Successful medical treatment with octreotide for chyloperitoneum following paraaortic lymphadenectomy in the treatment of gynecologic malignancies: a report of 2 cases.

BACKGROUND: Chyloperitoneum is a rare and challenging complication following systematic pelvic and retroperitoneal lymphadenectomy in the management of gynecologic malignancies. Despite its infrequent occurrence, postoperative chyloperitoneum is associated with significant morbidity. CASES: Two patients developed chyloperitoneum following paraaortic lymphadenectomy for ovarian carcinoma and endometrial carcinoma, respectively. In both cases early infusion of octreotide, a somatostatin analogue, resulted in rapid resolution of chyloperitoneum. There was no evidence of ascites at 6 and 10 months' follow-up, respectively. CONCLUSION: It is suggested that the early administration of octreotide in the course of chyloperitoneum following paraaortic lymphadenectomy in the treatment of gynecologic malignancies is highly effective and should be initiated early in the course of treatment before any invasive options are considered.

Acute urinary retention caused by endometrial carcinoma with large cystic cervix.

INTRODUCTION: Several pelvic masses have been known to cause urinary retention due to a mass effect with the bladder being obstructed secondary to compression of the urethra or bladder neck. MATERIALS AND METHODS: We report the extremely rare case of endometrial carcinoma with an enlarged cystic cervix which resulted in acute urinary retention. A 92-year-old woman was referred for acute urinary retention. Vaginal ultrasound revealed a 70 × 70 × 65 cm-sized cystic lesion in the cervix. Voiding became normal immediately after the incision and drainage of the mass. Ultrasound performed after the incision revealed a hyperechogenic mass with a honeycomb appearance in the uterine cavity. Endometrial biopsy revealed well-differentiated adenocarcinoma of the endometrium. Total hysterectomy and bilateral salpingo-oophorectomy was performed. CONCLUSION: The possible existence of endometrial carcinoma should be considered when the enlargement of cervix is clinically suspected in an elderly woman even if there is no vaginal discharge or bleeding.

The CYP17 MspA1 polymorphism is not associated with an increased risk of uterine leiomyomas in a Japanese population.

The CYP17 gene is thought to be a candidate gene for susceptibility to hormone-related diseases. A single (T?C) nucleotide polymorphism in the promoter region of CYP17 is speculated to influence its transcription. The present study was conducted to investigate the possible association between uterine leiomyomas and CYP17 gene polymorphism in a Japanese population. Genotyping analysis of the CYP17 gene was performed in 138 leiomyoma cases, 183 unaffected controls and 179 population controls using polymerase chain reaction and restriction fragment length polymorphism analysis. No significant difference in CYP17 genotype distribution was noted between leiomyoma cases and controls. Women carrying the A2 allele were not at an increased risk of uterine leiomyoma compared with those carrying the A1 allele in unaffected controls (odds ratio, 1.26; 95% confidence interval, 0.92-1.72) and those carrying the A1 allele in population controls (odds ratio, 0.99; 95% confidence interval, 0.72-1.36). No significant difference in allele frequencies were found between leiomyoma cases and controls. These findings suggest that CYP17 gene polymorphism is unlikely to be associated with an increased risk of uterine leiomyomas in a Japanese population.

The role of thyroid hormone in trophoblast function, early pregnancy maintenance, and fetal neurodevelopment.

OBJECTIVE: To review the literature on the roles of thyroid hormone in trophoblast function, early pregnancy maintenance, and fetal neurodevelopment. METHODS: MEDLINE was searched for English-language papers published from 1971 to 2003, using the key words "brain," "hypothyroidism," "placenta," "pregnancy," "threatened abortion," "thyroid hormone," "thyroid hormone receptor," "thyroid hormone replacement therapy," "thyroid hormone-responsive gene," and "trophoblast." RESULTS: Transplacental transfer of thyroid hormone occurs before the onset of fetal thyroid hormone secretion. Thyroid hormone receptors and iodothyronine deiodinases are present in the placenta and the fetal central nervous system early in pregnancy, and thyroid hormone plays a crucial role both in trophoblast function and fetal neurodevelopment. Maternal hypothyroxinemia is associated with a high rate of spontaneous abortion and long-term neuropsychological deficits in children born of hypothyroid mothers. Maternal iodine deficiency also causes a wide spectrum of neuropsychological disorders in children, ranging from subclinical deficits in cognitive motor and auditory functions to hypothyroid-induced cognitive impairment in infants. However, these conditions are preventable when iodine supplementation is initiated before the second trimester. Although thyroid hormone replacement therapy is effective for reducing the adverse effects complicated by maternal hypothyroidism, the appropriate dose of thyroid hormone is mandatory in protecting the early stage of pregnancy. CONCLUSIONS: Close monitoring of maternal thyroid hormone status and ensuring adequate maternal thyroid hormone levels in early pregnancy are of great importance to prevent miscarriage and neuropsychological deficits in infants.