Endoscopic Management of Adnexal Masses

Background:

The laparoscopic management of suspicious adnexal masses and early ovarian malignancies is discussed with the aim of maintaining accepted oncologic treatment principles. Comparative survival data of patients with gynecological malignancies managed by laparoscopy or laparotomy are still very scarce and the survival of cancer patients must not be compromised by new techniques. It is time to closely analyze laparoscopy and determine if it has a positive impact on the diagnosis and treatment of ovarian malignancies. In this paper we will address the following points:

• 1) Which ovarian cysts can be surgically treated by laparoscopy (pelviscopy)?
• 2) Is staging laparoscopy an accepted technique?
• 3) Is laparoscopy, as a second-look procedure, of benefit?
• 4) Is laparoscopic staging, together with histologic tissue sampling, adequate surgical technique in inoperable ovarian cancer with ascites and peritoneal carcinomatosis?
• 5) Does endoscopic biopsy of ovarian cancer stage Ia change the destiny of a patient into ovarian cancer Ic?

Data Base:

The above questions are analyzed based on our experience with the laparoscopic treatment of 1,225 patients with ovarian cysts and 165 ovarian cancer patients stage I to IV treated immediately by laparotomy during the years 1992-1995.

Conclusions:

Ovarian cystic tumors with no signs of malignancy can be dealt with by laparoscopic means with the option of immediate conversion to laparotomy or within one week if an ovarian malignancy is diagnosed. Today sampling laparoscopic lymphadenectomy of both pelvic and para-aortic is feasible and adequate. On a curative level, the number of lymph nodes to be resected has yet to be determined. The adnexa can be extracted from the abdominal cavity with bag extraction without the danger of spillage. The uterus can be removed transvaginally with laparoscopic assisted vaginal hysterectomy (LAVH). We must be cautious to advocate laparoscopy for ovarian cancer. However, it is an excellent tool when used as a staging procedure. A careful preoperative screening of the patient and an exact definition of existing cysts with imaging techniques allows us to frequently apply laparoscopic surgery for ovarian cysts, leaving only readily detectable cancer cases for laparotomy. Many gynecological oncologists employing staging and second-look procedures for ovarian cancer agree that initiating a case with laparoscopy may preclude laparotomy for many patients. Tumor propagation by performing a biopsy in FIGO stage Ia ovarian cancer patients does not occur if the patient receives adequate radical surgical treatment within one week. According to the reports of Sevelda et al. and Dembo et al., the degree of differentiation and the existence of ascites are more relevant to decreasing the five-year survival rate of patients with ovarian cancer stage I than the rupture of capsule or penetration of the tumor.^16,17A dependency on the first two parameters was found in these two large statistical studies.As the question of endoscopic operations for adnexal mass is predominantly put for the sanitation of small ovarian tumors (ovarian tumors with solid particles in the cysts can be put into the section of primary laparotomies) there remains a wide field of indications for the laparoscopic treatment of adnexal mass and ovarian cysts with benign indications. For many young patients with non-malignant ovarian lesions such as endometriosis, benign cysts, benign cystic proliferations and fibromas, a laparotomy can be avoided and these lesions treated by laparoscopy.     

Evaluation of Helicobacter pylori infection in patients with common migraine headache

Introduction

Migraine can cause headache in different communities so that 12-15% are suffering worldwide. Recently the relationship between infectious diseases such as Helicobacter pylori infection and migraine headache has been the focus of many studies. The current study was designed to evaluate IgG and IgM antibodies to H. pylori in patients suffering from migraine headaches.

Material and methods

Patients who had diagnostic criteria for migraine were chosen as cases compared to some healthy individuals as the control group amongst which immunoglobulin G (IgG), immunoglobulin M (IgM), age, job, gastro-intestinal (GI) disorders, history of migraine, special meals, medications, sleeping disorders, stress, environmental factors etc were analysed.

Results

The prevalence of disease was 38.6%. Household women had the highest prevalence (40%). Among them menstruation was related to high prevalence of migraine. 75.6% of patients had gastrointestinal disorders of which the gastric reflux was the most important sign (47.1%). The mean optical density (OD) value of IgG and IgM antibody to H. pylori was 60.08 ±7.7 and 32.1 ±8.7 for the case group, 21.82 ±6.2 and 17.6 ±9.4 for the control group, respectively.

Conclusions

There was a significant difference in mean OD value of both antibodies to H. pylori amongst the case and control groups. As a result, active H. pylori infection is strongly related to the outbreak and severity of migraine headaches, and H. pylori treatment reduces migraine headaches significantly. Hopefully, the definite treatment and eradication of this infection can cure or reduce the severity and course of migraine headaches significantly if not totally.     

Reports from spinal cord injury patients: eight months after the 2003 earthquake in Bam, Iran

OBJECTIVE: The World Health Organization defines disaster as a sudden ecologic phenomenon of sufficient magnitude to require external assistance. On December 26, 2003, the Bam earthquake left more than 200 spinal cord injury (SCI) patients. Our study of these SCI patients and the rehabilitation of disabled persons in Bam may assist in the organization of rehabilitation programs during future disasters. DESIGN: Eight months after the disaster, we planned to visit the SCI patients in Bam. We visited 61 patients in Bam, Baravat, and surrounding villages. We completed a questionnaire during our visit. RESULTS: The patients' mean age was 31.9 +/- 9.6 yrs. Twenty-nine (53.7%) patients were female, and 25 (46.3%) were male. Fifty-two (96.3%) patients had pain syndromes, which had started from 3 days to 8 mos after injury. Thirty-three (61%) patients used clean intermittent catheterization, and 29 (53.7%) did not have bowel programs. Nineteen (35.2%) patients had pressure sores. CONCLUSIONS: All aspects of disasters should be considered seriously by all countries. The special needs of people with disabilities during and long after any disaster are important. The impact of disasters on disabled people is magnified because of their condition, so special attention must be paid to this group.     

An image analysis approach for automatic malignancy determination of prostate pathological images

BACKGROUND: Determining malignancy of prostate pathological samples is important for treatment planning of prostate cancer. Traditionally, this is performed by expert pathologists who evaluate the structure of prostate glands in the biopsy samples. However, this is a subjective task due to inter- and intra-observer differences among pathologists. Also, it is time-consuming and difficult to some extent. Therefore, automatic determination of malignancy of prostate pathological samples is of interest. METHODS: A texture-based technique is first used to segment the prostate glands in the image. Features related to size and shape of these glands are then extracted and combined to generate an index, which is proportional to malignancy of cancer. A linear classifier is employed to classify the specimens into benign (low potential for malignancy) and malignant. RESULTS: The leave-one-out technique is employed to evaluate the method using two datasets. The first has 91 images with similar magnifications and illuminations while the second has 199 images with different magnifications and illuminations. In the experiments, accuracies of about 98 and 95% have been achieved for these two datasets, respectively. CONCLUSIONS: An image analysis approach is employed to evaluate prostate pathological images. Experimental results show that the proposed method can successfully classify the prostate biopsy samples into benign and malignant. They also show that the proposed method is robust to variations in magnification and illumination.     

Tele-counseling based on motivational interviewing to change sexual behavior of women living with HIV: a randomized controlled clinical trial

AIDS and Behavior - Sexual transmission accounts for the majority of new HIV infections in Iran. More than 80% of HIV-positive persons are sexually active, and nearly 68% reported never using a...     

Successful Management of Plastic Bronchitis in a Child Post Fontan: Case Report and Literature Review

Purpose

Plastic bronchitis is the occlusion of the major bronchial airways by a firm, gelatinous mucoid cast. It is a rare condition, which while classically described in asthma and sickle cell disease has greater mortality in patients with congenital heart disease. The management of this disease is obscure given the lack of clinical data regarding treatment therapies.

Methods

We describe a case of an 11-year-old female status after Fontan surgery who presented with respiratory distress secondary to atelectasis of the right lung.

Results

A bronchoscopy was performed demonstrating an obstructing bronchial cast with successful extraction. The plastic bronchitis continued to recur and she was placed on multiple inhaled mucolytics as well as inhaled tissue plasminogen activator with temporary resolution. Further evaluation of the etiology of her casts revealed that she had elevated pulmonary arterial pressures. Repeated bronchoscopic removal of the casts was utilized as well as continuation of the aggressive airway clearance. Ultimately fenestration of her Fontan was performed along with treatment of pulmonary vasodilators sildenafil and bosentan. Although there was improvement of the cast formation, her airway clearance could only be weaned to four times a day therapy with which she was discharged home after a 3-month hospitalization. She continues to remain on this therapy and has not required hospitalization since the initial incident over 1?year ago.

Conclusions

Plastic bronchitis in a patient with Fontan physiology presents a treatment dilemma that may require comprehensive therapy in severe cases such as described.     

Incidence,survival, pathology,and genetics of adult Latino Americans with glioblastoma

Latino Americans are a rapidly growing ethnic group in the United States but studies of glioblastoma in this population are limited. We have evaluated characteristics of 21,184 glioblastoma patients from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute. This SEER data from 2001 to 2011 draws from 28% of the U.S. population. Latinos have a lower incidence of GBM and present slightly younger than non-Latino Whites. Cubans present at an older age than other Latino sub-populations. Latinos have a higher incidence of giant cell glioblastoma than non-Latino Whites while the incidence of gliosarcoma is similar. Despite lower rates of radiation therapy and greater rates of sub-total resection than non-Latino Whites, Latinos have better 1 and 5 year survival rates. SEER does not record chemotherapy data. Survivals of Latino sub-populations are similar with each other. Age, extent of resection, and the use of radiation therapy are associated with improved survival but none of these variables are sufficient in a multivariate analysis to explain the improved survival of Latinos relative to non-Latino Whites. As molecular data is not available in SEER records, we studied the MGMT and IDH status of 571 patients from a UCLA database. MGMT methylation and IDH1 mutation rates are not statistically significantly different between non-Latino Whites and Latinos. For UCLA patients with available information, chemotherapy and radiation rates are similar for non-Latino White and Latino patients, but the latter have lower rates of gross total resection and present at a younger age.