Aspirin, a silent risk factor in urology.

Aspirin is a widely used drug for its analgetic, antiinflamatory and antipyretic effects as well as for prophylactic effect in cardiovascular diseases. However, an increased number of operative hemorrhagic complications in patients on daily aspirin have been reported, an adverse effect highly relevant in urology. In this review the normal hemostatic mechanism and the chief pharmacological effect of aspirin on hemostasis is described. The literature is reviewed for hemorrhagic complications to aspirin in urology. Few reports indicate that aspirin increases bleeding and need for transfusion following prostatectomy, but no placebo-controlled clinical trials with large patient groups have been carried out. Following prostate biopsy and extracorporeal shock wave lithotripsy aspirin-induced hemorrhagic complications have been reported. Cessation of aspirin ingestion one week prior to invasive urologic procedures and correction of bleeding complications with desmopressin, platelet concentration or fresh whole blood is described.

[Differentiation of benign and malignant ovarian tumors by transluminal ultrasound scanning]. / Differentiering af benigne og maligne ovarietumorer med transabdominal ultralydskanning.

We intended to evaluate ultrasonographic criteria for differentiation of benign and malignant ovarian tumours, and to estimate the risk of malignancy in unilocular ovarian cysts. The files of 186 women aged 40 or above, who had undergone surgery in the department of gynaecology and obstetrics at Hillerød hospital between 01.01.1988-31.12.1990 and where pathological ovarian histology was found were reviewed. Preoperative ultrasonographic examination concerning size and morphology was compared to histological diagnosis. Tumours were classified according to the ultrasonographic internal structure into a) unilocular cysts, b) unilocular cysts with solid areas, c) multilocular cysts, d) multilocular cysts with solid areas and e) solid tumours. Criteria for suspicion of malignancy were unilocular cysts > 10 cm and complex and solid tumours, whereas smaller unilocular cysts were thought to be benign. Twenty-one tumours, diagnosed by ultrasound as unilocular cysts were all histologically benign, independently of size. For complex and solid tumors there was an increased risk of malignancy, and a statistically significant correlation between tumour size and risk of malignancy was found. Using the ultrasonographic criteria for malignancy a sensitivity of 97% and a specificity of 28% was found. The suggested criteria for ultrasonographic suspicion of malignancy were found usable in differentiating benign and malignant ovarian tumours. The risk of malignancy for unilocular cysts seems to be low, independently of size.

[Beta-HCG-producing ovarian dysgerminoma]. / beta-HCG-producerende dysgerminoma ovarii.

A patient with stage 2C pure dysgerminoma which produced free beta-HCG subunit is described. The importance of excluding elements of other germ cell tumors is stressed. HCG-positive dysgerminomas should be treated like other pure dysgerminomas, and beta-HCG will in this case be a useful monitor of the effect of treatment.