs, along with appropriate organization and management of public health services.

Adolescent↗

Age, breed and seasonal patterns in the occurrence of ten dairy cow diseases: a case control study.

A total of 5,990 occurences of the diseases abomasal displacement, cystic graafian follicles, endometritis, hypocalcemia, ketosis, mastitis, metritis, ovarian hypofuction, pyometra and retained placenta were included in a case control study. The study was based on a hospital population of Holstein, Ayrshire, Guernsey and Jersey cows who were at least two years of age. The data were retrieved from computer storage of material abstracted for the Veterinary Medical Data Program. The transcription of data from original case records to these abstracts was examined as a source of error. An attempt was made to define each of the diseases by reference to random samples of the clinical records. Using the log-odds method, trends were noted for the youngest cows to be at increased risk of the reproductive diseases and for the Guernsey cows to be at increased risk of the uterine diseases. There was a tendency for peaks in disease occurrences in the winter (as opposed to summer) months.

Abomasum↗

High-dose chemotherapy with autologous bone marrow transplantation for refractory metastatic gestational trophoblastic disease.

A patient with gestational trophoblastic disease failed to respond to all standard multiple-agent chemotherapy and had progressive uterine disease. Total hysterectomy also proved ineffective. We therefore administered high-dose cyclophosphamide, etoposide, and melphalan with autologous bone marrow support. Severe marrow suppression followed but a complete remission was achieved and the patient remains free of disease 3 years after the completion of therapy. This result seems to confirm the value of using high-dose multiagent therapy to optimize the dose-effect of therapy regimens on drug-refractory gestational trophoblastic disease.

Adult↗

[Diagnosis of malignant tumors of the uterus by transabdominal ultrasonography: a utopia?].

Two hundred non-pregnant women with suspected uterine disease were included in a prospective study designed to assess the accuracy of sonography in conforming or excluding the presence of uterine cancer. All patients were operated on and the preoperative sonographic findings were compared with the final histological diagnosis. The predictive value of sonographic evidence of malignancy was 43.9% (18/41), the predictive value of benign disease was 94.8% (147/155). Sensitivity was 66.7% (18/27) and specificity 85% (147/173). The sonographic detection of uterine cancer is in need of improvement. At present it cannot be used as a substitute of invasive diagnostic tools in patients with suspected uterine cancer.

Adenoma↗

Integration of surgery and other techniques in the management of trophoblastic malignancy.

The role of surgery in the management of gestational trophoblastic neoplasms has changed over the years and warrants continuous re-evaluation. Surgical removal of the bulk of the disease in an attempt to shorten the hospital course and decrease the amount of chemotherapy required appears to be of value. This approach to therapy should therefore be considered in most patients with nonmetastatic disease without regard to the histologic diagnosis if they have completed their families. "Debulking" of primary uterine disease in the presence of metastases may decrease the chemotherapy necessary for cure and removes a potential source of resistant disease. Pulmonary surgery improves survival rates for patients with a solitary, resistant lung tumor and is advisable under the circumstances outlined herein. Craniotomy is rarely of value in the management of tumor in the brain but may be necessary in emergency situations caused by intracerebral hemorrhage. Surgery to control complications of the disease has been proved to be safe with acceptable morbidity even if performed during chemotherapy. Thus, although chemotherapy has replaced surgery as the primary management of patients with gestational trophoblastic disease, there remain a significant number of patients in whom surgery plays a significant role.

Combined Modality Therapy↗

[Appendicitis in pregnancy].

The incidence, symptoms, clinical and paraclinical findings, and complications of appendicitis during pregnancy is reviewed. The symptoms and signs do not differ from those in non-pregnant women with the disease. Uterine contractions may occur. The pregnancy ought not to divert the clinicians attention from the disease which is complicated by a considerable foetal mortality, premature labour and abortion. These complications are especially connected with perforated appendicitis. The perforation frequency is related to the delay prior to operation. Immediate appendectomy is recommended as soon as the disease is suspected, making use of prophylactic tocolytic therapy. Antibiotics should be administered according to the usual recommendations. Abdominal delivery should be reserved for obstetric indications only.

Abortion, Spontaneous↗

Screening techniques in endometrial cancer.

Carcinoma of the uterus is the most frequently seen malignancy of female genital tract. Screening techniques have lowered the incidence and morbidity of cervical neoplasia. Attempts to identify premalignant and silent cancers of the uterus have been made. A single diagnostic procedure has not been uniformly successful. It would appear that multiple techniques, using both cytologic and histologic material, would increase the possibility of achieving the goal of early diagnosis in uterine disease.

Adenocarcinoma↗

Abnormal findings on hysterosalpingography: effects on fecundity in a donor insemination program using frozen semen.

OBJECTIVE: We sought to evaluate the effect of abnormal baseline hysterosalpingography (HSG) on subsequent fecundity during the first six cycles of treatment. METHODS: Hysterosalpingography was performed on 208 asymptomatic ovulatory women with no history of pelvic disease who were referred for donor insemination. The findings were categorized into five groups: 1) normal study, 2) uterine anomaly or filling defect with bilateral tubal patency, 3) normal uterine anatomy with unilateral tubal patency, 4) normal uterine anatomy with bilateral tubal blockage, and 5) normal uterine anatomy with hydrosalpinx. Subjects in groups 4 and 5 received inseminations only if patency of at least one fallopian tube was demonstrated with laparoscopy. Life-table analysis was performed to calculate the average monthly fecundity and cumulative conception rates for each group. The Mantel-Haenszel test was used to compare group fecundities. RESULTS: A total of 1460 donor insemination cycles were performed. The number of cycles in each group were as follows: group 1, 1173 (80%); group 2, 153 (10%); group 3, 90 (6.2%); group 4, 16 (1.1%); and group 5, 28 (1.9%). None of the patients in group 4 or 5 conceived. The cumulative conception rates in the first three groups were 46, 34, and 40%, respectively, and were not significantly different from one another (P greater than .05). Although a high incidence of uterine filling defects and unilateral tubal blockage was observed (19.2%), the incidence of an abnormal HSG finding that significantly decreased fecundity was only 2.8%. CONCLUSION: In women with no history of tubal or uterine disease, routine HSG before initiation of donor insemination is of limited value for identifying decreased treatment fecundity.

Adult↗