Endometriosis recto-sigmoidea: a propósito de un caso

Intestinal endometriosis is often asymptomatic and is diagnosed incidentally during laparotomy or laparoscopy performed for other reasons. When this entity is symptomatic, the clinical manifestations are usually nonspecific and identical to those of other gastrointestinal disorders. Intestinal endometriosis is not usually suspected preoperatively, except in patients with a history of endometriosis or cyclical manifestations coinciding with menstruation. Intestinal endometriosis may mimic various gastrointestinal disorders such as Crohn's disease, diverticulitis, ischemic colitis or even neoplasia. Diagnostic tests usually provide little information, but colonoscopy, magnetic resonance imaging, echoendoscopy and especially biopsy may be useful for diagnosis and to rule out malignancy, mainly in rectosigmoidal lesions.     

Smoking and drinking cessation and risk of esophageal cancer (Spain)

Objectives:To explore the effectiveness of alcohol drinking and tobacco smoking cessation in reducing esophageal cancer risk, taking into account the key characteristics of each habit and the simultaneous exposure to both habits. Methods:Data from a series of five hospital-based case–control studies of incident squamous-cell carcinoma of the esophagus conducted by the International Agency for Research on Cancer (IARC, Lyon, France) in high-risk areas in South America were combined and analyzed by multivariate logistic regression procedures. A total of 2063 men (655 case patients and 1408 control subjects) were included in the pooled analysis. Results:For either habit, the risk of esophageal cancer decreased rapidly, strongly and significantly with longer periods of abstention. The risk reduction was statistically significant regardless of the intensity and duration of each habit and the type of tobacco or alcoholic drink consumed. For subjects exposed to both risk factors, the protective effect of quitting both habits appeared to be synergistic, reaching, after only five to nine years of simultaneous cessation of both exposures, a 70% risk reduction, a reduction that clearly overlapped with the risk intervals of both never-smokers and never-drinkers. The risk benefit of merely quitting alcohol drinking was delayed (>10 years of cessation) unless it was also accompanied by a few years of smoking cessation. Conclusions:Our findings solidly demonstrate for the first time the effectiveness of smoking and drinking cessation in reducing esophageal cancer risk. For the large proportion of subjects in the general population exposed to both risk factors, our results further emphasize the importance of smoking cessation to effectively reduce cancer risk.     

Verapamil-sensitive Ca2+ channel regulation of Th1-type proliferation of splenic lymphocytes induced by Walker 256 tumor development in rats

Recently, we demonstrated that verapamil, an L-type Ca2+ channel blocker, inhibits the activation of splenic lymphocytes during Walker 256 ascitic tumor development in adult rats. In the present study we have analyzed the changes in spleen size, splenic lymphocyte proliferation, white pulp organization and relative size as well as food intake, and levels of blood haemoglobin in Walker 256 tumor bearing rats. These rats displayed a spleen enlargement associated with a significant increase in white pulp area and TCD8+ lymphocyte proliferation. Levels of interferon-gamma, but not of interleukin-10, were elevated in tumor bearing rats, indicating a Th1-type immune response. These manifestations were accompanied by reduced food intake and anaemia. Treatment of tumor bearing rats with verapamil avoided spleen enlargement and increased expression of cytokines, as well as the splenic TCD8+ lymphocyte proliferation. In addition, verapamil treatment promoted an exacerbation of the anorexia and anaemia caused by Walker tumor development. No such effect was observed in control rats treated with verapamil. Taken together, these findings suggest that verapamil inhibits the immune response to cancer, resulting in an increase of the systemic effects induced by Walker 256 tumor.     

Postcoital testing after the use of a bio-adhesive acid buffering gel (ACIDFORM) and a 2% nonoxynol-9 product

ACIDFORM is a gel already shown to be safe in vaginal use during six consecutive days through colposcopic observation. A randomized, blinded, crossover study was carried out to compare the spermicidal effect of ACIDFORM to that of a commercial 2% nonoxynol-9 (N-9) product. Twenty sexually active, sterilized women, aged 19–45 years, with regular cycles, normal gynecological exam, no previous sexually transmitted infection (STI) and stable partner willing to undergo four postcoital tests (PCTs) at midcycle during four different menstrual cycles, were enrolled in the study. Known allergy to N-9 or ACIDFORM, oligospermic partner, chronic diseases, use of hormones, previous treatment for STI or presence of STI at screening tests were criteria for exclusion. ACIDFORM or N-9 product administered 0–30 min precoitus or ACIDFORM given 8–10 h precoitus significantly reduced the mean number of progressively motile sperm compared to control cycles (0.19, 0.07, 0.75 vs. 17.94, respectively, p<.05, Wilcoxon test). All treated cycles had five or fewer progressively motile sperm in midcycle cervical mucus, confirming in vivo the spermicidal effect of ACIDFORM previously observed in vitro and in animal models.     

Correlation of follicular diameter with oocyte recovery and maturity at the time of transvaginal follicular aspiration

Forty-four consecutive patients undergoing transvaginal follicular aspiration for in vitro fertilization underwent ultrasonic measurement of follicular diameter at the time of oocyte retrieval to determine the correlation of follicular size with recovery rates and oocyte maturity. Based on the results of 412 follicles aspirated, the data were grouped by size (11, 12–14, 15–17, 18–20, and 21 mm) and oocyte maturity. Recovery rates were significantly higher in 18- to 20-mm follicles (P<0.01) and lower in those 11 mm (P<0.001). The probability of retrieving a metaphase I or II oocyte was significantly lower in follicles 11 mm (P<0.001), somewhat higher in 12- to 14-mm follicles (P<0.01), and equally high among the other groups. There were no differences in the incidence of fractured zonas. We conclude that follicles 15 mm provide the highest probability of retrieving mature oocytes and the low recovery rates of mature oocytes from follicles 11 mm suggest that, in selected circumstances, the operating surgeon may choose not to aspirate them.     

Monitoring gonadotropin-stimulated cycles for in vitro fertilization and embryo transfer

One hundred fifty-one cycles stimulated with human menopausal gonadotropin (hMG) and/or folliclestimulating hormone (FSH) were analyzed retrospectively to determine the relationship of the monitoring parameters used: serum estradiol (E₂), transvaginal sonographic follicular size, and peripheral biologic estrogen response, with harvests and pregnancies resulting from in vitro fertilization and embryo transfer. Mean ± SE serum E₂ levels were higher on the day of human chorionic gonadotropin (hCG) administration in the miscarriage group (689.4±27.5 pg/ml) than in the nonpregnant group (527.7±25.8 pg/ml) (P=0.018) and highest in the ongoing pregnancy group (734.6±66.5 pg/ml) (P=0.003). When two or more preovulatory oocytes (preovs) were retrieved, the mean E₂ levels were higher (622.3±27.3 pg/ml) than if zero or one preov was retrieved (378.4±43.5 pg/ml) (P=0.001). The mean diameter of the two largest follicles at the time of hCG administration was significantly greater (14.7 mm) in the group with two or more preovs retrieved than in the group with zero or one preov (13.3 mm) (P=0.001). The relative probability of achieving a pregnancy was best predicted by the presence of two follicles16 mm in diameter on transvaginal ultrasound examination and was 1.63 times greater than that of all patients in this series.     

Detection of the microsporidian parasite Enterocytozoon bieneusi in specimens from patients with AIDS by PCR.

Microsporidia are protozoa parasites responsible for significant gastrointestinal disease in patients infected with human immunodeficiency virus. We evaluated a PCR assay of stool samples, duodenal aspirates, and biopsy specimens from patients with Enterocytozoon bieneusi infection. A 210-bp DNA fragment of the unique rRNA intergenic spacer could be amplified from all samples infected with E. bieneusi, but no amplification was seen by using DNA purified from samples with Septata intestinalis or other parasites and from negative control human cells. These results suggest that the PCR in stool samples may be a useful tool for the diagnosis of intestinal microsporidiosis in patients with AIDS.     

No association detected between a D3 receptor gene-expressed variant and schizophrenia

A missense polymorphism (glycine to serine) in the first exon of the dopamine D₃ (DRD3) gene was examined in a sib-pairs schizophrenia collection by the transmission test for linkage disequilibrium (TDT). No association due to linkage disequilibrium was detected using TDT. Additionally, no evidence for excess homozygosity was found. © 1996 Wiley-Liss, Inc.     

Comparison between laparoscopically and ultrasonographically guided transvaginal follicular aspiration methods in an in vitro fertilization program in the same patients using the same stimulation protocol

Summary Oocyte recovery from 43 patients undergoing ultrasound-guided transvaginal oocyte retrieval was compared to a previous laparoscopic oocyte retrieval cycle from the same patient. Gonadotropin stimulation in both cycles was performed using the same protocol. There were no statistically significant differences in the mean day of oocyte retrieval or the mean daily estradiol level up to the day of oocyte retrieval between laparoscopic and transvaginal cycles. The total number of follicles aspirated per cycle, preovulatory oocytes aspirated per cycle, and number of concepti of preovulatory origin transferred per cycle were not statistically different. The number of immatue oocytes aspirated per cycle was statistically decreased in transvaginal retrieval cycles, which resulted in an increased total number of concepti transferred per transfer in laparascopic retrieval cycles. Twelve pregnancies resulted from the transvaginal retrieval cycles (27.9%), seven of which are ongoing or delivered. Ultrasound-guided transvaginal follicular aspiration yields results comparable to laparascopic retrieval in the same patients and should be the method of choice for oocyte pickup because of its many advantages.Presented in part at the ACOG Annual Meeting, Boston, 1988.