The use of hysteroscopy in endometrial cancer: old questions and novel challenges.

Endometrial cancer is the most common gynecological malignancy with a relatively good overall prognosis. It traditionally has two subtypes: type 1 (endometrioid carcinoma) and type 2 (non-endometrioid carcinoma). The prognosis is excellent for stage I endometrioid cancer, with a 5-year survival rate of 96%. However, the prognosis is much worse for women with high-risk endometrial cancer. Effective preoperative staging is important in order to tailor treatment and achieve optimal long-term survival. The majority of asymptomatic polyps detected by ultrasound are treated surgically. Conventionally, dilatation and curettage was performed to obtain a histological diagnosis, but nowadays hysteroscopy with biopsy is starting to be considered as the gold standard. Hysteroscopic resection seems to reduce the risk of underdiagnosed (atypical endometrial hyperplasia) endometrial cancer. To avoid the spread of malignant cells, hysteroscopy should be performed with concern to keep intrauterine pressure low. In comparison with cervical injection, the hysteroscopic method has a better detection rate in the para-aortic area during sentinel lymph node mapping. In the assessment of cervical involvement, the accuracy of magnetic resonance imaging is significantly higher than the accuracy of hysteroscopy. In fertility-sparing cases, hysteroscopic endometrium resection with progesterone therapy is an acceptable option.

Effectiveness of different methods for polypectomy in the menopause: a retrospective study.

Introduction: Most endometrial polyps represent focal hyperplasia of the endometrium. Endometrial polyps can be diagnosed by ultrasound, hysterocontrast sonography, hysterosalpingography, endometrial biopsy, and uterine curettage, but diagnostic hysteroscopy is considered the gold-standard method, with the greatest sensitivity and specificity and also with the opportunity for treatment at the same time.Study design: A retrospective study was conducted on 424 patients between 2006 and 2018. The polyps were verified during diagnostic hysteroscopy and were removed by resectoscopy or curettage. All samples underwent histological examination. The effectivity of the type of resection and the recurrence rate were evaluated.Results: The average age of the patients was 60.2 ± 9.3 years. Polyps were excised in 62.97% by resectoscopic polypectomy and in 37.03% by curettage. Malignancy was confirmed in 4.24% of cases. Histological verification of polyps was 79.4% in the resectoscopy group and 69.04% in the curettage group; the difference was significant (p < 0.01). The recurrence rate was 20.47% after resectoscopy and 27.12% following curettage.Conclusion: Hysteroscopy remains the best option and the gold-standard method among diagnostic procedures of endometrial pathology. In this study, there was a significant difference in matching hysteroscopic and histological findings in the two methods of polypectomy. The recurrence rate is also lower following resectoscopy.

Clinical, radiological and pathological correlates of leukoaraiosis.

INTRODUCTION: Leukoaraiosis is characterized by an abnormal appearance of the brain white matter on imaging. Its pathogenesis is still a matter of investigation. The purpose of this study was to investigate the radiological, clinical and pathological correlates of leukoaraiosis. METHODS: The study population consisted of 93 deceased patients. The pre-mortem T2W magnetic resonance images were evaluated for the presence and grading of leukoaraiosis. The clinical and pathological characteristics based on the clinical charts and autopsy reports were evaluated. Tissue specimens of the blocks of 19 brains that demonstrated severe leukoaraiosis and those of five control brains were excised and stained. RESULTS: The variables found to be significantly associated with leukoaraiosis were age and a clinical history of Parkinson's disease. Other risk factors and pathological markers of atherosclerosis were not significantly correlated with leukoaraiosis. No significant difference was found between the scoring of the myelin integrity, glial fibrillary acidic protein, cluster of differentiation 68 and smooth muscle actin. There was a significant difference with respect to thickening of vessels walls. CONCLUSIONS: Our pathological results indicate that structural vascular abnormalities characterized by vessel wall thickening are associated with leukoaraiosis, supporting the assertion that vascular changes and ischemia generate leukoaraiosis. The relations between parkinsonism and leukoaraiosis may be explicable through vascular effects on the circuitry of the basal ganglia.

MRI of CNS lymphoma with choroid plexus involvement in five dogs and one cat.

OBJECTIVES: To describe the clinical features, magnetic resonance imaging (MRI) findings, and outcome of dogs and cats with central nervous system (CNS) lymphoma that involved the choroid plexus. MATERIALS AND METHODS: A bi-institutional retrospective study of MRI of dogs and cats with CNS lymphoma, in which the choroid plexus was affected on MRI. Signalment, clinical, MRI, clinicopathologic and histopathologic findings were recorded and evaluated. RESULTS: CNS lymphoma with choroid plexus involvement on the MRI was identified in five dogs and one cat. MRI revealed diffuse enlargement and multifocal nodularity in the choroid plexus in most cases, with the fourth ventricle the most common site affected. Five of the cases had signs of extraneural involvement (including the cat), while the sixth case was not staged. Four of five CSF samples analysed provided a diagnosis of lymphoma. CLINICAL SIGNIFICANCE: We report MRI findings of CNS lymphoma involving the choroid plexus. These results show the importance of recognising novel imaging patterns and the potential utility of CSF collection in diagnosing CNS lymphoma involving the choroid plexus ante mortem.

Suspected Phenobarbital-Induced Pseudolymphoma in a Dog.

Pseudolymphoma is a drug reaction to anti-epileptics that is well recognized in humans; it has been reported in one cat but not dogs. In this report, lymphoma-like clinical signs are suspected to be secondary to phenobarbital administration in a dog. A 2.5-year-old male, neutered Shepherd mix presented for a 3-day history of progressive ataxia, dazed mentation, pyrexia, and lethargy. While hospitalized, the dog developed generalized lymphadenopathy and sustained pyrexia. The dog was receiving levetiracetam and phenobarbital for epilepsy, and serum concentrations of both were within standard therapeutic ranges. Abdominal ultrasound revealed hepatomegaly, splenomegaly, and generalized lymphadenopathy. Cytology of the peripheral lymph nodes was consistent with reactive lymph nodes, and aspirates of the liver and spleen revealed histiocytic-neutrophilic inflammation. Phenobarbital was discontinued and replaced with zonisamide. Within 24 hours, the dog was normothermic, and other clinical signs resolved within a week. This case highlights a potentially serious yet reversible adverse reaction to phenobarbital in a dog. This idiosyncratic reaction could be mistaken for neoplasia and is an important differential for lymphoma-like signs in any dog administered phenobarbital.

Optimal MRI interval for detection of asymptomatic recurrence in surgically treated early cervical cancer by use of a mathematical model.

INTRODUCTION: Applications of mathematical modeling may provide an insight into the timing of surveillance modalities. We aimed to determine the optimal magnetic resonance imaging (MRI) interval for the detection of surgically treated early cervical cancer asymptomatic recurrence by using a mathematical model for volumetric tumor growth time. METHODS: We assumed that tumor volume increases by a factor equal to the basis of natural logarithms (e~2.718) at constant time intervals. Using a mathematical formula, the tumor volume (V) was converted to diameter (D), which could be expressed as a function of time (t), given an initial diameter Di (corresponding to initial volume Vi) and a constant DT, where DT is the time required for volumetric tumor growth by a factor (e). Three different DTs were used for demonstration of the model, i.e. 20, 100 and 400 days. RESULTS: Assuming complete surgical clearance, a worst-case scenario for a 20-day DT indicated that a 20 µm cervical tumor would need at least 12 months to reach 10 mm in diameter, which would be detected with an annual surveillance interval MRI. Over a 5-year (60 months) follow-up, nearly five surveillance MRIs would be required if the threshold of 10 mm was desired. For a 100-day DT over a 5-year (60 months) follow-up, a single only MRI would be required, if the threshold of 10 mm was desired. In the case of an indolent tumor (DT is 400 days), the model would not recommend a surveillance MRI to detect asymptomatic recurrence. A positive linear association between optimal MRI intervals and volumetric tumor DTs was demonstrated. CONCLUSION: In the absence of evidence, we postulate annual MRI scanning is probably the shortest interval, which can be clinically useful for optimization of routine surveillance follow-up protocols in surgically treated early cervical cancer. This mathematical model requires proper verification in prospective clinical studies. Hippokratia 2016, 20(1): 4-8.

Function of the extensor mechanism of the knee after using the 'patellar-loop technique' to reconstruct the patellar tendon when replacing the proximal tibia for tumour.

The aim of this study was to analyse the gait pattern, muscle force and functional outcome of patients who had undergone replacement of the proximal tibia for tumour and alloplastic reconstruction of the extensor mechanism using the patellar-loop technique. Between February 1998 and December 2009, we carried out wide local excision of a primary sarcoma of the proximal tibia, proximal tibial replacement and reconstruction of the extensor mechanism using the patellar-loop technique in 18 patients. Of these, nine were available for evaluation after a mean of 11.6 years (0.5 to 21.6). The strength of the knee extensors was measured using an Isobex machine and gait analysis was undertaken in our gait assessment laboratory. Functional outcome was assessed using the American Knee Society (AKS) and Musculoskeletal Tumor Society (MSTS) scores. The gait pattern of the patients differed in ground contact time, flexion heel strike, maximal flexion loading response and total sagittal plane excursion. The mean maximum active flexion was 91° (30° to 110°). The overall mean extensor lag was 1° (0° to 5°). The mean extensor muscle strength was 25.8% (8.3% to 90.3%) of that in the non-operated leg (p < 0.001). The mean functional scores were 68.7% (43.4% to 83.3%) (MSTS) and 71.1 (30 to 90) (AKS functional score). In summary, the results show that reconstruction of the extensor mechanism using this technique gives good biomechanical and functional results. The patients' gait pattern is close to normal, except for a somewhat stiff knee gait pattern. The strength of the extensor mechanism is reduced, but sufficient for walking.

Cortical projections originating from the cat's insular area and remarks on claustrocortical connections.

The cortical projections originating in the cat's insular cortex and claustrum were investigated with the aid of the horseradish peroxidase retrograde tracing technique. Twenty small injections of horseradish peroxidase were distributed along lateral and medial regions of the hemisphere. Labeling in the insular cortex occurred following all injections except those six situated along the lateral gyrus--that is, within the visual cortex. In the claustrum labeled neurons were found following all injections, except following the injection situated in the posterior temporal area. Claustral labeling was frequently more intense than insular labeling. The injections into the occipital cortex that revealed no insular innervation nevertheless received a considerable number of claustral projections. As the insular cortex itself receives at most a minor projection from the claustrum the differing cortical projection patterns of insula and claustrum have to be considered unrelated. Our findings confirm the view that the claustrum projects to most regions of the cerebral cortex; these projections are at least in part topographically organized. A topographical pattern can also be constructed for the insular cortex, though it is less stringent than for the claustrocortical connections. Both the afferent and efferent connections of the insula show similarities to those of the prefrontal cortex. Nevertheless, the insula differs in that it receives strong input from the sensory associative nuclei of the thalamus. Consequently, and in line with behavioral observations following its ablation, we consider the insula as involved in the temporal structuring of perceived patterns.

Comparative actions of synthetic omega-grammotoxin SIA and synthetic omega-Aga-IVA on neuronal calcium entry and evoked release of neurotransmitters in vitro and in vivo.

The effects of synthetic omega-grammotoxin SIA (omega-GsTxSIA) and synthetic omega-Aga-IVA were tested in in vitro and in vivo neurochemical assays that are reflective of voltage-sensitive calcium channel function. Synthetic omega-GsTx SIA inhibited K(+)-evoked rat and chick synaptosomal 45Ca2+ flux, K(+)-evoked release of [3H]D-aspartate and [3H]norepinephrine from rat hippocampal brain slices and K(+)-evoked release of [3H]norepinephrine from chick cortical brain slices with potency values that were comparable to those found previously with omega-GsTx SIA purified from the venom of the tarantula spider Grammostola spatulata. These results indicate that trace contaminants do not account for the pharmacology of purified omega-GsTx SIA. omega-GsTx SIA caused a complete inhibition of rat synaptosomal 45Ca2+ flux and hippocampal slice [3H]D-aspartate release, whereas omega-Aga-IVA caused a maximal inhibition of approx 75%. omega-GsTx SIA and omega-Aga-IVA caused an identical partial inhibition of K(+)-evoked increases of intracellular calcium in cortical neurons in primary culture. The addition of nitrendipine to either omega-GsTx SIA or omega-Aga-IVA resulted in an additive and virtually complete inhibition of the cortical neuron intracellular calcium response. In in vivo microdialysis studies, the K(+)-evoked release of glutamate from hippocampus of awake freely moving rats was inhibited with the following rank order of potency: omega-conotoxin GVIA > omega-GsTx SIA > omega-Aga-IVA. Complete inhibition of K(+)-evoked hippocampal glutamate release was observed with 300 nM omega-conotoxin GVIA and 3 microM omega-GsTx SIA. In urethane anesthetized rats, omega-CgTx GVIA caused a partial inhibition, whereas omega-GsTx SIA caused a concentration-dependent and complete inhibition, of basal serotonin release in the hippocampus. Therefore, omega-GsTx SIA was shown to inhibit responses that are sensitive to omega-conotoxin GVIA, omega-Aga-IVA and omega-conotoxin MVIIC, consistent with the notion that omega-GsTx SIA inhibits N-, P- and Q-type high threshold voltage-sensitive calcium channels.

Acoustic reflectometry in the detection of middle ear effusion.

Acoustic reflectometry, a new technique for detecting middle ear effusion, was compared with results from tympanocentesis or myringotomy in 75 patients (141 ears). There was a highly significant association (P less than .0001) for ears having middle ear effusion with high reflectivity (5 through 9 units) and for ears having no middle ear effusion with low reflectivity (0 through 4 units). In a pediatric population with middle ear effusion present in 98 of 141 ears and using reflectivity readings greater than 4 to indicate middle ear effusion, the sensitivity of this technique was 86.7% and the specificity was 69.8%. False-positive errors usually occurred in ears with thick tympanic membranes, or in ears in which reflectivity was determined prior to the induction of anesthesia. False-negative errors usually occurred in ears with both air and fluid. This technique was validated by direct comparison with tympanocentesis or myringotomy and can be used with pneumatic otoscopy and impedance tympanometry to follow children with middle ear effusion.

Jimson "loco" weed abuse in adolescents.

Over a three-year period, 29 adolescent patients were hospitalized because of intentional Jimson weed ingestion. Their records were reviewed for the presence of signs and symptoms of atropine/scopolamine toxicity clinical course, treatment, and outcome. Twenty-two were male and seven were female. All had mydriasis, hallucinations, and were disoriented. Tachycardia (heart rate greater than 95), dry mucous membranes, and flushed facies were often present. Urinary retention requiring catheterization was present in five patients. Sixty-five percent (17/26) had detectable atropine or scopolamine in their urine. The average length of hospitalization was 1.8 days. No serious complications were encountered during hospitalization and full recovery were noted in all patients. Gastric lavage and hospital admission for close monitoring and medical support are essential phases of management. Physicians who care for adolescents should be aware of this relatively new form of drug abuse and its management.

Identification in rodents and other species of an mRNA homologous to the human beta-amyloid precursor.

The isolation and sequencing of the core peptide (beta-amyloid) found in the plaques of patients with Alzheimer's disease has allowed the identification of a cDNA for the precursor protein. Using a human cDNA clone for this beta-amyloid material, we have identified an homologous mRNA (3.8 kb) in brain tissue obtained from 8 additional species. We have also determined its distribution in 7 brain regions and 12 organs obtained from rodents. A prominent, second mRNA species (2.2 kb) has been identified in rat non-neuronal tissues. The beta-amyloid gene is amply expressed in the brain of all vertebrates tested and in most rodent organs, indicating that it encodes a highly conserved and ubiquitous protein.

Complete and reversible block by omega-grammotoxin SIA of glutamatergic synaptic transmission between cultured rat hippocampal neurons.

omega-Grammotoxin SIA (omega-GsTx SIA), a peptide isolated from tarantula venom, inhibits synaptosomal Ca2+ influx and neurotransmitter release, and blocks N-, P-, and Q-type voltage-gated Ca2+ channels. The whole-cell patch-clamp was used to record glutamatergic excitatory post-synaptic currents (EPSCs) evoked by extracellular stimulation of presynaptic neurons in primary rat hippocampal cultures. EPSCs displayed rapid kinetics and were blocked by CNQX. omega-Conotoxin (1 microM) GVIA inhibited EPSCs by 46%, while 30 nM and 1 microM omega-agatoxin IVA produced 12% and 69% inhibition, respectively, consistent with coupling of N-, P- and Q-type Ca2+ channels to glutamatergic synaptic transmission. omega-GsTx SIA (1 microM) rapidly, completely, and reversibly blocked glutamatergic EPSCs, but did not affect currents evoked by bath application of kainate. Thus, omega-GsTx SIA blocks glutamatergic synaptic transmission by blocking presynaptic voltage-gated Ca2+ channels. omega-GsTx SIA is the only agent that blocks selectively and reversibly the Ca2+ channels coupled to glutamate release. omega-GsTx SIA provides a unique and powerful tool for experiments requiring recovery of function following presynaptic block of synaptic transmission.

Ethanol effects on synaptic glutamate receptors and on liposomal membrane structure.

Exposure of synaptic plasma membranes to 50 mM ethanol in vitro brought about a 3.5 degrees C decrease in the transition temperature of the high affinity glutamate binding process in these membranes. Ethanol had no effect on the energy of activation of glutamate binding below the transition temperature but decreased the energy of activation above the transition temperature. Electron paramagnetic resonance (EPR) studies of lipid organization of egg lecithin and bovine brain phospholipid liposomes indicated that ethanol at low concentrations (0.04--2 mM) caused small increases in the rigidity of the membrane near the surface. At higher concentrations (0.04--2 M) ethanol brought about increasing fluidization of both the surface and inner areas of the bilayer. Even at 4 mM concentration ethanol enhanced the ordered to fluid state transition of liposome membranes as shown by a 5.2 degrees C and 1.9 degrees C decrease in the transition temperatures of the membrane determined with the cholestane EPR probe.

Serological response to measles revaccination in a highly immunized military dependent adolescent population.

In the spring of 1986, there was a measles outbreak in the city of El Paso, Texas, with 92 cases reported to the City-County Health Department. Of those 92 cases, 31 (32%) occurred within a public high school's student population of 2524. A mass measles vaccination program was undertaken at that high school in order to limit the outbreak. The student enrollment included a military dependent population of 368 students. Despite documented histories of prior measles immunizations in this military dependent subgroup, three individuals contracted the disease. Since this subgroup of students represented a highly immunized adolescent population, it was of interest to serologically determine their immune status prior to and following reimmunization with the expectation that such a study would provide information relating to the level of "protective" immunity. Prevaccination and postvaccination sera were obtained from 95 students. Results of measuring anti-measles antibody activity by ELISA indicate that 13 (14%) students responded to revaccination and experienced a fourfold or greater rise in IgG antibody levels. There were no detectable IgM responses. All of the students who responded to revaccination produced an anamnestic response (IgG boost only). Since most of these individuals had received first immunizations at 15 months of age or older, these findings suggest that secondary vaccine failure (waning immunity) was responsible for the putative "lowered" immunity in these individuals, instead of primary vaccine failure (maternal antibody suppression). These findings support current recommendations for measles booster revaccination of school-age children and adolescents.

Expression of rat brain excitatory amino acid receptors in Xenopus oocytes.

Xenopus laevis oocytes when injected with rat brain mRNA synthesize neuronal receptors that can be analyzed electrophysiologically. After a post-injection incubation period of 24-72 hours, L-glutamic acid, kainic acid and quisqualic acid caused a dose dependent (10-100 microM) depolarization of the oocyte membrane. The voltage and conductance changes associated with kainate activation were distinguishable from those seen for L-glutamate or quisqualate. There was no response to L-aspartate application and an inconsistent response to N-methyl-D-aspartate. Upon fractionation of the mRNA on sucrose gradients, transcripts greater than 2 Kb in length were obligatory for the synthesis of excitatory amino acid receptors. The electrophysiological response of injected oocytes exposed to L-glutamate was similar to that of native oocytes when exposed to muscarinic agents. This similarity may reflect the activation of the same ionophore and suggests that the active mRNA fraction for glutamate responsiveness either encodes for a binding protein that can be assembled along with native ion channels into the oocyte membrane or encodes for a glutamate binding site with a similar channel.

Culture of sheep zygotes in synthetic oviduct fluid medium with different concentrations of sodium bicarbonate and HEPES.

An investigation was conducted of the viability of sheep zygotes in vivo subsequent to culture in synthetic oviduct fluid medium (SOFM) in which sodium bicarbonate was partly or wholly replaced with HEPES (N-2-hydroxyethylpiperazine-N'-2-ethanesulfonic acid); concentrations of 0, 6.25, 12.5, 18.75 and 25 mM HEPES were studied. The addition of HEPES lowered the pH during the culture period, and was associated with a reduction in the percentage of zygotes that developed to blastocysts (range 60.4 to 85.2%); this reduction was significant (P < 0.05) at concentrations of 18.75 and 25 mM. There was also a significant (P < 0.05) reduction in the percentage of zygotes that commenced hatching (range 47.2 to 74.1%) and a significant (P < 0.05) delay in the time of blastocyst formation (range 4 to 7 d) in medium containing 25 mM HEPES. Viability, as assessed by elongation of the trophoblast after transfer to recipient ewes, was similar for zygotes cultured for 3 d either in medium with 12.5 mM HEPES or in medium without HEPES (90.3 and 93.9%, respectively). Extending the culture period to 5 d was associated with a general decline in viability (P < 0.05), with 67.7% of zygotes cultured with HEPES elongating compared with 45.5% for those cultured without HEPES. This study confirms that sheep zygotes can be successfully cultured in SOFM for up to 3 d without loss of viability. The addition of HEPES provides additional buffering capacity but zygote development may be compromised.

Erythromycin prophylaxis for recurrent otitis media.

Patients with recurrent otitis media without persistent middle ear effusion were studied for antibiotic prophylaxis efficacy. In the first phase, erythromycin ethylsuccinate was used as prophylaxis for otitis media in 45 patients in a dose of 10 mg/kg twice daily. Acute otitis media occurred in eight of 45 (18%) while receiving erythromycin, and in 22 of 41 (54%) following prophylaxis termination. The attack rate (episodes of otitis media per 2-month period) was 0.86 before prophylaxis, 0.20 during prophylaxis, and 0.79 following prophylaxis. In a second phase of the study, erythromycin was compared with sulfisoxazole for otitis media prophylaxis in a group of 42 children. Sulfisoxazole (500 mg per dose) was administered twice daily. Acute otitis media occurred in five of 28 (18%) children while receiving erythromycin and in nine of 21 (43%) children while receiving no prophylaxis. The attack rate (episodes of otitis media per 2-month period) was 0.81 before erythromycin prophylaxis, 0.18 while receiving erythromycin, and 0.50 after erythromycin prophylaxis. Acute otitis media occurred in eight of 14 (51%) children while receiving sulfisoxazole, and in two of five (40%) children while receiving no prophylaxis. The attack rate (episodes of otitis media per 2-month period) was 0.78 before sulfisoxazole, 0.72 while receiving sulfisoxazole, and 0.56 after sulfisoxazole prophylaxis. Erythromycin antimicrobial prophylaxis for children with recurrent otitis media was superior to no prophylaxis and to sulfisoxazole prophylaxis in this study of patients with recurrent otitis media without persistent middle ear effusion.

"Latchkey". Three voices with one message.

Two to five million children, 6 through 13 years old, are unsupervised at home after school. This practice, called "latchkey," involves issues of children without adult supervision for periods of time and questions of safety and social isolation. There are no published age guidelines for "latchkey" or data on actual practice. To investigate age guideline opinions and the factors that influence them, a survey of pediatricians (the professional voice), military police (the legal voice), and parents (the popular voice) was undertaken. Solicited opinions concerned ages at which children can be left alone for brief or extended periods and can be allowed to babysit younger children. The three "voices" expressed similar mean ages and distributions for each of the "latchkey" questions. For less than 15 minutes without supervision, the means approximated 9 years; for periods of 1 hour or longer, 12 years; and for babysitting, 14 years. The data presented do not address actual or appropriate practice, but instead provide a basis to begin investigation.

Reestablishing Naturally Functioning Dunes on Developed Coasts.

/ The potential for reestablishing dune habitat is investigated in municipalities in New Jersey, USA, where natural coastal landforms and biota have been eliminated or reduced in extent. Dunes are classified using width, relationship to natural and cultural features, and changes through time, and they are assessed for their value as naturally functioning landforms in developed municipalities. The relationship between size and longevity that exists under natural conditions is altered by human activity. Small dunes on privately owned lots can survive as long as larger dunes in natural areas that are located farther inland, and foredunes repaired using sand fences and earth-moving equipment can survive where they could not under natural conditions.Common beach management practices reduce the ecological values of coastal dunes. Mechanical beach cleaning eliminates incipient dunes, habitat for nesting birds, seed sources for pioneer dune colonizers and food for fauna, and artificially small, stabilized foredunes reduce the variability in microenvironments necessary for biodiversity. Recent initiatives for reducing coastal hazards, protecting nesting birds, and encouraging nature-based tourism provide incentive for the development of a restoration program for beaches and dunes that is compatible with human use. Suggested changes in management practice include restricting or rerouting pedestrian traffic, altering beach-cleaning procedures, using symbolic fences to allow for aeolian transport while preventing trampling of dunes, and eliminating or severely restricting exotic species. Landforms will be more natural in function and appearance but will be more dynamic, smaller and in a different position from those in natural areas. Research needs are specified for ecological, geomorphological, and attitudinal studies to support and inform restoration planning.