Anesth Analg 2006 Jun; 102(6): 1765-7 (Read article online)

Su HP, Tso JY, Chen YS, Chen TY, Shiau JM, Tseng CC

We evaluated paravertebral transcutaneous electrical nerve stimulation (TENS) as a means of enhancing anesthesia during hysterectomy. Patients were randomly assigned to experimental (n = 21) and control (n = 20) groups. Anesthesia with isoflurane was performed uniformly for all patients. Paravertebral (T6 and T7) TENS (50 mA, 15 Hz, continuously) was applied in the experimental group. After 15 min of isoflurane, a lower abdominal, skin-to-adipose-tissue incision was made. Seventeen of 21 patients in the experimental group showed no arm or leg movements during the incision, compared to 8 with 20 patients in the control group (P = 0.007). TENS deserves further exploration as an adjunct technique for general anesthesia.

Rheumatol Int 2006 May 20; (Read article online)

Hayırlıoglu A, Gökaslan H, Andaç N

The objective of this study is to investigate the effect of bilateral oophorectomy with total abdominal hysterectomy on bone loss, comparing the cases having surgery before and after the menopause. Bone mineral density (BMD) measurements were obtained from the lumbar spine and femoral neck of totally 127 cases. Out of 127, 105 had surgery before menopause and 22 cases were operated on postmenopausally. The results were compared with the USA normal values. The average age of surgical menopause (SM) cases was 48.45 years with a mean duration of menopause of 5.77 years. The average height and weight were 157.67 cm and 68.19 kg, respectively. The average age of cases having surgery after menopause (SAM) was 62.45 years with a mean duration of 5.59 years after the surgery (duration after menopause is 13.23 years). The average height and weight were 157.45 cm and 73.55 kg, respectively. The average of BMD measurements of lumbar spines L2-L4 was 1.04 gr/cm(2) (BMD = 85.65% and T score = -0.96) in the cases with SM. On the contrary, the average of the BMD measurements of lumbar spines L2-L4 was 1.05 gr/cm(2) (BMD = 101.14% and T score = 0.24) in the cases with SAM. The average of the BMD measurements of femoral neck was 0.85 gr/cm(2) (BMD = 91.39% and T score = -0.64) in the cases with SM. On the contrary, the average of the BMD measurements of femoral neck was 0.82 gr/cm(2) (BMD = 96.69% and T score = -0.31) in the cases with SAM. The bilateral oophorectomy as a surgical procedure is not a statistically significant factor for the acceleration of the bone loss. The main points are the age and the duration of menopause of the patient affecting the bone loss if the surgery is performed before menopause.

Radiat Med 2006 Feb; 24(2): 91-7 (Read article online)

Uno T, Isobe K, Yamamoto S, Kawata T, Ito H

Postoperative radiation therapy (PORT) for cervical cancer has been empirically performed for patients with pathologic risk factors for recurrence after surgery. The efficacy of PORT is mainly supported by retrospective studies. Despite convincing evidence demonstrating a reduction in pelvic recurrence rates when PORT is employed, there is no evidence that it eventually improves patient survival. Local recurrence, such as vaginal stump recurrence, is not always fatal if diagnosed earlier. Some patients, unfortunately, may develop distant metastases even after PORT. The positive effects of PORT also may be counterbalanced by increased toxicities that result from combining local therapies. These factors obscure the efficacy of PORT for cervical cancer patients. There has been no consensus on the predictive value of risk factors for recurrence, which renders indication of PORT for early-stage cervical cancer quite variable among institutions. Today, efforts have been made to divide patients into three risk groups based on the combination of risk factors present after radical hysterectomy. In Europe/USA and Japan, however, a fundamental difference exists in the indications for radical surgery, highlighting differences in the concept of PORT; "adjuvant pelvic irradiation for stage IB-IIA patients after complete resection" in Europe/USA and "pelvic irradiation after surgery irrespective of initial clinical stage and surgical margin status" in Japan. Thus, it is questionable whether scientific evidence established in Europe/USA is applicable to Japanese clinical practice. The purpose of this article is to review the role of PORT by interpreting the results of clinical studies.

Anesth Analg 2006 Jun; 102(6): 1830-5 (Read article online)

Fassoulaki A, Kaliontzi H, Petropoulos G, Tsaroucha A

We studied the effect of sevoflurane and desflurane on regional cerebral oxygenation (rSO(2)). Twenty-two patients undergoing abdominal hysterectomy received sevoflurane and desflurane for 15 min each and 30 min apart under steady-state conditions in a randomized, crossover manner to maintain a bispectral index (BIS) of 40-50. In another 22 patients undergoing the same anesthesia and surgery BIS was maintained at 20-30. During the 15-min administration of each anesthetic at steady-state conditions rSO(2), BIS, inspired and end-tidal anesthetic concentrations, end-tidal CO(2), Spo(2), systolic and diastolic blood pressures, and heart rate were recorded every 3 min. The rSO(2) did not differ between sevoflurane and desflurane when BIS values were maintained between 40-50 or 20-30. The MAC(BIS) values required to maintain BIS at 40-50 and at 20-30 were 1.0 versus 1.2 (P = 0.004) and 1.6 versus 1.8 (P < 0.001) for desflurane and sevoflurane respectively. Higher rSO(2) values were obtained by 1.6 MAC (71 +/- 13) than by 1 MAC of desflurane (66 +/- 10; P < 0.001) and by 1.8 MAC (72 +/- 11) than by 1.2 MAC of sevoflurane (66 +/- 13; P < 0.001). In conclusion, equipotent concentrations of desflurane or sevoflurane in terms of BIS are associated with similar rSO(2) values, but larger anesthetic concentrations of both anesthetics increased the rSO(2) values.

Ultrasound Obstet Gynecol 2006 May 19; 27(6): 664-671 (Read article online)

De Smet F, De Brabanter J, Van den Bosch T, Pochet N, Amant F, Van Holsbeke C, Moerman P, De Moor B, Vergote I, Timmerman D

OBJECTIVES: Preoperative knowledge of the depth of myometrial infiltration is important in patients with endometrial carcinoma. This study aimed at assessing the value of histopathological parameters obtained from an endometrial biopsy (Pipelle((R)) de Cornier; results available preoperatively) and ultrasound measurements obtained after transvaginal sonography with color Doppler imaging in the preoperative prediction of the depth of myometrial invasion, as determined by the final histopathological examination of the hysterectomy specimen (the gold standard). METHODS: We first collected ultrasound and histopathological data from 97 consecutive women with endometrial carcinoma and divided them into two groups according to surgical stage (Stages Ia and Ib vs. Stages Ic and higher). The areas (AUC) under the receiver-operating characteristics curves of the subjective assessment of depth of invasion by an experienced gynecologist and of the individual ultrasound parameters were calculated. Subsequently, we used these variables to train a logistic regression model and least squares support vector machines (LS-SVM) with linear and RBF (radial basis function) kernels. Finally, these models were validated prospectively on data from 76 new patients in order to make a preoperative prediction of the depth of invasion. RESULTS: Of all ultrasound parameters, the ratio of the endometrial and uterine volumes had the largest AUC (78%), while that of the subjective assessment was 79%. The AUCs of the blood flow indices were low (range, 51-64%). Stepwise logistic regression selected the degree of differentiation, the number of fibroids, the endometrial thickness and the volume of the tumor. Compared with the AUC of the subjective assessment (72%), prospective evaluation of the mathematical models resulted in a higher AUC for the LS-SVM model with an RBF kernel (77%), but this difference was not significant. CONCLUSIONS: Single morphological parameters do not improve the predictive power when compared with the subjective assessment of depth of myometrial invasion of endometrial cancer, and blood flow indices do not contribute to the prediction of stage. In this study an LS-SVM model with an RBF kernel gave the best prediction; while this might be more reliable than subjective assessment, confirmation by larger prospective studies is required. Copyright (c) 2006 ISUOG. Published by John Wiley & Sons, Ltd.

Biol Reprod 2006 May 17; (Read article online)

Satterfield MC, Bazer FW, Spencer T

Peri-implantation conceptus (embryo/fetus and associated extraembryonic membranes) growth and development is primarily regulated by secretions from the uterus. This study investigated the effects of progesterone on pre- implantation conceptus development and endometrial galectin 15 (LGALS15). Ewes received daily injections of either corn oil (CO) vehicle or 25 mg progesterone (P4) from 36 h post-mating to hysterectomy. Treatment with P4 increased blastocyst diameter by 220% on Day 9 and advanced time of elongation of blastocysts to a filamentous conceptus on Day 12. Effects of P4 treatment on blastocyst development were blocked by administration of RU486, a progesterone receptor antagonist. Consistent with early elongation of blastocysts, interferon tau (IFNT) protein was about 50-fold greater in uterine flushes from Day 12 P4-treated compared to CO-treated ewes. Expression of cathepsin L (CTSL) and radical S- adenosyl methionine domain containing 2 (RSAD2), both IFNT-stimulated genes, was increased in endometria of Day 12 P4-treated ewes. LGALS15 mRNA, expressed only in the endometrial luminal epithelium and superficial glands, was detected between Days 9 and 12 and was more abundant in P4- than CO-treated ewes on both Days 9 and 12. RU486 treatment ablated P4 induction of LGALS15 mRNA in the endometrial epithelia. LGALS15 protein in uterine flushings was not different on Day 9, but tended to be greater in P4- compared to CO-treated ewes on Day 12. The advanced development of blastocysts in P4-treated ewes is hypothesized to involve early induction of specific genes in the endometrial epithelia, such as LGALS15, and undoubtedly components of uterine histotroph.

BJOG 2006 Jun; 113(6): 729-732 (Read article online)

Turner MJ, Agnew G, Langan H

This study reviewed all cases of complete uterine rupture (UR) in pregnancy during the decade 1993-2002. In 69 412 deliveries, 5320 women had a single prior caesarean section. Of these, 4021 had a trial of labour and 3129 (77.8%) delivered vaginally. In nine (0.22%) cases, the previous transverse scar ruptured during labour. None of these nine ruptures resulted in maternal or fetal death, peripartum hysterectomy or fetal morbidity. In our practice, a trial of labour in women with a previous low transverse caesarean is associated with a high rate of vaginal delivery and a low rate of UR.

Eur J Gastroenterol Hepatol 2006 Jun; 18(6): 685-688 (Read article online)

Huddy JE, Patel P, Johnson MW, Hamilton-Farrell MR, Ede RJ, Sanderson JD

Radiation enteritis can be challenging to diagnose and treat. We report the case of a 44-year-old woman who was diagnosed with a squamous cell carcinoma of the cervix in 1978 and treated with hysterectomy and post-operative radiotherapy. Over the next 20 years she required multiple intestinal operations resulting in short bowel syndrome. She became symptomatic of severe hypomagnesaemia which could not be corrected with oral supplementation and which required intravenous magnesium sulfate every 5-7 days for an 11-month period. However, following 25 sessions of hyperbaric oxygen therapy, she was able to discontinue intravenous magnesium and maintain her serum magnesium level with oral treatment. Her weight and stoma output improved. For over 4 years subsequent to this therapy she has not required further intravenous magnesium although has needed temporary nutritional support. Her case is complicated by vitamin A, B and D deficiencies.

Ann Behav Med 2006 Jun; 31(3): 271-8 (Read article online)

Bunde M, Suls J, Martin R, Barnett K

Background: The Internet has become a popular source of health information for patients with a variety of medical concerns; however, research examining patient interactions on the Internet has been limited. Purpose: Four questions were examined in a survey study of hysterectomy patients who visited http://www.hystersisters.com: (a) Do hysterectomy patients use the support Web site because they perceive their proximal sources of social support to be inadequate? (b) What kinds of support do patients receive from the Web site? (c) What attributes characterize the "Hystersisters" that are perceived to be most helpful? (d) How do informational sources vary depending on the nature of the patient concern? Methods: Women (N = 137) responded to questions about social support, Web site use, and perceptions of other Web site users. Results: Participants reported high levels of perceived support and tangible assistance from their proximal social environment during recovery from surgery (93%-100%). Hystersisters who were perceived as helpful tended to share similar attributes, such as religion and children. On the Web site, information and advice (61%) was sought significantly more than emotional or esteem support (p < .01). For issues involving spiritual or partner matters versus factual issues connected to the hysterectomy, patients expressed greater interest in communicating with a patient who shared their values even if they were not more knowledgeable. Conclusions: This research contributes to our understanding of how patients utilize the Internet for health information. Longitudinal research is needed to evaluate causal relationships between Internet use and health outcomes.

Biol Reprod 2006 May 17; (Read article online)

Pennefather JN, Patak E, Ziccone S, Lilley A, Pinto FM, Page NM, Story ME, Grover S, Candenas ML

Regulation of the contractile effects of tachykinins and histamine on human uterus was investigated using biopsy sections of the outer myometrial layer. The effects of neurokinin A and human hemokinin-1 in tissues from pregnant but not from non-pregnant women were enhanced by inhibition of neprilysin. The effects of neurokinin A and eledoisin were blocked by the NK2 receptor antagonist, SR 48968 but not by the NK1 receptor antagonist SR 140333 in tissues from both groups of women. Human hemokinin-1 acted as partial agonist blocked by SR 48968 and to a lesser extent by SR 140333; endokinin D was inactive. In tissues from pregnant women, responses to high potassium-containing Krebs solution were 2-3 fold higher than those from non-pregnant women. Mepyramine-sensitive maximal responses to histamine were similarly enhanced. The absolute maximum responses to neurokinin A and its stable NK2 receptor selective analogue, [Lys(5)MeLeu(9)Nle(10)]NKA(4-10) were increased in pregnancy, but their efficacies relative to potassium responses were decreased. Tachykinin potencies were lower in tissues from pregnant compared to non-pregnant women. These data (a) show for the first time that human hemokinin-1 is a uterine stimulant in the human, (b) confirm that the NK2 receptor is predominant in mediating tachykinin actions on human myometrium, and (c) indicate that mammalian tachykinin effects are tightly regulated during pregnancy in a manner that would negate an inappropriate uterotonic effect. The potencies of these peptides in tissues from non-pregnant women undergoing hysterectomy are consistent with a possible role in menstrual and menopausal disorders.

Aust N Z J Obstet Gynaecol 2006 Jun; 46(3): 250-3 (Read article online)

Gargett CE

Abstract The human endometrium is a dynamic, cyclically regenerating tissue. Because adult stem cells are present in other regenerative tissues, a clonal analysis of purified endometrial epithelial and stromal cells derived from hysterectomy tissue was undertaken, as a first attempt to identify and characterise endometrial stem/progenitor cells. Rare populations of epithelial and stromal cells were clonogenic. Only those cells initiating large clones, 0.09% of epithelial cells and 0.02% of stromal cells, are likely to be endometrial stem/progenitor cells.

East Afr Med J 2006 Feb; 83(2): 79-85 (Read article online)

Mteta KA, Mbwambo J, Mvungi M

OBJECTIVE: To review iatrogenic ureteric and urinary bladder injuries from obstetric and gynaecological surgeries treated in the urology department analysing; ureteric anatomy, aetiologic factors, diagnosis, treatment and outcomes. DESIGN: A retrospective study. SETTING: Institute of Urology, Kilimanjaro Christian Medical Center (KCMC), Moshi, Tanzania. SUBJECTS: Twenty three women were treated for iatrogenic ureteric and bladder injuries secondary to obstetric and gynaecological procedures in the department of urology between June 1994 and July 2004. RESULTS: Hysterectomy was the leading cause of ureteric injuries contributing to nine (47.4%) of the 19 ureteric injuries. Caesarian sections were the second leading cause and contributed 6(31.6%) of 19 ureteric injuries. Vesical vaginal fistula (VVF) repairs lead to two (10.5%) ureteric injuries one of which was bilateral. There was a case each (5.3%) from ovarian cystectomy and forceps delivery. There were only three cases of intra-operative diagnosis of ureteric injuries. There were four bladder injuries half of which came from hysterectomy. The leading definitive urological treatment for ureteric injury was ureteric re implantation and all kidneys were saved. CONCLUSION: Iatrogenic ureteric and bladder injuries from gynaecologic surgeries are globally rare but are liable to occur due to the inherent ureteric anatomic factors in the pelvis. Intra-operative diagnosis of injury is a rare feature. The practical principles to prevent and repair ureteric injuries have been presented and discussed. The true risk to the patient lies in delayed, missed diagnosis and inadequate treatment. Endourologic techniques offer an alternative diagnostic and treatment method for women previously injured in open pelvic surgeries.

BJOG 2006 Jun; 113(6): 695-699 (Read article online)

Mason A, Goldacre M, Meddings D, Woolfson J

Objective To identify suitable outcome measures for comparing gynaecology performance between hospitals. Design Analysis of routinely collected statistics. Setting England. Population A total of 1.45 million gynaecology admissions in 1999/2001. Methods The database used was a linked file of English NHS hospital admission statistics and death certificate data. Case fatality rates (CFRs)and emergency readmission (ERA) rates were calculated for different components of gynaecology workload. Funnel plots, using age-sex standardised measures, were displayed to compare the outcomes. Main outcome measures CFRs and ERA rates. Results The CFR within 30 days after admission for patients with cancer was 5.1%. These patients accounted for only 3% of all the admissions but for 73% of all 30-day deaths. All other 30-day CFRs were extremely low-below 0.5%. The 30-day ERA rates ranged from 1.8% after day case care to 17.4% after emergency admissions for people who did not have an operation. Funnel plots showed considerable variation between hospitals for ERA after day case care but not after elective abdominal hysterectomy. Conclusions There are no measures of mortality that could be used routinely and meaningfully to compare the performance of gynaecology units. We suggest that two suitable comparative measures of outcome, derivable from routine hospital statistics, are 30-day ERA rates after day case admissions and after elective abdominal hysterectomy, excluding those records with a cancer diagnosis. These measures are relatively homogeneous with respect to their likely rates of adverse events and have sufficient numbers to produce potentially useful comparative results.

JSLS 2006; 10(1): 26-29 (Read article online)

Morrison JE, Jacobs VR

OBJECTIVE: We report and review herein our 10-year experience with classic intrafascial supracervical hysterectomy focusing on our long-term experience, evolution of the operative technique, and increased use of this technique.METHOD: We performed a parallel, observational study with retrospective data to evaluate classic intrafascial supracervical hysterectomy, a laparoscopic hysterectomy technique, at Fayette Medical Center, a community hospital in Northwestern Alabama, USA. Patients comprised a consecutive series of 579 over a 10-year period from November 1992 through November 2002.RESULTS: The classic intrafascial supracervical hysterectomy technique, similar to standard supracervical hysterectomy, leaves the cardinal ligament, uterosacral ligament, vascular supply, and innervation to the upper vagina and cervix intact, but unlike supracervical hysterectomy removes the transition zone and endocervical canal. For 579 patients, the average age was 45.4 years (range, 22 to 92), follow-up was 75.3 months (range, 17 to 137), operating room time was 69 minutes (range, 44 to 370), blood loss was 72 mL (range, 10 to 765), length of hospital stay was 23.2 hours (range, 14 hours to 5 days), time to return to work was 13.2 days (range, 3 to 28). Complications include 11 cervical bleedings, 1 uterine artery bleeding, 1 pelvic hematoma, 1 postoperative ileus, and 16 mucoceles of the cervical stump. Three patients were converted from a laparoscopic to an open procedure (0.52%). Long-term follow-up of up to 137 months shows no adverse events thus far.CONCLUSIONS: Classic intrafascial supracervical hysterectomy is a safe procedure with a low short- and long-term complication rate. It has a short recuperation period and high patient satisfaction. It is the procedure of choice when hysterectomy is indicated for benign disease.

Int Urogynecol J Pelvic Floor Dysfunct 2006 May 12; (Read article online)

Duggan P, Williams R

A case is presented of an incisional hernia of the inguinal canal presenting 9 months after a tension-free vaginal tape (TVT) procedure and anterior vaginal repair. The TVT and repair procedure was complicated by prolonged postoperative urinary retention requiring midline incision of the tape for resumption of normal voiding. The patient had a hysterectomy several years earlier via a Pfannenstiel incision. No other risk factors for hernia were identified. There are no previous reports of TVT-related incisional hernia. We conclude that incisional hernia is a rare complication of the TVT procedure and that the characteristics of the TVT tape may contribute to late occurrence of herniation.

J Minim Invasive Gynecol 2006 May-Jun; 13(3): 183-9 (Read article online)

Bojahr B, Raatz D, Schonleber G, Abri C, Ohlinger R

STUDY OBJECTIVE: The aim of the study was to determine perioperative morbidity and complication rate after a standardized technique of laparoscopic supracervical hysterectomy (LASH). DESIGN: Retrospective analysis of consecutive patients (Canadian Task Force classification II-3). SETTING: Private hospital. PATIENTS: Seventeen hundred and six consecutive patients with symptomatic uterine myomata, dysfunctional uterine bleeding, dysmenorrhea, or chronic pelvic pain. INTERVENTION: Laparoscopic supracervical hysterectomy using a unipolar hook for dissection of the body of the uterus followed by electric morcellation MEASUREMENTS AND MAIN RESULTS: The main indications for LASH were uterine myomata with dysfunctional uterine bleeding (31.1%) or without (45.4%) and therapy-resistant dysfunctional uterine bleeding (21%). The mean uterine weight was 226.4 +/- 193.9 g (95% CI 217.1-235.6), the mean duration of surgery was 91.4 +/- 33.3 minutes (95% CI 89.9-93.0), and the mean duration of hospital stay was 2.15 +/- 0.63 days (95% CI 2.12-2.18). Nine hundred two (52.9%) of the patients had a history of at least one laparotomy. In 14 patients (0.82%), a conversion to laparotomy was necessary. Of these, 11 were due to the size and immobility of the uterus, one was due to severe adhesions, and two because of intraoperative complications. In total, five (0.3%) intraoperative and 20 (1.2%) postoperative complications occurred. The mean weight of the uterus in the five patients with intraoperative complications (three bladder injuries, one ureter injury, and one severe intraoperative bleed) was 818.4 +/- 911.9 g (95% CI -313.9-1950.7). In two patients who suffered trauma to the bladder, there was a history of cesarean sections (two and three, respectively). The most common postoperative complications were bleeding from the cervix and pain caused by adhesions or postoperative infection. CONCLUSION: Laparoscopic supracervical hysterectomy is a minimally invasive surgical method that should be regarded as an alternative to all other methods of total hysterectomy in benign conditions of the uterus (uterine myomata, dysfunctional uterine bleeding, uterine adenomyosis) as it is associated with a low perioperative morbidity and a rapid period of convalescence. Of special significance is that LASH can be performed on nulliparous patients, patients who have not previously had vaginal delivery, and patients who have had previous abdominal surgery.

Diabetologia 2006 May 11; (Read article online)

Simmons D, Shaw J, McKenzie A, Eaton S, Cameron AJ, Zimmet P

AIMS/HYPOTHESIS: We sought to determine the risk of diabetes and IGT/IFG with grand multiparity. SUBJECTS, MATERIALS AND METHODS: Women, aged >/=25 years, from the Australian Diabetes, Obesity and Lifestyle Study and the Crossroads Undiagnosed Disease Study (a rural study in Victoria, Australia), participated in a household census (response 67 and 70%, respectively), subsequently attending a biomedical examination that included an oral glucose tolerance test (58% [6198] and 69% [819]). RESULTS: After adjusting for age, obesity and socio-economic status, diabetes, but not IGT/IFG, was less common among women with a parity of 1 to 2 (odds ratio [OR]=0.64 [0.48-0.84]) and 3 to 4 (OR=0.72 [0.53-0.96]) than in grand multiparous women. This relationship was unrelated to past hysterectomy, use of the oral contraceptive pill or menopausal status. CONCLUSIONS/INTERPRETATION: Grand multiparity is associated with an increased risk of diabetes but not of IGT/IFG. We postulate that parity accelerates transition from IGT/IFG to diabetes, more than it does transition from normal glucose tolerance to IGT/IFG.

Gynecol Oncol 2006 May 10; (Read article online)

Nagar H, Dobbs S, McClelland HR, Price J, McCluggage WG, Grey A

OBJECTIVES.: The objective of this study was to determine the diagnostic accuracy of magnetic resonance imaging (MRI) in detecting cervical involvement by endometrial cancer. METHODS.: A retrospective accuracy study of 135 consecutive women who underwent preoperative MRI and surgery for endometrial cancer at a single gynaecological cancer centre between 1st February 2003 and 30th November 2004. RESULTS.: For the detection of any cervical involvement by MRI, the sensitivity was 72%, specificity 93.2%, positive predictive value (PPV) 89.8%, negative predictive value (NPV) 80.2%, positive likelihood ratio (+LR) 10.7 and negative likelihood ratio (-LR) 0.3. When cervical stromal invasion was considered alone, the sensitivity was 84.4%, specificity 87.4%, PPV 67.5%, NPV 94.7%, +LR 6.7 and -LR 0.18. CONCLUSION.: We believe that MRI is able to accurately predict cervical involvement in endometrial cancer and allows a decision to be made on the type of hysterectomy to be offered.

J Cutan Med Surg 2006 May 25; (Read article online)

Lamba M, Verma S, Prokopetz R, Pierscianowski TA, Jabi M, Moyana T

BACKGROUND: There are a number of reports documenting familial cases of leiomyomatosis cutis associated with uterine leiomyomata. However, to our knowledge, the association of gastrointestinal stromal tumour (GIST) with this entity has not as yet been reported. We report an interesting case of cutaneous leiomyomatosis, metachronous uterine leiomyomata, and a gastric GIST in a 43-year-old woman. OBSERVATION: The patient had previously undergone two separate uterine myomectomies at ages 25 and 26 years, respectively, followed by a hysterectomy at 27 years. At 36 years she underwent partial gastrectomy for excision of GIST and this was followed by the development of extensive, symptomatic cutaneous leiomyomata at 43 years. In the report, we have documented histological, immunohistochemical and clinical observations and furthermore report on the therapeutic measures undertaken. CONCLUSION: We report an interesting association of cutaneous leiomyomatosis, uterine leiomyomas and GIST.

Arch Intern Med 2006 May 8; 166(9): 1027-32 (Read article online)

Chen WY, Manson JE, Hankinson SE, Rosner B, Holmes MD, Willett WC, Colditz GA

BACKGROUND: Although short-term unopposed estrogen use does not seem to increase breast cancer risk, the effect of longer-term estrogen use remains unclear. We sought to assess the relationship between longer-term use of unopposed estrogen and the risk of invasive breast cancer over an extended follow-up period. METHODS: Within the Nurses' Health Study, a prospective cohort study, we observed 11 508 postmenopausal women who had a hysterectomy and reported information on estrogen use at baseline (1980). The study population was expanded every 2 years to include women who subsequently became postmenopausal and had a hysterectomy, so that 28 835 women were included in the final follow-up period (2000-2002). Estrogen use was assessed from self-reported data on biennial questionnaires. The main outcome was invasive breast cancer. RESULTS: A total of 934 invasive breast cancers were included in the analysis. Breast cancer risk increased with duration of unopposed estrogen use among longer-term users with the highest risk seen in cancers positive for estrogen receptor (ER+) and progesterone receptor (PR+). The multivariate relative risks (RRs) and 95% confidence intervals (CIs) for breast cancer with current use of unopposed estrogen for less than 5 years, 5 to 9.9 years, 10 to 14.9 years, 15 to 19.9 years, and 20 years or longer were, respectively, 0.96 (95% CI, 0.75-1.22), 0.90 (95% CI, 0.73-1.12), 1.06 (95% CI, 0.87-1.30), 1.18 (95% CI, 0.95-1.48), and 1.42 (95% CI, 1.13-1.77) (P for trend <.001). The risk of ER+/PR+ breast cancers was noted to be statistically significant after 15 years of current use (RR, 1.48; 95% CI, 1.05-2.07). CONCLUSION: Users of unopposed estrogen were at increased risk of breast cancer but only after longer-term use.