Management of precancerous lesions prior to conception and during pregnancy: a narrative review of the literature.

Special considerations aiming at preserving reproductive function have to be implemented when treating young patients with precancerous lesions of the lower genital tract. These high-grade lesions may progress into invasive cancer if left untreated. Currently, there are limited data on the impact of vulvar and vaginal precancerous lesions on fertility and its management during pregnancy. However, management and outcomes for cervical lesions have been extensively reported. The main approach for vulvar and vaginal lesions are maintaining anatomical function and cosmetics; whereas, treatment options for cervical precancerous lesions range from observation, cryotherapy or the more aggressive conisation. Gestational age is the most important factor in determining expectant management or surgical intervention. This narrative review draws attention to the relevant aspects of precancerous lesions of the lower genital tract, the potential effects and management prior to conception and during pregnancy.

[A classification of anterior open bite].

OBJECTIVE: It intended to investigate different craniofacial types of anterior open bite. METHODS: 116 patients with anterior open bite were selected randomly. The craniofacial morphology and airway structures were measured and analyzed with multivariate analyses. RESULTS: 4 factors (mandible rotation factor, facial height factor, dental and skeletal saggittal factor and maxillary rotation factor) were extracted from 156 items including age, gender and craniofacial characteristics by data reduction and factor analysis procedure. Anterior open-bite patients were classified into 5 types, which are dental-alveolar type, mandibular clockwise rotation type, long face type, maxillary counter-clockwise rotation type and skeletal Class III type with K-means cluster analysis procedure. A simple cluster method was summarized to facilitate clinical practice. CONCLUSION: It suggested that classification play an important role in diagnosis and decision making procedure.

Perception of facial esthetics by native Chinese participants by using manipulated digital imagery techniques.

This investigation utilized a manipulated digital video imaging model to elicit profile facial esthetics preferences in a lay population of native Chinese participants from Beijing. A series of 4 distinct digitized distortions were constructed from an initial lateral cephalogram. These images represented skeletal or dental changes that differed by 2 standard deviations from the normative values for Chinese adults. Video morphing then created soft-tissue profiles. A series of nonparametric tests validated the digitized distortion model. The native Chinese participants in this sample found that the profile distortions most acceptable were the "flatter", or bimaxillary retrusive distortion, in the male stimulus face and the "anterior divergent", or maxillary deficiency, in the female stimulus face.

Mature teratoma with secondary infection: case report.

Mature teratoma (dermoid cyst) is a common disorder in women of reproductive age. Sometimes the tumor is complicated by torsion, rupture, and malignant change. However, it rarely presents with fever. We present a 38-year-old woman with an intermittent fever for 30 days, who received occasional medical treatment without improvement. She was to our clinic for evaluation and treatment; however, fever persisted for three days without clinical improvement. No definite infection source could be identified except the presence of a huge pelvic tumor. The patient underwent exploratory laparotomy and an ovarian dermoid cyst with infection was noted. Pathology review revealed mature teratoma with superimposed infection by Escherichia coli. Fever impressively subsided on the fifth postoperative day. Although the majority of patients suffering from fever initially search for medical treatment at primary clinics, rare conditions such as persistent fever should be consulted by specialists to make differential diagnosis. Mature teratoma is rarely superimposed by infection and rarely causes fever. Furthermore, the possibility of fever caused by tubo-ovarian abscess (TOA) is often missed in patients with history of tubal ligation since there is a lower incidence of TOA in these unique patients. However, based on this case report, we should be alert whenever long-term fever is noted. Prompt surgical treatment for extirpation and an appropriate antibiotic treatment would be the choice of treatment in such cases.

Lymphocyte-infiltrated FIGO Stage IIB squamous cell carcinoma of the cervix is a prominent factor for disease-free survival.

BACKGROUND: The data of histopathological factors affecting prognosis of patients with FIGO Stage IIB squamous cell carcinomas of the cervix are rarely known. The purpose of this study was to evaluate the histopathological factors rendering therapeutic failure in patients with FIGO Stage IIB. METHODS: Survival and prognostic factors were analyzed in 83 patients with FIGO stage IIB squamous cell carcinoma of the cervix treated with radical hysterectomy and retroperitoneal lymphadenectomy between 1980 and 1989. The relapse-free and overall survival rate was 61.4%. RESULTS: Univariate analysis demonstrated that the degree of lymphoreticular cells infiltrating the cervix, lymph node metastases, barrel shape of the cervix, lymph-vascular space invasion, more than three lymph nodes involved, and bulky tumor size (i.e. tumor size larger than 4 cm) were of prognostic significance in disease-free survival. However, pronounced lymphoreticular cells infiltrating the cervical cancer was the only independent factor to disease-free survival in patients with FIGO stage IIB squamous cell carcinoma treated with radical hysterectomy and retroperitoneal lymph node dissection using multivariate analysis. CONCLUSIONS: We concluded that the immune function of the host might play a crucial role in the process of anti-neoplasm even if local advanced carcinoma of the cervix is noted. Individual therapies may very well have limited efficacy based on the patient's tumor or the inherent host response. How to strengthen the power of the host's immune system may offer another thinking process to treat such a subgroup of patients. More studies are required.

Rapid progression of squamous cell carcinoma of the cervix after hyperbaric oxygenation.

The role of hyperbaric oxygenation in the treatment of radiation-induced sequelae and chronic ulcer is well established. On the contrary, a possible cancer-causing or growth-enhancing effect by hyperbaric oxygenation was highly controversial. Herein, we present a 55-year-old Chinese woman with recurrent squamous cell carcinoma of the cervix on her left inguinal area. She received concurrent chemoradiation therapy followed by radical inguinal lymphadenectomy due to persistent tumor mass. The patient was complicated with severe radiation fibrosis and unhealed wounds, so she was treated with hyperbaric oxygenation (HBO). However, the patient died of complications of the disease after completing HBO therapy I month later and autopsy of the patient showed carcinomatosis of the abdominal cavity and lower abdominal wall. Because previous studies have been inconclusive regarding the effect of HBO on tumor cells, we reviewed the possible relation between the HBO and tumor cells.

Delayed onset of intestinal injury after laparoscopic assisted vaginal hysterectomy: a case report.

Because of the increasing popularity of laparoscopic surgery for gynecological diseases, it is inevitable that complications from such procedures will become more common. The majority of complications occur during operation where they are immediately identified and managed; recovery and outcome are relatively good after immediate repair. However, there are still a few cases that are not diagnosed until severe complications become evident. Herein, we report a relatively rare complication--a delayed onset of small intestinal perforation detected one week after initial laparoscopic assisted vaginal hysterectomy. Although we performed an emergent exploratory laparotomy to repair this complication, the patient died of uncontrolled sepsis and possible sudden onset of arrhythmia. Through a review of the literature, possible mechanisms of this complication are discussed. In addition, we hope that this case review will help avoid such complications in the future.

Laparoscopic surgery for heterotopic pregnancies: a case report and a brief review.

A heterotopic pregnancy is in effect a multiple pregnancy with one or more intrauterine pregnancies coexisting with an ectopic pregnancy and is rarely spontaneous. With the increasing popularity of ovulation induction performed during assisted reproductive techniques, it will not be surprising to observe that this phenomenon has increased significantly. However, diagnosis is often delayed because of its rarity and difficulty. We report a case of a woman with a viable intrauterine pregnancy who had a complication of ovarian hyper-stimulation syndrome secondary to ovulation induction following in vitro fertilization and embryo transfer, but who, during hospitalization, presented with clinically progressive abdominal pain. An unruptured ectopic pregnancy of the right fallopian tube was diagnosed accidentally by laparoscopy and laparoscopic salpingectomy was immediately performed. Post-operative follow-up revealed that the intrauterine pregnancy continued normally. She delivered a normal female baby at 38 weeks of gestation. The promising neonatal outcome might suggest that laparoscopy might be safely performed to aid differential diagnosis in an uncertain condition during pregnancy: therefore, laparoscopic surgery might be an appropriate method to manage some carefully selected patients with HP. A brief review of the published literature on the role of laparoscopy in the diagnosis and management of heterotopic pregnancy is given.

Ovarian surgery during pregnancy and puerperium: twelve-year experience at the Veterans General Hospital-Taipei.

BACKGROUND: This study was performed in order to assess the surgical effects and characteristics of ovarian tumors during pregnancy and analyze their prognosis. METHODS: Between 1982 and 1993, 121 patients who had undergone ovarian surgery during pregnancy or puerperium were reviewed at the Veterans General Hospital-Taipei. These patients were analyzed with particular emphasis on the length of gestation at the time of surgery, complications related to the stage of pregnancy, surgical and pathologic findings and the outcome of pregnancy. RESULTS: Ovarian tumors were commonly detected during the second trimester (54.5%) and most of them (79.3%) were asymptomatic. The pathologic review found 38 patients (31.4%) with benign teratoma, 16 patients (13.1%) with corpus luteum and four patients (3.3%) with malignancy. There was a significant difference between emergent ovarian surgery and elective ovarian surgery in the spontaneous fetal wastage rate (14.1% vs 1%, p = 0.009). Compared with elective surgery, cases necessitating oophorectomy, with or without salpingectomy, increased significantly during emergency surgery (57% vs 36%, p = 0.03). All ovarian surgeries performed before a gestational age of seven weeks resulted in spontaneous fetal wastage. CONCLUSIONS: Although the majority of the ovarian tumors detected during pregnancy were benign, emergency laparotomy was sometimes required, which led to an increase in the risk of a fetal wastage. Preconception counseling should be emphasized because early removal of non-functional ovarian tumor before conception, especially teratoma, would decrease the incidence of ovarian surgery during pregnancy. Furthermore, elective and well-prepared surgical intervention appears to be a crucial factor for favorable pregnancy outcome.

High-risk gestational trophoblastic disease: analysis of clinical prognoses.

PURPOSE OF INVESTIGATION: An attempt to better define factors leading to patient survival in the high-risk group of malignant gestational trophoblastic disease (GTD). METHODS: From January 1, 1997 to December 31, 1995 25 cases of malignant high-risk GTD were retrospectively collected to evaluate prognostic factors by univariate and multivariate analysis. RESULTS: We identified the presence of liver metastases and/or brain metastases and the presence of intestinal metastases as significant by using univariate analysis. However, only the presence of liver metastases of brain metastases was significant by multivariate analysis (p=0.009). CONCLUSIONS: Although a high-risk group of GTD can be identified according to the modified World Health Organization (WHO) prognostic scoring system, liver metastases were not emphasized (only two points) in this scoring system. We suggested that these risk factors, including brain metastases and liver metastases, should be weighted more than other risk factors.

Estrogen regulates galanin but not tyrosine hydroxylase gene expression in the rat locus ceruleus.

The neuropeptide galanin (GAL) is coexpressed by the majority of noradrenergic neurons in the rat locus ceruleus (LC) and may function as an inhibitory modulator of noradrenergic transmission. Because estrogen has been shown to induce GAL expression in other brain regions and modulate noradrenergic transmission, we used in situ hybridization histochemistry to assess the effects of chronic estrogen treatment on GAL and tyrosine hydroxylase (TH) gene expression in the LC of ovariectomized female rats. We found that GAL mRNA levels were significantly elevated in rats implanted with a Silastic capsule containing estradiol compared to sham-implanted controls. Both the average optical density (P < or = 0.05) and the labelling area (P < or = 0.007) differed significantly between the groups. In contrast, TH gene expression measured in alternate brain sections did not differ between the groups. If GAL functions as an inhibitory modulator of noradrenergic transmission as postulated, these findings suggest that chronic estrogen treatment could reduce the noradrenergic tone of the brain in the absence of significant alterations in TH expression by enhancing the level of cosecreted GAL.

Papillary cystic tumors of the pancreas: assessment of malignant potential by analysis of progesterone receptor, flow cytometry, and ras oncogene mutation.

BACKGROUND: Although the biologic behavior of papillary cystic tumor (PCT) of the pancreas is more favorable than the adenocarcinoma, a malignant form has been reported. There has been much controversy as to the histologic evidence for malignancy. The purpose of this study is to evaluate whether the ras oncogene mutation is present in the PCT, together with hormone receptor status and DNA flow cytometry that can be used to predict tumor aggressiveness. MATERIALS AND METHODS: In 6 collected cases of PCT, estrogen receptors (ER) and progesterone receptors (PR) were detected by immunohistochemical techniques, DNA ploidy and S-phase fraction (SPF) were studied by flow cytometry, and H, K, and N-ras oncogene mutation were analyzed by polymerase chain reaction (PCR). RESULTS: General strong positive immunostaining of PR and negative staining of ER are found in all 6 cases of PCT, including 5 adolescent girls and one 55-year-old women with areas of anaplastic transformation. Flow cytometry analysis revealed diploid DNA in all 6 cases but higher SPF in the anaplastic portion of the old one. None of the 6 cases showed H-, K-, or N-ras oncogene mutation. CONCLUSIONS: These results suggest PR status and ras oncogene mutation appear to be not useful in predicting aggressive behavior. DNA ploidy and S-phase fraction may provide useful information for prognosis, but their more precise prognostic value of PCT needs a larger number of cases to clarify.

NIRCA: a rapid robust method for screening for unknown point mutations.

We describe a method for screening for dispersed point mutations, based on the observation that RNase frequently cleaves both strands of base pair mismatches in duplex RNA targets. The mismatched substrates are generated by in vitro transcription of wild-type and mutant templates amplified by the PCR or reverse transcription (RT)-PCR; bacteriophage promoters are incorporated into the PCR primers to permit both strands of the products to be transcribed into RNA. Complementary wild-type and mutant transcripts are hybridized and treated with RNase, and the cleavage products are separated on agarose gels and detected by visualization of the ethidium-stained sample under UV light. The method is thus non-isotopic, and since the cleavage products remain double-stranded during analysis, the labor-intensive RNase inactivation steps required in the original procedure can be eliminated. Also, nonspecific background cleavage is reduced so that longer target regions (1 kb) can be screened in a single step. The Non-Isotopic RNase Cleavage Assay (NIRCA) achieved a detection rate of 88%-90% in blind studies in a Factor IX model system, and it was also used to detect unknown p53 mutations in breast tumor samples. NIRCA provides a rapid method for sensitive, non-isotopic, high-throughput genetic screening.

Effects of granulocyte-macrophage colony-stimulating factor and interleukin 6 on the growth of leukemic blasts in suspension culture.

We examined the stimulatory effects of recombinant human granulocyte-macrophage colony-stimulating factor (GM-CSF) and interleukin 6 (IL)-6 on the in vitro proliferation of leukemic blast cells from patients with acute leukemia. Bone marrow or peripheral blood leukemic blast cells were obtained from 21 patients, including 14 cases of acute myeloblastic leukemia (AML), four cases of acute lymphoblastic leukemia (ALL), two cases of acute undifferentiated leukemia, and one case of acute mixed-lineage leukemia. The proliferation of leukemic blast cells was evaluated by measuring the incorporation of 3H-thymidine into cells incubated with various concentrations of cytokines for 3 days. GM-CSF stimulated the DNA synthesis (with greater than 2.0 stimulation index) of blast cells in 9 of 14 (64%) AML cases, two cases of acute undifferentiated leukemia and one case of acute mixed-lineage leukemia. Only two cases of AML blasts responded to IL-6 to grow in the short-term suspension cultures. GM-CSF and IL-6 did not display a synergistic effect on the growth of leukemic cells. Moreover, GM-CSF and IL-6 did not stimulate the proliferation of ALL blast cells. Binding study also revealed the specific binding of GM-CSF on the blast cells of acute undifferentiated leukemia and acute mixed-lineage leukemia. Our results indicated that leukemic blast cells of acute undifferentiated leukemia and acute mixed-lineage leukemia possessed functional GM-CSF receptors.