The clinical utility of a vaginal template designed to standardize suture placement during retropubic colposuspensions.

Suture placement and bite size utilizing a vaginal template are compared to a traditional surgical approach during modified retropubic colposuspension on four fresh-frozen human female cadavers. Overall, a larger suture bite was obtained utilizing the template (71.5 +/- 4.6 vs 46.7 +/- 25.3 mm2, P = 0.001). However, with increased surgical experience the suture bites obtained with the traditional approach and template technique were similar. Inconsistent suture placement relative to the urethrovesical junction and urethra was observed with both techniques. Differences in pelvic floor anatomy make consistent suture placement with respect to the urethrovesical junction and urethra neither possible nor entirely preferable with either technique. There seems to be little clinical value in the use of this vaginal template during modified retropubic colposuspensions.

Laparoscopy in morbidly obese patients.

STUDY OBJECTIVE: To assess the safety and efficacy of different insufflation methods in morbidly obese women undergoing laparoscopy. DESIGN: Retrospective analysis of 13 years' experience (Canadian Task Force classification II-2). SETTING: University-affiliated hospital. PATIENTS: One hundred thirty-eight morbidly obese women (weight >250 lbs, body mass index >36). The heaviest patient weighed 400 lbs and had a body mass index of 66. INTERVENTION: Laparoscopic tubal sterilizations and diagnostic laparoscopies performed on an outpatient basis by residents under faculty supervision. MEASUREMENTS AND MAIN RESULTS: Of 138 patients, 36 underwent standard transumbilical insufflation with 5 failures, 83 had transuterine insufflation with 3 failures, 12 had subcostal insufflation with 1 failure, and 7 had open laparoscopy with 2 failures. CONCLUSION: The insufflation failure rate was significantly high for transumbilical insufflation and open laparoscopy, and not for transuterine or subcostal insufflation. Morbid obesity was not a contraindication to laparoscopy. (J Am Assoc Gynecol Laparosc 6(3):307-312, 1999)

Laparoscopic suturing and ligation techniques.

The laparoscopic literature addressing operative techniques and use of suturing and knot tying is reviewed. Many operations that have traditionally been performed by laparotomy, may now be primarily accomplished by laparoscopy. Increasing improvements in laparoscopic instruments and techniques permit more surgical procedures to be performed on an ambulatory basis, therefore setting a new trend in gynecologic surgery. The evolution of endoscopic procedures will require laparoscopic surgeons to master suturing techniques which will improve their level of comfort and performance. This review of suturing and knot tying procedures may be helpful to both the established surgeons and the beginners as it gives a comprehensive review of laparoscopic suturing and knot tying techniques.

[Correlation between weather factors and the number of premature and yearly births]. / Korelacija izmedu vremenskih faktora i broja prijevremenih i rocnih poroda.

In a retrospective study for a period of five years, a total of 41,760 births in Sarajevo were analysed. For the same period, also meteorological data, such as air temperature, humidity, rain, cloudiness, barometric pressure, were gathered, by determining the weather type for each day. Using computer analyses, daily weather types with the number of births were compared. On the basis the statistical method of Friedman's test it is concluded that there is a significant correlation (p less than 0.05) between the weather types and the daily number of births. By comparing the daily number of births with the weather type of the preceding day the same conclusion was drawn. A cyclic fluctuation was also observed in the number of human births: the increased number of births in the December-January period and the decreased number of births in the August-September period. Premature births did not show any cyclic pattern.

[Steroid receptors and breast carcinoma]. / Steroidni receptori i karcinom dojke.

The rate of response of human breast cancer to endocrine therapy depends upon the estrogen receptor ER levels and progesterone receptor PR levels in tumor tissue. About 55% to 60% of all breast cancers have positive estrogen receptors. Higher values of ER are observed in postmenopausal women compared to younger women, and about 45% to 55% of metastatic breast tumors have positive estrogen receptor values. Approximately 60% of ER positive tumors will respond objectively to endocrine therapy, and about 80% of ER positive and PR positive tumors will respond to hormone therapy. Absence of ER in breast tumors seems to correlate well with the increased response to chemotherapy of the patients. The observation that patients whose tumors contained higher ER values, had longer disease free survival than patients with ER negative tumors, led to the use of ER and PR as the prognostic indicators of the disease. Thus, measurement of ER and PR in tumor biopsies gives us important information concerning future treatment and prognosis of the disease.

[Laparoscopic treatment of extrauterine pregnancy]. / Laparoskopski tretman vanmatericne trudnoce.

This study presents 45 consecutive cases of ectopic pregnancies, of which twenty six cases were managed by pelviscopic surgery and 19 by laparotomy. Laparoscopy failed in six of the nineteen laparotomy patients, probably due to poor hemostasis or an excessive hemoperitoneum. There was a significantly shorter hospital stay of 1.07 days for the laparoscopy group vs. 4.2 days for the group treated by laparotomy. Also a higher treatment cost was observed in the laparoscopy vs. laparotomy group. The operating time was not statistically different in the two groups, averaging 96 minutes in both groups. There were no complications in the laparoscopy group.

Transuterine insertion of Veress needle in laparoscopy.

A pneumoperitoneum separating the anterior abdominal wall from the intraperitoneal organs is essential to view the pelvic organs and to perform laparoscopic surgery. A Veress needle was inserted through the uterine fundus to establish a pneumoperitoneum in 100 women undergoing laparoscopy for sterilization or diagnostic purposes. The transuterine approach was chosen for 86 women because of obesity and for 14 because a previous abdominal insertion had been unsuccessful. There were no complications associated with the transuterine Veress needle placement. This method should be considered for obese patients and for those women in whom the transabdominal approach is unsuccessful.

Comparison of sex steroid receptor determinations in human breast cancer by enzyme immunoassay and radioligand binding.

Most investigators comparing ligand-binding procedures for quantifying estrogen and progestin receptors in human breast cancer with procedures employing monoclonal antibody-based methods have utilized an inappropriate variety of reaction conditions, including the elimination of sodium molybdate in the steroid-binding assays. We studied 197 biopsies of human breast cancer, comparing the results of simultaneous measurements of both estrogen and progestin receptors in identical cytosols by enzyme immunoassay and by radioligand binding using the commercially available kits developed by Abbott Laboratories and by DuPont/NEN Products, respectively. Regression analyses comparing the results from the two procedures indicated a linear relationship, with correlation coefficients ranging from 0.79 to 0.93 for both types of receptors over a wide range of data. Using the widely established cutoff value of 10 fmol/mg of cytosol protein for the ligand-binding method, and calculating sensitivity and specificity limits according to McNeil et al. (1975), an equivalent cutoff value of 15 fmol/mg of cytosol protein was determined for the enzyme immunoassay of these receptors. Endocrine status of the patient did not appear to alter the cutoff values of either estrogen or progestin receptors when determined by enzyme immunoassay. We recommend that these cutoff values be considered until the results of clinical correlations are completed.

[Early diagnosis of malignant tumors of the the ovary using ultrasound]. / Ranija dijagnostika malignih tumora ovarija pomocu ultrazvuka.

On Gynecology-Obstetric Clinic in Sarajevo in 100 women, aged 22-80, was made the indication for laparotomy because of the changes on ovaries and it was done according to the palpatory, ultrasound and laparoscopic examination. After the operative treatment and pathologic verification from the 100 studied tumors were found 15 (15%) carcinous cystadenoma, 2 (2%) mucinous cystadenocarcinoma, 25 (25%) serous cystadenoma, 10 (10%) serous cystadenocarcinoma, 10 (10%) adenocarcinoma, 23 (23%) teratoma and 13 (13%) tumors of the other kind, 25 (25%) of tumors were malign and 75 (75%) was benign. The predicted value of the ultrasoundly proved malignity was 80% (20 from 25 patients) and for the benign tumors it was 96% (72 from 75 patients). Malignant tumor of ovary is the third most common malignant disease of genital organs of a woman and at the same time the most often cause of death of women suffering from gynecologic malignant diseases. From all kinds of gynecologic malignant tumors 25% are carcinoma of ovaries. It is the cause of death in 47% women with the malignant diseases of genital organs. The bad prognosis of this tumor is mostly caused by the late diagnosis. Patients most often do not feel any disturbances until the illness comes to the phase of methastase and the most of patients (60-70%) at the time of diagnosis is already in the III or IV stage of illness.

Influence of O.C.T. embedding compound on determinations of estrogen and progestin receptors in breast cancer.

Estrogen receptor (ER) and progestin receptor (PR) concentrations in tumor biopsies are important predictive indicators of a clinical response to endocrine therapy of breast cancer. To assess interference of O.C.T. (optimum cutting temperature) embedding compound in assays of ER and PR by radioligand binding, we determined specific binding capacities and affinities of ER and PR in cytosols by a multipoint titration method, using split samples of 14 breast-tumor biopsies, one portion serving as untreated control, the other treated with O.C.T. There was no statistically significant difference between these two groups. We then compared these data with those of historical controls analyzed both in the presence and absence of sodium molybdate (10 mmol/L). Eighty breast-tumor specimens (mean +/- SD patients' ages, 59 +/- 14 y) embedded in O.C.T. compound and analyzed without molybdate gave ER and PR values that differed insignificantly from those for 306 samples (patients' ages, 61 +/- 14 y) untreated with O.C.T. Thirty-nine specimens (patients' ages, 58 +/- 15 y) embedded in O.C.T. compound were analyzed in the presence of molybdate and compared with the results for 288 specimens (patients' ages, 61 +/- 14 y) untreated with O.C.T. Again, there was an insignificant difference in the concentrations and affinities of receptors in the two groups. Evidently O.C.T. compound does not alter the receptor status of tumor biopsies.

A new algorithm for diagnosis of anemia.

Studies of the cognitive processes of diagnosis have shown that use of heuristics (eg, shortcuts, rules of thumb) dominates clinical problem solving. Thus, an algorithmic approach to diagnosis can be particularly useful. Because the sensitivity and specificity of many tests are not known, however, this approach is not perfect. Therefore, algorithms should be taken as a general guide to diagnosis but should not be applied too rigidly. In the past, algorithms for anemia did not apply any principles of decision analysis. The algorithm presented in this article is based on test operating characteristics reported in the literature. Disease is excluded by highly sensitive tests (screening tests) and confirmed by highly specific tests (pathognomonic findings). This algorithm can reduce the need for expensive, complex procedures, including radioisotope studies (eg, chromium 51 red blood cell study, ferrokinetics). It provides a rational and semiquantitative estimation of diagnostic possibilities. Alternate pathways to diagnosis may arise in individual cases. Also, the algorithm is difficult to apply to multifactorial anemias.