Impact of endo- and exogenous estrogens on heart rate variability in women: a review.

Measurement of heart rate variability (HRV) is an established method to assess the activity of the autonomic nervous system. The aim of this review was to examine the link between HRV, reproductive life stages and menopausal hormone therapy. A literature review was performed using the Medline database. Based on title and abstract, 45 studies were extracted out of 261 citations screened. Due to different study designs and evaluation methods, HRV indices were not directly comparable. Qualitative comparisons in between the vast majority of studies, however, demonstrated a decrease of the vagal dominance on the heart from the follicular to the luteal cycle phase, although some studies asserted no change. The intake of oral contraceptives appeared not to alter the vagal modulation of the heart. All investigations agreed on a decline of HRV towards higher sympathetic control after menopause. Different menopausal hormone therapy approaches showed a supporting impact of estrogen on HRV in most studies. A combined therapy of estrogen and progestogens revoked this benefit. Further research is needed to demonstrate how this process might be attenuated by different menopausal hormone therapies.

Multiple primary neoplasms. Ovarian carcinoid tumor, mucinous cystadenoma of low malignant potential tumor of left ovary, and adenocarcinoma of the colon.

We describe a case of primary left ovarian carcinoid tumor with metastases to the right paraovarian tissue, left fallopian tube, the right lung, omentum, cul-de-sac, pericolonic fat, and, most likely, metastasis to the contralateral ovary, as well as a simultaneous left ovarian mucinous cystadenoma of low malignant potential and a well-differentiated colonic adenocarcinoma. Primary ovarian carcinoids are almost always unilateral. Metastases from such tumors to the lung and adrenal gland are very rare. To our knowledge, no such combination of all the above tumors has been reported.

Serum analyte pattern characteristic of fulminant hepatic failure.

Fulminant hepatic failure (FHF) is a poorly understood condition in which total liver failure occurs and is thought to be caused by a variety of conditions including Reye's syndrome, hepatitis, drug overdoses, and vascular insufficiency. While this condition is an uncommon one, it carries with it a high fatality rate and must therefore be diagnosed as rapidly as possible. Six patients have been observed over a two-year period with biopsy and/or autopsy-confirmed FHF: one with acute hepatitis B-delta; three with histories of alcoholism, two of them with cirrhosis; one with acute tylenol overdose; and one with hepatic vascular insufficiency. All of these patients, except one, exhibited a rapid, fatal downhill course after onset of symptoms. In all of these patients, a consistent elevation was observed in serum levels of aspartate aminotransferase (AST) or serum glutamate oxaloacetate transaminase (SGOT) and alanine aminotransferase (ALT) or serum glutamate pyruvate transaminase (SGPT) such that the ratio of AST to ALT was significantly greater than 1 and in serum levels of ammonia. Other liver function tests were found to be abnormal but not in so consistent a pattern, although total protein and albumin were found to be significantly decreased in all of these patients. The stereotypical elevation of the transaminases with high AST-to-ALT ratios and the rise in ammonia appear to characterize this life-threatening illness most reliably.

Aortoduodenal fistula. Two case reports and a review of the literature.

Aortoduodenal fistulas (ADF) are relatively rare causes of fatal exsanguination. They occur predominantly in the third and fourth parts of the duodenum. Symptoms of ADF consist of flank or abdominal pain, hematemesis, melena, and an abdominal mass. We report two fatal cases of ADF, one of which includes the afferent loop of a Billroth II anastomosis, an event previously unrecognized, as well as a more conventional case of ADF, involving the third portion of the duodenum.

Hematoidin crystals in cervicovaginal smears. Review of 27 cases seen in one year.

The occurrence of hematoidin crystals in cervicovaginal smears has recently been described. A prospective search for hematoidin crystals in smears taken during a one-year period was carried out, with a subsequent retrospective chart review. This study revealed that the occurrence of hematoidin crystals was more common than previously thought and was often associated with pregnancy or pregnancylike states. The clinical correlations and possible etiologies of this finding are discussed.