Efficacy of laparoscopic subtotal hysterectomy in the management of menorrhagia: 400 consecutive cases

STUDY OBJECTIVE

To assess the safety and patient satisfaction of laparoscopic subtotal hysterectomy (LSH) using a standardised surgical technique.

DESIGN

Prospective observational study.

SETTING

Princess Royal University Hospital, Chelsfield Park Hospital and Sloane Hospital, Kent, UK.

PATIENTS AND MATERIALS

Four hundred consecutive women with menorrhagia underwent LSH. The procedure was performed using the Plasma Kinetic Bipolar Diathermy (Gyrus International Ltd, Berkshire, UK) for pedicle ligation and the Lap Loop system (Roberts Surgical Healthcare Ltd, Kidderminster, UK) to detach the cervix. An electromechanical morcellator (Morcellex; Ethicon Women's Health and Urology, Cincinnati, OH, USA) was used to remove the uterus from the abdominal cavity.

MAIN OUTCOME MEASURES

Patient satisfaction, morbidity rates and readmission rates.

RESULTS

A total of 400 LSH were performed between February 2003 and November 2006. The principal clinical indication for hysterectomy was menorrhagia. The mean duration of surgery was 46.4 minutes. The mean operative blood loss was 126 ml. Concurrent surgery was performed in 141 women. Minor and major perioperative complications were encountered in 5% (n= 20) of women. The major complication rate was 1.2% (n= 5): three women (0.75%) with bladder perforation, two women (0.5%) with bowel injury and one woman (0.25%) with a vesicocervical fistula. Eight women (2%) suffered from cyclical vaginal bleeding postoperatively.

CONCLUSIONS

LSH is a safe and effective treatment for menorrhagia and other menstrual disorders when hysterectomy is indicated. Women appreciate the quick recovery period, reduced time off work and faster return to normal activity. Our data suggest that LSH can replace abdominal hysterectomy in selected cases.

The BH3-only member Noxa causes apoptosis in melanoma cells by multiple pathways

The molecular causes for resistance of melanoma to apoptosis are currently only partly understood. In the present study, we examined gene transfer and expression of the proapoptotic BH3-only protein Noxa as an alternative approach to chemotherapy and investigated the molecular mechanisms regulating Noxa-induced apoptosis. Noxa gene transfer caused dysregulation of both mitochondria and, as shown for the first time, also the endoplasmic reticulum, resulting in the accumulation of reactive oxygen species. Interestingly, expression of Noxa not only triggered the classical mitochondrial caspase cascade, but also resulted in the activation of apoptosis signal-regulating kinase1 and its downstream effectors c-Jun N-terminal kinase and p38. The activation of these kinases was abolished by antioxidants. Moreover, inhibition of the kinases by RNA interference or pharmacological inhibitors significantly attenuated Noxa-induced apoptosis. Thus, our data provide evidence for the involvement of multiple pathways in Noxa-induced apoptosis that are triggered at mitochondria and the endoplasmic reticulum, and suggest Noxa gene transfer as a complementary approach to chemotherapy.

First Report of Peach latent mosaic viroid Infecting Peach in Egypt

Peach latent mosaic viroid (PLMVd) is a widespread pathogen of stone fruit trees in some European and Mediterranean countries and also in North America. To access the presence of the viroid in Egypt, a survey was conducted that covered five commercial peach orchards in the El Khatatba Region in Al Minufiya Governorate. During 2003 and 2004, 73 peach trees (cv. Florida grafted on Nemagard rootstock) were visually inspected and sampled. No symptoms characteristic of PLMVd infection, such as mosaic, delayed growth, or fruit suture cracking, were observed. All samples were tested for the presence of PLMVd using dot-blot hybridization and reverse transcription (RT)-PCR. Aliquots (5 μl) of total nucleic acids extracted from approximately 2 mg of leaf tissue were spotted onto positively charged nylon membranes and hybridized under stringent conditions with a digoxigenin-labeled riboprobe (2). The extracts (1 μl) also were used in RT-PCR as described (1). Only 1 of the 73 peach trees was positive for PLMVd using these detection techniques. The RT-PCR product was of the size expected for PLVMd and was cloned and sequenced. The 339 nucleotide sequence was deposited in GenBank as Accession No. DQ839564. The sequence of this Egyptian PLMVd isolate was 94% identical to the reference PLMVd variant (GenBank Accession No. M83545) and most closely (95%) related to Canadian isolate variant 16 (GenBank Accession No. AJ550911). Such a low incidence compared with other countries may be because the survey was restricted to a limited number of samples, conducted on newly reclaimed lands where no sources of infection existed before, and material with relatively low PLMVd incidence might have been used for planting. Although the incidence of PLMVd was low in this survey, the occurrence represents a threat to the stone fruit tree industry in this country and regular screening of PLMVd in certification programs is suggested. To our knowledge, this is the first report of PLMVd on peach in Egypt. References: (1) S. Loreti et al. EPPO Bull. 29:433, 1999. (2) A. M. Shamloul et al. Acta Hortic. 386:522, 1995.

The effect of administration order of BU and CY on engraftment and toxicity in HSCT mouse model

Conditioning regimens are an important issue determining the outcome of hematopoietic stem cell transplantation (HSCT). Less toxicity, early engraftment and no relapse are the aims of efficient conditioning. Our objective was to investigate the long-term effects of BU-CY and their administration order on the toxicity and chimerism in a mouse model of HSCT. Female BALB/c mice were treated with either BU (15 mg/kg/day x 4)-CY (100 mg/kg/day x 2) or CY-BU. Treated mice were transplanted with Sca-1+ cells from male BALB/c mice. Until 90 days after HSCT, the animals were monitored for body weight and analyzed for cellular phenotype of the thymus, spleen and BM, total chimerism, the spleen chimerism of DCs and T regulatory (Treg) cells, and hepatotoxicity. BU-CY and CY-BU treatments exerted comparable myeloablative and immunosuppressive effects. The long-term engraftment of donor cells in the BM and thymus regeneration showed the same features in both groups. However, the two regimens differed; in general, hepatotoxicity and chimerism of DC and Treg cells. In the long term, BU-CY, but not CY-BU caused a marked decrease in body weight and a significant increase in the activities of the liver enzymes, particularly aspartate amino transferase (AST). We conclude that the alteration of the administration order of BU-CY to CY-BU not only gives the same level of engraftment but also reduces the toxicity of the conditioning regimen that might be valuable specially in young patients who are undergoing HSCT.

[Pathologics fractures of the members: about 43 cases collected in Niamey]

This retrospective and prospective study over 49 months has permitted us to count 43 cases of pathologic fractures: the population concerned is a population of adults whose average age is 43.5 years old. The social groups, which are more affected, are these having poor economical revenue. The male sex is predominating lightly with 22 cases (51.2%). Within 16 cases (37.2%) the pathologic fracture has revealed the causal affection and 27 cases (62.8%) where the affection was already known before the occurrence of pathologic fracture. Pain, tumefaction and functional impotence constitute the main reason (motive) for consultation. Femur is the most affected bone with 26 cases over 43 cases. The principal etiologies are represented by malignant bone tumors 37.2%, osteoporosis 23.2%, and osteomyelitis 23.2%. Imperfect osteogenosa 6.9%, ricket 6.2%. The standard face and profile radiography and biopsy are the principal complementary exams. The treatment is surgical in 81.4% of cases and orthopedic in 18.6% of cases.

Endometrial endothelial cells are derived from donor stem cells in a bone marrow transplant recipient

BACKGROUND

The endometrium is a dynamic, cyclically regenerating tissue: a unique model of physiological angiogenesis in adults. However, the source of new endothelial cells (ECs) for vessel regrowth is obscure. We studied if male EC could be detected in the endometrial blood vessels of female human or mouse recipients of haematological stem cells from male donors.

METHODS

Endometrial biopsies, obtained from one patient after non-myeloablative allogeneic bone marrow transplantation and two controls, were analysed by immunohistochemistry of CD34 and VEGFR2 antibodies for the immunophenotyping of EC, and FISH probes for the detection of donor cells. Chimerism was analysed using real-time PCR. The same experiment was also applied on the animal model.

RESULTS

At the time of a Caesarean section in a female bone marrow transplanted patient, an average 14% of her endometrial EC were donor-derived. One year later, that figure was 10%. In contrast, none of two non-transplanted females demonstrated a mismatch in endometria at Caesarean section. In samples from female mice, harvested 40 days after a haematological stem cell transplant, a 6% average of donor-derived EC was detected.

CONCLUSIONS

Bone marrow-derived endothelial progenitors contribute to the formation of new blood vessels in the endometrium.

The oral cavity of elderly patients in diabetes

Diabetes mellitus is a common and growing global health problem leading to several complications. Among these periodontal diseases are considered as the sixth complication of diabetes mellitus. This article reviews the relationship between diabetes and oral health, particularly focusing on periodontal diseases, dental caries and xerostomia. There is a bidirectional interrelationship between diabetes and periodontal diseases. Periodontitis is more prevalent and severe in patients with diabetes than in normal population. Therapy of periodontal infection contributes to a positive glycaemic control management and enables reduction of the burden of complications of diabetes mellitus. Diabetics have an increased predisposition to the manifestation of oral diseases like candidiasis which is associated with poor glycaemic control and therapeutic dentures. This predisposition also contributes to xerostomia, which may be due to increased glucose levels in oral fluids or immune dysregulation.

Risk factors for low-grade neuroendocrine carcinoma (LGNET): Hospital-based case-control study in US

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Background: There has been an increase in the diagnosed incidence of LGNET in US over the last 2 decades. Little is known about the etiology of LGNET. In this hospital-based, case-control study we evaluated the association of cigarette smoking, alcohol consumption, diabetes mellitus (DM) and family history of cancers with LGNET of different sites. Method: Cases were patients with LGNET referred to The University of Texas M.D. Anderson Cancer Center between 12/1999 and 9/2005. Controls were selected from healthy individuals who accompanied patients with other cancers. Logistic regression was applied to estimate the adjusted odds ratio (AOR) and 95% confidence interval (CI) for potential risk factors and demographic characteristics. Result: We identified 951 LGNET patients with primary sites including appendix (n=102, 10.7%), small bowel (n=234, 24.6%), lung (n=149, 15.7%), pancreas (n=166, 17.5%), stomach (n=55, 5.8%), rectum (n=56, 5.9%), and others (n=189, 19.2%). Cases were compared to 924 controls. Majority of subjects were white-race (cases, 79.7%; controls, 89.5%). Gender distribution was similar in LGNET patients with 1:1 ratio. DM was associated with pancreatic and gastric primary sites; AOR and 95% CI were 2.5 (1.6–3.9) and 4.5 (2.2–9.3) respectively. Ever cigarette smoking was associated with lung carcinoid (OR=1.3; 95%CI, 1.01–1.9) especially among heavy smokers (20 cigarettes per day), (OR=1.7; 95%CI, 1.01–2.9). Ever or heavy alcohol consumption (= 60 ml ethanol/day) was not significantly related to LGNET of any site. The significantly elevated risk for carcinoid tumors extended to participants with a family history of breast, colon, esophageal, pancreas, prostate, and renal cancers after adjustment for demographic and environmental risk factors (P<.05). Conclusion: Smoking, DM, and family history may increase the risk of LGNET of various sites. Determining environmental and genetic factors related to LGNET may lead to development of surveillance and prevention strategies for high-risk individuals.

No significant financial relationships to disclose.

Elevated stem cell marker CD133 mRNA in peripheral blood predicts colon cancer recurrence

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Background: CD133 is a specific stem cell marker that enriches cancer stem cells of many tumor types including colon cancer as well as circulating endothelial progenitors (CEP). CEP is vital in postnatal angiogenesis and elevated CEP is a proven favoable prognositic marker for heart disease but a potentially poor prognostic marker for cancer. We examined whether elevated CD133 mRNA expression levels in peripheral blood mononuclear cells (PBMC) predict recurrence in colon cancer patients. Methods: We developed and validated a semi-quantitative real-time RT-PCR to quantify CD133 mRNA levels relative to GADPH mRNA. Sixty-six colon cancer patients were enrolled between February 2002 and December 2003. The protocol excluded patients with history of cardiac disease or surgery < 4 weeks from the enrollment and were followed for recurrence for a median 30 months. A central statistician performed multivariate unconditional logistics regression analysis. Results: Among the patients without recurrence, 93% had a CD133 mRNA level < 4.79, whereas 7% had a CD133 mRNA value ≥ 4.79 (p = 0.029). Among patients with a CD133 mRNA value ≥ 4.79, 85% had experienced recurrence compared to 15% of the patient who had no recurrence (p = 0.03). Elevated CD133 mRNA levels at a cut-off point ≥ 4.79 versus < 4.79 were associated with an odd ratio of 22.6 for recurrence (95% CI, 1.7–291.2; p = 0.02); in comparison, the odds ratio for recurrence was 17.2 (95% CI, 1.8–164; p = 0.01) for stage IV patients versus stage I-III patients. No other predictive variables for recurrence were identified including age, race, sex, tumor differentiation, smoking, and diabetes etc. We also observed an trend of association with elevated carcinoma embryonic antigen (CEA) levels (p = 0.03, one sided) and a decreased survival (p = 0.035, one sided) with elevated CD133 mRNA level at a cutoff point ≥ 4.79. Conclusions: Elevated CD133 mRNA levels at a cutoff ≥ 4.79 in PBMC predict colon cancer recurrence independent of stage IV disease. The current assay has certain advantages over flow cytometry for wider clinical application. CD133+ cells measured by CD133 mRNA may contain both CEP and cancer stem cells, leading to increased risks of recurrence.

No significant financial relationships to disclose.

A functional cardiovascular model with disorders

This paper introduces a functional model of the cardiovascular system that is capable of describing its behavior in normal as well as pathologic cases. The developed model includes all the main compartments of the circulatory system and also the baroreflex-feedback regulatory mechanism. The model response to the incorporation of two critical cardiovascular disorders namely hypertension and acute congestive heart failure is realistic and within the expected range of the results of the literature experimental data.

Impact on the cytomegalovirus (CMV) viral load by CMV-specific T-cell immunity in recipients of allogeneic stem cell transplantation

Patients experience cytomegalovirus (CMV) reactivation after stem cell transplantation (SCT) and need repeated courses of pre-emptive therapy. Analysis of CMV-specific immunity might help to assess the need for antiviral therapy. Forty-eight patients were studied during the first 3 months after SCT. Peripheral blood lymphocytes were stimulated by CMV antigen, and interferon (INF)-gamma production by CD3+ and CD4+ T cells was analysed. Results were correlated to transplant factors and CMV disease. Patients with INF-gamma production by CD3+ cells at 4 weeks after SCT had lower peak viral loads than patients with no such production (P=0.03). There was a similar tendency as regards CD4+ cells (P=0.09). Patients who underwent reduced-intensity conditioning (RIC) more frequently had CD3+ (48%) and CD4+ immunity (56%) 4 weeks after SCT compared with patients who received myeloablative conditioning (CD3+ 25%; CD4+ 35%). There was no effect of stem cell source, donor type or acute graft-versus-host disease. Three of 48 patients developed CMV disease and none of them had detectable INF-gamma production. CMV-specific T-cell response is associated with a lower rate of CMV replication. RIC results in improved T-cell reconstitution. Recovery of CMV-specific immunity might be delayed in patients with CMV disease. These observations suggest that detection of CMV-specific T-cells is useful in assessing the immunity against CMV.

Bovine hypodermosis: prevalence and economic significance in southern Punjab, Pakistan

Prevalence and economic losses of warble fly infestation (WFI) in cattle and buffaloes were recorded in Dera Ghazi Khan and Rajan Pur districts of southern Punjab (Pakistan). A total of 18,000 cattle and 9000 buffaloes were examined in the field and slaughter house. Only one species of Hypoderma, i.e. Hypoderma lineatum was recorded from this area. The prevalence of WFI was higher in slaughter house versus field, cattle versus buffaloes, males versus females, and young versus old animals in both the districts. The highest month-wise prevalence was recorded in December and the lowest in July. Organ-wise prevalence of WFI was highest in oesophagus followed in order by rumen and spleen. The economic losses based on the value of warbled and warble-free hides were estimated as Rs. 22.8 million per annum (currency exchange rate is Rs. 57.5=US 1 dollar).

Screening for cervical carcinoma using visual inspection with acetic acid

OBJECTIVE

To assess the performance of visual inspection with acetic acid (VIA) as a screening test for early detection of cervical carcinoma in the Dakahlia Governorate in Egypt.

METHODS

Diluted acetic acid (5%) was applied to the cervix during routine gynecologic examination. Women with positive results were referred for colposcopy. Those with negative results were referred for colposcopy only when they had clinical indications.

RESULTS

Among the 5,000 women who were screened using VIA, 409 were referred for colposcopy. Cervical intraepithelial neoplasia (CIN) was diagnosed in 151 (60%) of the 253 women with positive screening results and in 4 of the 156 women with negative screening results. There were 39 women with high-grade and 116 with low-grade CIN. The sensitivity and negative predictive value of the VIA screening test was 97%. Its positive predictive value was 60% for all grades of CIN and 90% for high-grade CIN.

CONCLUSION

Visual inspection with acetic acid, although associated with a relatively high rate of false-positive results, is a valuable test for the screening of cervical carcinoma.

[Etiology of pleurisy in the Service of Pneumology, Point G]

This study describes epidemiologic, etiologic and evaluative aspects of Pleurisy pneumology department of Point "G". From 1st January 1998 to 31 December 2002 was realised a study about hospitalized patients in the department. Pleurisy represented 15; 9% of hospitalizations. The sex Ratio was 2,3 en for men aged of 41 years 55 of pleurisy were located on right. In 60% of cases the liquid was sero-fibrin, purulent in 25% of cases and haemorrhagic in 15%. Tuberculosis was the most frequent etiology with 37% of cases. According to liquid aspect tuberculosis represented 54, 3% of sero-fibrin pleurisy in one hand, on the other 60% of haemorrhagic pleurisy was due to cancer. The serology HIV have been realised on 89 patients and it was positive on 56% of cases. Association pleurisy/HIV tuberculosis etiology represented 56% of cases. Among 369 patients we have counted 100 deaths, 27% and 86% of these death occurred before a month of hospitalization. Even if the prevalence of neoplastic pleurisy increases, tuberculosis still the 1st etiology of pleurisy. It co-infection with HIV is the principal cause of morbidity and mortality.