Comparison of Perineal Sonographically Measured and Functional Urodynamic Urethral Length in Female Urinary Incontinence.

Objectives. To detect the anatomical insufficiency of the urethra and to propose perineal ultrasound as a useful, noninvasive tool for the evaluation of incontinence, we compared the anatomical length of the urethra with the urodynamic functional urethral length. We also compared the urethral length between continent and incontinent females. Methods. 149 female patients were enrolled and divided into four groups (stress, urge, or mixed incontinence; control). Sonographically measured urethral length (SUL) and urodynamic functional urethral length (FUL) were analyzed statistically. Standardized and internationally validated incontinence questionnaire ICIQ-SF results were compared between each patient group. Results. Perineal SUL was significantly longer in incontinent compared to continent patients (p < 0.0001). Pairwise comparison of each incontinent type (stress, urge, or mixed incontinence) with the control group showed also a significant difference (p < 0.05). FUL was significantly shorter in incontinent patients than in the control group (p = 0.0112). But pairwise comparison showed only a significant difference for the stress incontinence group compared with the control group (p = 0.0084) and not for the urge or mixed incontinent group. No clear correlation between SUL, FUL, and ICIQ-SF score was found. Conclusions. SUL measured by noninvasive perineal ultrasound is a suitable parameter in the assessment of female incontinence, since incontinent women show a significantly elongated urethra as a sign of tissue insufficiency, independent of the type of incontinence.

Primary pulmonary choriocarcinoma: case report and review of the literature.

Primary pulmonary choriocarcinoma is a rare disease with only 31 reported cases in the literature so far. Here, we summarize all published cases, including a recent case of our own clinic. Patients usually presented with symptoms like dyspnea, cough, chest pain, weight loss or hemoptysis. In some cases, the nodule in the lung was found in a routine check-up in asymptomatic patients. In the present case, the patient presented to our clinic because of a positive urine pregnancy test despite taking oral contraceptives. Patients in the analyzed cases were either treated with surgery, chemotherapy, radiotherapy or best supportive care. In the present case, a complete resection of the tumor was possible and the patient has not had any signs of recurrence so far. When looking at the published cases and corresponding outcomes, a slight tendency toward a complete resection followed by chemotherapy or close follow-up examinations seems to give the patients the best survival chances. Nevertheless, the overall prognosis of primary pulmonary choriocarinoma is poor and the 5-year survival rate is below 5%.

Chronological evaluation of inflammatory mediators during peritoneal adhesion formation using a rat model.

PURPOSE: The inflammatory response to peritoneal injury is considered to be of particular importance in adhesion formation. The aim of this study was to investigate the dynamics of inflammatory mediators in peritoneal adhesions. METHODS: In 60 male rats, a peritoneal defect was performed using a standardized cecal abrasion model. On days 3, 5, 14, 30, 60, and 90, ten animals were sacrificed. The expression of five integral mediators for the cellular immune response (macrophages, T lymphocytes), inflammation (COX-2), cell differentiation, and proliferation (ß-catenin, c-myc) in visceral and parietal adhesions were analyzed. RESULTS: A distinct infiltration of macrophages was observed in all animals up to the 90th postoperative day with a peak on day 3 for visceral adhesions (26.3 ± 5.6%) and on day 14 for parietal adhesions (5.1 ± 1.1%). Compared to parietal adhesions, macrophage levels were significantly higher on day 3 (p = 0.001) and 5 (p = 0.002) but significantly lower on days 30, 60, and 90 in visceral adhesions (p = 0.041; p = 0.001; p = 0.017). T lymphocytes were detected over time with the highest levels on day 3 (visceral 4.0 ± 0.7%; parietal 6.7 ± 2.9%). High levels of COX-2 expression could be detected for the whole observation period. Positive expression of both ß-catenin and c-myc was detected in persistent adhesions; however, no expression of c-myc was observed in parietal adhesions. CONCLUSIONS: The inflammatory reaction in adhesions is not limited to the early postoperative phase. Macrophages may be fundamental in triggering adhesions, and the presence of T cells indicates an additional role of the adoptive immune system. Identification of chemokines and chemokine receptors that trigger the cellular immune response might be a potential option to minimize adhesion formation.