Does the localisation of tumour at stage I endometrial endometrioid adenocarcinoma have an impact on invasion of the tumour and individualisation of the surgical procedure?

OBJECTIVE: To detect whether the localisation of the tumour has an impact on the dissemination of the tumour and whether or not surgical procedures should be individualized according to the localisation of the tumour. MATERIAL METHOD: 106 clinically surgically stage I endometrial endometrioid carcinoma cases treated multi-institutionally at Gulhane Military Medical Academy (GATA) and Dr. Zekai Tahir Burak (ZTB) Women's Health Education and Research Hospital Gynecologic Oncology Units in the last five years were evaluated retrospectively. The tumours localised near the internal cervical os and not invading the cervical canal were accepted as lower uterine segment (LUS) localisation and the corporal location as upper uterine segment (UUS) localisation. RESULTS: Tumour localisation was more frequent in the upper segment than LUS (85.9% vs 14.1%). There was no statistically significant difference between only endometrial and only serous invasion rates. Myometrial invasion less than one-half was significantly higher in the UUS group than the LUS group (p < 0.05). Lymph vascular space involvement rate was significantly higher in the LUS group (60%, 9/15) than the UUS group (23 %, 21/91), (p < 0.01). Positive peritoneal cytology rate was 20% (3/15) in the LUS group and 6.6% (6/91) in the UUS group (p > 0.05). CONCLUSION: Patients with LUS involvement should be considered as high-risk patients. Thus more expanded surgery must be taken into consideration. In this study a limitation was the low number of patients with LUS involvement. Larger prospective studies are necessary to confirm our results.

Magnesium infusion reduces perioperative pain.

BACKGROUND AND OBJECTIVE: Magnesium has antinociceptive effects in animal and human models of pain. These effects are primarily based on the regulation of calcium influx into the cell. The aim of this study was to determine whether perioperative infusion of magnesium would reduce postoperative pain and anxiety. METHODS: Twenty-four patients, undergoing elective hysterectomy, received a bolus of 30 mg kg(-1) magnesium sulphate or the same volume of isotonic sodium chloride solution intravenously before the start of surgery and 0.5 g h(-1) infusion for the next 20 h. Intraoperative and postoperative analgesia were achieved with fentanyl and morphine respectively. Patients were evaluated pre- and postoperatively for anxiety. RESULTS: Fentanyl consumption and total morphine requirements were significantly decreased in the magnesium group compared to the control group. Postoperative anxiety scores and sedation were similar between groups. CONCLUSIONS: Continuous magnesium infusion, including the pre-, intra-, and postoperative periods reduces analgesic requirements. These results demonstrate that magnesium can be an adjuvant for perioperative analgesic management.

Comparative methods of repairing left ventricular aneurysms.

Between 1 March 1992 and 31 June 1996, we enrolled 72 patients with left ventricular aneurysms in a prospective, nonrandomized study to compare--by study of cardiac indices, single-plane ejection fractions, and nuclear ventriculograms--the effects of classical aneurysmectomy (group 1, n = 36) with those of endoaneurysmorrhaphy (group 2, n = 36). Preoperative and postoperative cardiac index measurements were, respectively, 1.96 +/- 0.6 and 3.51 +/- 0.53 for group 1, and 1.96 +/- 0.31 and 3.43 +/- 0.41 for group 2. In this regard, there was not any significant difference between the groups preoperatively or postoperatively. Preoperative and postoperative multiple-gated acquisition measurements, were, respectively, 34.3 +/- 7.76 and 43.1 +/- 11.1 for group 1, and 37 +/- 3.88 and 66.5 +/- 5.2 for group 2. Although there was not any significant preoperative difference between the groups (P = 0.34), group 2 had significant postoperative improvement in left ventricular ejection fractions (P < 0.001). Preoperative and postoperative single-plane contrast ventriculographic ejection fractions were, respectively, 43.4 +/- 8.7 and 48.6 +/- 11.2 for group 1, and 43.8 +/- 5.5 and 60.8 +/- 15.1 for group 2. Again, there was not any significant difference between the 2 groups in preoperative left ventricular ejection fractions (P = 0.87), but the postoperative left ventricular ejection fractions of group 2 were significantly better than those of group 1 (P = 0.022). We conclude that left ventricular functional improvement with endoaneurysmorrhaphy is superior to that with classical aneurysmectomy.

Diagnostic problems in a case with mucometrocolpos, polydactyly, congenital heart disease, and skeletal dysplasia.

Mucometrocolpos is the distention of the uterus and vagina caused by obstruction to the drainage of genital secretions. Although most cases of mucometrocolpos are sporadic, it may be part of an autosomal recessive condition, known as McKusick-Kaufman syndrome (MKS), including postaxial polydactyly and congenital heart disease as main findings. The diagnosis may be difficult when the presence of additional findings creates an overlap with other syndromes. We report on a female infant with mucometrocolpos, postaxial polydactyly, congenital heart disease, short limbs, short ribs, and chest constriction. The clinicopathological findings are described and discussed in the context of the phenotypic spectrums of MKS and mucometrocolpos concomitant with Ellis van Creveld syndrome.

Malignant degeneration of mature cystic teratomas.

Malignant transformation of benign cystic teratoma is rare and the most common malignancy is squamous cell carcinoma. The diagnosis is rarely made preoperatively and the prognosis is usually poor. We report 4 cases with dermoid cysts showing malignant transformation, 3 with squamous carcinoma and 1 with adenocarcinoma. The patients were within the reproductive age and underwent surgical intervention with intraoperative evaluation. Frozen section identified 2 cases with malignant transformation and staging laparotomy was performed at the initial laparotomy. One of the remaining underwent reoperation following a pregnancy termination and the other refused further surgery. None had metastases and/or capsule invasion. One had tumour rupture during excision and received combined chemotherapy following surgery. Three of the patients remain well and 1 is lost to follow-up.

Laparoscopy for adhesion prevention following myomectomy.

OBJECTIVE: To evaluate adhesion formation after classic abdominal myomectomy and the role of early, second-look laparoscopic adhesiolysis in the management of post-myomectomic pelvic adhesions in a prospective study. METHOD: Forty-eight patients with infertility, recurrent abortion or symptomatic myoma underwent second-look laparoscopy (SLL) 8 days after abdominal myomectomy. The degree of adnexal adhesions were scored according to the American Fertility Society Classification and were lyzed laparoscopically. The success of the SLL was evaluated in 18 patients who underwent a third-look procedure (cesarean section or laparoscopy) RESULTS: Myomectomy incisions on the posterior uterine wall were associated with more adhesions than that on the fundus or anterior wall (P < 0.01). Myomectomies performed on uteri larger than 13 weeks gestation resulted in significantly higher adhesion scores than smaller ones (P < 0.001) and mainly intra-mural myomas than only sub-serous ones (P < 0.01). More than one uterine incision was found to result in more adhesions (P < 0.05), while the number of myomas removed were not found to affect adhesion formation (P > 0.05). In the patients who underwent a third-look procedure, adhesion scores were found to be significantly lower than the SLL (6.2 +/- 6.4 vs. 3.1 +/- 3.4) (P < 0.01). CONCLUSION: Myomectomy operations frequently result in pelvic adhesions, which may impair fertility. Early laparoscopy and adhesiolysis after myomectomy is useful for assessing the degree of adhesions, technical ease in performing adhesiolysis and resulting in lower adhesion scores as shown by third-look procedures.

Massive ovarian oedema: a nonneoplastic adnexal mass mistaken for a neoplasm.

Massive ovarian oedema (MOO) is an unusual clinical entity occurring in teenage girls and young women, and is thought to result from periodic and intermittent torsion of the ovarian pedicle. It is usually mistaken for an ovarian neoplasm and treated by oophorectomy. A case that underwent more radical surgery than is necessary is presented.

Vulvar syringoma exacerbated during pregnancy.

Although syringoma of the eyelids and the cheeks are well known and defined, vulvar syringoma is a rare clinical variant of this benign eccrine tumor. A case of syringoma of the vulva exacerbated during pregnancies with regression in the periods in between is presented. Histopathological examination showed typical features of syringomas. Only 20 patients with vulvar syringoma have been previously reported in the literature.

Intraoperative evaluation of prognostic factors in stage I endometrial cancer by frozen section: how reliable?

The incidence of pelvic/paraaortic lymph node metastases is related to the grade of the tumor, the depth of myometrial invasion and the cervical involvement. These prognostic factors determine the initial surgery. Intraoperative evaluation and frozen section (FS) have been used for this purpose in order to identify patients requiring pelvic/paraaortic lymphadenectomy and adjuvant therapy, thereby eliminating routine lymphadenectomy with its complications. We used frozen section for this purpose and identified accurately 90% of patients requiring pelvic/paraaortic lymphadenectomy. The depth of myometrial invasion was accurately predicted in 90.6% and histologic grade in 91.9% of the patients; however, 60% of patients with cervical involvement were identified by FS. We recommend the use of frozen section as an inexpensive, simple and accurate way of estimating the poor prognostic factors.