A. Fishman

A modified, prolonged desensitization protocol in carboplatin allergy

Carboplatin (CP) is the mainstay therapy in ovarian and testicular carcinoma. Several cases of allergic reactions to CP have been descr ibed? -3 Pre t rea tment with steroids and antihistamines did not prevent recurrent reactions. 1,3 A successful 4-hour desensitization protocol was documen ted in a single pa t i en t? We describe two patients allergic to CP who had recurrent reactions while undergoing the 4-hour desensit ization protocol . One of the patients had an allergic react ion on receiving a diluted solution of CP (1/100 of the total dose). In an a t tempt to overcome these reactions, we designed a modified protocol , which was pro longed to more than 3 days, for one of the patients. This modificat ion enabled both patients to receive the p lanned CP dose without adverse effects for numerous t rea tment courses.

High Frequency of Adenomyosis in Postmenopausal Breast Cancer Patients Treated with Tamoxifen

Pathologic evaluation for adenomyosis in uterine specimens as well as demographic characteristics, health habits and risk factors for endometrial cancer were compared in 28 postmenopausal breast cancer patients with tamoxifen (TAM) treatment and in 11 similar patients without TAM treatment in order to determine the association between postmenopausal TAM exposure and the frequency of adenomyosis. The same comparison was also made between TAM-treated patients with adenomyosis and TAM-treated patients without adenomyosis. Adenomyosis was histologically diagnosed in 53.6% TAM-treated patients and in 18.2% non-TAM patients. Overall, there were no significant statistical differences in all parameters tested between the 2 groups, as well as between the TAM-treated patients with adenomyosis and the TAM-treated patients without adenomyosis. It can be concluded that adenomyosis was significantly more common among postmenopausal breast cancer patients who were treated with TAM as compared to similar patients without TAM treatment (p = 0.0186). This significant high rate of adenomyosis may be attributed to the continuous and unopposed exposure to TAM. It is, however, impossible to predict which postmenopausal breast cancer patient will develop adenomyosis after treatment with TAM.

OC28.08: SAFE‐T‐CHOICE: a new transvaginal ultrasound guided device to improve imaging in surgical abortions

and we checked this information later using Medison’s Accuvix XQ 3D eXtended Imaging (3DXI) software, for 100 selected patients. Results: The informs made by the sonographer who perform the exam were compared with the one made by another sonographer who only reviewed the 3D volume. In 98/100 patients, the results were the exactly same, and in those 2 cases in disagreement a later review confirmed the results obtained by the 3D volume analysis (a little leyomioma of 9 mm and an adnexal mass suggestive of hydrosalpinx). Conclusions: We can conclude that this new technique represents big advantages over the traditional way to perform ultrasound examination, allowing the posterior analysis of the 3D volume using differents angles and plans of view and avoiding the lost of information.

P04.52: Prenatal diagnosis of fetal urinoma

Objective: Some studies have pointed at maternal smoking as a causative factor for gastroschisis. To our knowledge no study has investigated the role of maternal smoking on outcome of gastroschisis patients. The aim was to compare postnatal outcome of gastroschisis patients of smoking and non-smoking mothers. Methods: We conducted an observational study based on data from the institutional registry of neonatal surgery and chart review including all fetuses with a prenatal diagnosis of gastroschisis between January 1990 and February 2005 (n = 68). Maternal smoking habits during the first half of the pregnancy were recorded. Long term survival (censoring date 15.04.2005) was checked by census data. The main endpoints were postnatal mortality and morbidity of the gastroschisis patients. Statistical analyses were performed by SPSS 12.0. Results: Two pregnancies were terminated and 1 fetus died inutero. Sixty-five babies were live born; 21 (32.3%) mothers were smokers, 44 (67.7%) were non-smokers. The smoker/nonsmoker groups did not differ significantly concerning maternal age (24.2 vs. 24.5 years), percentage of nullipara (76.2 vs. 68.2%), time of diagnosis (21.5 vs. 21.8 weeks), percentage Cesarean deliveries (90.5 vs. 68.2% p = 0.07), gestational age at delivery (36.1 vs. 36.4 weeks), birth weight (2604 vs. 2716 g), 1 min (6.9 vs. 7.3) and 5 min Apgar scores (8.0 vs. 8.5) and associated major anomalies (14.3 vs. 20.5%). Primary closure was performed in 90.5 vs. 79.5%, p = 0.48 and the frequency of reoperation for complications was 19.0 vs. 39.5%, p = 0.16 (smoker vs. nonsmoker). Neonatal survival was 85.7 vs. 97.7% (p = 0.095) in the smoker vs. non-smoker groups, respectively. Long term survival was significantly decreased in the smoking group; 76.2 vs. 95.5%, p = 0.031 (smoker/non-smoker). Conclusion: Maternal smoking in early pregnancy was associated with a tendency to reduced neonatal and long term survival.

P04.54: Prenatal diagnosis of meconium periorchitis

Objective: Some studies have pointed at maternal smoking as a causative factor for gastroschisis. To our knowledge no study has investigated the role of maternal smoking on outcome of gastroschisis patients. The aim was to compare postnatal outcome of gastroschisis patients of smoking and non-smoking mothers. Methods: We conducted an observational study based on data from the institutional registry of neonatal surgery and chart review including all fetuses with a prenatal diagnosis of gastroschisis between January 1990 and February 2005 (n = 68). Maternal smoking habits during the first half of the pregnancy were recorded. Long term survival (censoring date 15.04.2005) was checked by census data. The main endpoints were postnatal mortality and morbidity of the gastroschisis patients. Statistical analyses were performed by SPSS 12.0. Results: Two pregnancies were terminated and 1 fetus died inutero. Sixty-five babies were live born; 21 (32.3%) mothers were smokers, 44 (67.7%) were non-smokers. The smoker/nonsmoker groups did not differ significantly concerning maternal age (24.2 vs. 24.5 years), percentage of nullipara (76.2 vs. 68.2%), time of diagnosis (21.5 vs. 21.8 weeks), percentage Cesarean deliveries (90.5 vs. 68.2% p = 0.07), gestational age at delivery (36.1 vs. 36.4 weeks), birth weight (2604 vs. 2716 g), 1 min (6.9 vs. 7.3) and 5 min Apgar scores (8.0 vs. 8.5) and associated major anomalies (14.3 vs. 20.5%). Primary closure was performed in 90.5 vs. 79.5%, p = 0.48 and the frequency of reoperation for complications was 19.0 vs. 39.5%, p = 0.16 (smoker vs. nonsmoker). Neonatal survival was 85.7 vs. 97.7% (p = 0.095) in the smoker vs. non-smoker groups, respectively. Long term survival was significantly decreased in the smoking group; 76.2 vs. 95.5%, p = 0.031 (smoker/non-smoker). Conclusion: Maternal smoking in early pregnancy was associated with a tendency to reduced neonatal and long term survival.

OC31.06: Sonographic appearance of the uterine cavity following treatment with Mifepristone and Misoprostol for termination of pregnancy

Introduction: Little information is available about prevalence of pathology among women presenting with acute gynaecological problems. The aim of this study was to look at the prevalence of pathology in women presenting to an AGU with pelvic pain and/or vaginal bleeding. Method: All doctors examining patients were required to complete data sheets about 1000 consecutive women, detailing age, pregnancy, presenting complaints and pathology found on scan. Results: Data sheets were completed for 920/1000 (92%) women. Mean age was 31.2 years (S.D9.81). 542 (58.9%) were pregnant. 89.3% had an intrauterine pregnancy (IUP) and 32 (prevalence 3.5%) had an ectopic pregnancy (EP) visualised on transvaginal scan (TVS). Of these, 18 (56.3%) presented with pain, 10 (31.3%) with pain and bleeding and 4 (12.5%) with only bleeding. The women with pregnancies of unknown location were evenly distributed among the 3 presentations 33 (37.9%) pain, 28 (32.2%) pain and bleeding and 26 (29.9%) bleeding alone. 378 non pregnant women presented to AGU during the study period. 65.1% of those presenting with pelvic pain had a normal TVS. 31 (16.7%) had an ovarian cyst > 5 cm diameter, 6 (3.2%) had a tuboovarian abscess, 1 had a pelvic mass and 1 a pelvic abscess. 42% non pregnant women with vaginal bleeding had a normal scan. 15 (21.7%) had significant fibroids, 4 an endometrial polyp and 3 postmenopausal women had thickened endometrium (> 5 mm). 54.3% non pregnant women who presented with pain and bleeding had a normal scan. 3 had significant fibroids, 2 an ovarian cyst > 5 mm and 1 an early IUP. Conclusion: This is the first study to look at the variety of pathology presenting to an AGU. A 3.5% prevalence of EP emphasises the importance of having an ultrasound scan available at the time of initial consultation. The majority of pregnant women had an IUP and were reassured. Women with pelvic pain and/or bleeding can be efficiently triaged to appropriate management based on ultrasound findings.

P06.12: Combination of endometrial thickness and time since menopause in predicting endometrial cancer in women with postmenopausal bleeding

PURPOSE This study was conducted to assess the combination of endometrial thickness, as measured by transvaginal sonography, and time since menopause, in predicting the presence of endometrial cancer in women with postmenopausal bleeding. METHODS The study group consisted of 95 women with postmenopausal bleeding who underwent sonographic measurement of endometrial thickness followed by endometrial biopsy. No patient had ever received hormone replacement therapy. RESULTS The mean endometrial thickness was significantly lower in the absence of endometrial carcinoma (6.9 +/- 4.3 mm) than in its presence (13.5 +/- 7.7 mm) (p < 0.005). The incidence of endometrial carcinoma increased with increases in endometrial thickness and the number of years since menopause. No patient had carcinoma when the endometrium was less than 5 mm thick, but 18.5% did when the thickness exceeded 9 mm. The incidence of cancer was 2.6% in women who had undergone menopause less than 5 years earlier but was 21.4% in women who had undergone menopause more than 15 years prior. Multiple logistic regression analysis showed that time since menopause and endometrial thickness were statistically significant predictors of endometrial carcinoma. CONCLUSIONS Time since menopause and endometrial thickness together define cutoff points for the diagnostic biopsy of tissue samples for endometrial carcinoma; that is, within a particular time interval, sampling should not be performed if the thickness is below a given value. When using cutoff points of 6 mm of endometrial thickness for women experiencing menopause 5-15 years prior and 5 mm in those going through menopause 15 or more years prior, approximately 60% of invasive procedures may be avoided. In addition, models derived by multiple logistic regression can be used to calculate a patients risk of cancer based on her age and endometrial thickness.

Estrogen and Progesterone Receptors in Benign Ovarian Tumors of Menopausal Breast Cancer Patients Treated with Tamoxifen

In order to assess possible ovarian cell potential for interaction with tamoxifen, thus demonstrating possible effects of this agent on the development of ovarian pathologies through growth stimulation and cell proliferation, we measured estrogen receptors (ER) and progesterone receptors (PR) by immunohistochemical method in 16 benign ovarian tumors removed from 11 postmenopausal breast cancer patients treated with tamoxifen (study group). The results were compared with those measured in 7 similar ovarian tumors obtained from 5 similar patients without tamoxifen treatment (control group I), and in 9 similar tumors removed from 9 age-matched postmenopausal women (control group II). There were no significant differences with regard to ER or PR expression between the study group and control group I and II (ER = 18.75, 0.0 and 11%, respectively; PR = 43.75, 28.5 and 44%, respectively; p = NS). There were also no significant statistical differences between the three groups when subdividing the ovarian pathologies according to different histological types. From the results obtained in this study, it seems that tamoxifen probably does not have any direct influence on the ovaries of menopausal breast cancer patients.