Eric L. Jenison

Serum and peritoneal lavage fluid CA-125 levels in endometriosis

Serum and peritoneal lavage fluid CA-125 levels were assayed in 20 women with endometriosis and 20 control women at the time of laparoscopy. Serum levels of CA-125 were significantly higher in women with endometriosis. Peritoneal lavage fluid CA-125 levels were significantly higher than serum levels but showed no significant difference between control and endometriosis patients. Peritoneal lavage fluid CA-125 did not follow expected dilution curves when attempts were made to validate the assay. Serum CA-125 levels were a more sensitive indicator of endometriosis, than peritoneal lavage fluid CA-125 levels.

Surgical treatments for vulvar and vaginal dysplasia: a randomized controlled trial.

OBJECTIVE: To compare pain, adverse effects and recurrence of dysplasia in patients with vaginal intraepithelial neoplasia or vulvar intraepithelial neoplasia prospectively treated by carbon dioxide laser or ultrasonic surgical aspiration. METHODS: Patients were randomly assigned to receive treatment by laser or ultrasonic surgical aspiration from 2000–2005. Preoperative biopsy was done to confirm presence of dysplasia. Patients completed a visual analog scale regarding pain and were evaluated at 2–4 weeks to assess scarring, wound healing, and adverse effects. Patients returned every 3 months for 1 year for pelvic examination and cytology to assess recurrence. Follow-up colposcopy and biopsy were used at the discretion of the treating physician. Student t test, &khgr;2, analysis of variance and multiple logistic regression were used for analysis. RESULTS: One hundred ten patients were randomly assigned. Ninety-six (87.3%) patients completed 1 year follow-up. Mean age of patients was 48.5 years. Mean visual analog scale score was significantly lower in patients treated by ultrasonic surgical aspiration (20.7 compared with 35.1; P=.032). For patients with vulvar lesions, there was less scarring with ultrasonic surgical aspiration (P<.01). Recurrence overall was 25% and was similar for ultrasonic surgical aspiration compared with laser (relative risk 0.96, 95% confidence interval 0.64–1.50, number needed to treat 95.6). Recurrence was associated with younger age (P<.01). CONCLUSION: Patients treated with ultrasonic surgical aspiration for vulvar and vaginal dysplasia reported less postoperative pain. Vulvar scarring was more common in patients treated by the laser. There was no difference in recurrence of dysplasia during a 1-year follow-up period between the two surgical modalities. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00394758 LEVEL OF EVIDENCE: I

Polymorphism in the IL18 Gene and Epithelial Ovarian Cancer in Non-Hispanic White Women

Over 22,000 cases of ovarian cancer were diagnosed in 2007 in the United States, but only a fraction of them can be attributed to mutations in highly penetrant genes such as BRCA1. To determine whether low-penetrance genetic variants contribute to ovarian cancer risk, we genotyped 1,536 single nucleotide polymorphisms (SNP) in several candidate gene pathways in 848 epithelial ovarian cancer cases and 798 controls in the North Carolina Ovarian Cancer Study (NCO) using a customized Illumina array. The inflammation gene interleukin-18 (IL18) showed the strongest evidence for association with epithelial ovarian cancer in a gene-by-gene analysis (P = 0.002) with a <25% chance of being a false-positive finding (q value = 0.240). Using a multivariate model search algorithm over 11 IL18 tagging SNPs, we found that the association was best modeled by rs1834481. Further, this SNP uniquely tagged a significantly associated IL18 haplotype and there was an increased risk of epithelial ovarian cancer per rs1834481 allele (odds ratio, 1.24; 95% confidence interval, 1.06-1.45). In a replication stage, 12 independent studies from the Ovarian Cancer Association Consortium (OCAC) genotyped rs1834481 in an additional 5,877 cases and 7,791 controls. The fixed effects estimate per rs1834481 allele was null (odds ratio, 0.99; 95% confidence interval, 0.94-1.05) when data from the 12 OCAC studies were combined. The effect estimate remained unchanged with the addition of the initial North Carolina Ovarian Cancer Study data. This analysis shows the importance of consortia, like the OCAC, in either confirming or refuting the validity of putative findings in studies with smaller sample sizes. (Cancer Epidemiol Biomarkers Prev 2008;17(12):3567–72)

Endometrial cancer survivors' assessment of the benefits of exercise

OBJECTIVE The majority of women who have had endometrial cancer remain at risk for obesity related diseases. The social cognitive theory was used to explore their beliefs about exercise to aid in the development of effective interventions. METHODS Women who had been treated for Stage I endometrial cancer were asked about their level of exercise to determine if they had been exercising regularly for more than 6 months (exercisers vs non-exercisers). They were asked to rate the likelihood that exercise would result in various health outcomes (expectations) and to rate the importance of these outcomes (expectancies). Scores for how likely exercise would result in an outcome of importance were calculated. Height and weight were obtained from nurses for calculation of BMI. Statistics were conducted using SPSS v 15. RESULTS There were 106 valid questionnaires (86% participation rate); 41% were exercisers. Mean BMI was significantly lower in exercisers (31.6 ± 1.2 vs. 37.3 ± 1.2, p=0.001); a significantly greater proportion reported not having diabetes, heart disease or hypertension (69.8% vs. 49.2%, p=0.035). Exercisers were significantly more likely to report that feeling better physically and emotionally versus reducing the risk of diseases were likely and important outcomes of exercise (18.2 ± 0.8 vs 15.0 ± 1.0, p=0.002). CONCLUSIONS Exercisers identified outcomes of exercise that are more immediate and subjective as being important and likely outcomes of exercise. Focusing on these aspects of exercise (feeling better physically and emotionally) may aid in the development of effective interventions for non-exercisers.

Training to maintain surgical skills during periods of robotic surgery inactivity

The study was performed to establish a level of practice needed for newly‐trained residents to maintain robotic surgical skills during periods of robotic inactivity.

A rare case of carcinosarcoma of the fallopian tube presenting with torsion, rupture and hemoperitoneum

► Fallopian tube carcinosarcomas may present emergently with hemoperitoneum. ► Fallopian tube carcinosarcomas may be detected better with MR than with CT. ► Heterologous fallopian tube carcinosarcomas have been reported more often than the homologous type.

Amish and non-amish women's use of complementary and alternative medicine

a 7 cm solitary lesion in the right lower lobe of the lung was noted on abdominal radiographs. The lung mass was resected in a right lower lobectomy, and an exploratory laparotomy was performed, with total abdominal hysterectomy, bilateral salpingo-oophorectomy, lymph node dissection, cytology and omentectomy. Pathological diagnosis was biphasic pulmonary blastoma of the right lung, with metastasis to the right ovary. Diagnostic criteria, histology and special stains are discussed. Conclusions: Pulmonary blastoma is a rare primary lung malignancy. To our knowledge, this is the first documented case of a pulmonary blastoma metastasis to the ovary.