Diagnostic Value of Magnetic Resonance Imaging in Gynaecology

In this study 23 patients with various gynaecological pathologies were evaluated. Ultrasonography and magnetic resonance imaging were performed in all cases, but only 14 were evaluated with computed tomography. On the basis of ultrasonography, 4 patients were labelled as having malignant ovarian tumours, however, this diagnosis was confirmed by magnetic resonance imaging in only 1 of the 4. Magnetic resonance imaging also determined the correct diagnosis in a patient with endometrioma whereas computed tomography showed only a simple cyst, and ultrasonography diagnosed a subserous myoma. Tumour was demonstrated by magnetic resonance imaging in 2 patients with cervical carcinoma although computed tomography and ultrasonography had previously shown no tumour mass in these patients. It was concluded that magnetic resonance imaging is much superior to computed tomography and ultrasonography in gynaecological diagnosis. This advantage results from the correct detection of the contents of ovarian cysts, the number and localization of uterine leiomyomas in T2 scans, invasion of uterine malignancies and differential diagnosis of subserous uterine leiomyomas from ovarian tumours.     

Giant Cervical Polyp Due to a Foreign Body in a ''Virgin''

A 17-year-old virgin who had a giant cervical polyp which had developed through a foreign body and protruded out of the hymen was evaluated; the aetiological significance of the foreign body in the formation of the cervical polyp is discussed.     

Influence of long term erythropoietin therapy on the hypothalamic-pituitary-thyroid axis in patients undergoing capd

OBJECTIVE: Treatment of anemia with recombinant human erythropoietin (rHuEpo) in hemodialysis patients has been associated with improvement of several abnormalities in hypothalamic-pituitary function. The aim of the present study is to investigate the effects of long term erythropoietin therapy on the hypothalamic-pituitary-thyroid hormone axis in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). DESIGN: Single center, prospective study. PATIENTS AND METHODS: Ten patients who were clinically stable and had been on CAPD were evaluated. Eleven age and sex matched healthy volunteers were chosen as controls. All of the patients were clinically euthyroid. All patients were on CAPD therapy and none of them had received rHuEpo treatment previously. In all patients after basal estimations of free T3, free T4, TSH, GH and prolactin levels, a bolus of 400 microg TRH was administered intravenously. Levels of TSH, GH and prolactin were measured in blood samples collected every 30 min of the 3 h test period. After the treatment with rHuEpo, TRH test with the same protocol was repeated. RESULTS: Before the improvement in serum hemoglobin levels with rHuEpo treatment, the patients on CAPD showed abnormal hypothalamic-pituitary-thyroidal functions, including delayed and prolonged TSH (NS), paradoxically elevated GH (p < 0.001) and increased and prolonged prolactin (p = 0.001) responses to TRH. After improvement of anemia with rHuEpo no significant difference was found between the patients and control groups for baseline TSH levels. In the patients peak TSH level and AUC of TSH secretion were significantly reduced after the treatment (p < 0.05 for both). Furthermore the improvement in anemia did not eliminate the paradoxic GH and prolonged prolactin responses to TRH administration. CONCLUSION: Some hypothalamic-pituitary-thyroid function abnormalities including delayed and blunted TSH, increased and prolonged prolactin and paradoxical GH responses to TRH administration were observed in uremic patients treated with CAPD and the improvement in anemia with rHuEpo seems to cause slight changes on the hypothalamic-pituitary-thyroid axis and peripheral thyroid hormones.     

Primary amyloidosis presenting with massive generalized lymphadenopathy

Systemic amyloidosis is an unusual cause of generalized massive lymphadenopathy. In such cases the clinical picture may mimic lymphoma. We report a case of generalized massive lymphadenopathy caused by amyloidosis. The 55-year old female patient was admitted to our hospital with dyspnea and edema in the lower extremities. These were diminished breath sounds with bilateral basal congestion hepatosplenomegaly and generalized massive lymphadenopathy in axillary, cervical, and inguinal areas. The diagnosis was made by excisional biopsy of one of the involved lymph nodes. Amyloidosis (AL type) was shown and treatment with melphalan and prednisone was initiated. Unfortunately the patient died after 51 days in hospital.     

Does systematic lymphadenectomy have a benefit on survival of suboptimally debulked patients with stage III ovarian carcinoma? A DEGOG* Study

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate whether systematic lymphadenectomy is necessary in suboptimally cytoreduced patients with stage III ovarian carcinoma. METHODS: Prognostic significance and the effect on survival of systematic pelvic and para-aortic lymphadenectomy were investigated retrospectively in 61 suboptimally debulked patients with stage III ovarian carcinoma. All patients received platinum-based chemotherapy after surgery; 51 patients had been followed for > or =1 year, or until death. Survival curves were calculated according to the Kaplan-Meier method and were evaluated by log-rank test. RESULTS: Most patients had stage IIIC disease (60.7%), poorly differentiated tumor (45.9%), and serous histological type (59%). Systematic pelvic and para-aortic lymphadenectomy was performed in 29 patients (47.5%). Lymph node metastases were found in 17 (58.6%) patients; the median number of metastatic nodes was 7 (5-10). Lymph node metastasis was significantly higher in patients with residual disease of >2 cm (P < 0.05). Both univariate and multivariate analyses showed that systematic pelvic and para-aortic lymphadenectomy was not a significant prognostic factor (P > 0.05). In lymph node-dissected patients, survival was significantly longer in patients with minimal residual tumor than in those with residual tumor size >2 cm (P = 0.005). CONCLUSIONS: Lymphadenectomy seems not to have an evident prognostic value and a benefit on survival in suboptimally debulked patients with stage III ovarian carcinoma.     

The effect of postmenopausal hormone therapy with or without folic acid supplementation on serum homocysteine level.

OBJECTIVE: To evaluate the effects of postmenopausal hormone therapy (HT) with or without the addition of folic acid (FA) on serum homocysteine levels in a randomized, placebo-controlled design. Additionally, a non-randomized control group with no treatment was included. METHODS: Forty non-hysterectomized healthy postmenopausal women were randomly allocated to receive either oral continuous combined HT (0.625 mg conjugated equine estrogen with 2.5 mg medroxyprogesterone acetate daily) and oral folic acid (5 mg/day, n = 20) or HT and placebo (n = 20) for 3 months. A control group (n = 15) did not receive any study medication and was followed in the same manner. The fasting total serum homocysteine level was measured by fluorescence polarization immunoassay with a sensitivity of < 0.5 micromol/l. Serum levels of folate, estrogen and lipid profile were also followed. RESULTS: The mean age of the postmenopausal women was 52 +/- 6 years. Baseline homocysteine level was the highest in the HT + FA group (9.96 +/- 2.82 micromol/l), compared to HT + placebo (9.64 +/- 1.89 micromol/l) and control groups (9.01 +/- 1.83 micromol/l) (ANCOVA, p = 0.022). Low baseline folate and vitamin B12 levels contributed significantly to the high level of baseline homocysteine in the HT + FA group. The addition of FA to HT led to a significant decrease in the serum homocysteine level from the baseline level of 9.96 +/- 2.82 micromol/l to the final level of 8.92 +/- 2.53 micromol/l (p = 0.023). On the other hand, HT alone (HT + placebo group) significantly increased the serum homocysteine level from 9.64 +/- 1.89 micromol/l to 10.22 +/- 1.77 micromol/l without a decline in serum folate level (p = 0.045). The serum homocysteine level in the control group did not change significantly (from 9.01 +/- 1.83 micromol/l to 9.58 +/- 2.05 micromol/l, p = 0.29). CONCLUSIONS: Three months of oral continuous combined HT increased the fasting total serum homocysteine level without affecting the serum folate level. Lowering the homocysteine level in postmenopausal woman on HT is achievable by folic acid supplementation.     

Evaluating social work discharge planning services for elderly people: access, complexity, and outcome.

The discharge planning role of hospital social workers has become increasingly important in services to elderly people. This article examines three issues: (1) the extent to which elderly people most in need receive social work services, (2) the extent to which the discharge planning performed is a professional task, and (3) the effectiveness of discharge planning for those who return to their homes after hospitalization. The study focused on 1,100 elderly patients from five Baltimore hospitals. Data were gathered from their social workers, from the patients themselves (by phone after discharge), and from medical records. Results show that only a minority of elderly patients who return to the community after hospitalization receive social work services while in the hospital but that those who do are likely to have posthospital needs. In most cases, the discharge planning uses professional skills, but 28 percent of cases are fairly routine. Finally, social work services were effective in reducing the level of unmet needs in the areas of nursing, medication, and physical therapy.     

A case of coumarin necrosis with penile and pedal involvement

A 57-year-old male patient with advanced adenocarcinoma of the lung, who was administered oral anticoagulant therapy because of pulmonary embolism, developed coumarin necrosis confined to the penis and feet. To our knowledge, this patient showing acral involvement is the seventh case of coumarin-induced penile necrosis reported to date.