The immunocytochemical versus cytosol measurement of the oestrogen receptor in invasive breast cancer tissue.

To compare two methods of measurement of oestrogen receptor (ER)-expression in invasive breast cancer tissue. Sections from 299 breast cancer cases were stained for the ER by immunocytochemical assay (ICA), using mouse monoclonal antibody (MAb) NCL-ER-6SF11, and by the dextran-coated charcoal assay (DCC). Concordant results were observed in 230 of the 299 cases (77%), 69 patients had discordant results (kappa=0.537). We found a moderate concordance between ICA and DCC for ER measurement in breast cancer tissue. If we change the golden standard from DCC to ICA, 23% of patients would receive a different therapeutic approach.

Tubal ostium membranes and their relation to infertility.

OBJECTIVE: To define the clinical significance of tubal ostium membranes. DESIGN: Retrospective multivariate stepwise logistic regression analysis. SETTING: Algemene Kliniek Sint--Jan, Brussels, Belgium. PATIENTS: Three thousand forty-six hysteroscopies on 2979 patients, including 172 with infertility, over a 9-year period. MAIN OUTCOME MEASURES: Presence of tubal ostium membranes, age, infertility, endometrial thickness, and hormonal environment. RESULTS: Tubal ostial membranes were present in 74 (2.5%) patients: they were unilateral in 30 (42.1%) and bilateral in 44 (57.9%). Their presence was independent from hormonal state and from endometrial thickness. The incidence of ostial membranes was significantly higher (9.9%) in patients referred for infertility for unilateral (3.5%) as well as for bilateral presence (6.4%). Only the bilateral form was age dependent. CONCLUSIONS: Tubal ostium membranes may be one of the unknown limiting factors affecting female fertility and thus reducing the monthly fecundity rate. The present data suggest that bilateral and unilateral tubal ostium membranes may have a different clinical significance. The unilateral form is unrelated to age, hormonal state, or endometrial thickness and can be congenital. This form is most clearly related to infertility. The bilateral form is less related to infertility, is found in women of older age, and can be acquired. Further prospective analysis is needed to clarify the pathogenesis and pathophysiology of tubal ostium membranes. Tubal ostium membranes should routinely be looked for when performing a hysteroscopic examination in infertile women.

Hysteroscopic findings in patients with a cervical polyp.

OBJECTIVE: Our objective was to determine the presence of intrauterine lesions in patients with a cervical polyp. STUDY DESIGN: We performed a retrospective analysis to determine the influence of hormonal treatment and age on 165 patients with a cervical polyp and bleeding on admission. All 165 patients underwent a diagnostic hysteroscopy to rule out intrauterine lesions, including polyps, fibroids, hyperplasia, and adenocarcinoma. RESULTS: Endometrial polyps were found in up to 26.7% of patients who had a cervical polyp. In patients undergoing a combined pill treatment this incidence was much lower (8.3%). Menopausal patients had a 56.8% incidence of cervix-related endometrial polyps, and hormone replacement therapy did not significantly increase (45.7% vs 28.6%) the incidence of coexisting polyps. All cervical polyps present during tamoxifen treatment were associated with endometrial polyps. Abnormal vaginal bleeding was of no clinical significance in excluding concomitant endometrial polyps. CONCLUSIONS: All menopausal patients with a cervical polyp could benefit from a diagnostic hysteroscopy. Premenopausal patients receiving a combined pill treatment are the least likely to have coexistent endometrial polyps.

Endometrial lesions in patients undergoing tamoxifen therapy.

Forty-six nonhysterectomized women treated with tamoxifen during 6-36 months as adjuvant therapy for breast cancer underwent a hysteroscopy to assess the endometrial effects of this drug. Whereas the endometrium was normal among 23 patients, 13 presented with endometrial polyps, 8 with hyperplasia and 2 with adenocarcinoma. The rate of endometrial lesions was directly related to the cumulative dose of tamoxifen but it was not statistically different among patients receiving progestational therapy compared to patients who did not receive this therapy.

Hysteroscopic follow-up during tamoxifen treatment.

In order to study the action of Tamoxifen upon the uterus, 16 breast cancer patients were prospectively evaluated by means of an hysteroscopy before Tamoxifen therapy and again after 6 to 36 months of treatment. The results show the occurrence of an endometrial polyp in four cases and of an adenocarcinoma in one case. Moreover, the previously atrophic mucosa became mildly proliferative in seven of the patients who were evaluated.

[Early detection of ureteral injuries associated with hysterectomy. A prospective echographic study]. / Dépistage précoce du traumatisme urétéral associé à l'hystérectomie. Etude échographique prospective.

Among ureteral injuries that occur during hysterectomy some are neglected and remain asymptomatic. They occur even, although not particularly, during so-called easy operations. Their severity and their need for early treatment point to the use of effective screening. It is not possible to carry out intravenous urography routinely. Searching, however, for pyelo-calyceal dilatation by ultrasound of the kidneys can show ureterohydronephrosis and can detect ureteral trauma. The authors carried out such ultrasound controls in 150 consecutive patients the day before, and the fourth and ninth days after hysterectomy. On the fourth day pyelo-calyceal dilatation is seen more frequently but is not large. Large dilatation appearing on the fourth postoperative day may be considered an early and reliable sign of suspect injury. The authors suggest that renal ultrasound should be carried out routinely on the day before and the fourth day after hysterectomy. The authors feel that when dilatation of the pyelo-calyceal area increases by 12 mm or more between the two examinations major ureteral injury must be suspected and urography carried out intravenously.

[Renal ultrasonic diagnosis in pregnancy. Prospective study of pyelo-calyceal changes in the mother and their obstetric implications]. / Echographie rénale durant la grossesse. Etude prospective des modifications pyélo-calicielles maternelles et de leurs implications obstétricales.

An acute pyelonephritis is still a serious complication of pregnancy. Urinary stasis plays an important role in the pathogenicity of this infection. 232 patients without symptoms were studied to find out how much urinary stasis occurred by measuring dilatations of the pyelo-calices by ultrasound. The authors suggest that a correlation between the bacteriological examination of the urine and the ultrasound appearance of the kidney can be established. Asymptomatic urinary infection occurs more frequently when there is dilatation of the pelvis of the kidney greater than 12 mm in the right kidney and 7 mm in the left. This is why they suggest that an ultrasound examination of the hilum of the kidney should be carried out routinely to screen for patients who are at risk of having pyelonephritis in pregnancy.