Does pelvic radiation increase rectal cancer incidence? - A systematic review and meta-analysis.

BACKGROUND: One of the late complications associated with radiation therapy (RT) is a possible increased risk of second cancer. In this systematic review, we analysed the incidence of rectal cancer following primary pelvic cancer irradiation. METHODS: A literature search was conducted using the PubMed and EMBASE libraries. Original articles that reported on secondary rectal cancer after previous RT for a primary pelvic cancer were included. Sensitivity analyses were performed by correcting for low number of events, high risk of bias, and outlying results. RESULTS: A total of 5171 citations were identified during the literature search, 23 studies were included in the meta-analyses after screening. A pooled analysis, irrespective of primary tumour location, showed an increased risk for rectal cancer following RT (N = 403.243) compared with non-irradiated patients (N = 615.530) with a relative risk (RR) of 1.43 (95% confidence interval [CI] 1.18-1.72). Organ specific meta-analysis showed an increased risk for rectal cancer after RT for prostate (RR 1.36, 95%CI 1.10-1.67) and cervical cancer (RR 1.61, 95% CI 1.10-2.35). No relation was seen in ovarian cancer patients. The modality of RT did not influence the incidence of rectal cancer. CONCLUSIONS: This review demonstrates an increased risk for second primary rectal cancer in patients who received RT to the pelvic region. This increased risk was modest and could not be confirmed for all primary pelvic cancer sites. The present study does not provide data to change guidelines for surveillance for rectal cancer in previously irradiated patients.

Dyspareunia and depressive symptoms are associated with impaired sexual functioning in women with endometriosis, whereas sexual functioning in their male partners is not affected.

STUDY QUESTION: To what extent are endometriosis and its related physical and mental symptoms associated with the perceived level of sexual functioning in women and their male partners? SUMMARY ANSWER: Dyspareunia and depressive symptoms are associated with impaired sexual functioning in women with endometriosis, whereas sexual functioning in their male partners is not affected. WHAT IS KNOWN ALREADY: Women with endometriosis suffer from more dyspareunia, lower sexual functioning, and lower quality of life. In qualitative studies, partners of women with endometriosis report that endometriosis affected their quality of life and produced relational distress. STUDY DESIGN SIZE, DURATION: In this cross-sectional study, sexual functioning in women with endometriosis (n = 83) and their partners (n = 74) was compared with sexual functioning in a control group of women attending the outpatient department for issues related to contraception (n = 40), and their partners (n = 26). PARTICIPANTS/MATERIALS, SETTING, METHODS: Women and partners were recruited in the Maastricht University Medical Centre (MUMC) and the VieCuri Medical Centre Venlo between June 2011 and December 2012. All participants were asked to complete a set of online questionnaires. MAIN RESULTS AND THE ROLE OF CHANCE: Response rates were 59.3% (83/140) for women with endometriosis and 52.3% (74/140) for their partners. Response rates in the control group were respectively 43.2% and 27.4% (41/95 and 27/95), of whom 40 women and 26 partners could be included in the study. Women with endometriosis as compared with the control group, reported significantly more frequent pain during intercourse (53% versus 15%, P < 0.001); higher levels of chronic pain (median VAS 2.0 cm versus 0.0 cm, P < 0.001); more impairment of sexual functioning (median Female Sexual Function Index 25.4 versus 30.6, P < 0.001); more impairment of quality of life (median Short Form-12 66.3 versus 87.2, P < 0.001); more pain catastrophizing (mean Pain Catastrophizing Scale 17.8 versus 8.5, P < 0.001), more depression and anxiety symptoms (median Hospital Anxiety and Depression Scale for depression 7 versus 4, P < 0.001 and for anxiety 4 versus 1, P < 0.001). Sexual functioning was comparable between male partners of women with endometriosis and male partners of the control group based on the International Index of Erectile Function. Logistic regression analyses showed that dyspareunia (OR 0.54; 95% CI 0.39-0.75) and depressive symptoms (OR 0.761; 95% CI 0.58-0.99) were independent and significant negative predictors for sexual functioning. Chronic pelvic pain (OR 0.53; 95% CI 0.35-0.81) and depressive symptoms (OR 0.65; 95% CI 0.44-0.96) were independent and significant negative predictors for quality of life. LIMITATIONS, REASONS FOR CAUTION: Patient recruitment was performed in one tertiary care centre and to a lesser extent one general hospital, possibly leading to an over-representation of patients with more severe endometriosis. All participating women had a partner and are therefore 'survivors' in relationship terms. This may have led to an underestimation of the impact of endometriosis on sexual functioning. WIDER IMPLICATIONS OF THE FINDINGS: It would be worthwhile to further explore the role of depressive symptoms in women with symptomatic endometriosis and to assess the effect of treatment of depressive symptoms on sexual functioning and quality of life. The fact that the partners did not report impaired sexual functioning could be a reassuring thought to women that might be discussed in the consulting room. STUDY FUNDING/COMPETING INTERESTS: The study was funded by the MUMC. An unconditional research grant was given by the Dutch Society of Psychosomatic Obstetrics and Gynaecology (21 June 2011). TRIAL REGISTRATION NUMBER: Not applicable.

Bladder endometriosis, a remarkable resemblance in a monozygotic twin.

It is known for many years that heritability plays a role in the development of endometriosis in many patients. Deep endometriosis of the bladder is a rare presentation of the disease and bladder endometriosis was not reported in monozygotic twin studies so far. Since monozygotic twins share the same genes, concordance and differences in presentation of endometriosis may help to discriminate between genetic and environmental determinants. The remarkable resemblance in the presentation of bladder endometriosis in this monozygotic twin seems to indicate that genetic factors are of importance in the arising of deep endometriosis in the bladder too.

[Fertility after treatment for ectopic pregnancy: evaluation of the switch from laparotomy to laparascopy]. / Fertiliteit na behandeling wegens extra-uteriene graviditeit: evaluatie van de overgang van laparotomie naar laparoscopie.

OBJECTIVE: Evaluation of the switch in surgical treatment for ectopic pregnancy from laparotomy to laparoscopy at the Sophia Hospital, Zwolle, the Netherlands. DESIGN: Retrospective. METHOD: Initially an ectopic pregnancy was treated by means of laparotomy at the Sophia Hospital, Zwolle, the Netherlands. At the end of 1996 laparoscopic treatment became the method of first choice. In 2003, all patients who received surgical treatment for ectopic pregnancy in the period 1995-2001 were evaluated. As well as examining their medical records, all patients were questioned about the fertility outcome since the ectopic pregnancy. All of the patients could be traced and the response was 100%. RESULTS: In the study period 97 patients were operated on due to an ectopic pregnancy. The admission period was significantly shorter after laparoscopy compared to laparotomy. The complication rate in both groups was low. In total 78 (80%) of the patients still wanted to conceive. During the observation period, 94 pregnancies occurred in 61 patients. The pregnancy rates following laparotomy and laparoscopy were the same. After salpingostomy, the future fertility was significantly higher (p < 0.05) compared to salpingectomy. CONCLUSIONS: A laparoscopic treatment of ectopic pregnancy is more advantageous for the patient compared to laparotomy: in our results this did not compromise future fertility. Salpingostomy was associated with an increased chance of later pregnancy compared to salpingectomy.

Problems related to the cervical stump at follow-up in laparoscopic supracervical hysterectomy.

OBJECTIVES: To evaluate our experience with laparoscopic supracervical hysterectomy (LASH) and to assess the short- and medium-term outcome. METHODS: Retrospective analysis of patient and surgery characteristics from chart review and evaluation of patient satisfaction by a questionnaire. RESULTS: Forty-one patients who underwent LASH were studied with a mean length of follow-up of 27 months. Operative complications consisted of one bladder lesion and one bleeding at the trocar site. Postoperative complications were bladder atony (1), paralytic ileus (1), a pulmonary embolism (1) and vaginal hemorrhage from the colpotomy incision (1). Twenty-five percent of the patients continued to menstruate, and 10% had symptoms of discharge. Overall, 98% of the patients were satisfied with their operation. CONCLUSIONS: Although preservation of the cervix with laparoscopic hysterectomy for benign diseases was satisfactory in most of the cases, several women had complications of the remaining cervix. Special attention should be paid to the careful treatment of the cervical stump. Further prospective studies are needed to evaluate the advantages of retaining the cervix at laparoscopic hysterectomy.

Diagnosis of Johne's disease in cattle: a comparison of five serological tests under field conditions.

Sera from 775 adult milking cattle on 13 farms in Friesland and from 359 of the same cattle taken during the following year, were examined for evidence of infection with M johnei by the complement fixation, fluorescent antibody, haemagglutination, haemagglutination-lysis and immunodiffusion tests. Eighteen animals, not clinically affected but which had serologically positive tests were slaughtered and M johnei was isolated in cultures from 16. The fluorescent antibody test was as sensitive as the complement fixation test. The other tests were relatively insensitive and would only be of value as confirmatory tests in the presence of reactions to the first two tests. It is concluded that the use of the fluorescent antibody and the complement fixation test together was of value in detecting sub-clinical Mycobacterium johnei infection.

The recovery of the B-cell population in adult thymectomized, lethally irradiated and bone marrow-reconstituted mice.

The recovery of the B-cell population in adult thymectomized, irradiated and bone marrow-reconstituted mice (T X BM mice was estimated at various times after bone marrow transplantation. The spleen cells to be tested were mixed with dexamethasone-resistant thymocytes (DRT) and sheep red blood cells (SRBC) and transferrred to irradiated recipients. The number of plaque-forming cells (PFC) in the spleen of the recipients was determined 7 days later. Using this functional B-cell assay a sequential appearance of the precursors of IgM-, IgG- and IgA-PFC in the spleen of T X BM mice was observed. The precursors of IgM-PFG (IgM-B cells) were present immediately after transplantation. The first IgG-B cells could be detected at 13-16 days after transplantation and the IgA-B cells finally appeared at 22 days after transplantation. The number of B cells reached a constant and normal level at 30 days after transplantation. The IgM-, IgG- and IgA-B cell development in sham-thymectomized, irradiated and bone narrow-reconstituted mice (ST X BM mice) was virtually the same as in T X BM mice.