Ovarian carcinoma diagnosis

BACKGROUND: Ovarian carcinoma often is called the "silent killer" because the disease usually is not detected until an advanced stage. The authors' goal was to evaluate preoperative symptoms and factors that may contribute to delayed diagnosis for women with ovarian carcinoma. METHODS: A two-page survey was distributed to 1500 women who subscribe to CONVERSATIONS!, a newsletter about ovarian carcinoma. Because the survey could be copied and given to other patients, 1725 surveys were returned from women in 46 states and 4 Canadian provinces. RESULTS: The median age of the surveyed women was 52 years, and 70% had Stage III or IV disease (International Federation of Gynecology and Obstetrics). When asked about symptoms before the diagnosis of ovarian carcinoma, 95% reported symptoms, which were categorized as abdominal (77%), gastrointestinal (70%), pain (58%), constitutional (50%), urinary (34%), and pelvic (26%). Only 11% of women with Stage I/II and 3% with Stage III/IV reported no symptoms before their diagnosis. Women who ignored their symptoms were significantly more likely to be diagnosed with advanced disease compared with those who did not (P = 0.002). The time required for a health care provider to make the diagnosis was reported as less than 3 months by 55%, but greater than 6 months by 26% and greater than 1 year by 11%. Factors significantly associated with delay in diagnosis were omission of a pelvic exam at first visit; having a multitude of symptoms; being diagnosed initially with no problem, depression, stress, irritable bowel, or gastritis; not initially receiving an ultrasound, computed tomography, or CA 125 test; and younger age. The type of health care provider seen initially, insurance, and specific symptoms did not correlate with delayed diagnosis. CONCLUSIONS: This large national survey confirms that the majority of women with ovarian carcinoma are symptomatic and frequently have delays in diagnosis.     

Carotid Sinus Itypersensitivity: A Cause of Syncope in Patients with Tumors of the Head and Neck

Carotid sinus hypersensitivity secondary to the presence of an underlying head and neck cancer has only recently been discussed in the literature. We present seven cases of carotid sinus hypersensitivity, each with paroxysmal bradycardia and hypotension associated both with and without palpation of the carotid bifucation. A discussion of the anatomy and the etiology of the hypersensitivity is given. Currently available therapeutic modalities are discussed in regard to their efficacy in this study. Carotid sinus hypersensitivity secondary to tumor in the neck is most often vasodilatory in nature and hence does not respond well to transvenous pacemaker. The best treatment for severe hypersensitivity appears to be periarteriectomy or intracranial nerve root section. Radiation therapy is occasionally beneficial.     

Treatment of pregnancy-related pelvic girdle and/or low back pain after delivery design of a randomized clinical trial within a comprehensive prognostic cohort study [ISRCTN08477490]

Background  

Pregnancy-related pelvic girdle and/or low back pain is a controversial syndrome because insight in etiology and prognosis is lacking. The controversy relates to factors eliciting pain and some prognostic factors such as the interpretation of pain at the symphysis. Recent research about treatment strategies also reflects those various opinions, in fact suggesting there is professional uncertainty about the optimal approach. Currently, physiotherapists often prescribe a pain-contingent treatment regime of relative rest and avoiding several day-to-day activities. Additionally, treatment more often includes an exercise program to guide rectification of the muscle imbalance and alignment of the pelvic girdle. Effectiveness of those interventions is not proven and the majority of the studies are methodologically flawed. Investigators draw particular attention to biomedical factors but there is growing evidence that important prognostic issues such as biopsychosocial factors appear to be even more important as point of action in a treatment program.     

Frequency of symptoms of ovarian cancer in women presenting to primary care clinics

Context  Women with ovarian cancer frequently report symptoms prior to diagnosis, but distinguishing these symptoms from those that normally occur in women remains problematic. Objective  To compare the frequency, severity, and duration of symptoms between women with ovarian cancer and women presenting to primary care clinics. Design, Setting, and Patients  A prospective case-control study of women who visited 2 primary care clinics (N = 1709) and completed an anonymous survey of symptoms experienced over the past year (July 2001-January 2002). Severity of symptoms was rated on a 5-point scale, duration was recorded, and frequency was indicated as number of episodes per month. An identical survey was administered preoperatively to 128 women with a pelvic mass (84 benign and 44 malignant). Main Outcome Measures  Comparison of self-reported symptoms between ovarian cancer patients and women seeking care in primary care clinics. Results  In the clinic population, 72% of women had recurring symptoms with a median number of 2 symptoms. The most common were back pain (45%), fatigue (34%), bloating (27%), constipation (24%), abdominal pain (22%), and urinary symptoms (16%). Comparing ovarian cancer cases to clinic controls resulted in an odds ratio of 7.4 (95% confidence interval [CI], 3.8-14.2) for increased abdominal size; 3.6 (95% CI, 1.8-7.0) for bloating; 2.5 (95% CI, 1.3-4.8) for urinary urgency; and 2.2 (95% CI, 1.2-3.9) for pelvic pain. Women with malignant masses typically experienced symptoms 20 to 30 times per month and had significantly more symptoms of higher severity and more recent onset than women with benign masses or controls. The combination of bloating, increased abdominal size, and urinary symptoms was found in 43% of those with cancer but in only 8% of those presenting to primary care clinics. Conclusions  Symptoms that are more severe or frequent than expected and of recent onset warrant further diagnostic investigation because they are more likely to be associated with both benign and malignant ovarian masses.      

Safety syringes can reduce the risk of needlestick injury in venous thromboembolism prophylaxis

Patients undergoing major orthopaedic surgery of the lower extremities are at high risk of developing venous thromboembolism (VTE). Pharmacologic thromboprophylaxis has greatly reduced the likelihood of VTE. The most effective medications are administered once or twice daily by subcutaneous injection, a drug delivery route associated with an increased risk of needlestick injury. Awareness of the potential lethality of needlestick injuries has increased during the past decade, resulting in the development of national safety guidelines from the Occupational Safety and Health Administration on the handling and management of needles and other sharps. This article reviews the potential risks and costs associated with needlestick injury during the administration of VTE prophylaxis in patients undergoing major orthopaedic surgery. The development of novel anticoagulants and accompanying devices to prevent needlestick injury is also discussed.     

Endoxin antagonist lessens myocardial ischemia reperfusion injury

Endoxin antagonist lessens myocardial ischemia reperfusion injury@柯永胜$Department of Cardiology, Yijishan Hospital, Wannan Medical College, Wuhu, 241001 China @王德国$Department of Cardiology, Yijishan Hospital, Wannan Medical College, Wuhu, 241001 C     

Evaluation of p27 in preinvasive and invasive malignancies of the cervix

OBJECTIVE: p27 is a cell cycle inhibitor whose loss is commonly found in epithelial tumors. Low levels have been associated with poor prognosis. Our goal was to determine if p27 expression could be used to screen for dysplasia and if it is a prognostic factor for cervical malignancies. METHODS: Ten normal cervices, 51 consecutive cone biopsies for preinvasive disease, and 128 consecutive hysterectomies for invasive cervical cancer (1994-1999) were stained for p27 using standard immunocytochemical techniques. All of the cervical cancer patients were managed with radical hysterectomy and lymph node dissection, except for 14 women who underwent adjuvant hysterectomy and lymph node sampling after chemoradiation. RESULTS: There was no significant difference in p27 staining between normal cervices (all stained 4+) and preinvasive lesions (46/51 stained 4+ and 5/51 stained 3+). For the invasive lesions, 47 women had no residual disease in the hysterectomy specimen, due to prior cone biopsy (41) or radiation (6). All had 4+ p27 staining in the residual cervix. None of these women recurred. Eighty-one women had residual disease in the hysterectomy specimen; 25/81 (31%) had p27 staining of <50%. Loss of p27 was not significantly associated with invasion >50% (32 vs 27%), size >4 cm (20 vs 13%), or use of postoperative radiation (36 vs 20%). Loss of p27 was associated with lymphvascular space invasion (LVSI) (44 vs 20%, P = 0.04). Only 4 women had nodal metastasis; all 4 had p27 staining less than 50%; 6/81 (7%) women with residual disease developed recurrences and died. Of the women who died, 3/6 had p27 staining less than 50%. CONCLUSION: p27 is not lost in preinvasive cervical lesions and, therefore, cannot be used to screen for dysplasia. In cervical cancers p27 staining was <50% in 31% of cases, and is associated with increased risk of LVSI. Perhaps, because of the excellent overall survival of this group of women with Stage I cervical cancer, loss of p27 staining was not associated with poor prognosis.     

Chronic bullous disease of childhood and a paecilomyces lung infection in chronic granulomatous disease

A 12 year old boy suffering from p67-phox deficient chronic granulomatous disease presented with a bullous skin disease and a lung infection with paecilomyces species. The histopathology of a bullous lesion showed subepidermal blister formation and microabcesses containing eosinophils in the dermal papillae. By direct immunofluorescence, linear staining of IgA at the dermal-epidermal junction was detected which confirmed the clinical diagnosis of chronic bullous disease of childhood (linear IgA dermatosis).     

Pediatric Aerodigestive Foreign Body Injuries Are Complications Related to Timeliness of Diagnosis

Foreign body (FB) injury from aspiration or ingestion is a common pediatric health problem. Diagnosis relies on clinical judgment plus medical history, physical examination, and radiographic evaluation. A multi-institutional review of 1269 FB events revealed that 85% were correctly diagnosed following a single physician encounter. However, 15% of the children had an elusive diagnosis(>1 week), despite previous evaluation. Delays in diagnosis were seven times more likely to occur in aspirations than in ingestions. Secondary injuries(e.g., pneumonia and atelectasis) occurred in 13% of airway FBs but in only 1.7% of esophageal FBs. Plain radiographs were used in 82% of children, and special studies (e.g., fluoroscopy) in only 7%. We conclude that diagnosis of FB injury in children is frequently achieved at the initial evaluation but that continued surveillance by follow-up visits to health care facilities from parents and other caretakers is important, to reduce pulmonary injuries.     

Fallopian tube prolapse after hysterectomy. A report of two cases

Two patients were treated for fallopian tube prolapse after abdominal hysterectomy. This rare complication is usually seen after vaginal hysterectomy. Our patients presented with a profuse, blood-tinged vaginal discharge and lower abdominal pain two and three months after hysterectomy. The tender, fimbriated end of the fallopian tube must be distinguished from common cuff granulation tissue, one patient underwent painful cautery treatments for over a year before the correct diagnosis was made. Biopsy of the prolapsed tissue in both cases failed to provide the correct diagnosis. In cases reported on previously, repair of the prolapsed tube usually was accomplished transvaginally, but in one of our patients laparotomy was required to control bleeding from the retracted proximal tube. The other patient had her prolapsed tube diagnosed and resected laparoscopically. This technique, described in detail, has the advantage of avoiding more-extensive surgery in selected cases.