The microscopic appearance of a sodium-potassium exchange resin in histologic sections.

The histologic appearance of Kayexalate, an ion-exchange resin, in bronchioles and alveolar spaces is described. Aspiration of this material occurred as a terminal event in an infant who suffered neonatal asphyxia and meconium aspiration. A solution of Kayexalate prepared for comparison appears to be identical to that found in the lung sections.

Clinical evaluation of luteal function.

OBJECTIVE: To determine the ability of luteal phase length determined by basal body temperature (BBT) pattern and a midluteal serum progesterone level to predict the result of an endometrial biopsy in a subsequent cycle. METHODS: We performed a retrospective analysis of 141 women with a history of infertility who were being evaluated for luteal function. The luteal phase length determined from a BBT chart of one menstrual cycle was compared to a single midluteal serum progesterone level from a second menstrual cycle. These findings were compared to a luteal phase endometrial biopsy performed in a third menstrual cycle. Subjects were divided into four groups depending upon luteal phase length (normal 11 or more days) and serum progesterone level (normal at least 10 ng/mL). The four groups were designated "normal," "short luteal phase," "low progesterone," and "abnormal," depending upon the results of the two tests. The frequency of in- and out-of-phase endometrial biopsy results in the four groups was compared. RESULTS: There was no difference in the occurrence of an in- or out-of-phase endometrial biopsy when the four groups were compared. CONCLUSION: Neither luteal phase length nor a single midluteal serum progesterone level was predictive of subsequent in-phase or out-of-phase endometrial biopsy.

Serum relaxin concentrations in patients with out-of-phase endometrial biopsies.

When luteal phase relaxin concentrations were summed to give an integrated measure (pg/mL per cycle), relaxin was found to be significantly lower in those cycles with an out-of-phase endometrial biopsy. In addition, peak relaxin concentrations were lower in out-of-phase cycles compared with normal cycles. These data indicate that relaxin secretion may be related to normal luteal function and suggest that shortening of the luteal phase results in reduced relaxin production. Measurement of circulating relaxin may prove to be useful in making the diagnosis of out-of-phase biopsy and needs to be assessed for its usefulness in diagnosing abnormal luteal function.

Detection of malignant ovarian neoplasms: a review of the literature. I. Detection of the patient at risk; clinical, radiological and cytological detection.

Risk factors for epithelial ovarian cancer are summarized in Table 1. Calculation of ovulation-years appears to be a potentially useful and practical method for identification of the high-risk individual. Risk factors for nonepithelial ovarian cancer are largely unknown, and consequently clinical diagnosis is stressed in the early detection of these tumors. Patients with Peutz-Jeghers syndrome or ovarian dysgenesis are significantly at risk and require at least regular pelvic examination. Of course, individuals with sexual precocity are at high risk for sex cord/stromal or germ cell malignancies. Individuals with a family history of Sertoli-Leydig cell tumors and benign thyroid disease also deserve close observation. Early clinical detection requires a sensitivity to presenting symptomatology (e.g., diffuse abdominopelvic complaints) as well as the skill and knowledge needed to recognize and appropriately manage adnexal masses. Harbingers of ovarian malignancy in the elderly woman, including unexplained hypercalcemia, new onset dermatomyositis, and cerebellar degeneration, should motivate thorough gynecologic evaluation. While radionuclide ovarian imaging for detection of early epithelial cancers of the ovary may become more generally available in the future, ultrasound imaging of the postmenopausal ovary, and peritoneal cytology may be of immediate value in screening high-risk women.

Detection of malignant ovarian neoplasms: a review of the literature. III. Immunological detection and ovarian cancer-associated antigens.

In summarizing the data on characterization of the immune system in the ovarian cancer patient, it is possible to conclude that both cellular and humoral immune responses occur in the presence of ovarian cancer. However, the specificity of such reactions is less certain. Although most of the tests outlined above are of doubtful utility in cancer immunodetection, data obtained from some studies support the assumption that there exist epithelial ovarian cancer-associated antigens which are expressed in tumors arising in different individuals, and that these antigens are the target of an immune response in many patients. It is unclear, however, how widely distributed such antigens are among normal tissues and other neoplasms. Direct characterization of ovarian cancer-associated antigens may provide more well-defined test antigens with which to assay individuals for a specific immune response. An immune response to specific cancer-associated antigens could precede the appearance of detectable levels of such antigens in the circulation.

The effects of prenatal diethylstilbestrol (DES) exposure on the genitalia of pubertal Macaca mulatta. I. Female offspring.

Nineteen pregnant female rhesus monkeys (Macaca mulatta) received 1 mg/day diethylstilbestrol (DES) over three time periods during gestation: day 21 to delivery (group I), day 100 to delivery (group II) and day 130 to delivery (group III). Seven females and five males of a total of 20 offspring are presently alive at 5 1/2 years of age; one female died at 5 years of age. No deaths have been shown to be treatment related. In female offspring, menstruation began at about 2 1/2 years of age, was irregular for approximately one and one-half to two years and then became regular. Vaginal ridging and/or cervical hooding have been observed in seven of the eight DES-exposed females, and three had histologically demonstrable vaginal adenosis. None of the anomalies was related to a specific treatment period, for they appeared in all treatment groups, nor did they occur in the age-matched controls. Furthermore, none of the animals, either treated or control, showed any evidence of adenocarcinoma. Therefore, exposure of Macaca mulatta females to DES in utero appears to be teratogenic, but thus far no carcinogenicity has been observed. Reports in humans indicate that adenocarcinoma is an additional manifestation of prenatal exposure to DES; also, treatment effects appear to be more commonly observed in individuals exposed during the early stages of gestation. From this viewpoint, the rhesus monkey is a potentially valuable model for the study of vaginocervical anomalies and adenosis, but it is premature to consider it a suitable model for the study of adenocarcinoma.

Sonographic evaluation of hydatidiform mole and its look-alikes.

Seventeen proven cases of complete hydatidiform mole and 14 sonographically similar nonmolar cases were studied in detail with a variety of ultrasound transducers. Complete hydatidiform moles can be reliably differentiated from other lesions with similar sonographic appearances by using a highly focused ultrasound transducer to image the near field of the intrauterine contents.

Sonographic spectrum of retroplacental hemorrhage.

Retroplacental hemorrhage (RPH), or abruptio placentae, usually occurs in the third trimester of pregnancy and may or may not be clinically significant. Sonographic criteria necessary for diagnosis of RPH include visualization of a linear or biconcave, and usually well-marginated mixed echogenic or anechoic region posterior to the placenta. Large areas of hemorrhage may cause bulging of the chorionic plate while small areas may be difficult to discern with routine scanning. Secondary signs of RPH include associated intraplacental anechoic regions secondary to bleeding or infarction and visualization of intra-amniotic hemorrhage. In this report, nine cases of pathologically confirmed RPH are reviewed. Also reviewed are normal and other pathological conditions of the placenta which may mimic RPH but should not be confused with the sonographic diagnosis.

Endometriosis-related malignancies.

The purpose of this study is to describe the clinical findings, treatment, and outcome of patients with endometriosis-related cancers. Patients meeting Sampson and Scott's criteria for cancer associated with endometriosis in the Sacramento region were identified by chart review and pathology reports. Twenty-seven patients were identified with endometriosis-related malignancies (mean age 51.4 years). The site of origin was ovary in 17 (63.0%) and extra-ovarian in 10 (37%) including vagina, fallopian tube or mesosalpinx, pelvic sidewall, colon, and parametrium. The pattern of spread was local in five (18.5%), regional in 20 (74.1%) and distant in two (7.4%). Six patients had taken unopposed estrogen replacement (mean duration 23.4 years) and all six had extragonadal disease. Surgical procedures included hysterectomy, salpingo-oophorectomy, radical local excision, partial colectomy, and surgical staging. Eighteen patients received postoperative chemotherapy since the majority of patients had ovarian involvement. Fifteen patients received regional radiation therapy. Nineteen patients are without evidence of recurrence (70.4%, mean follow-up of 31 months). Endometriosis-related malignancies have a favorable prognosis. Extragonadal disease was commonly associated with unopposed estrogen replacement therapy. The predominance of local and regional disease strongly influence the application of treatment modalities.