bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of the Hagen-Poiseuille Law: A New Mathematical Approach for the Integration and Evaluation of Anorectal Physiological Testing in Patients with Faecal Incontinence and Pelvic Dyschezia and in Normal Controls
Authors: Farag A.
Published: April 2003

This work was done in order to study the possibility of using the Hagen-Poiseuille law for flow of fluids through tubes to integrate and quantitate the anorectal physiological parameters in patients suffering from faecal incontinence and functional pelvic outlet obstruction compared to normal controls. The Hagen-Poiseuille law was intended to be used in the explanation of the role played by different sensory and motor functions of the anorectal segment in maintaining continence and normal rectal evacuation. The intrarectal pressures during rest, coughing, attempted defaecation, rectal sensation, and rectal compliance at the point of first rectal sensation were measured using anorectal manometry. Anal canal length and diameter were measured using lateral defaecographic views during rest, squeeze, and attempted defaecation, and the anal sphincteric reflex contraction in response to coughing or Valsalva’s manoeuver was measured using plug or needle electromyography. These factors were analyzed using the Hagen-Poiseuille law in order to determine anal canal resistance and flow to air, water, and BaSO4 during rest, coughing, and attempted defaecation in controls, during attempted defaecation in patients with functional pelvic outlet obstruction, and during rest and coughing in patients with faecal incontinence. The Hagen-Poiseuille law could detect anal continence in all controls and could also detect and quantitate functional pelvic dyschezia in all patients. The equation could detect and quantitate faecal incontinence in 8 of 14 patients (57.14%) during rest, in 11 of 14 (78.57%) during coughing, and in all 14 patients after correction for sensory and reflex deficits. Both the Hagen-Poiseuille law and the law of Laplace and their proposed hybrid law were successful in explaining some facts concerning factors affecting normal continence and defaecation. The Hagen-Poiseuille law is a useful new mathematical approach for the integration and quantitation of normal and abnormal continence and defaecation. It can be used to plan for treatment and to determine the outcome of patients suffering from functional anorectal disease.
Biocompatibility of Cellulose Sponge with Bone
Authors: Märtson M. , Viljanto J. , Hurme T. , Saukko P.
Published: April 2003

The purpose of this study was to investigate the biocompatibility of viscose cellulose sponge (VCS) with bone. Twenty-five Sprague-Dawley rats were used for the study. After curettage of the bone marrow from both femoral cavities, VCS (15 × 1 × 1 mm) was implanted into one femur, leaving the contralateral side empty as a control. The rats were killed 1–6 weeks after curettage, and bone formation inside the sponge was assessed by light-microscopic examination and histomorphometric assessment. Whereas normal bone formation in rat femoral cavity took place in 2 weeks after curettage, 4 weeks were needed for bone formation in the cellulose sponge. VCS is a compatible matrix for osseous tissue ingrowth and it may be useful as a scaffold for bone tissue engineering in experiments and possibly also in clinical practice.
Effects of Hexose Sugars: Glucose, Fructose, Galactose and Mannose on Wound Healing in the Rat
Authors: Kössi J. , Peltonen J. , Ekfors T. , Niinikoski J. , Laato M.
Published: April 2003

The effects of four hexose sugars (D-glucose, D-fructose, D-galactose, D-mannose) on the developing granulation tissue in rats were examined. Cylindrical hollow sponge implants were used as an inductive matrix for the growth of granulation tissue. In the test group, the implants were injected with 0.1 ml of solution containing the different hexoses in 0.01, 0.1 and 1 M concentrations daily for 7 days while the implants of the control groups were injected with 0.1 ml of phosphate-buffered saline solution only. Analyses of granulation tissue and wound fluid in the sponge implants were carried out 7 days after implantation. The results demonstrated that galactose caused a significant increase in the accumulation of granulation tissue as estimated by histological analyses, but no significant differences were observed in various chemical analyses. In striking contrast, statistically significant decreases were observed in the number of leukocytes in wound fluid, in the amount of DNA, RNA, collagen hydroxyproline, nitrogen, hexosamines and uronic acids in sponges treated with 0.1 or 1 M mannose, reflecting decreased granulation tissue formation. This effect was also observed in histological analyses of the specimens. There were no major changes in sponges treated with glucose or fructose. In summary, the findings of the present study demonstrate that galactose may enhance wound healing and mannose treatment inhibits the inflammatory reaction in wound healing and decreases granulation tissue formation in an experimental wound model.
Current Concepts and Practice in Postoperative Pain Management:Need for a Change?
Authors: Filos K.S. , Lehmann K.A.
Published: April 2003

Despite a growing trend in acute pain management, many deficiencies still account for the high incidence of moderate to severe postoperative pain to date. Patients nowadays continue to receive inadequate doses of analgesics, but additionally the identification and treatment of those patients with pain still remains a significant health care problem. Advanced techniques are available including epidural or intrathecal administration of local anaesthetics and opioids, various opioid administration techniques such as patient-controlled analgesia and infusions via sublingual, oral-transmucosal, nasal, intra-articular and rectal routes. Nonopioid analgesics such as nonsteroidal anti-inflammatory drugs and newer nonopioid drugs such as α2-adrenergic agonists, calcium channel antagonists and various combinations of the above are possible. However, the solution to the problem of inadequate pain relief lies not so much in the development of new drugs and new techniques, but in the effective strategy of delivering these to patients through the introduction of acute pain management services on surgical wards.
Clinical Significance of the Detection of Thymidine Phosphorylase Activity in Esophageal Squamous Cell Carcinomas
Authors: Ikeguchi M. , Oka S. , Saito H. , Kondo A. , Tsujitani S. , Maeta M. , Kaibara N.
Published: April 2003

In this study, we obtained fresh samples of tissue (tumors, adjacent normal mucosas, and metastatic lymph nodes) from 64 patients (metastatic lymph nodes were obtained from 16 patients) with esophageal cancer who underwent esophagectomy between 1993 and 1998. The thymidine phosphorylase (dThdPase) levels of tumors as determined by the ELISA method were compared with clinicopathological findings of tumors and were evaluated for their usefulness as a prognostic parameter for these patients. The dThdPase levels of tumors (221 ± 21 U/mg protein) and metastatic lymph nodes (253 ± 51 U/mg protein) were significantly higher than the dThdPase level of normal mucosas (53 ± 7 U/mg protein, p < 0.001). The dThdPase levels of tumors did not correlate with the histopathological grading of tumors, the depth of tumor invasion, and lymph node metastasis. The 3-year survival rate of 32 patients with a high level of dThdPase (42%) was not different from that of 32 patients with a low level of dThdPase (52%, p = 0.267). Moreover, the dThdPase level of tumors was not an independent prognostic factor for patients with esophageal cancer. These findings suggest that the level of dThdPase activity in esophageal cancers may not correlate with tumor progression and may not be a useful prognostic marker for patients with esophageal squamous cell carcinoma.
Augmentative Effect of Cyclosporin A on Rat Liver Regeneration: Influence on Hepatocyte Growth Factor and Transforming Growth Factor-β1
Authors: Morii Y. , Kawano K. , Kim Y.-I. , Aramaki M. , Yoshida T. , Kitano S.
Published: April 2003

We investigated the effect of cyclosporin A (CsA) on rat liver regeneration following partial hepatectomy with reference to cytokine production. Rats were divided into two groups: those without CsA pretreatment (group 1) and those with CsA pretreatment (group 2). Animals were given olive oil vehicle or CsA (10 mg/kg) dissolved in olive oil daily by gavage from 4 to 1 days before hepatectomy. The ratio of regenerating liver weight to initial body weight in group 2 was significantly higher than that in group 1 at 72 h. Although a peak 5-bromo-2-deoxyuridine labeling index was found at 24 h after hepatectomy in both groups, the peak value in the CsA-treated animals was significantly higher than in controls. In both groups, hepatocyte growth factor concentrations in both plasma and liver tissue showed maximal values at 12 h. Liver tissue values in group 2, however, were significantly higher from 1 to 12 h compared to group 1. Transforming growth factor-β1 (TGF-β1) concentrations showed minimal serial changes in group 1, while those in liver tissue of group 2 rats were significantly lower than in group 1. Plasma TGF-β1 concentrations did not differ. These results suggest that upregulation of hepatic regeneration with CsA pretreatment might be attributed in part to changes in production of these mitogenic and mitoinhibitory cytokines.
Protective Effect of Human Urinary Thrombomodulin on Ischemia- Reperfusion Injury in the Canine Liver
Authors: Kaneko H. , Joubara N. , Yoshino M. , Yamazaki K. , Mitumaru A. , Miki Y. , Satake H. , Shiba T.
Published: April 2003

This study was performed to determine whether human urinary soluble thrombomodulin plays a role in liver ischemia-reperfusion injury. Liver ischemia was induced in two groups of dogs. Group 1 was exposed to 60 min ischemia, and group 2 was exposed to 60 min ischemia after preischemic administration of human urinary soluble thrombomodulin. In group 1, the thrombin-antithrombin complex and hyaluronic acid were significantly elevated after ischemia, compared with the preischemic values. While liver issue blood flow and the plasmin-α2-plasmin inhibitor complex significantly decreased, AST, ALT and m-AST dramatically increased after reperfusion. In group 2, the increase in the thrombin-antithrombin complex and hyaluronic acid was significantly suppressed, and AST, ALT and liver tissue blood flow significantly improved, compared with group 1. Histologically, in group 2, the hepatic tissue structure, including endothelial cells, was relatively intact. These findings suggest that administration of thrombomodulin inhibits endothelial cell injury and coagulopathy and offers protection from liver ischemia-reperfusion injury.
Intimal Hyperplasia after Long-Term Venous Catheterization
Authors: Xiang D.Z. , Verbeken E.K. , van Lommel A.T.L. , Stas M. , De Wever I.
Published: April 2003

Objective: Intimal hyperplasia is a well-known consequence of arterial injury and arterialization in vein grafts. However, the subacute and chronic vein wall changes which occur after catheterization have not been well studied. In this animal study, intimal hyperplasia in the vein wall after catheterization was examined. Methods: A silicon catheter was placed in the anterior caval vein of 54 rats. After in situ fixation at scheduled intervals (1 day to 6 months), the pathologic changes in the vein wall were studied on semi-serial histology sections by means of light microscopy. Results: Three forms of intimal hyperplasia could be observed: plaque-like, papillary-like and incorporation of the mural part of the sleeve into the underlying vein wall. Although the appearance of each was different, their composition was identical. All were mainly composed of α-actin-positive cells and collagen localized above the internal elastin layer, and covered by endothelium if facing the lumen. The plaque-like and papillary-like forms were mainly localized in the anterior vena cava, while sleeve incorporation mainly occurred in the jugular vein. Plaque-like and papillary-like intimal hyperplasia could be seen together on the same slide, but these two forms were never seen together with sleeve incorporation. Conclusion: Intimal hyperplasia occurs after venous catheterization and is probably caused by chronic injury to the vein wall due to knocking and rubbing movements of the catheter against the wall.
A Study of Fetal Sex Determination in Coelomic Fluid
Authors: Lau Tze Kin , Fung Tak Yuen , Fu Wong Yick , Fung Hedy Yun Mei
Published: April 2003

Coelomic fluid and fetal parts were obtained in 35 patients undergoing surgical termination of pregnancy. Fetal gender was determined by Y-sequence-specific polymerase chain reactions (PCR). Fourteen male pregnancies out of 35 cases were identified by examination of fetal parts. The overall concordance rate of gender determination between coelomic fluid and fetal parts was 91.4%. There were 2 cases of male pregnancies not being identified and 1 case of false positive result by coelocentesis. The gestation of pregnancy and the volume of coelomic fluid obtained appeared not to be related to the discrepancy in the paired results. We conclude that sex determination using coelocentesis and PCR remains unreliable to be used as a definitive prenatal diagnostic test for sex-linked disorders.
A Significant Correlation between Melatonin Deficiency and Endometrial Cancer
Authors: Grin W. , Grünberger W.
Published: April 2003

Endometrial cancer is the most common pelvic genital cancer in women. Its incidence is increasing. Unlike the successful screening method for cervical cancer, there is no such equivalent procedure for the early diagnosis of endometrial cancer. Screening procedures currently being tested are too insensitive and nonspecific while diagnostics are either too complex or invasive. In Austria, a multicenter study was begun to search for parameters appropriate for a screening program. 138 women were selected based on anamnestic, serologic and cytologic risk factors. 68 women were diagnosed with endometrial cancer, 70 patients had abnormal bleeding. There were no significant differences in age and menopausal status. Secondary diseases including diabetes mellitus, hypertonia and adipositas were evenly distributed in both groups. In addition to the routine hormone analyses, we tested the patients’ plasma for differences in melatonin levels. We found a significant correlation (p < 0.001) between melatonin plasma levels and the presence of endometrial cancer. The mean plasma melatonin value was 6.1 pg/ml in the cancer-positive group and 33.2 pg/ml in the cancer-negative control group resulting in a 6-fold difference between the two groups. We conclude that decreasing melatonin plasma levels may be an indicator of endometrial cancer and that this may therefore be used as a reliable screening parameter.
Three-Dimensional Ultrasonographic Assessment of the Umbilical Cordduring the 2nd and 3rd Tri mesters of Pregnancy
Authors: Hata Toshiyuki , Aoki Showa , Hata Kohkichi , Miyazaki Kohji
Published: April 2003

Objective: To evaluate the umbilical cord and its abnormalities by use of three-dimensional ultrasonography with a specially developed abdominal three-dimensional transducer. Patients and Methods: Ninety-five pregnancies (92 normal, 2 with hydrops fetalis, and 1 with omphalocele) from 14 to 40 weeks of gestation were studied with a specially developed abdominal three-dimensional transducer (3.5 MHz). This system can provide conventional two-dimensional ultrasonography images and can also generate within seconds high-quality three-dimensional images in the surface and transparent mode with no need for an external workstation. A proportion of the umbilical cords (coiled or noncoiled free loop, abdominal insertion, and placental insertion) visualized at each gestational age interval is presented. Results: The proportion of the umbilical cords visualized during pregnancy except for between 24 and 27 weeks of gestation was about 70% (range 64–83%). Optimal visualization of the umbilical cord was achieved between 24 and 27 weeks of gestation. During this period it was possible to adequately depict the umbilical cord in 93% of the cases. The proportions of the noncoiled umbilical cord depicted during pregnancy ranged from 8 to 45%. The detection rate of abdominal insertion of the umbilical cord visualized at 14–19 weeks was 44%; the detection rate decreased thereafter. Placental insertion of the umbilical cord could not be identified after 28 weeks of gestation. In 2 cases with hydrops fetalis, edematous umbilical cord was evident. In 1 fetus, omphalocele was clearly depicted. Conclusions: The new three-dimensional ultrasound technology generates within seconds high-quality three-dimensional images of the umbilical cord, although limitation of viewing direction exists. These results suggest that the new three-dimensional ultrasonography has the potential to be a supplement to two-dimensional ultrasonography and might be useful in identifying abnormal umbilical cords in utero.
Comparative Changes in Uterine Artery Blood Flow Waveforms in Singleton and Twin Pregnancies
Authors: Chen Qian , Izumi Akio , Minakami Hisanori , Sato Ikuo
Published: April 2003

We prospectively studied 99 women with uncomplicated singleton pregnancies and 24 women with uncomplicated twin pregnancies to examine the effect of the location of the placenta on the pulsatility index (PI) in the uterine arteries in twin pregnancies and to compare singleton and twin pregnancies with regard to changes in the PI of uterine arteries over the course of the pregnancy. The flow velocity waveforms in both the right and left parametrial uterine arteries were recorded longitudinally at 2-week intervals from a gestational age of 19 weeks until delivery. The location of the placenta was determined by real-time ultrasonography at 18–20 weeks of gestation to determine which uterine artery was the ipsilateral artery. In both the ipsilateral and contralateral uterine arteries, the PI exhibited a steady decrease toward term in singleton pregnancies. In twin pregnancies, the PI exhibited a steady decrease until 27 weeks of gestation and remained unchanged thereafter. The PI in the ipsilateral artery was consistently lower than that in the contralateral artery in singleton as well as twin pregnancies. The mean values of PI of the ipsilateral and contralateral uterine arteries of twin pregnancies was consistently lower than that of singleton pregnancies at any gestational week. These results suggest that the ipsilateral uterine artery contributes more to placental perfusion than does the contralateral uterine artery in twin as well as in singleton pregnancies. Twin pregnancies differed from singleton pregnancies with respect to changes in PI in the uterine artery according to gestational age. The PI of uterine arteries declined more rapidly and reached a plateau earlier in twin than in singleton pregnancies.
Effect of the Duration of Labor on Postpartum Postvoid Residual Bladder Volume
Authors: Yip Shing-Kai , Hin Lin-Yee , Chung Tony K.H.
Published: April 2003

In order to investigate the possibility of protracted labor as a risk factor for postpartum urinary retention and to study the relation between duration of labor and postpartum day 1 postvoid residual bladder volume, the postpartum postvoid residual bladder volume (PVRBV) of a group of patients was studied using ultrasonography. Out of 707 patients investigated during a 2-month study period, a homogeneous group of 164 patients, with possible risk factors for postpartum urinary retention being controlled, was studied. The homogeneous group’s postpartum day 1 postvoid residual bladder volumes were assessed by ultrasonography and analyzed with respect to the duration of labor. The incidence of postpartum urinary retention (≥150 ml) was 11% in this homogeneous group. Labor duration longer than or equal to 800 min was associated with a higher incidence of postpartum urinary retention (χ2 test; p < 0.05). Moreover, there is a direct relationship between the duration of labor and PVRBV which is described by a quadratic regression curve. Protracted labor longer than or equal to 800 min is a risk factor for postpartum urinary retention. The PVRBV is directly related to the duration of labor.
Ovarian Stimulation with Low-Dose Pure Follicle-Stimulating Hormone in Polycystic Ovarian Syndrome Anovulatory Patients:Effect of Long-Term Pretreatment with Gonadotrophin-Releasing Hormone Analogue
Authors: Vegetti Walter , Testa Giovanna , Ragni Guido , Parazzini Fabio , Crosignani Pier Giorgio
Published: April 2003

A randomised clinical trial was performed to evaluate the effect of a 3-month gonadotrophin-releasing-hormone analogue (GnRH-a) in one cycle of ovulation induction with low-dose pure follicle-stimulating hormone (pFSH) in patients with polycystic ovarian syndrome (PCOS) anovulation. Twenty patients with chronic anovulation due to PCOS were randomised to ovulation induction with pFSH administered in a low-dose schedule with (10 patients) and without (10 patients) a 3-month pretreatment with GnRH-a. Ultrasound scan only monitoring of follicular growth, evaluation of plasmatic oestradiol at the day of triggering of ovulation with human chorionic gonadotrophin 5,000 IU and evaluation of plasmatic progesterone 8 days after were the main outcome measures. Ovulation occurred in 9 patients treated with pFSH and in 2 patients treated with GnRH-a plus pFSH. Five pregnancies in the pFSH group and no pregnancy in the GnRH-a group were obtained. Five cycles were stopped due to multifollicular growth in the GnRH-a group and 1 in the pFSH group. Pretreatment with a 3-month administration of a GnRH-a did not improve the ovulation rate and pregnancy rate in PCOS patient ovulation induction with low-dose pFSH.
Cushing’s Syndrome in Pregnancy Secondary to Adrenal Adenoma
Authors: Lo Keith Wing-Kit , Lau Tze-Kin
Published: April 2003

We describe a case of Cushing’s syndrome complicating pregnancy presented with acute heart failure, hypertension and glucose intolerance. A left adrenal adenoma was removed at 24 weeks of gestation. The pregnancy was ended with an emergency lower-segment Caesarean section at 31 weeks of gestation because of severe pre-eclampsia and HELLP syndrome. The case is reported not only because of its rarity but also to induce the discussion of surgical treatment during pregnancy.
Effect of Age on Pregnancy Outcome without Assisted Reproductive Technology in Women with Elevated Early Follicular Phase Serum Follicle-Stimulating Hormone Levels
Authors: Check Jerome H. , Peymer Mark , Lurie Deborah
Published: April 2003

There are data suggesting that patients with elevated early follicular phase serum follicle-stimulating hormone (FSH) levels have a poor fertility outcome. This has been attributed to a high rate of aneuploidy in the oocytes. It is not clear whether the spindle defects leading to nondisjunction are related to the high FSH levels or the age of the oocyte. The study presented herein retrospectively evaluated 6-month pregnancy rates in women with elevated early follicular phase serum FSH levels according to age. Only cases without in vitro fertilization were used, since the elevated FSH levels were deemed likely to interfere with multiple egg recruitment needed for assisted reproductive technology. The 6-month clinical and ongoing pregnancy rates were significantly higher in the women <40 years of age (46.1 and 34.6%, respectively) than in those aged 40 or older (10.5 and 5.3%). These data suggest that women with elevated follicular-phase serum FSH levels have a better fertility prognosis when they are younger.
Progesterone Increases cAMP Release and Accumulation in Isolated Term Human Myometrium
Authors: Fu Xin , Bäckström Torbjörn , Ulmsten Ulf
Published: April 2003

Objective: To study the relationship between the action of progesterone on term human myometrial contractile activity and cAMP alterations. Study design: Myometrial tissues were obtained from 13 term pregnant women who underwent elective cesarean section. The contractile activity of muscle strips was recorded isometrically, and the level of cAMP in both superfusion media and experimental biopsies was measured by radioimmunoassay. Results: An increased cAMP release into the superfusion media and an increased accumulation of cAMP in myometrium were observed after the addition of progesterone (3, 15 and 150 µM). Simultaneously, the frequency and tonus of contractions were increased, while the amplitude and activity area of contractions were decreased. Conclusions: The data indicate that an increase in cAMP concentration plays a role in the action of progesterone on the regulation of term human myometrial contractile activity.
Laparoscopic Suturing Technique for Total Abdominal Hysterectomy
Authors: Ostrzenski Adam
Published: April 2003

The objective of this report is to present the laparoscopic technique for total abdominal hysterectomy executed with no transvaginal approach, and by suturing and tying an extracorporeal sliding and an intracorporeal two-flat square knot. The hysterectomy methodology itself was adapted from classic abdominal hysterectomy and completed via laparoscopy with necessary modifications to meet laparoscopic technology standards. Following uterine extirpation, prophylactic, retroperitoneal posterior culdoplasty (the retroperitoneal layer of the uterosacral ligaments, rectal fascia, and paravaginal fascia were incorporated into the reconstructive process), and vaginal vault re-suspension were executed posteriorly, to the deep layer of the uterosacral ligaments, laterally, to the cardinal ligaments, and anteriorly, to the vesicocervical fascia. Laparoscopic total abdominal hysterectomy with posterior culdoplasty and vaginal vault suspension by suturing method appeared to be a safe and effective operation.
Use of Energy Color Doppler in Visualizing Fetal Pulmonary Vascularization to Predict the Absence of Severe Pulmonary Hypoplasia
Authors: Roth Ph. , Agnani G. , Arbez-Gindre F. , Pauchard J.-Y. , Burguet A. , Schaal J.-P. , Maillet R.
Published: April 2003

Objective: The aim of our study was to determine if the assessment of pulmonary vascularization by energy color Doppler during ultrasound examination can predict the absence of pulmonary hypoplasia before birth in situations where it is a high risk. Methods: In a prospective study of 12 pregnancies presenting a risk of pulmonary hypoplasia (5 early and prolonged premature ruptures of the membranes, 1 diaphragmatic hernia, 1 chylothorax, 1 pulmonary sequestration, 1 omphalocele, 1 anamnios and 2 Potter’s syndromes) energy color Doppler was used to visualize pulmonary vascularization. Results: In 10 cases where pulmonary vascularization could be visualized, none of the infants had pulmonary hypoplasia. In the 2 cases of Potter’s syndrome where pulmonary vascularization was not visualized there was a pulmonary hypoplasia. Conclusion: The visualization of fetal pulmonary vascularization with energy color Doppler in situations with a high risk of pulmonary hypoplasia can predict the absence of severe pulmonary hypoplasia.
Clinical Application of Intrauterine Sonography with High-Frequency, Real-Time Miniature Transducer in Gynecologic Disorders
Authors: Senoh Daisaku , Yanagihara Toshihiro , Hata Toshiyuki
Published: April 2003

Our purpose was to determine whether intrauterine sonography with high-frequency, real-time miniature transducer (20 MHz) is useful for the diagnosis of gynecologic disorders. The study consisted of 37 women: 8 normal volunteers, 2 with molar pregnancy, 4 fibromyoma, 4 endometrial polyp, 1 intrauterine adhesion, 1 septate uterus, 5 atypical hyperplasia, 8 endometrial cancer, and 4 with cervical cancer. Comparison of diagnostic efficacy for gynecologic disorders between transvaginal and intrauterine sonography was made. The probe was easily introduced into the endometrial cavity in all patients. No notable complications were encountered. In subjects with a normal uterus, higher resolution for endometrial texture was obtained with intrauterine sonography than with transvaginal scanning. In patients with molar pregnancy, typical vesicular echos were clearly identified. In patients with fibromyoma, myoma nodules were not clearly visualized because of poor attenuation of ultrasound. In subjects with endometrial polyp, intrauterine adhesion, and septate uterus, intrauterine lesions were clearly identified. In patients with atypical hyperplasia, high echogenicity of the endometrium was characterized. Myometrial invasion of the endometrial cancer was estimated correctly in 6 of 8 patients (75%). Intrauterine sonography could clearly detect early cervical invasion of the cervical cancer in all 4 patients, but transvaginal sonography could not do it. Intrauterine sonography with a high-frequency, real-time miniature transducer might be a useful diagnostic modality in gynecologic disorders, especially in the evaluation of early cervical cancer, endometrial cancer, and possibly in infertility practice.
Patient’s Acceptance of Outpatient Hysteroscopy
Authors: Lau W.C. , Ho R.Y.F. , Tsang M.K. , Yuen P.M.
Published: April 2003

There is a trend towards performing hysteroscopy and endometrial biopsy on an outpatient basis, as this alleviates the need for both an inpatient stay and a general anesthesia. Despite the wide acceptance by medical staff, there are few publications on how patients actually tolerate and accept these procedures. We performed a survey on 185 patients attending the outpatient hysteroscopy clinic at a teaching hospital to assess the degree of pain and their acceptance to those procedures using a visual analogue scale. All procedures were successfully performed under no anesthesia without complications. The mean age of the patients was 48 (range 24–78) and 9.4% were nulliparas. The mean pain experienced was 4.7 (SD 2.7) during hysteroscopy and 5.0 (SD 2.9) during endometrial biopsy. The overall preference scores for the procedure to be done under was 3.1 (SD 3.7). About 7% of patients expressed a preference for an overnight stay in hospital after the procedure, but the preference score was low (2.5, SD 3.6). The procedure was well accepted (8.3, SD 2.4) and highly recommended by the patients (8.4, SD 2.9). Outpatient hysteroscopy is well accepted and tolerated by patients.
Fetal Compromise Assessed byDoppler Ultraso und of Venous Flow in Pregnancy-Induced Hypertension
Authors: Ochi Hiroshi , Matsubara Keiichi , Kusanagi Yasuki , Furutani Kouichi , Katayama Tomihiro , Ito Masaharu
Published: April 2003

The purpose of this study was to determine the change of venous flow patterns in the inferior vena cava of fetuses in pregnancy-induced hypertension (PIH). We studied 80 normal pregnant women and 46 pregnant women with PIH and their fetuses. We determined the pulsatility index (PI) for arterial vessels, the ratio of peak flow velocities in early diastole and late diastole (E/A) in atrioventricular valves, and the preload index for the inferior vena cava. Twelve of the 46 PIH women showed an umbilical artery PI higher than the 95th percentile in normal pregnant women. Five of them demonstrated a decreased middle cerebral artery PI. Three of the 5 had an increased mitral E/A. Two of them had a decreased tricuspid E/A, an increased preload index, and a poor prognosis. An increased preload index suggests severe compromise in fetuses with a redistribution of arterial and intracardiac blood flow.
Short-Term Treatment of Uterine Fibromyomas with Danazol
Authors: de Leo Vincenzo , la Marca Antonio , Morgante Giuseppe
Published: April 2003

The aim of this study was to evaluate the effects of danazol in reducing the volume of fibromyomas and in the treatment of associated symptoms. Twenty women (34–42 years) with uterine fibromyomas were treated with 400 mg/day of danazol for 4-month periods. The women underwent ultrasound examination to determine their uterine volume at enrollment in the follicular phase and after 2 and 4 months. The examination was repeated by the same sonographer 3 and 6 months after the end of therapy. Blood samples were taken on the same days for LH, FSH, estradiol and progesterone assays. After therapy, fibromyoma volume decreased significantly (p < 0.01) by an average of 23.6 ± 5%. All patients experienced partial or complete relief of symptoms while using danazol. Three and six months after the end of treatment the fibromyoma volume had only increased slightly with respect to the volume at the end of therapy, but was still lower than the starting volume. The present study shows the efficacy of danazol at a dose of 400 mg/day for 4 months in reducing the volume of fibromyomas and associated symptoms. The mechanism by which danazol reduces the volume of fibromyomas may be due to reduced estrogen concentrations and to its antiprogesterone effects on uterine myomas.
Morphine Suppresses the Oxytocin Response in Breast-Feeding Women
Authors: Lindow S.W. , Hendricks M.S. , Nugent F.A. , Dunne T.T. , van der Spuy Z.M.
Published: April 2003

The activity of opiate-mediated regulatory mechanisms of oxytocin secretion during breast-feeding was studied by the administration of either morphine, naloxone or placebo to women prior to the commencement of breast-feeding. Seventeen healthy women in the first week after delivery who had established lactation were ramdomized to receive either intravenous morphine 5 mg (n = 6), naloxone 2.4 mg (n = 6) or a placebo, sterile water (n = 5), which was given prior to commencement of breast-feeding. Oxytocin levels were measured by radioimmunoassay prior to initiation of breast-feeding and then at 2-min intervals until the feed was complete. Breast-feeding produced a significant rise in oxytocin levels in the control and naloxone groups but no significant rise in the patients given morphine. There was a significant reduction in oxytocin response following morphine administration when compared to placebo but not between naloxone and placebo. In conclusion, oxytocin secretion to breast-feeding is inhibited by exogenous morphine when compared to a control group but the administration of naloxone did not produce a significant difference from control.
Dyspareunia, Back Pain and Chronic Pelvic Pain: The Importance of This Pain Complex in Gynecological Practice and Its Relation with Grandmultiparity and Pelvic Relaxation
Authors: Gürel Hulusi , Atar Gürel Sebahat
Published: April 2003

The aim of this study was to evaluate the correlation between severe dyspareunia, back pain, dysmenorrhea and chronic pelvic pain (CPP), and the relationship of each pain type with various sociodemographic factors, pelvic relaxation and high parity. Two hundred thirty-five premenstrual individuals were included. The prevalences of CPP, deep dyspareunia, dysmenorrhea and back pain were found to be 80.4, 30.6, 57.0 and 57.4%, respectively. Marriage duration was longer (p < 0.01) and also parity was higher (p < 0.0001) in CPP cases than controls. However, none of the demographic factors had a significant correlation with dyspareunia, back pain and dysmenorrhea. CPP was correlated with both back pain (r = 0.18, p < 0.005) and dyspareunia (r = 0.19, p < 0.004). However, there was no correlation between back pain and dyspareunia. On the other hand, dysmenorrhea did not show a correlation with any pain types. While grandmultiparity had a significant effect on CPP (p < 0.0001), it did not have a significant effect on other pain types in a MANOVA model. CPP is very often seen in our population and it often makes a pain complex with dyspareunia and back pain. The prevention of grandmultiparity is important to decrease the incidence of CPP.
Prognostic Value of p53 Expression in Stage IB1 Cervical Carcinoma
Authors: Chen Huey-Yi , Hsu Chao-Tien , Lin Wu-Chou , Tsai Horng-Der , Chang Weng-Cheng
Published: April 2003

The purpose of this retrospective study was to evaluate the patterns of p53 expression in stage IB1 squamous cell carcinoma of the uterine cervix, to compare p53 expression with clinicopathological findings, and to assess its prognostic value. 27 patients with stage IB1 squamous cell carcinoma of the uterine cervix underwent abdominal radical hysterectomy and pelvic lymph node dissection. Expression of p53 was studied immunohistochemically. Overexpression of p53 was detected in 33.3% of the tumors, low expression was seen in 11.1%, and negative expression was found in 55.6%. Deep cervical stromal invasion (≧1/2) was found to be associated with the increased risk of lymph node metastases (odds ratio = 17.5). A significantly lower percentage of patients survived when p53 overexpression was observed (p = 0.0315). Univariate analysis revealed that tumor size (2–3.9 cm), lymph node metastasis, tumor invasion into parametria, tumor invasion into blood/lymph vessels, squamous cell carcinoma antigen (≧2 ng/ml), and p53 overexpression had a significantly lower recurrence-free survival rate. None of these above factors obtained significance in the multivariate analysis. This study suggests that expression of p53 may be indicative of an unfavorable prognosis in patients with stage IB1 squamous cell carcinoma of the uterine cervix.
An Outpatient Phase II Study of Subcutaneous Interleukin-2 and Interferon-Alpha-2b in Combination with Intravenous Vinblastine in Metastatic Renal Cell Cancer
Authors: Pectasides D. , Varthalitis J. , Kostopoulou M. , Mylonakis A. , Triantaphyllis D. , Papadopoulou M. , Dimitriadis M. , Athanassiou A.
Published: April 2003

A prospective phase II trial was carried out to define the activity of a low-dose subcutaneous regimen of interleukin-2 (IL-2) and interferon α-2b (IFN-α) in combination with intravenous administration of vinblastine (VLB) in patients with metastatic renal cell cancer (RCC). Thirty-one patients with advanced RCC who had received no prior biochemotherapy were treated with IL-2 4.5 MU × 2/24 h thrice weekly for 2 weeks, IFN-α 3 MU/24 h thrice weekly (alternating days) for 2 consecutive weeks and VLB 4 mg/m2 every 3 weeks. Patients were to have a 1-week rest period after each 2 weeks of therapy with cytokines. Treatment was repeated every 3 weeks. Maximum duration of treatment was 1 year. Treatment was administered on an outpatient basis. There were 4 complete (12.9%) and 8 partial responses (25.8%), with an overall response rate of 38.7%. The median duration of response was 6.5 months. Responses were seen in lung, lymph nodes, bones, liver and other tumor metastases. Toxicity was mild to moderate, consisting of fever, anorexia, malaise and nausea-vomiting in >80% of patients. Hypotension and transient alopecia occurred in >20% of patients. Liver enzyme elevation was frequently observed. Treatment-induced eosinophilia occurred in the majority of patients, while in 52% of patients granulocytopenia grade II and grade III did not require dose modification of drugs. Transient inflammation and local induration at the injection sites was observed in the majority of patients. None of the patients experienced major VLB-related toxicity and no toxic deaths occurred. This three-drug combination immunochemotherapy may be a promising regimen with modest toxicity in advanced RCC.
A Pilot Study on Intensive Weekly 24-Hour Intra-Arterial Infusion with 5-Fluorouracil and Folinic Acid for Colorectal Liver Metastases
Authors: Lorenz M. , Staib-Sebler E. , Gog C. , Petrowsky H. , Köhne C.H. , Encke A.
Published: April 2003

Purpose: A pilot study was performed to evaluate the tolerance and efficacy of a hepatic arterial infusion (HAI) of 5-fluorouracil (5-FU) and folinic acid (FA) in patients with unresectable liver metastases from colorectal carcinoma. Patients and Methods: In 11 patients, 135 applications of high-dose HAI of 5-FU/FA were administered. All patients had been intra-arterially pretreated, and 2 of them had received an additional intravenous therapy. The chemotherapy regimen consisted of a weekly HAI of FA 500 mg/m2 over 1 h, immediately followed by HAI of 5-FU over 24 h. Four patients received a 5-FU starting dose of 2,000 mg/m2 and 7 patients of 2,400 mg/m2. One course consisted of 12 weekly applications interrupted by 1 week after 6 applications and 4 weeks after 12 applications. Results: The applied regimen caused only mild side effects. Nausea and vomiting were the most frequently side effects with 36 episodes out of 135 applications (WHO grade ≥3: 2 episodes). Diarrhea was a minor problem occurring with 8 episodes (WHO grade ≥3: 1 episode). There was no evidence of myelosuppression, hand-foot syndrome, neurotoxicity, and biliary sclerosis. A partial remission was observed in 3 patients, and a disease stabilization in 2 patients while the disease progressed in 6 patients under high-dose HAI of 5-FU/FA. Conclusion: The present pilot study demonstrates that the weekly high-dose HAI of 5-FU/FA is well tolerated and associated with very mild toxicity. Because of the encouraging response rate in patients, whose disease progressed under the conventional intra-arterial therapy either with 5-FU/FA or 5-fluorodeoxyuridine, this regimen seems to be an effective second-line treatment and should be evaluated in nonpretreated patients in a phase II study.
Prognostic Value of HLA-DR Expression and Dendritic Cell Infiltration in Gastric Cancer
Authors: Ishigami Sumiya , Aikou Takashi , Natsugoe Syoji , Hokita Syuuichi , Iwashige Hirohumi , Tokushige Masahiro , Sonoda Syunro
Published: April 2003

We attempted to correlate the expression of human leukocyte antigen DR (HLA-DR) and tumor infiltration by S-100-protein-positive dendritic cells with clinicopathologic features in 165 patients with gastric cancer. The expression of HLA-DR was correlated with the histologic type. Infiltration of dendritic cells correlated negatively with distant lymph node metastases, clinical stage, and peritoneal invasion. There was no correlation between the expression of HLA-DR and infiltration by dendritic cells. In patients with resectable gastric cancer, the grade of infiltrating dendritic cells may be a suitable predictor of prognosis.
Clinical Management and Current Research in Isolated Limb Perfusion for Sarcoma and Melanoma
Authors: Hohenberger Peter , Kettelhack Christoph
Published: April 2003

Currently, isolated limb perfusion (ILP) attracts major interest in the treatment of soft tissue sarcoma and melanoma confined to the limb. The procedure combines innovative approaches such as hyperthermia, the use of cytokines, as well as the administration of high-dose chemotherapy. Although used since more than 40 years, the basic knowledge on the mode of action of ILP is still limited. Besides regional toxicity, systemic effects following the application of rhTNF in the perfusion circuit have to be taken into account. Furthermore, WHO criteria of tumor response are rarely met after perfusion of sarcomas. To overcome this, new modalities based on tumor metabolism are currently under investigation. Also the clinical decision on how to proceed after a successful ILP is discussed.
Diagnosing and Staging of Pancreatic Carcinoma – What Is Necessary?
Authors: Böttger Thomas C. , Boddin Jörg , Düber Cristoph , Heintz Achim , Küchle Raphael , Junginger Theo
Published: April 2003

The aim of the present prospective observational study was to diagnose and stage pancreatic carcinoma with a minimum of diagnostic procedures. Our experiences in 307 patients with a histologically confirmed pancreatic carcinoma show that for diagnosing pancreatic carcinoma sonography and computed tomography are sufficient in 95% of the cases. The combination of both has a sensitivity equal to that of endoscopic retrograde cholangiopancreatography (ERCP; 96.8 vs. 98.7%; n.s., χ2 test). ERCP is only indicated in cases with negative sonography and computed tomography, and suspicion of pancreatic cancer. For tumor staging, the routine performance of angiography cannot be recommended in view of the fact that although it provides greater sensitivity for the evaluation of an infiltration of the portal vein (80% for angiography vs. 22% for sonography or computed tomography), it is associated with a lower positive predictive value (56.4 vs. 68 and 72%) which results in a lower accuracy. Despite recent advantages in diagnostic technology, less than 50% of unresectable tumors were identified preoperatively at a 10% false-positive rate. The major reason for unresectability is infiltration into the mesenteric axis, which cannot be identified laparoscopically. Laparoscopy or percutaneous biopsy is recommended only in the presence of a tumor with suspicion of distant metastasis detected by radiological imaging and requiring histological confirmation. In conclusion, sonography and computed tomography as the only diagnostic images are sufficient for diagnosing and staging of pancreatic carcinoma in more than 95% of the patients. Only a small number of patients needs further diagnostic procedures.
Mucosal Squamous Cell Carcinoma of the Esophagus: A Clinicopathologic Study of 30 Cases
Authors: Natsugoe Shoji , Baba Masamichi , Yoshinaka Heiji , Kijima Fumio , Shimada Mario , Shirao Kazusada , Kusano Chikara , Fukumoto Toshitaka , Mueller James , Aikou Takashi
Published: April 2003

A clinicopathologic study was carried out on 30 patients with mucosal esophageal cancer (MEC). The depth of cancer invasion was subdivided histologically into three categories: m1 = carcinoma in situ (intraepithelial carcinoma) or carcinoma with questionable invasion beyond the basal membrane; m2 = cancer invasion confined to the lamina propria, and m3 = cancer reaching to or infiltrating into the muscularis mucosae. Lymph node metastases and lymphatic invasion were found only in the tumors reaching or infiltrating the muscularis mucosae (m3). The maximum histologic vertical extent of the tumors was more than 1 mm in 4 of 5 patients with lymph node metastasis or lymphatic invasion. None of the patients died of recurrent esophageal disease, and 3 of the 6 patients who had a second primary tumor died of this other malignancy. It is critical to distinguish between m1, m2 and m3 tumors to plan a treatment strategy, including an endoscopic mucosal resection.
Management of Stage III Breast Cancer
Authors: Honkoop Aafke H. , Wagstaff John , Pinedo Herbert M.
Published: April 2003

Stage III breast cancer encompasses a heterogenous group of patients. According to the American Joint Committee on Cancer (AJCC) these tumors include stage IIIA and stage IIIB disease, the first generally being operable but the second inoperable. Patients with inflammatory breast cancer are also included in stage IIIB disease, and these patients have the worst prognosis. Multidisciplinary therapy has become the treatment of choice for these patients. Primary or neoadjuvant chemotherapy, followed by locoregional therapy, either surgery, radiotherapy or both, is now an accepted strategy. Most patients achieve a response to chemotherapy, resulting in downstaging of the tumor, and 5-year-survival rates have improved from 10–20% with local therapy alone to 30–60% with the multidisciplinary approach. Although many prospective, mainly phase II trials have been performed in stage III breast cancer, the optimal treatment scheme still has to be established. The role of new therapeutic strategies such as high-dose chemotherapy with hematopoietic stem cell rescue and higher dose intensity regimens with hematopoietic growth factors is currently under investigation. This article will review the literature and discuss our own research in this area.