Ultrasonography of abnormal neck lymph nodes.

Ultrasonography is a useful imaging modality for assessing cervical lymphadenopathy in patients with head and neck carcinomas. Features of cervical lymph nodes using gray-scale and color and power Doppler ultrasonography can help to distinguish normal and reactive lymph nodes from potentially metastatic lymph nodes. The distinguishing features that separate abnormal from normal cervical lymph nodes include peripheral vascularity, shape, overall lymph node echogenicity, absence of hilus, presence of nodal microcalcifications, and cystic changes. Often, a combination of these features is needed to assign a cervical lymph node as being abnormal.

Retinoic acid improves ciliogenesis after surgery of the maxillary sinus in rabbits.

OBJECTIVES/HYPOTHESIS: Retinoids have been shown to be important cofactors in regulating the differentiation and proliferation of ciliated epithelial cells of the respiratory tract. In particular, retinoic acid has been shown to enhance the regeneration of paranasal sinus mucosa. The objective of this study is to use scanning electron microscopy techniques to evaluate the effect of topical retinoic acid on mucosal wound healing in a rabbit model of maxillary sinus surgery. It is hypothesized that the application of topical retinoic acid will enhance ciliogenesis and improve the morphology of regenerated cilia compared with controls. STUDY DESIGN: Prospective multi-arm controlled animal trial. METHODS: Eighteen New Zealand white rabbits underwent surgical opening of the maxillary sinuses through a midline incision. The rabbits were divided among four experimental groups: 1) mucosal stripping alone (stripped control), 2) stripping followed by topical application of an inert aqueous gel, 3) stripping followed by application of 0.01% retinoic acid in aqueous gel, and 4) no mucosal stripping and no topical treatment (nonstripped control). After 14 days, the medial wall of the maxillary sinus was harvested and examined by scanning electron microscopy at x2,000 and x5,000 magnification. The micrographs were then rated by a blinded review panel for ciliary density, orientation, and morphology. RESULTS: Mean scores for ciliary density, orientation, and morphology were all significantly higher for the retinoic acid treatment group compared with both the inert aqueous gel treatment group and the stripped control group (P=.004-.03 for all comparisons, Student's t test). Mean scores for the retinoic acid treatment group were numerically lower than the nonstripped control group but did not approach statistical significance for any parameter (P=.23-.31). CONCLUSIONS: In a rabbit model of maxillary sinus surgery, topically delivered retinoic acid enhances ciliogenesis. Qualitative assessment of ciliary density, orientation, and morphology shows improved healing in retinoic acid treated sinuses compared with both untreated control sinuses and aqueous gel treated sinuses.

Prospective follow-up of changes in menopausal complaints and hormone status after surgical menopause in a Malaysian population.

OBJECTIVE: Surgical menopause, in comparison with natural menopause, has traditionally been claimed to lead to faster onset of more severe menopausal symptoms. There is little prospective research to support this view. We aimed to evaluate the speed of onset and magnitude of climacteric symptoms after oophorectomy and whether they relate to serum hormone changes. This would aide in counseling women before surgery. METHODS: The Greene Climacteric Scale (GCS) was used in a sample of women before either total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAHBSO) or hysterectomy with one or both ovaries preserved. After surgery, women filled out GCS questionnaires weekly until the final assessment 5 to 6 weeks after surgery. Follicle-stimulating hormone, leuteinizing hormone, and estradiol levels were determined preoperatively at day 10 and postsurgery at day 37. RESULTS: All study participants had high preoperative GCS scores. Scores were highest in the TAHBSO group, but by 5 to 6 weeks after surgery, ratings had returned to premenopausal levels, showing marked improvement of ratings for anxiety, depression, and somatic complaints. Vasomotor symptoms remained unchanged. Hormone levels dropped within 10 days to postmenopausal levels in women undergoing TAHBSO. Fewer than 25% of women considered themselves symptomatic, and their symptom ratings increased significantly only between 2 and 3 weeks after surgery. CONCLUSIONS: This study suggests that vasomotor and other symptoms do not manifest as rapidly and severely in our study population as claimed in the literature and that many women have minimal or no symptoms. Improved symptom rating may be caused by perceived improvement of overall quality of life after surgery. This supports the concept that menopausal complaints depend on a multitude of factors other than hormone levels alone.