Ovarian thecoma: A very unusual cause of postmenopausal bleeding

We describe a 67-year-old woman with postmenopausal bleeding having ceased estrogen plus progestogen therapy nine months before. Transvaginal ultrasonography showed endometrial thickening with normal ovarian appearance. Hormonal studies revealed high estradiol and inhibin B levels but normal androgens and adrenal hormones. Magnetic resonance image demonstrated a 13-mm left ovarian tumour. Hysterectomy and bilateral salpingo-oophorectomy were performed, and the pathological study revealed an 8 mm ovarian thecoma. This case illustrates a very unusual cause of postmenopausal bleeding. We suggest a study protocol and discuss the differential diagnosis of this case.

Control of dissolved CH4 in a municipal UASB reactor effluent by means of a desorption - Biofiltration arrangement

The direct anaerobic treatment of municipal wastewater represents an adapted technology to the conditions of developing countries. In order to get an increased acceptance of this technology, a proper control of dissolved methane in the anaerobic effluents should be considered, as methane is a potent greenhouse gas. In this study, a pilot-scale system was operated for 168 days to recover dissolved methane from an effluent of an upflow anaerobic sludge blanket reactor and then oxidize it in a compost biofilter. The system operated at a constant air (0.9 m³/h ±0.09) and two air-to anaerobic effluent ratio (1:1 and 1:2). In both conditions (CH₄ concentration of 2.7 ± 0.87 and 4.3% ± 1.14, respectively) the desorption column recovered 99% of the dissolved CH₄ and approximately 30% ± 8.5 of H₂S, whose desorption was limited due to the high pH (>8) of the effluent. The biofilter removed 70% ± 8 of the average CH₄ load (60 gCH₄/m³h ± 13) and 100% of the H₂S load at an empty bed retention time of 23 min. The average temperature inside the biofilter was 42 ± 9 °C due to the CH₄ oxidation reaction, indicating that temperature and moisture control is particularly important for CH₄ removal in compost biofilters. The system may achieve a 54% reduction of greenhouse gas emissions from dissolved CH₄ in this particular case.

Primary hyperaldosteronism in essential hypertensives: prevalence, biochemical profile, and molecular biology

There is evidence that primary aldosteronism (PA) may be common in patients with essential hypertension (EH) when determinations of serum aldosterone (SA), plasma renin activity (PRA), and the SA/PRA ratio are used as screening. An inherited form of primary hyperaldosteronism is the glucocorticoid-remediable aldosteronism (GRA) caused by an unequal crossing over between the CYP11B1 and CYP11B2 genes that results in a chimeric gene, which has aldosterone synthase activity regulated by ACTH. The aim of this study was to evaluate the prevalence of PA and the GRA in 305 EH patients and 205 normotensive controls. We measured SA (1-16 ng/dL) and PRA (1-2.5 ng/mL x h) and calculated the SA/PRA ratio in all patients. A SA/PRA ratio level greater than 25 was defined as being elevated. PA was diagnosed in the presence of high SA levels (>16 ng/dL), low PRA levels (<0.5 ng/mL x h), and very high SA/PRA ratio (>50). Probable PA was diagnosed when the SA/PRA ratio was more than 25 but the other criteria were not present. A Fludrocortisone test was done to confirm the diagnosis. GRA was differentiated from other forms of PA by: the aldosterone suppression test with dexamethasone, the high levels of 18-hydroxycortisol, and the genetic detection of the chimeric gene. In EH patients, 29 of 305 (9.5%) had PA, 13 of 29 met all the criteria for PA, and 16 of 29 were initially diagnosed as having a probable PA and confirmed by the fludrocortisone test. Plasma potassium was normal in all patients. The dexamethasone suppression test was positive for GRA in 10 of 29 and 18-hydroxycortisol levels were high in 2 of 29 patients who had also a chimeric gene. In normotensive subjects, 3 of 205 (1.46%) had PA, and 1 of 205 had a GRA. In summary, we found a high frequency of normokalemic PA in EH patients. A high proportion of PA suppressed SA with dexamethasone, but only a few had a chimeric gene or high levels of 18-hydroxycortisol. These results emphasize the need to further investigate EH patients.

[High prevalence of undiagnosed primary hyperaldosteronism among patients with essential hypertension]

BACKGROUND

Classically, primary hyperaldosteronism was diagnosed in no more than 1% of patients with hypertension, when hypokalemia was used as the screening test. However, numerous patients with primary hyperaldosteronism do not have hypokalemia and the disease remains undiagnosed.

AIM

To assess the prevalence of normokalemic primary hyperaldosteronism among patients classified as having essential hypertension.

PATIENTS AND METHODS

One hundred hypertensive patients with a blood pressure over 145/95 were studied. Plasma aldosterone and plasma renin activity were measured in all. A primary hyperaldosteronism was diagnosed when high aldosterone levels (over 16 ng/dl) and low plasma renin activity (below 0.5 ng/ml/h) coexisted in two blood tests or the aldosterone/plasma renin activity ratio was over 50. A probable primary hyperaldosteronism was diagnosed when the ratio was between 25 and 50 and these patients were subjected to a Fludrocortisone test to confirm the diagnosis. A dexametasone suppression test was done to discard glucocorticoid remediable aldosteronism. An adrenal TAC scan was done to all patients with primary hyperaldosteronism.

RESULTS

A diagnosis of primary hyperaldosteronism was reached in ten patients. Seven had elevated aldosterone and low plasma renin activity. In three the diagnosis was confirmed with the fludrocortisone test. All ten patients had normal serum potassium levels. Dexametasone suppression test was positive in three patients, that normalized their blood pressure levels. Adrenal TAC scans showed an adenoma in one patient and hyperplasia in another.

CONCLUSIONS

Primary hyperaldosteronism is more frequent than previously thought, it is overlooked when hypokalemia is used as the screening test and it can only be diagnosed measuring plasma aldosterone and renin activity.

Reproductive health outcomes among female flight attendants: an exploratory study

Recent studies have suggested that female flight attendants may experience increased rates of spontaneous abortion. We conducted a survey of female flight attendants who were pregnant at any time between January 1, 1990, and December 31, 1991 (n = 418) using a mailed self-administered interest survey (response rate, 60 %) and follow-up questionnaire regarding reproductive outcomes and potential risk factors for adverse outcomes (response rate, 64%). The cumulative hazard of spontaneous abortion was 17% when maternal age, smoking, alcohol use, and prior spontaneous abortions were control led for, using a Cox life-table regression model. Of the female flight attendants who worked outside the home, 47 of 321 (15%) experienced a spontaneous abortion, compared with 6 of 73 (8%) who did not work outside the home during the pregnancy period (odds ratio [OR] = 1.91, 95 % confidence interval [CI] = 0.78-4.66). Flight attendants who experienced a spontaneous abortion during their first pregnancy during the study period reported working significantly more flight hours per month during their pregnancy (74 hours per month) than did flight attendants who delivered a live birth (64 hours per month) (Student's t = -3.30, P = 0.002). We conclude that although the results of this study must be considered preliminary because of the relatively low overall response rate (38%), we did not find an overall increased risk for spontaneous abortion among flight attendants, compared with other working women (10%-20%). Women who continue working as flight attendants during pregnancy and those who work relatively higher numbers of flight hours during pregnancy may, however, be at increased risk for spontaneous abortion, compared with flight attendants who do not perform such work.

Induction of dead fetus labor with 15-(S)-methyl prostaglandin F2 alpha

This study examines whether labor can be induced with the intramuscular administration of 15-(S)-methyl prostaglandin F2 alpha in cases of intrauterine fetal death. The success rate of labor induction in the studied group was 93.75%, and was the same for primigravid and multigravid patients. The authors conclude that the prophylactic administration of an analgesic potentiator, an anti-emetic and an anti-diarrheal is advantageous to a woman's tolerance of the prostaglandin. PGF2 alpha is a quick and effective drug for use in the induction of labor to terminate pregnancies with intrauterine fetal death and offers tolerable side-effects when used with adjuvant medication.