Laparoscopic-assisted vaginal versus abdominal surgery in patients with endometrial cancer--a prospective randomized trial

OBJECTIVE: We compared a laparoscopic-vaginal approach with the conventional abdominal approach for treatment of patients with endometrial cancer. METHOD: Between July 1995 and August 1999, 70 patients with endometrial cancer FIGO stage I-III were randomized to laparoscopic-assisted simple or radical vaginal hysterectomy or simple or radical abdominal hysterectomy with or without lymph node dissection. RESULTS: Thirty-seven patients were treated in the laparoscopic versus 33 patients in the laparotomy group. Lymph node dissection was performed in 25 patients by laparoscopy and in 24 patients by laparotomy. Blood loss and transfusion rates were significantly lower in the laparoscopic group. Yield of pelvic and para-aortic lymph nodes, duration of surgery, and incidence of postoperative complications were similar for both groups. Overall and recurrence-free survival did not differ significantly for both groups. CONCLUSION: The laparoscopic-vaginal approach for treatment of endometrial cancer is associated with lower perioperative morbidity compared with the conventional abdominal approach.     

Photodynamische Therapie bei chorioidalen Hämangiomen

AIM: Evaluation of functional and anatomical long-term results of patients with symptomatic choroidal hemangioma treated with photodynamic therapy (PDT). PATIENTS AND METHODS: All 8 patients suffered from progressive loss of vision caused by exudation into the macular area. PDT with a verteporfin dose of 6 mg/m(2) body surface area and a light dose of 100 J/cm(2) at 692 nm was carried out. Two to four treatments were applied at 6 week intervals using a single laser spot. Standardized evaluation was used before and at 6-week intervals after each treatment and at 3, 6 and 12 months. In the further follow-up control intervals were extended up to 1 year in the case of stable anatomical and functional results. RESULTS: All patients showed complete regression of the tumor. The tumor height was reduced from an average of 3.64 mm to undetectable. One patient showed a stable visual acuity, seven patients a significant increase. Central scotometry showed withdrawal of scotomas from the macula. No patient showed any sign of recurrence during the follow-up of up to 60 months. CONCLUSION: The long-term results of patients with active choroidal hemangioma demonstrate that PDT is a most effective and safe treatment option. Complete tumor regression is combined with good functional recovery.     

Hyperparathyroidism and subsequent incidence of breast cancer

Preliminary data are available on the coexistence of primary hyperparathyroidism and breast carcinoma. To further understand the association between hyperparathyroidism and breast cancer, we conducted a record-linkage study in Sweden using the Swedish Cancer Registry from 1958-1997. A total of 9,835 women who underwent surgery for primary parathyroid adenoma were followed to evaluate the hypothesis that a history of primary hyperparathyroidism increases the risk of subsequent breast cancer. During 99,929 person-years of follow-up, 331 cases of newly diagnosed breast cancer were reported. The number of expected breast cancers in this population was 260.0. This resulted in a standardized incidence ratio of 1.27 (95% confidence interval [CI] = 1.14-1.41). The relation persisted over time after the surgical removal of the parathyroid adenoma. Possible explanations for the observed association are a shared etiology including genetic and environmental factors such as early life radiation, and hypercalcemia after the overproduction of parathyroid hormone, which may increase breast cancer incidence.     

Photodynamic therapy with verteporfin: a new treatment in ophthalmology

Photodynamic therapy (PDT) with verteporfin is a new treatment modality in ophthalmology that has previously shown its effectiveness in treatment of a variety of neoplastic pathologies. In this therapeutic approach, the photosensitizer verteporfin is activated by non-thermal laser light to obtain closure of neovascular structures. Preclinical and clinical studies have indicated that PDT is a safe, selective, and effective treatment for choroidal neovascularization in age-related macular degeneration. No significant damage to the neurosensory retina was found, which explains why PDT does not cause loss of visual acuity and may be used in a larger population than laser photocoagulation. This review summarizes the mechanisms of action of PDT, and the results of preclinical and clinical studies in ophthalmology.     

Laparoscopically assisted vaginal hysterectomy as an alternative to abdominal hysterectomy in patients with fibroids

Objective: Introduction of laparoscopically assisted vaginal hysterectomy (LAVH) was evaluated for its usefulness to replace abdominal hysterectomy in fibroids. Study design: A total of 240 women with a mean age of 46.7 years underwent hysterectomy over a period of one year. The technique of LAVH was introduced starting in the second quarter of the study period. Clinical data of 60 patients undergoing either LAVH or abdominal hysterectomy for fibroids were compared in a cross-sectional study by χ ²- and t-test. Results: A comparison between the first and the last quarter of the study period showed that the rate of abdominal hysterectomies decreased from 66% to 12%, whereas LAVH increased from 0 to 40% (p < 0.05). The rate of vaginal hysterectomies remained between 34% and 48%. Compared to abdominal hysterectomy, LAVH operating time was about 1/3 longer, hospital stay was shorter (3 days), and LAVH proved more cost-effective than abdominal hysterectomy (significance of all differences: p < 0.05). Conclusions: LAVH is a valid alternative to abdominal hysterectomy in fibroids. Received: 10 April 1996 / Accepted: 15 August 1996     

Risk factors for sudden infant death syndrome following the prevention campaign in New Zealand: a prospective study

OBJECTIVES: To identify the risk factors for sudden infant death syndrome (SIDS) following a national campaign to prevent SIDS. METHODS: For 2 years (October 1, 1991 through September 30, 1993) data were collected by community child health nurses on all infants born in New Zealand at initial contact and at 2 months. RESULTS: There were 232 SIDS cases in the postneonatal age group (2.0/1000 live births) and these were compared with 1200 randomly selected control subjects. Information was available for 127 cases (54.7%) and 922 (76.8%) of controls. The previously identified modifiable risk factors were examined. The prevalence of prone sleeping position of the infant was very low (0.7% at initial contact and 3. 0% at 2 months), but was still associated with an increased risk of SIDS. In addition, the side sleeping position was also found to have an increased risk of SIDS compared with the supine sleeping position (at 2 months: adjusted odds ratio (OR) = 6.57; 95% confidence interval (CI) = 1.71, 25.23). Maternal smoking was found to be the major risk factor for SIDS. Bed sharing was also associated with an increased risk of SIDS. There was an interaction between maternal smoking and bed sharing on the risk of SIDS. Compared with infants not exposed to either bed sharing or maternal smoking, the adjusted OR for infants of mothers who smoked was 5.01 (95% CI = 2.01, 12.46) for bed sharing at the initial contact and 5.02 (95% CI = 1.05, 24. 05) for bed sharing at 2 months. In this study breastfeeding was not associated with a statistically significant reduction in the risk of SIDS. The other risk factors for SIDS identified were: unmarried mother, leaving school at a younger age, young mother, greater number of previous pregnancies, late attendance for antenatal care, smoking in pregnancy, male infant, Maori ethnicity, low birth weight, and shorter gestation. CONCLUSIONS: After adjustment for potential confounders, prone and side sleeping positions, maternal smoking, and the joint exposure to bed sharing and maternal smoking were associated with statistically significant increased risk of SIDS. A change from the side to the supine sleeping position could result in a substantial reduction in SIDS. Maternal smoking is common in New Zealand and with the reduction in the prevalence of prone sleeping position is now the major risk factor in this country. However, smoking behavior has been difficult to change. Bed sharing is also a major factor but appears only to be a risk to infants of mothers who smoke. Addressing bed sharing among mothers who smoke could reduce SIDS by at least one third. Breastfeeding did not appear to offer a statistically significant reduction in SIDS risk after adjustment of potential confounders, but as breastfeeding rates are comparatively good in New Zealand, this result should be interpreted with caution as the power of this study to detect a benefit is small.