Open laparoscopy without special instruments or sutures. Comparison with a closed technique.

An important advantage of open laparoscopy over closed techniques is the avoidance of placing a sharp trocar blindly into the peritoneal cavity. Although an open technique theoretically minimizes the risk of major retroperitoneal vessel injury and bowel injury, most laparoscopies are performed using a closed technique. In an effort to simplify open laparoscopy, a technique was developed that can be done without special equipment or sutures and nearly as quickly as a closed technique. To compare the effectiveness of this open laparoscopic technique to a closed technique, a prospective, observational, cohort study was carried out on 66 women undergoing laparoscopy for either infertility or pelvic pain. The open technique was performed on 35 consecutive patients and compared to a closed technique performed on 31 patients on a different service during the same period. Evaluation included total duration of the procedure, length of the incision, incidence of CO2 leakage and complications. The open technique took slightly longer, and the incision was slightly longer. CO2 leakage occurred in 5 of 35 of the open cases but in none of the 31 closed cases. Leakage was controlled effectively in every case by application of a towel clip to the skin incision. No complications occurred with either technique. This study suggested that an open technique that requires no special equipment or sutures may be a useful alternative approach for laparoscopy when insertion of a sharp trocar is undesirable.

Loss of heterozygosity and overexpression of the p53 gene in ovarian carcinoma.

Mutation and allelic loss of the p53 gene have been demonstrated in a variety of human cancers. In this study, DNA was extracted from formalin-fixed paraffin sections of ovarian carcinoma from 33 patients informative for a restriction fragment length polymorphism (RFLP) for BstU 1 within the 4th exon of the p53 gene. Allelic loss of p53 as indicated by loss of heterozygosity for this RFLP was demonstrated in 16/33 cases (48%). Because immunoreactivity for p53 correlates closely with the presence of mutation in the p53 gene, we performed immunohistochemical staining with the monoclonal antibody PAb1801. Diffuse nuclear p53 immunoreactivity was observed in 16 of the 33 (48%) informative cases used for loss of heterozygosity analysis (37/80 (46%) cases of ovarian carcinoma overall). A significant correlation (Fisher's exact test, P = 0.04) was observed between p53 overexpression and allelic loss. We found no evidence of association of p53 allelic loss or overexpression with advanced stage or other clinical or pathologic prognostic parameters. We conclude that mutation and allelic loss of p53 are common and probably related events in the development of ovarian carcinoma. This study demonstrates the use of paraffin sections in the analysis of p53 alterations in neoplasia.

Conservative management of bilateral massive edema of the ovary. A case report.

A case of bilateral massive ovarian edema with unilateral ovarian torsion is reported. Following surgical removal of the adnexa with the torsion, the edema of the opposite ovary resolved with oral contraceptive therapy. This has not been previously reported. This case is instructive because the nodular appearance and yellow color of the ovaries and the presence of yellow ascitic fluid could lead to an erroneous diagnosis of malignancy, resulting in performance of a more radical surgical procedure than is necessary. A review of the literature and the unusual nature of this lesion indicates the need for caution in diagnosis and management.