Assessment of dose to functional sub-structures in the lower urinary tract in locally advanced cervical cancer radiotherapy.

PURPOSE: To provide an analysis of dose distribution in sub-structures that could be responsible for urinary toxicity after Image-Guided Adaptive BrachyTherapy (IGABT) in Locally Advanced Cervical Cancer (LACC). METHODS: 105 LACC patients treated with radiochemotherapy and IGABT were selected. Sub-structures (bladder wall, trigone, bladder neck, urethra) were contoured on IGABT-planning MRIs. D2cm3 and D0.1cm3, ICRU Bladder-Point (ICRU BP) and Posterior-Inferior Border of Symphysis points (PIBS, PIBS + 2 cm, PIBS - 2 cm) doses were extracted. Internal-Urethral-Ostium (IUO) and PIBS-Urethra (PIBS-U) points were defined as urethral dose surrogates. Finally, the Vaginal Reference Length (VRL) was extracted. Values were converted into total EBRT + BT equivalent dose in 2 Gy fractions using α/ß = 3 and T1/2 = 1.5 h. RESULTS: Median D2cm3 for bladder and trigone were 71.7[interquartile-range:66.5;74.1]Gy and 57.8[53.3;63.6]Gy, respectively, while median D0.1cm3 were 82.2[77.6;89.1]Gy and 70.7[62.0;76.7]Gy, respectively. Median ICRU BP dose was 63.7[56.5;70.5]Gy and correlated with trigone D2cm3 and D0.1cm3, while bladder and trigone D2cm3 had poor correlation (R2 = 0.492), as well as D0.1cm3 (R2 = 0.356). Bladder neck D0.1cm3 was always lower than trigone D0.1cm3 and higher than IUO. Correlation between PIBS + 2 cm and IUO was poor (R2 = 0.273), while PIBS and PIBS-U were almost equal (R2 = 0.990). VRL correlated with dose to bladder base. CONCLUSIONS: The study confirmed that ICRU BP and trigone doses correlate. Bladder D2cm3 is not representative of trigone dose because hotspots are often placed in the bladder dome. VRL is a good indicator for bladder base sparing. In addition to D2cm3 and D0.1cm3 for whole bladder, ICRU BP, trigone D2cm3 and D0.1cm3, IUO and PIBS are useful for lower urinary tract reporting.

Subjective and objective results of anterior vaginal wall repair in an outpatient clinic: a 5-year follow-up.

INTRODUCTION AND HYPOTHESIS: This prospective follow-up study evaluates long-term subjective and objective outcome of conventional anterior vaginal wall repair in an outpatient setting. METHODS: Eighty-two women were operated. At 5-year follow-up anatomical results were evaluated by clinical examination. Furthermore, the women filled in a validated symptom and quality of life questionnaire. RESULTS: Seventy (85%) women attended the follow-up visit. Eleven percent of these had been reoperated for anterior vaginal wall prolapse and was considered a separate group in the analysis. Thirty-four percent had no pelvic organ prolapse (POP). Twenty-nine percent had stage 1 POP whereas 24% had stage 2 and 2% stage 3 at follow-up. Seventy-eight percent of the women had no bulge symptoms, and 73%of the women considered their condition improved. CONCLUSIONS: At 5-year follow-up 78 % was relieved from their bulge symptoms by an operation using local anesthesia. Eleven percent of the women had been reoperated.

Ultrasound and MRI before and after radical hysterectomy: does the operation affect the pelvic floor muscles?

PURPOSE: To evaluate pelvic floor muscles and bladder neck mobility before and after radical hysterectomy for cervical cancer with magnetic resonance imaging (MRI) and ultrasound. METHODS: A prospective follow-up study of 22 patients studied with MRI and ultrasound preoperatively, three and 12 months after radical hysterectomy was carried out. RESULTS: Bladder neck mobility was decreased three months postoperatively, but one year after the operation, it had almost attained the preoperative level. The size of the pelvic floor muscles was reduced three months after the operation, but one year postoperatively, muscle size had almost returned to the preoperative level. Age and number of deliveries affected the starting point in muscle size and the mobility of the bladder neck, but the development was identical in all the women. CONCLUSIONS: We showed that pelvic floor muscle size and mobility of the bladder neck were reduced three months after radical hysterectomy, and that they regenerated to a level only slightly below the preoperative level one year later.

Urogynaecological dysfunction after radical hysterectomy.

AIMS: To identify self-reported urogynaecological dysfunctions in women treated by radical hysterectomy, and predict risk factors. METHODS: A survey using questionnaires. Questionnaires were mailed to 396 patients. RESULTS: Symptoms of urinary incontinence and urinary retention were reported by more than one-third, respectively. One-third of the patients reported cystitis and dysuria. However, 78% of the women did not consider their symptoms as a problem. Analyses identified body mass index, at least one delivery, pre-operative urinary incontinence, and pulmonary disease as predictors for development of post-operative urinary incontinence. Predictive variables for urinary retention symptoms were age, cystitis and/or dysuria, previous rupture of the anal sphincter, fetal weight at delivery > or =4000 g, sensation of vaginal dryness, and pre-operative urinary retention symptoms. Considering post-operative cystitis and/or dysuria, fetal weight > or =4000 g, sensation of vaginal dryness, cystitis and/or dysuria before the operation, and physical activity were predictive variables. CONCLUSIONS: Patients can be informed and advised about possible urinary tract symptoms. Special attention in the pre- and post-operative period can be paid to a subgroup of patients at high risk of later urogynaecological problems.

An audit of European training in obstetrics and gynaecology.

During 1997, The European Network of Trainees in Obstetrics and Gynaecology (ENTOG) circulated a questionnaire to audit training in Europe. Results describe number and gender in each country, access to training, duration of training, tutor/tutee scheme, logbooks, minimum curriculum, assessment, criteria for accreditation, training abroad, final examination, hospital inspection, subspecialty, academic training, and career progression. Quality of life is tried to address with questions relating to salary, working hours, maternity leave, annual leave and study leave. EBCOG has drawn up recommendations to try and achieve a standardisation of quality of training whilst fully understanding that complete standardisation of training is not a realistic possibility due to social, cultural and ethical differences. A repeat audit is planned after 3 years to close the feedback loop.

Characteristics of vaginal bleeding during pregnancy.

OBJECTIVE: To describe vaginal bleeding and associated pain in pregnancies terminated by childbirth. DESIGN: A descriptive study based on information obtained by questionnaires administered during pregnancy. SETTING: Antenatal care clinic at the Obstetrical Department, Aarhus University Hospital, Denmark. SUBJECTS: Women (n = 8714) with singleton pregnancies attending routine antenatal care at the Department during a 2-year period from 1989 to 1991. Three questionnaires were administered during pregnancy and 5868 (67%) women completed all questionnaires. MAIN MEASURES: Bleeding was characterized by frequency, gestational age at first occurrence, duration, and amount. Hemorrhage associated with abdominal pain and hospitalization was also described. RESULTS: The overall frequency of bleeding was 19% (n = 1091). The median week of first occurrence was 8 gestational weeks. The median duration of bleeding was 2 days, and the median number of episodes was one. An association between the amount and duration of bleeding was found. Two thirds of the women had no abdominal pain associated with bleeding. Women with pain experienced heavier bleeding and bled for more days than women without pain. Bleeding resulted in hospitalization in one out of five women. In particular, women with second trimester bleeding, with heavy bleeding, long duration, and associated pain were hospitalized. CONCLUSION: By the use of self-administered questionnaires a higher frequency of bleeding was found than in previous studies in which information has been based on medical records. Thus, the source of information in studies of pregnancy and bleeding-associated pregnancy complications must be carefully considered and described.

Lymphoepithelioma-like carcinoma of the vulvar region.

A case of lymphoepithelioma-like carcinoma of the vulvar region is described. Histologically, the tumour was similar to lymphoepithelioma of the nasopharynx but was Epstein-Barr virus negative. Infiltrating lymphocytes were predominantly T-cells, but also included some B-cells. Immunohistochemical stains showed positivity in tumour cells for cytokeratins but negativity for neuroendocrine markers, the melanoma-associated antigen. HMB45 and leucocyte common antigen. We conclude that the tumour histologically resembles lymphoepithelioma of the nasopharynx and lymphoepithelioma-like carcinomas of the skin, and has no relation to prior infection with the Epstein-Barr virus.

[Laser therapy of ankle sprain]. / Laserbehandling af fodledsdistorsion.

The effect of low-power laser therapy on acute ankle sprains was evaluated in a double-blind randomised clinical study consisting of 40 patients from the casualty ward. All patients received treatment until their ankle joint was painless. No statistically significant differences regarding discolouring, pain, oedema, and use of analgetics were observed between patients treated with laser and placebo. The patients treated with active laser had a significantly longer sick leave.

[Second extrauterine pregnancy after laparoscopic sterilization]. / Den anden ekstrauterine graviditet efter laparoskopisk sterilisation.

A case is presented where a woman had a second ectopic pregnancy after laparoscopic sterilization. The causes of the condition are discussed together with possible methods of prevention.