Prevalence of severe pelvic inflammatory disease and endometriotic ovarian cysts: a 7-year retrospective study.

INTRODUCTION: The purpose of this study was to delineate the association between endometriosis and pelvic inflammatory disease (PID) and the prevalence of this coexistence. MATERIALS & METHODS: The records of all patients with endometriotic ovarian cysts treated at the 3rd Department of Obstetrics and Gynecology of the University of Athens and in "Lito" Maternity Hospital of Athens from 2000 through 2007 were reviewed. RESULTS: During this 7-year period 720 women underwent surgery due to endometriotic ovarian cysts. The average age was 40.9 years (range: 17-70). Median diameter of the cysts was 4.495 cm and 59% were located in the right ovary. PID was identified in 21 (2.9%) cases. The average age of these women was 31 years (range: 21-39). Half of the women presented with fever (10/21; 47.6%). Ultrasound examination was performed in all women, followed by laparoscopy. In 47.6% (10/21) the PID abscess was located in the right ovary and the rest (52.38%) in the left. The mean diameter of the endometriotic cysts in these women was 3.52 cm. Laparoscopy was the treatment of choice in all the women with the exception of five cases, where due to technical difficulties during laparoscopy, a laparotomy was performed. In all the cases with PID, abscesses were evacuated laparoscopically. No operative complications were observed. CONCLUSIONS: Endometriosis and PID are two conditions that can easily confuse the physician in setting the diagnosis, especially in the situation where they co-exist. In our study we report that the prevalence of PID in women with endometriosis is sufficiently higher than the prevalence in the general population.

Prevalence of acute hemoperitoneum in patients with endometriotic ovarian cysts: a 7-year retrospective study.

INTRODUCTION: Endometriosis is a quite common condition in women of reproductive age. The purpose of this study is to delineate the association between hemoperitoneum and endometriosis. MATERIALS & METHODS: The records of all patients with endometriotic ovarian cysts treated at the 3rd Department of Obstetrics and Gynecology of the University of Athens and at "Lito" Maternity Hospital of Athens from 2000 through 2007 were reviewed. RESULTS: During this 7-year period 720 women underwent surgery due to endometriotic ovarian cysts. The average age was 40.9 years (range: 17-70). The median diameter of the cysts was 4.49 cm and 59% were located in the right ovary. Hemoperitoneum was identified in 16 (2.22%) of them. The average age of these women was 28.5 years (range: 22-44). Ten (62.5%) of these women presented with acute and strong abdominal pain and moderate signs of cardiovascular shock. The rest presented with abdominal pain and distension worsening at the onset of menses, nausea and/or vomiting and hemorrhagic fluid in the pelvis. Ultrasound examination was performed in all women and afterwards they underwent laparoscopy to identify the source of bleeding. In all cases a ruptured endometriotic cyst was found. In 68.8% (11/16) the ruptured cyst was located in the left ovary and the rest (31.2%) in the right. A thorough examination did not reveal any other sources of bleeding. No operative complications were observed. DISCUSSION: The simultaneous occurrence of ascites and endometriosis is rare. A physician, though, must always take into consideration endometriosis in the differential diagnosis of ascites and acute abdominal pain or pelvic mass.

Miniplate osteosynthesis for fractures of the edentulous mandible: a clinical study 1989-96.

Our 8 years experience of treating fractures of the edentulous mandible by miniplate osteosynthesis, is discussed. Forty patients (31 men and 9 women) aged 37 to 86 years (mean: 64.6 years, SD: +/- 14.07) with 67 fracture sites were treated. The surgical approach was mainly intraoral (37 out of 40 patients) without the use of intermaxillary fixation. The postoperative clinical and radiological findings are reported and discussed. The advantages of the method are of great importance since immediate postoperative opening of the mouth is permitted, as the fractured bones are anatomically stabilized by means of titanium miniplates and screws. Our results were felt to be satisfactory, with a reoperation rate of only 3.9% (two out of 51 operated fracture sites, 16 condylar fractures were treated conservatively). This allows us to propose intraoral miniplate osteosynthesis as a routine method of treatment in cases of edentulous mandibular fractures which are mainly seen in elderly people.

The effects of anesthesia and mode of delivery on the parameters of the renin-angiotensin system.

Paired maternal venous (MV) before (P1) and after (P2) general anesthesia, cord venous (CV) and cord arterial (CA) blood was taken from two groups of primagravid women, one delivered vaginally and the other by elective lower segment Caesarian section (ELSCS). ACTH, Cortisol (CoSol) Aldosterone (Aldo) Plasma Renin Activity (PRA) Plasma Renin Concentration (PRC) Angiotensin II (AII) Solium (N alpha) and Potassium [K]+ were measured in both study groups. Of the various hormones studied, all but cortisol were raised in the P2 sample with only ACTH and AII achieving significant increase. A number of significant positive correlations was found between P1 and P2 samples as well as between the hormones themselves. Four of the vaginally delivered group received epidural analgesia and demonstrated significantly higher levels of ACTH and CoSol in the CV sample. A comparison of the studied variables between the two groups showed a significant decrease in the ELSCS group of ACTH and CoSol in the MV sample, of ACTH, CoSol, PRC in the CV sample, and of CoSol in the CA sample. Of all the parameters, studied, only [K]+ together with Aldo was found to be elevated in the CV sample of the ELSCS group but only [K]+ achieved significant increase.

Fibrocystic disease of the breast.

PIP: Benign breast disease (BBD), of which fibrocystic disease (FCD) is the most common, results from an imbalance in estrogen-progestogen ratios or inappropriate target gland response to changing tides of hormonal stimulation. Histologically, FCD may present as simple cystic glandular hyperplasia, adenosis, chronic cystic mastitis with apocrine metaplasia, and ductal papillomatosis. Fibroadenoma, a pseudoencapsulated tumor, is another variant. Experimental animal data yield some clues as to the etiology of FCD, but extrapolation to the human may be inappropriate. The anovulatory female rarely develops severe FCD, as manifested by marked pain and lumpiness. Oral contraceptives (OCs) reduce the incidence of FCD and the frequency of mammary cancer in comparison with controls. The administration of methyltestosterone, and at times testosterone, to males has resulted in multiple soreness and gynecomastia. Cancer of the breast has occurred in 2 male transvestites who had been on estrogens. The development of mammary cancer in men on stilbestrol therapy for prostatic cancer has recently been challenged. 1 in 11 women in the U.S. will develop breast cancer in her lifetime. Warren has claimed that malignancy was 4.5 times greater in women who had been biopsied for FCD than in normal female population. Cole and MacMahon reviewed the world literature and found the presence of FCD increased the risk of cancer by 2.64 times. FCD is an exaggeration of the normal tissue response of the breast resulting from the ebb and flow of ovarian hormones. FCD is characterized by pain and tenderness, most marked in the premenstrual period but later may continue throughout the cycle. The lumpiness or nodularity may be localized or generalized, unilateral or bilateral. Reported surveys showing that oral contraceptives (OCs) lessen the incidence of FCD suggest that hormonal manipulation can effectively reduce the frequency of this disease, and, possibly in turn, the incidence of mammary cancer. Cystic masses should be aspirated and the contents examined for cytologic atypia. It is important to find those women who are at greater risk of developing mammary cancer because of florid fibrocystic disease. FCD should be medically managed unless a dominant lump develops, in which case a biopsy should be performed. The use of a newsteroidal agent, danazol, on a 3-6 month trial of 100-400 mg/day will eliminate pain and nodosities in some 69% of women and in another 30% the signs and symptoms will be diminished.^ieng

Endocrine studies in postmenopausal women during oral replacement therapy with unconjugated oestrogens.

Two groups of postmenopausal women were seen at monthly intervals during a three-month trial of continuous therapy with oral unconjugated oestrogens. Ten women in the first group were administered daily Hormonin No. 1 containing oestriol (E3) 0.135 mg, oestradiol (E2) 0.3 mg and oestrone (E1) 0.7 mg. Eight women in the second group received Hormonin No. 2 containing E3 0.27 mg, E2 0.6 mg and E1 1.4 mg. E1, E2, E3 and dehydroepiandrosterone (DHA) as well as follicle-stimulating hormone (FSH) and luteinizing hormone (LH) were measured by radioimmunoassay. Maturation index of vaginal smears and clinical effects were also evaluated. Oral replacement therapy with these unconjugated oestrogens produced a significant elevation of E1 (p less than 0.05) and E2 (p less than 0.05) to values corresponding well with the premenopausal range measured in our laboratory. Postmenopausal levels of FSH and LH showed only a moderate but significant decrease (p less than 0.05). There was consistent relief of vasomotor symptoms. One case of endometrial focal adenomatous hyperplasia uncovered during the period of treatment was transformed to functional secretory endometrium after an appropriate course with progestogens. Oral administration of unconjugated oestrogens and periodic withdrawal bleeding induced with a progestational agent seems to be an effective method of replacement therapy in postmenopausal women.

The role of estrogens in mastopathy and mammary cancer in perimenopausal women.

Fibrocystic disease of the breast (FCD) is an exaggeration of the normal physiologic response to cyclic estrogen and progesterone stimulation. The disorder can persist, with much less severity, in the menopausal woman. Whether FCD predisposes to mammary cancer remains moot. A new steroidal agent, danazol, can eliminate nodosities in the majority of women with FCD. Thermography may identify women who are at greater risk because of increased heat production. Mammography should be employed in women with persistently abnormal thermograms, even though no suggestive breast masses are palpable. Needle biopsy or surgical biopsy should be undertaken whenever a firm indurated mass is palpated, regardless of negative findings with a thermogram or mammogram. In a series of 1548 women treated for 10,715 women-years, the incidence of breast cancer after prolonged estrogen therapy was not increased. Although estrogens and prolactin have been incriminated in the etiology of mammary cancer, no hard facts exist to confirm such allegations.

Fibrocytic breast disease: current status of diagnosis and treatment.

Improved diagnostic procedures and use of a new steroidal agent, danazol (Danocrine), should reduce the need for surgical intervention in fibrocystic breast disease. Thermography, a non-invasive procedure that may be used with impunity, may help identify women at high risk. Mammography, which is useful in revealing malignancy in an early stage, should be done in women with tow consecutive abnormal thermograms. Biopsies should be performed, however, on suspicious, firm, irregular masses, regardless of results on thermography or mammography. Use of danazol may be advantageous not only in ameliorating pain and eliminating nodosities, but also in guiding the surgeon to the nodule that is unresponsive to treatment and therefore should be evaluated by biopsy.