Effect of surgical approach on risk of recurrence after vaginal brachytherapy in early-stage high-intermediate risk endometrial cancer.

OBJECTIVE: The objective was to determine if surgical approach affects time to recurrence in early-stage high-intermediate risk endometrial cancer (HIR-EC) treated with adjuvant vaginal brachytherapy (VBT). METHODS: In this retrospective cohort study, HIR-EC patients treated with VBT between 2005 and 2017 were identified and those who received open or minimally invasive hysterectomies (MIS) were included. Clinical and surgical variables were analyzed and time to recurrence was compared between surgical groups. RESULTS: We identified 494 patients, of which 363 had MIS hysterectomies, 92.5% had endometrioid histology, 45.7% were stage IA and 48.0% stage IB. Open hysterectomy patients had higher BMIs (p = 0.007), lower rates of lymph node sampling (p < 0.001) and lymphovascular space invasion (LVSI) (p = 0.036), however in patients who recurred, no differences were noted between groups. Overall, 65 patients (13.2%) recurred, 14 in the open group (10.7%) and 51 in the MIS group (14.0%) (p = 0.58), while vaginal recurrences were noted in 4.6% and 6.1% respectively. When compared to the open group, the MIS group had a significantly shorter time to any recurrence (p = 0.022), to pelvic (p = 0.05) and locoregional recurrence (p = 0.021) and to death from any cause (p = 0.039). After adjusting for age, BMI, grade, LVSI and surgery date, the MIS group had a higher risk of any recurrence (HR 2.29 (1.07-4.92), p = 0.034) and locoregional recurrence (HR 4.18 (1.44-12.1), p = 0.008). CONCLUSIONS: Patients with HIR-EC treated with VBT after MIS hysterectomy have a shorter time to recurrence and higher risk of recurrence when compared to open hysterectomy patients. Further studies into the safety of MIS in high-intermediate risk patients are required.

Ultrasonography of imperforate anus in neonate: an approach correlated with current surgical concepts.

Neonates with an imperforate anus pose a challenge to those responsible for diagnosing and treating the congenital abnormality. Early assessment and accurate diagnosis of the type of imperforate anus are essential for determining the appropriate surgical procedure. Transperineal ultrasonography (US) can be used to identify the internal fistula and to define the type of imperforate anus. Thus, US represents an useful noninvasive imaging modality for assisting in the diagnosis and appropriate management of this disease. We will describe this imaging technique and present different types of illustrative scans of an imperforate anus.

Transperineal sonography of the anal sphincter complex in neonates and infants: differentiation of anteriorly displaced anus from low-type imperforate anus with perineal fistula.

PURPOSE: To evaluate the usefulness of transperineal sonography of the anal sphincter complex for differentiating between an anteriorly displaced anus, which is a normal anatomical variant, and a low-type imperforate anus with perineal fistula, which is a pathological developmental abnormality requiring surgical repair. MATERIALS AND METHODS: Transperineal sonography was performed with a 13-MHz linear-array transducer on 8 infants (1 day-5.3 months old) who were considered on clinical grounds to have an anteriorly displaced anus and on 9 infants (0-8 months old) with a low-type imperforate anus and perineal fistula confirmed at surgery. The anal sphincter complex was identified and the relationship between the anal canal and the anal sphincter complex was evaluated. RESULTS: Transperineal sonography was feasible for all children without any specific preparation. An anal canal running within an intact sphincter complex was identified in all infants with an anteriorly displaced anus (n = 8). In 8 of 9 infants with a low-type imperforate anus, a perineal fistula running outside the anal sphincter complex was correctly diagnosed by transperineal sonography. In one infant with a low-type imperforate anus, transperineal sonography revealed a deficient anal sphincter complex. CONCLUSION: Transperineal sonography appears to be a useful non-invasive imaging technique for assessing congenital anorectal abnormalities in neonates and infants, allowing the surgeon to select infants who would benefit from surgical repair.

Cervical atypical mycobacterial lymphadenitis in childhood: findings on sonography.

PURPOSE: To describe the sonographic appearance of cervical lymph nodes in twelve children with histopathologically confirmed atypical mycobacterial lymphadenitis. MATERIALS AND METHODS: Sonography of cervical lymph nodes was performed with a real-time linear scanner using a 13 MHz probe. Sonographic findings were retrospectively reviewed in 9 girls and 3 boys age 1.7 to 10.7 years (median age, 3.7 years), with cervical lymphadenopathy at initial presentation. RESULTS: Strong echoes within the lymph nodes were found in 4 (33 %) of the children, corresponding to calcifications on histopathological examination. Loss of regular nodal shape with circumscript polypoid spread of nodal masses into the subcutaneous tissue was found in 6 (50 %) patients; at least 1 of these 2 features was noted in 10 (83 %) of our 12 patients. At surgery, abscess formation was found in 8 (67 %) children. CONCLUSION: When nodal calcifications and spread of nodal masses into the subcutaneous tissue are found in patients with cervical lymphadenopathy, the examiner should maintain a high level of clinical suspicion for atypical mycobacterial lymphadenitis. Contrary to other causes of cervical lymphadenopathy, total surgical excision is the treatment of choice. Identification of these patients prior to surgery is therefore of utmost importance. Our data suggest that sonography could serve as an easy non-invasive method for this purpose.

Assay of salsolinol in peripheral blood mononuclear cells of alcoholics and healthy subjects by gas chromatography-mass spectrometry.

Endogenous 6,7-dihydroxy-1-methyl-1,2,3,4-tetrahydroisoquinoline (salsolinol) could be a potential marker involved in the aetiology of alcoholism. Whereas the amount of salsolinol in plasma and urine depends on several dietary conditions, the salsolinol from peripheral mononuclear cells should be formed endogenously. Salsolinol was quantified in lymphocytes of 10 controls and 11 alcoholics (after 1 and 13 weeks of abstinence) using solid phase extraction and gas chromatography/mass spectrometry. Alcoholics showed significantly lower salsolinol concentration than the controls. After 13 weeks of abstinence a further significant decrease of SAL levels could be seen in the lymphocytes of alcoholics. The findings of this study support the theory that salsolinol might be a trait marker in alcoholism.

The QUinapril Ischemic Event Trial (QUIET): evaluation of chronic ACE inhibitor therapy in patients with ischemic heart disease and preserved left ventricular function.

Angiotensin-converting enzyme inhibitors improve endothelial function, inhibit experimental atherogenesis, and decrease ischemic events. The Quinapril Ischemic Event Trial was designed to test the hypothesis that quinapril 20 mg/day would reduce ischemic events (the occurrence of cardiac death, resuscitated cardiac arrest, nonfatal myocardial infarction, coronary artery bypass grafting, coronary angioplasty, or hospitalization for angina pectoris) and the angiographic progression of coronary artery disease in patients without systolic left ventricular dysfunction. A total of 1,750 patients were randomized to quinapril 20 mg/day or placebo and followed a mean of 27 +/- 0.3 months. The 38% incidence of ischemic events was similar for both groups (RR 1.04; 95% confidence interval 0.89 to 1.22; p = 0.6). There was also no significant difference in the incidence of patients having angiographic progression of coronary disease (p = 0.71). The rate of development of new coronary lesions was also similar in both groups (p = 0.35). However, there was a difference in the incidence of angioplasty for new (previously unintervened) vessels (p = 0.018). Quinapril was well tolerated in patients after angioplasty with normal left ventricular function. Quinapril 20 mg did not significantly affect the overall frequency of clinical outcomes or the progression of coronary atherosclerosis. However, the absence of the demonstrable effect of quinapril may be due to several limitations in study design.

Demonstration of 2-unsaturated C19-steroids in the urine of female Asian elephants, Elephas maximus, and their dependence on ovarian activity.

Air-borne volatile substances have been demonstrated to signal oestrus, induce ovulation and synchronize ovarian activity in different mammals. An oestrous-related pheromone of the female Asian elephant (Elephas maximus) is known to induce behavioural responses in elephant bulls. Additional data revealed that timing of oestrus in females with close social relationships tends to be synchronized. Therefore, urine from female Asian elephants might be expected to contain luteal phase-dependent volatile substances, which may function as additional chemical signals in this species. The aim of the present study was to identify such compounds and to investigate their pattern of excretion throughout the ovarian cycle. Urine samples were collected three times a week during the follicular phase and one to three times a week during the luteal phase from five adult female Asian elephants from a total of 13 non-conception cycles and one conception cycle, including the first 72 weeks of pregnancy. A simple headspace solid-phase microextraction method has been developed for quantification of urinary volatile substances and analysis was performed by gas chromatography. The comparison of urine collected during the follicular and the luteal phase indicated the presence of two luteal phase-dependent substances. Mass spectrometry was used to identify one substance as 5alpha-androst-2-en-17-one and a second substance as the corresponding alcoholic compound 5alpha-androst-2-en-17beta-ol. The 5alpha-androst-2-en-17beta-ol and -17-one profiles reflected cyclic ovarian activity with clear (10-20-fold) luteal phase increases. Furthermore, measurements of both compounds were correlated positively with the concentration of urinary pregnanetriol and indicated cycle duration (15.1 +/- 1.2 weeks) similar to that obtained from pregnanetriol measurements (15.2 +/- 1.6 weeks). The results demonstrate the presence of two luteal phase-specific steroidal volatile compounds in elephant urine. One of the substances, 5alpha-androst-2-en-17-one, has been demonstrated in human axillary bacterial isolates. The measurement of both volatile substances in elephant urine can be used for rapid detection of the stage of the ovarian cycle, as the analysis can be completed within 2 h.

In vitro pharmacological activity of the tetrahydroisoquinoline salsolinol present in products from Theobroma cacao L. like cocoa and chocolate.

Cocoa and chocolate contain the tetrahydroisoquinoline alkaloid salsolinol up to a concentration of 25 microg/g. Salsolinol is a dopaminergic active compound which binds to the D(2) receptor family, especially to the D(3) receptor with a K(i) of 0.48+/-0.021 micromol/l. It inhibits the formation of cyclic AMP and the release of beta-endorphin and ACTH in a pituitary cell system. Taking the detected concentration and the pharmacological properties into account, salsolinol seems to be one of the main psychoactive compounds present in cocoa and chocolate and might be included in chocolate addiction.

Effects of coronary stents on cardiovascular outcomes in broad-based clinical practice.

BACKGROUND: Although stents have been shown to reduce the need for repeated percutaneous coronary intervention (PCI) in randomized trials, the effects of stents in broad-based, diverse clinical practice have not been well studied, nor has their effect on subsequent myocardial infarction or cardiac death. METHODS: A retrospective cohort study was performed that included all 43 hospitals performing PCI in Pennsylvania in the last quarter of 1995, with the use of the Pennsylvania Health Care Cost Containment Council database. All 5258 patients who underwent PCI, excluding those with previous PCI within the preceding 6 months, were included. The primary outcomes were in-hospital events (death or coronary bypass), 6-month revascularization rates, and 6-month rates of cardiac death or myocardial infarction. RESULTS: A total of 1240 patients (24%) had a stent procedure. Compared with nonstent procedures, stents reduced the risk of in-hospital events (multivariable odds ratio adjusted for patient and hospital level differences, 0.63; 95% confidence interval, 0.41-0.97), primarily because of a 52% reduction in the need for coronary bypass. Stents also reduced the need for follow-up revascularization procedures (multivariable hazard ratio, 0.72; 95% confidence interval, 0.59-0. 87), primarily because of a 31% reduction in repeated PCI. However, stents had no effect on 6-month rate of myocardial infarction or cardiac death (multivariable hazard ratio, 0.97; 95% confidence interval, 0.71-1.33). CONCLUSIONS: Using stents decreases the need for repeated PCI in broad-based clinical practice, confirming results from randomized trials. However, this study did not detect any effect on subsequent myocardial infarction or cardiac death.

Intestinal ultrasonography in children and young adults: bowel wall thickness is age dependent.

The purpose of this study was to investigate bowel wall thickness in children, adolescents, and young adults as measured by ultrasonography. Ultrasonographic evaluation of the small bowel and the colon was performed in 128 subjects (age range, 3 days to 40 years). Bowel wall thickness increased significantly (P < 0.0001) increased with age, reaching a maximum colon wall thickness of 2.0 mm at the age range of 20 to 29 years. In the ileum, maximum wall thickness reached 1.5 mm at the age range of 10 to 14 years. The findings emphasize the need for age-specific normal values for bowel wall thickness measured by ultrasonography.

Bowel wall thickness measured by ultrasound as a marker of Crohn's disease activity in children.

Non-invasive procedures are desirable for assessing disease activity in the follow-up of children with Crohn's disease. We show that bowel wall thickness measured by ultrasound is related to clinical and histological assessment of disease activity and could represent an easy method for monitoring the intestinal inflammatory process in Crohn's disease.

Angiotensin II formation in human vasculature after chronic ACE inhibition: a prospective, randomized, placebo-controlled study. QUO VADIS Investigators.

The QUO VADIS (the effects of QUinapril On Vascular Ace and Determinants of ISchemia) study was a randomized, double-blind, placebo-controlled trial designed to evaluate the effects of long-term angiotensin-converting enzyme (ACE) inhibition on angiotensin II formation in human vasculature. Patients (n = 187) scheduled for coronary artery bypass surgery used study medication 27 +/- 1 days before surgery. Segments of internal mammary arteries were exposed to increasing doses (0.1 nM-1 microM) of angiotensin I and II in organ baths. The rate of local angiotensin II formation is a function of the reciprocal of the difference between the pEC50's of the dose response curves to angiotensin I and II (-log/mol) and of the area between the curves (units). Quinapril (40 mg) and captopril (3 x 50 mg) similarly and significantly reduced mean blood pressure compared with placebo (p = 0.04). Difference between pEC50's was 0.90 +/- 0.08 in quinapril patients compared with 0.60 +/- 0.08 for placebo (p = 0.01); the area between curves was 91 +/- 8 for quinapril patients compared with 67 +/- 8 for placebo (p = 0.03). Angiotensin II formation was decreased to a lesser extent with captopril and was not statistically different from placebo (p = 0.3); the difference between pEC50's was 0.83 +/- 0.15; the area between curves was 84 +/- 12. This is the first randomized study to demonstrate that long-term oral treatment with an ACE inhibitor reduces vascular angiotensin II formation in humans.

Comparative study of ACE-inhibition, angiotensin II antagonism, and calcium channel blockade on flow-mediated vasodilation in patients with coronary disease (BANFF study)

OBJECTIVES: To determine the effect of angiotensin-converting enzyme (ACE) inhibition on brachial flow-mediated vasodilation. BACKGROUND: Quinapril, an ACE inhibitor with high affinity, has been shown to improve coronary endothelial dysfunction in patients with coronary artery disease. The effectiveness of different vasoactive agents to improve human endothelial function is unknown. METHODS: High resolution ultrasound was used to assess endothelium-dependent brachial artery flow-mediated vasodilation (FMD) in patients with coronary disease. We studied 80 patients (mean age 58 +/- 0.9 years) in a partial-block, cross-over design trial. Patients were randomized to one of four different drug sequences to receive quinapril 20 mg, enalapril 10 mg, losartan 50 mg or amlodipine 5 mg daily. Each patient received three drugs with a two-week washout period between treatments. The primary end point was the absolute difference in FMD after eight weeks of each study drug compared with their respective baselines analyzed in a blinded fashion. RESULTS: There was mild impairment of FMD at baseline (7.3 +/- 0.6%). The change in FMD from baseline was significant only for quinapril (1.8 +/- 1%, p < 0.02). No change was seen with losartan (0.8 +/- 1.1%, p = 0.57), amlodipine (0.3 +/- 0.9%, p = 0.97) or enalapril (-0.2 +/- 0.8%, p = 0.84). No significant change in nitroglycerin-induced dilation occurred with drug therapy. The improvement in quinapril response was not seen in those with the DD ACE genotype (0.5 +/- 2.1%) but was seen in those with the ID and II genotype (3.3 +/- 1.2 and 3.2 +/- 1.9%, respectively, p = 0.03). CONCLUSION: Only quinapril was associated with significant improvement in FMD, and this response is related to the presence of the insertion allele of the ACE genotype.

Influence of smoking status on angiotensin-converting enzyme inhibition-related improvement in coronary endothelial function. TREND Investigators. Trial on Reversing Endothelial Dysfunction.

Our study evaluated the influence of smoking status on coronary endothelial function in normotensive patients with coronary artery disease who received placebo or the angiotensin-converting enzyme inhibitor quinapril in the TREND study (Trial on Reversing Endothelial Dysfunction). In this retrospective analysis of data from the previously published study, patients were classified as either smokers (n = 23) or nonsmokers (n = 82). Patients underwent coronary angiography at baseline and again after 6-month follow-up. The primary response variable was the net change in acetylcholine-induced diameter of the target coronary artery segments (n = 105) between the baseline and 6-month follow-up angiograms. The secondary response variables were based on analysis of all segments (n = 300) and the mean diameter responses of target and all segments at 6 months. At baseline, coronary artery vasomotor responses were similar in smokers and nonsmokers in the placebo and quinapril groups. There was a significant improvement in the primary response variable for both smokers (P = 0.008) and nonsmokers (P = 0.047) randomized to quinapril compared with placebo. At 6-month follow-up, nonsmokers in the placebo group showed no significant change in the mean vasoconstrictor responses (8.3% vs. 8.0% at acetylcholine 10(-4) mol/L), whereas nonsmokers in the quinapril-treated group showed significantly less vasoconstriction (2.7% vs. 13.2%; P = 0.003). Among smokers in the placebo group, vasoconstriction increased nonsignificantly (21.7% vs. 17.2% at baseline) but decreased significantly in the quinapril group (0.5% vs. 17.9%; P = 0.002). These results indicate that ACE inhibition improves the coronary vasomotor response in both smokers and nonsmokers, but that smokers apparently derive greater benefit.

Pelvic ultrasonography in Turner syndrome: standards for uterine and ovarian volume.

The purpose of this study was to investigate uterine and ovarian size according to age and pubertal stage in patients with Turner syndrome. Ultrasonographic evaluation of the uterus and the ovaries was performed in 93 patients with Turner syndrome, aged 12 days to 17.85 years. The data were compared with those of 190 healthy controls. One or both ovaries were detected in 41 of 93 patients (44%). Within the prepubertal group, mean uterine volume and mean ovarian volume of the patients with Turner syndrome were significantly (P<0.001) lower than those of controls (0.5+/-0.2 ml versus 1.0+/-0.3 ml; 0.3+/-0.3 ml versus 0.6+/-0.4 ml, respectively). In prepubertal girls, no significant relationship was found between age and uterine size or ovarian size. Both uterine volume and ovarian volume of 19 women with spontaneous puberty increased during breast development, although mean uterine volume and mean ovarian volume were significantly (P<0.01) lower than those of pubertal control patients.

Quantitative determination of endogenous tetrahydroisoquinoline salsolinol in peripheral blood mononuclear cells by gas chromatography-mass spectrometry.

Endogenous 1-methyl-1, 2, 3, 4-tetrahydro-6,7-dihydroxyisoquinoline (salsolinol) could be a potential marker involved in the etiology of alcoholism. The amount of salsolinol analyzed previously from plasma and urine by different methods depends on several dietary conditions because nutrition has an important influence on salsolinol excretion. Whereas plasma salsolinol is influenced by the diet the salsolinol from peripheral mononuclear cells should be endogenously formed. Therefore, a method for the quantification of S-and R-salsolinol from lymphocytes by using gas chromatography-mass spectrometry was developed. The average amount of salsolinol in 10(6) cells was 1.25 ng corresponding to 2.41 x 10(-5) M and was shown to be much higher than the plasma salsolinol concentration (2.6 x 10(-9) M).