Does raloxifene therapy affect mammographic breast cancer screening in postmenopausal patients?

OBJECTIVE: The aim of the study was to determine mammographic breast density changes during raloxifene therapy in postmenopausal patients MATERIALS AND METHODS: Fifty-five cases who were using raloxifen therapy were included in this retrospective analysis. Raloxifene was given for osteopenia and osteoporosis according to low bone mineral density measured by dual-energy X-ray absorptiometry (DEXA). None of the patients were using hormone replacement therapy 12 months before the initiation of raloxifene treatment or during the study. Mammographic breast density was determined by mammography before the initiation of raloxifene treatment (baseline) and after 12 to 16 months of therapy. The Breast Imaging Reporting and Data System (BI-RADS) breast density score was used for the evaluation of mammographic density. RESULTS: There was no change in mammographic breast density when the baseline and the first mammography taken after the initiation of therapy were compared (p = 0.32). There was no significant correlation between the duration of raloxifene treatment and mammographic density measured after raloxifene treatment (r = -0.158, p = 0.25). Only in one patient did the BI-RADS classification of 2 change to 3 after 12 months of therapy. CONCLUSIONS: In conclusion, raloxifene therapy for 12 to 16 months does not increase mammographic breast density in postmenopausal women with low bone mass.

Large cell neuroendocrine carcinoma of the uterine corpus metastatic to brain and lung: case report and review of the literature.

Neuroendocrine carcinoma of the uterine corpus is a rare aggressive tumor with a similar unfavorable outcome to that of the cervix. The large cell type is considerably rarer than the small cell neuroendocrine carcinoma of the uterine corpus. We report a case of a 52-year-old woman who presented with a large cell neuroendocrine tumor of the uterine corpus with very aggressive clinical behavior, cerebral and pulmonary metastases six and four months after initial diagnosis and adjuvant radiotherapy, respectively. Despite successful surgical extirpation of the cerebral metastatic lesion she did not respond to chemotherapy and died four months after disease recurrence.

Acute myeloblastic leukemia in pregnancy: a case report and review of the literature.

Leukemia is a rare event during pregnancy. The presence of leukemia during pregnancy raises several concerns about the effect of pregnancy on the prognosis of leukemia, the effect of the disease on pregnancy outcome and the teratogenic and mutagenic effect of chemotherapeutic agents on the fetus. We report a case of acute myeloblastic leukemia diagnosed during the third trimester of gestation and treated with chemotherapeutic agents before delivery. The duration of pregnancy was able to be prolonged for four weeks after clinical diagnosis of the disease and then terminated by cesarean section due to the presence of signs of fetal distress.

Cellular angiofibroma of the vulva: report of a case.

A case of vulvar cellular angiofibroma in a 50-year-old woman was immunohistochemically examined. She presented with a right labial mass which was noticed four years before. Surgical excision of the mass was performed. Histopathological examination revealed typical characteristics of cellular angiofibroma. Immunohistochemically, the lesion was CD34 positive but non-reactive for desmin, smooth muscle actin and S-100 protein. In this article, we present a case of vulvar cellular angiofibroma, a lesion that should be considered in the differential diagnosis of vulvar soft tissue tumors.

Subcutaneous metastasis of endometrial adenocarcinoma: case report of an incidental diagnosis during abdominal sonography.

A rare case of subcutaneous metastasis from endometrial adenocarcinoma detected incidentally on the anterior abdominal wall during routine abdominal sonography is reported. A 62-year-old woman with clinical FIGO Stage IA, grade 2 endometrial mixed type (endometrioid and mucinous) adenocarcinoma was found with a subcutaneous mass located in the abdomen 18 months after initial surgery.

Comparison of hydrosonography and diagnostic hysteroscopy in the evaluation of infertile patients.

OBJECTIVE: In the present study we evaluated the value of hydrosonography in the screening for intracavitary structural pathologies in patients with a history of infertility before the implementation of assisted-reproductive technology. Hysterescopy was regarded as the gold standard procedure. STUDY DESIGN: A retrospective study. MATERIAL AND METHODS: A total number of 115 infertile women aged between 19 and 47 (33.4 +/- 5.3), who were candidates for assisted reproductive techniques, were enrolled in this retrospective analysis. The study comprised data obtained from patients undergoing infertility investigation between 2001 and 2003 at Ozel Ege IVF Center and the Department of Obstetrics and Gynecology of Ege University Faculty of Medicine. The results obtained by hydrosonography were later compared with those of hysteroscopy. Sensitivity, specificity, positive predictive value and negative predictive value for hydrosonography were calculated. RESULTS: In a total of 115 women, 53 (46%), 24 (20%), 30 (26%) and 8 (7%) were found to have normal endometrial cavities, submucous myoma, endometrial polyps and uterine septum, respectively, on hydrosonography. Forty-five (85%) of 53 women, who were supposed to have normal findings on hydrosonography, were confirmed by hysteroscopy. In the remaining eight women (15%), two had endometrial polyps, three had uterine septum, one had submucous myoma and two had intrauterine synechia on hysteroscopic examinations. The sensitivity, specificity, positive and negative predictive values of hydrosonography in the detection of structural endometrial cavity lesions were 85%, 75%, 75% and 84%, respectively. Two intrauterine adhesions were not recognized by hydrosonography. CONCLUSION: Hydrosonography may be a useful tool in the evaluation of intrauterine cavity structural pathologies in infertile patients with the exception of intrauterine adhesions. In addition, hydrosonography was found to be sensitive in the detection of intrauterine septum.

Pulmonary edema after ritodrine therapy during pregnancy and subsequent cesarean section with epidural anesthesia.

Ritodrine, a beta-sympathicomimetic drug that is frequently used for the prevention of preterm birth. Preterm delivery is an important cause of low birth weight. One of the most important side-effects of ritodrine is pulmonary edema. In patients developing pulmonary edema after ritodrine therapy, aggressive fluid resuscitation during the operation period should be avoided. Successful epidural anesthesia can be achieved with a slow-onset epidural block after moderate fluid infusion. We report the management of a pregnant patient developing pulmonary edema after ritodrine therapy and undergoing cesarean section with epidural anesthesia.

Preemptive meloxicam for postoperative pain relief after abdominal hysterectomy.

OBJECTIVE: This study was conducted to evaluate the analgesic efficacy of meloxicam in abdominal hysterectomy. METHODS: The study population consisted of 52 patients scheduled for total abdominal hysterectomy who were ASA 1 or 2 physical status female. Patients were allocated randomly to receive orally either 15 mg of meloxicam (Group M, n = 27) or placebo (Group P, n = 25) before anesthesia induction. After intravenous administration of 1.5 mg kg(-1) of tramadol, anesthesia was induced with an intravenous loading dose of 1-2 mg kg(-1) propofol. Anesthesia was maintained on intravenous infusion of propofol at 6-12 mg kg(-1) h plus tramadol at 1 mg kg(-1) h(-1), vecuronium, and a 2:1 nitrous oxide-oxygen mixture. RESULTS: The relative propofol consumption was lower in Group M than in Group P, (p < 0.05). The time for analgesic rescue decreased in the order Group M > Group P (p < 0.01). The degree of sedation was similar between the groups (p > 0.05) and the visual analog scores (10-cm scale) and verbal rating scale data differences were present in the first 2 h only (p < 0.05). When side-effects were evaluated nausea and vomiting were found to be lower in group M than in group P (p < 0.05). CONCLUSION: Preemptive meloxicam provided better postoperative analgesia than placebo.

Pelvic actinomycosis in a postmenopausal patient with systemic lupus erythematosus mimicking ovarian malignancy: case report and review of the literature.

Pelvic actinomycosis is a chronic granulomatous suppurative disease caused by an anaerobic gram-positive organism Actinomyces israelii usually associated with intrauterine devices. Systemic lupus erythematosus is an autoimmune disorder associated with multiple primary and drug-related immunological defects that predispose patients to infections. The combination of both diseases in a postmenopausal patient is a rare occurrence. A case of a pelvic mass in a 49-year-old postmenopausal patient with systemic lupus erythematosus treated with immunosuppressive therapy for two years is presented. The patient presented with lower abdominal pain to the gynecology clinic and was found to have a pelvic tumor. She had no history of intrauterine device use. Histopathologic examination of the laparotomy specimen revealed pelvic actinomycosis.