A systematic review of ultrasonography-guided transvaginal aspiration of recurrent ovarian endometrioma.

BACKGROUND: Ovarian endometriosis is present in 17%-44% of women with endometriosis. The main treatment is surgery, but ultrasonography-guided aspiration is a less invasive alternative. OBJECTIVES: To evaluate the effectiveness of this alternative treatment in recurrent ovarian endometrioma. SEARCH STRATEGY: Multiple databases were searched for articles published between 1994 and 2014 using the keywords "ultrasound-guided aspiration," "ovarian," and "endometriosis." SELECTION CRITERIA: Randomized controlled trials and observational studies published in English, Portuguese, or Spanish were included. DATA COLLECTION AND ANALYSIS: Two researchers independently extracted and reviewed the data. The main outcome of interest was the recurrence rate. MAIN RESULTS: Eight studies were eligible. Ovarian endometriosis is associated with high recurrence rates after one ultrasonography-guided aspiration (28.9%-91.5%), but involves less ovarian manipulation. The results of aspiration followed by sclerotherapy are not uniform, but overall the addition of a sclerosing agent does not seem to significantly reduce the likelihood of recurrence (13.3%-75.0%). Repeated aspiration of the cysts can reduce the recurrence rate to 5.4% by the sixth aspiration. CONCLUSIONS: Repeated ultrasonography-guided aspiration of ovarian endometriomas can be performed for the treatment of recurrent ovarian endometriosis. Further studies comparing the efficacy of this procedure and ovarian surgery are needed.

Appendiceal Nodules in the Setting of Endometriosis Can Be Carcinoid Tumors.

INTRODUCTION: Endometriosis is occasionally found in the appendix, particularly in severe forms of deep infiltrating disease. Carcinoid tumor is the most common neoplasm of the appendix and may be overlooked or misdiagnosed when there are multiple endometriosis lesions in the pelvis. CASE DESCRIPTION: We describe two cases of carcinoid tumor diagnosed in patients who underwent surgery to treat endometriosis, in whom the diagnosis of appendiceal endometriosis was presumed. DISCUSSION: In the context of endometriosis, surgery is indicated when the appendix is affected. Despite the more likely diagnosis of appendiceal endometriosis, carcinoid tumors cannot be ruled out by imaging examinations.

Breast cancer management in middle-resource countries (MRCs): consensus statement from the Breast Health Global Initiative.

In middle resource countries (MRCs), cancer control programs are becoming a priority as the pattern of disease shifts from infectious diseases to non-communicable diseases such as breast cancer, the most common cancer among women in MRCs. The Middle Resource Scenarios Working Group of the BHGI 2010 Global Summit met to identify common issues and obstacles to breast cancer detection, diagnosis and treatment in MRCs. They concluded that breast cancer early detection programs continue to be important, should include clinical breast examination (CBE) with or without mammography, and should be coupled with active awareness programs. Mammographic screening is usually opportunistic and early detection programs are often hampered by logistical and financial problems, as well as socio-cultural barriers, despite improved public educational efforts. Although multidisciplinary services for treatment are available, geographical and economic limitations to these services can lead to an inequity in health care access. Without adequate health insurance coverage, limited personal finances can be a significant barrier to care for many patients. Despite the improved availability of services (surgery, pathology, radiology and radiotherapy), quality assurance programs remain a challenge. Better access to anticancer drugs is needed to improve outcomes, as are rehabilitation programs for survivors. Focused and sustained government health care financing in MRCs is needed to improve early detection and treatment of breast cancer.

SISMAMA--implementation of an information system for breast cancer early detection programs in Brazil.

As national health systems seek to apply breast cancer screening recommendations to an entire population of women (within target age ranges for which there is evidence that screening reduces mortality), the volume of screening tests and resulting diagnostic investigations arising from abnormal test results-and the cost associated with them-will grow dramatically. Population-based early detection (screening) programs will need information systems and management tools to help these programs. This report describes Brazil's highly decentralized health care system and then describes in greater detail how the development and implementation of an information system for Brazil's nationwide breast cancer early detection program was carried out with input from various stakeholders. Challenges encountered in the implementation are shared. Preliminary findings from the first 1.5 million mammograms are presented to demonstrate the kind of provocative management information such a system can yield in a relatively short period of time. The potential of such information systems for improving efficiency, efficacy and cost-effectiveness of early detection programs is emphasized.

Trail making and cognitive set-shifting

We tested the hypothesis that Part B of the Trail Making Test (TMT) is a measure of cognitive set-shifting ability in 55 normal subjects with the conventional (written) TMT and a verbal adaptation, the "verbal TMT" (vTMT). The finding of a significant association between Parts B of TMT and vTMT (r = 0,59, p < 0,001), after correcting for age and education, supports the view that Part B of TMT is a valid measure of the ability to alternate between cognitive categories