Unexpected ovarian malignancy found after laparoscopic surgery in patients with adnexal masses--a single institutional experience.

Laparoscopy has become the standard surgery for the treatment of benign ovarian tumors. The aim of this study was to evaluate the appropriateness of laparoscopy for ovarian tumors, including those with malignant potential. A total of 487 patients with adnexal masses underwent laparoscopic surgery in Social Insurance Chukyo Hospital from January 2000 to December 2012. We reviewed 471 cases that fulfilled the criteria set for this study, and examined 10 cases with unexpected ovarian malignancy to analyze their preoperative diagnosis, second surgery, postoperative chemotherapy, and prognosis. The ages of the 471 patients ranged from 13 to 50 years, with a median of 31. Nulliparous patients numbered 321(68.1%). Of all, 436 patients mostly consisted of those with endometrioma, benign ovarian neoplasm or functional cyst. In all, we histologically identified 10 women with malignancy: 6 with borderline ovarian tumors (BOT), 2 with ovarian cancer, and 2 with histologically rare tumors (immature teratoma and granulosa cell tumor). All patients with BOT were diagnosed with a mucinous histology. Two patients underwent both second radical surgery (hysterectomy and contra- or bilateral salpingo-oophorectomy) and chemotherapies that consisted of CBDCA and PTX or DTX. Thus, 2 patients underwent staging procedures, but the remaining 8 cases did not. None of them had evidence of recurrences. With accurate staging and careful postoperative follow-up, laparoscopic surgery could be a feasible initial operation for patients with adnexal masses including early-stage ovarian malignancy.

Metastatic breast cancer to the uterine cervix mimicking a giant cervical leiomyoma.

Metastasis to the uterine cervix is a complication of breast cancer that is not commonly known. Detection of cervical metastasis before the diagnosis of the primary tumor is even rarer. The present report describes a case of a 52-year-old woman who had a large cervical tumor appearing as a leiomyoma. She underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy. Histopathological examination of the cervical tumor showed patterns characteristic of invasive lobular carcinoma of the breast, leading to the discovery of the primary in the left breast. She subsequently underwent mastectomy, hormone therapy and chemotherapy, and is alive at 7-year follow-up.

Ureterocolic Fistula Secondary to Diverticulitis of the Sigmoid Colon after Laparoscopic Salpingo-Oophorectomy: A Case Report and Literature Review.

Ureterocolic fistula is a rare phenomenon and cases secondary to diverticulitis are even rarer. We present a case of ureterocolic fistula secondary to diverticulitis of the sigmoid colon following laparoscopic salpingo-oophorectomy due to endometriomas. To our knowledge, this is the first case that occurred in a patient with gynecologic surgery.

Dichloroacetate treatment for mitochondrial cytopathy: long-term effects in MELAS.

The long-term effects of the sodium salt of dichloroacetic acid (DCA) were evaluated in four patients with mitochondrial encephalomyelopathy with lactic acidosis and stroke-like episodes (MELAS) carrying A3243G mutation. Oral administration of DCA in MELAS patients was followed for an average of 5 years 4 months. Serum levels of lactate and pyruvate were maintained at around 10 and 0.6 mg/dl, respectively. Serum levels of DCA were 40-136 microg/ml. Symptoms responding to treatment included persistent headache, abdominal pain, muscle weakness, and stroke-like episodes. In contrast, no improvements in mental status, deafness, short stature, or neuroelectrophysiological findings were observed. Adverse effects included mild liver dysfunction in all patients, hypocalcemia in three and peripheral neuropathy in one. None of these adverse events was severe enough to require discontinuation of treatment. To determine suitable indications for DCA therapy, analysis of many more patients who have undergone DCA administration is required.

Peer support via video-telephony among frail elderly people living at home.

We evaluated the effect of a video-phone network on peer support among frail elderly people living at home. We conducted a one-year trial of network formation among 14 people (five men and nine women, age range 78-85 years) through coordinator intervention and the use of ISDN video-phones. The purpose of the intervention was to support and improve the functional independence of frail elderly people at home and to widen their social network. During the study, the subjects made 1400 video-calls, lasting a total of 25,867 min. One subject made no calls. There was greater use of video-phones by those living outside the central city area. Calls between men and women were infrequent. The men generally had shorter call times and made fewer calls. The participants could be categorized into three groups: those using video-phones every day; those using them once per week; and those using them once per month. All subjects in the first group clearly expressed their satisfaction with the video-phone. A video-phone network appears to be helpful for elderly people in their peer support relationships.