Preoperative CA 125 Tumour Marker in Endometrial Cancer: Correlation With Advanced Stage Disease

ObjectiveTo evaluate if a preoperative serum CA 125 level ≥ 35 kU/L in patients with endometrial cancer correlates with a surgical stage III or IV and poor histopathological prognostic factors.MethodsWe conducted a retrospective cohort study of 254 patients who underwent hysterectomy and full staging for endometrial cancer. Preoperative serum CA 125 was available for each patient as well as complete clinical and histopathological data. Chi-square, Fisher exact test, multivariate logistic regression, and receiver operating characteristic curve curves were used for statistical analysis.ResultsA total of 186 (73%) patients had stage I or II disease and 68 (27%) had stage III or IV disease. A statistically higher number of patients from the stage III or IV group had a serum CA 125 level > 35 kU/L (58%) compared with the stage I or II group (16%) (OR 7.44; P < 0.001). There was no correlation between serum CA 125 level and histological subtype. Patients with stage I or II disease and serum CA 125 ≥ 35 kU/L (46%) had significantly more frequent deep myometrial invasion (> 50%) than did those with serum CA 125 < 35 kU/L (18%) (OR 3.68; P = 0.006).ConclusionAssay of the preoperative serum CA 125 level is a very simple test to detect patients with more advanced stage endometrial adenocarcinoma. Its routine use could help triage high risk patients preoperatively.     

Cerebral perfusion pressure,and not cerebral blood flow,may be the critical determinant of intracranial injury in preeclampsia: a new hypothesis

OBJECTIVE: The relationship between cerebral perfusion pressure (CPP) and cerebral blood flow is unclear in preeclampsia. Our objective was to clarify this issue by comparing normal pregnant women to those with mild and severe preeclampsia. STUDY DESIGN: Patients with mild (n = 72) and severe (n = 120) preeclampsia underwent transcranial Doppler (TCD) imaging of the maternal middle cerebral artery (MCA). At the same time, blood pressure was taken with a Dinamap monitor (Dinamap; Criticon Inc, Tampa, Fla). CPP, resistance area product (RAP), and the cerebral flow index (CFI) were calculated by standard formulas. Data were plotted on normative curves for pregnancy (5% and 95%) and compared by chi(2) and Mann-Whitney U tests. RESULTS: CFI is usually normal in both severe (75%) and mild (72%) cases. If CFI is abnormal in severe cases, it may be either increased (14%) or decreased (10%), although in mild cases almost all abnormal CFI (25%) is lower than normal. In those cases with low or normal CFI, severe cases are associated with a significantly higher CPP, RAP, and MAP than mild cases (P <.05), although the CFI is not significantly different. A significant proportion of severe cases have high CPP (52%), whereas in mild cases the CPP is almost always normal (87%). Overall, in severe cases the RAP is abnormally high, although it is within the normal range in mild cases. CONCLUSIONS: One of the fundamental differences between mild and severe cases relates to the degree of cerebral perfusion pressure that the MCAs are subjected to. Because most preeclamptic women, regardless of degree of severity, have a normal CFI, it appears that autoregulation is generally intact. Because women with severe cases are more prone to cerebral catastrophe than those with mild preeclampsia, uncontrolled CPP may cause barotrauma and vessel damage, leading to hypertensive encephalopathy and overperfusion injury. Therapeutic strategies that ensure reduction of the CPP with maintenance of the CFI seem most likely to prevent the cerebral injuries (overperfusion or underperfusion) that cause seizures or death in women with preeclampsia.     

Adherence to WCRF/AICR cancer prevention recommendations and metabolic syndrome in breast cancer patients

Metabolic syndrome (MetS), conventionally defined by the presence of at least three out of five dismetabolic traits (abdominal obesity, hypertension, low plasma HDL‐cholesterol and high plasma glucose and triglycerides), has been associated with both breast cancer (BC) incidence and prognosis. We investigated the association between the prevalence of MetS and a score of adherence to the World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) recommendations for the prevention of cancer in a cross‐sectional study of BC patients. The DIet and ANdrogen‐5study (DIANA‐5) for the prevention of BC recurrences recruited 2092 early stage BC survivors aged 35–70. At recruitment, all women completed a 24‐hour food frequency and physical activity diary on their consumption and activity of the previous day. Using these diaries we created a score of adherence to five relevant WCRF/AICR recommendations. The prevalence ratios (PRs) and 95% confidence intervals (CIs) of MetS associated with the number of recommendations met were estimated using a binomial regression model. The adjusted PRs of MetS decreased with increasing number of recommendations met (p < 0.001). Meeting all the five recommendations versus meeting none or only one was significantly associated with a 57% lower MetS prevalence (95% CI 0.35–0.73). Our results suggest that adherence to WCRF/AICR recommendations is a major determinant of MetS and may have a clinical impact.     

腹腔镜手术治疗休克型异位妊娠29例分析

目的:探讨休克型异位妊娠的腹腔镜手术的安全性及可行性。方法:对2009年9月至2011年8月经腹腔镜手术治疗的29例休克型异位妊娠病例进行回顾性分析。结果:29例患者均顺利经腹腔镜完成手术,无1例中转开腹,未出现严重手术并发症。结论:对于休克型异位妊娠,在具备熟练的腹腔镜手术技巧、配合严密的麻醉监护及有效的抗休克治疗的前提下,腹腔镜手术是安全可行的。