Endometriosis in episiotomy scar with anal sphincter involvement

A case of endometriosis in an episiotomy scar with involvement of the external anal sphincter is presented. The clinical, operative, and pathologic findings are reported. The question of etiology and treatment is discussed, and the literature is reviewed. Wide excision of the ectopic endometrial tissue with primary reconstruction of the external sphincter was curative, and the functional result was excellent. It is suggested that this treatment policy should be recommended for these cases.     

Varicocele treatment: prospective randomized trial of 3 methods.

This study was done to evaluate the surgical results and the impact on fertility potential of 3 methods of varicocele treatment. Consecutive varicocele patients with primary or secondary infertility were randomly assigned to 3 treatment groups. Of the patients 36 underwent percutaneous embolization, 55 high ligation of the internal spermatic vein and 28 transinguinal simultaneous ligation of the internal and external spermatic veins. The transinguinal ligation proved to be safe. There was no difference in pregnancy rates but the seminal variables showed a slight improvement with statistical significance only in the 2 open surgical methods. There were no surgical failures in the transinguinal group as opposed to the other 2 techniques. Transinguinal ligation of the internal and external spermatic veins may be recommended as the primary treatment for varicocele. This technique also seems to be the procedure of choice when repeat intervention is required for failure of high ligation or embolization.     

Acute necrotizing pancreatitis in the guinea pig

The effect of chlorophylla on experimental acute pancreatitis in guinea pigs was investigated. Pancreatitis was induced by intrapancreatic infiltration of a sodium taurocholate solution. Animals treated with intrapancreatic or intraperitoneal injections of chlorophylla showed higher survival rate than untreated controls.Supported in part by a Research Grant from the Chief Scientist, The Ministry of Health, Israel.     

Immunological profile changes following perioperative autologous vs. homologous blood transfusion in oncologic patients

To determine the effect of perioperative blood transfusion on immunological parameters, T cells, T-cell subsets, and concanavalin A-induced suppression were measured in 25 patients with colorectal and breast cancer. During the operation, 15 patients received autologous blood and 10 patients had homologous transfusion. The immunological status was again determined after curative surgery. Before surgery, normal percentage of T lymphocytes, decreased ratios of helper/suppressor cells, and impaired con A-induced suppression were found. Following the operation, the helper and suppressor cell percentages reversed to normal, whereas the con A-induced suppression remained impaired. This change was significantly more pronounced in patients who received autologous blood transfusion than in the other group. Autotransfusion has an impact on immune parameters that might prove less detrimental to the clinical outcome in oncologic surgery than homologous transfusion. © 1994 Wiley-Liss, Inc.     

Diagnosis of carcinoma of the breast by fine needle aspiration cytology

During a six year period, 1,953 fine needle aspiration cytologies (FNAC) were performed for lumps of the breast. Of these, 355 were diagnosed as carcinoma of the breast. The FNAC was performed on an outpatient basis and the pathologic interpretation was available within 30 to 60 minutes. The treatment strategy was always guided by the clinical impression of the physician. If the results of a suspected mass were negative on FNAC, biopsy was performed and histologic study gave the final diagnosis. There were no false-positive results and only 6 per cent were false-negative findings diagnosed later by open biopsy. The over-all accuracy rate was 90 per cent plus 4 per cent diagnosed on cytologic examination as "suspicious" and which proved to be malignant. Based upon our accumulated results, simplicity of performing the test, its low cost, the extremely low morbidity, the immediate response and, above all, an over-all high accuracy rate, we conclude that FNAC is a highly recommended method for the diagnosis of carcinoma of the breast.     

Using the Nordic–Baltic perinatal death classification to assess perinatal care in Ukraine

Objective: To identify health care issues important to reduce the perinatal mortality rate (PMR) in Ukraine. Study Design: Perinatal deaths in the Donetsk region (Ukraine) in 1997–1998 were compared with those in Denmark in 1996 by using the Nordic–Baltic classification for perinatal deaths. Clinical guidelines, use of technology and rates of interventions in the two regions were described. Results: A two-fold increase in PMR was found in Ukraine compared to Denmark, mainly explained by higher rates of antenatal deaths of growth restricted fetuses, intrapartum deaths, and neonatal deaths due to asphyxia. Vacuum extraction is rarely used in Ukraine. The clinical guidelines for care differ significantly between the two regions. Conclusion: Appropriate use of technology and implementation of evidence-based guidelines should be a matter of high priority in the Donetsk region, Ukraine.     

Diagnosis of varicocele and postoperative evaluation using inguinal ultrasonography

Ultrasonographic real-time imaging and measurements of spermatic veins in the inguinal canal were evaluated in two groups of patients: 20 young men with varicocele and 18 controls. Examinations were performed with the patient in an upright relaxed position, and performing the Valsalva maneuver. The increase in diameter of the main vein during Valsalva maneuver was considered to quantitatively represent venous reflux. The data obtained were correlated with pre- and postoperative clinical findings. This method of evaluation proved to be a useful noninvasive diagnostic modality for detecting varicocele and for assessing treatment results. On the basis of venous diameters and reflux values, a classification of varicocele is proposed. Such an objective method of grading would eliminate the subjective impression and interpretation factors of the examiner.     

Familial retrocaecal appendicitis.

Four members of the same family operated on for acute retrocaecal appendicitis are reported. It is suggested that they provide further support for the hypothesis that an hereditary factor might be involved in the pathogenesis of acute appendicitis.     

Tc-99m-Sestamibi Scintimammography for the Diagnosis of Breast Malignancies

Abstract: Breast cancer is a leading cause of morbidity and mortality in the Western world. The most efficient method for improving the outcome of this disease is early detection. We evaluated the efficacy of Tc-99-sestamibi (MIBI) scintimammography as a method for detection of breast cancer in 212 patients. One hundred forty-nine of these patients had pathological confirmation of the results: 47 cytological and 102 histologic examinations. Sixty-three additional patients were scanned because they belonged to high-risk groups. The results demonstrated that among the 149 patients who had histologic or cytological examinations, positive scans were obtained in 68 patients: 47 of them had breast malignancies and 21 were false positive. Negative scans were obtained in 81 patients: 76 were true negative and in 5 there was a false-negative result. In 63 additional patients in whom no histologic confirmation was obtained, there was a negative scan. In 11 months of follow-up, no malignancy was discovered in this group of patients. The sensitivity, specificity, and positive and negative predictive values were 90.4%, 78.4%, 69.1%, and 93.8%, respectively. Four out of five false-negative results were obtained in patients with nonpalpable lesions smaller than 1 cm in size. Total accuracy was 82.6%. In 182 of the 212 patients examined by scintimammography, mammography was available. MIBI scan was superior to mammography in its sensitivity, 90% versus 80%. Total accuracy of both examinations was similar. MIBI scan is a sensitive method for early detection of breast cancer and should be considered as a complimentary tool to the combination of physical examination and mammography.