Asunto(s)

RESUMEN

Sexual assaults on girls occur at an alarming rate representing a significant public health problem, but difficulties in correctly identifying the problem, managing the child and reporting for legal purposes have been recognized. We describe data obtained on 154 recent cases of child and adolescent sexual assault. Results indicate that those at highest risk of sexual assault are girls at age of 11-15 years having a stepfather, although the most girls at age of > 15 were assaulted by strange men with higher incidence of cross-race assault. Over a quarter of girls showed signs of physical trauma with face and neck as most common site of contact. A total of 17.5% reported threat of violence or with weapons and 9.7% had alcoholic influence. Pattern and incidence of genital injuries were described.

Asunto(s)

RESUMEN

105 adolescent girls with mean age of 17.3 (11-19) years had laparoscopy/pelviscopy between 1996 and 1997. In 37 cases, endometriosis was diagnosed (35.2%). The majority of the girls (32.4%) presented with endoscopic endometriosis classification (EEC) stage I. 2.8% of the girls had stage EEC II. The lesions involved one site or pelvic organ (64.8%) with a mean age of 18.7 (14-19) years. In 35.2% of cases, the lesions were at multiple sites with a mean age of 16.9 (11-19) years. Indications for laparoscopy included chronic or acute pelvic pain and right-sided lower abdominal pain. Endometriotic lesions were found in the pouch of Douglas (64.8%), uterosacral ligaments (37.8%), and ovarian fossa (24.3%), 42.8% of directed biopsies were positive. Endocoagulation of the endometriotic lesions was performed in 91.9% of cases.

Asunto(s)

RESUMEN

Endometriosis associated with chronic pelvic pain is one of the most indications for gynecological pelviscopy. The differential diagnosis of chronic appendicitis is difficult to the similar symptoms, chronic course of both diseases and the increase of an earlier diagnosis of endometriosis concerning the age of women. The meticulous inspection of the whole abdominal cavity is necessary to exclude not only surgical diseases but for evaluation of endometriotic lesions in the area of genital and extragenital organs. Planning of hormone therapy and second-look pelviscopy should be performed by gynecologists.

Asunto(s)

RESUMEN

We describe 24 consecutive patients with cervical cancer stage III or IV who received palliative urinary diversion by percutaneous nephrostomy. All patients had proven malignant ureteric obstruction, uremia and failed ureteric stenting. 11 of 17 patients with extensive primary cancer and local lymph node involvement had an acceptable quality of life for 2 or more months while the mean survival was 5.6 months. Patients with disseminated metastasizing cancer were not satisfactorily served by nephrostomy.

Asunto(s)

RESUMEN

Four out of 42 cases of primary tubal malignancy diagnosed in our histopathological laboratory were malignant mixed Müllerian tumors (MMMT). All four patients were postmenopausal with a mean age of 66.5 years at diagnosis. A correct preoperative diagnosis was made only in one case. Tumor staging (FIGO) revealed stage IIa, IIIc and IV. One patient died of postoperative pulmonary embolism, a second patient of an unknown cause five month after surgery and a third patient died of disease after 11 months with secondary deposits in pelvic peritoneum, omentum and paraaortic lymph nodes. The fourth patient is still alive. One patient received chemotherapy alone, one by radiation and chemotherapy and two patients by radiation alone. Tumor spread at the time of diagnosis and the residual tumor volume were the most important prognostic factors. All tumors were histologically the homologous type of MMMT (carcinosarcomas). No heterologous elements were found. Metastatic tumors showed only sarcomatous elements.

Asunto(s)

RESUMEN

120 imprint-cytology specimens obtained from standardized areas of 20 endometrial carcinomas were investigated by use of a computed-controlled image analysis system to determine special quantitative DNA-parameters. The stem line ploidy, the 2c deviation index (2cDI), the DNA-associated graduation of malignancy (DNA-MG) as well as the 5c exceeding rate (5cER) were calculated for each preparation. 85% of the imprint-cytology preparations had diploid stem lines, and aneuploidy was found in 15%. There were statistically significant correlations between the DNA-MG, the 5cER and the stem line ploidy as well as between the DNA-MG and the 5cER. The sensitivity of the 5cER was 76.6% in our study and so we cannot regard this parameter as prouding accurate information about tumor malignancy in endometrial carcinoma. Special DNA-parameters defined mathematically should be utilized for objective grading of tumor malignancy.

Asunto(s)

RESUMEN

In total, 62 cases with advanced gynecological malignancy were analyzed for the value of interventions for intestinal obstruction. 35 patients had an ileostomy, 7 patients had other palliative surgical intervention and 20 patients were managed conservatively. The median survival after surgical intervention was 7.7 months as against 1.3 months in conservatively treated patients. After surgery, all patients were affected by severe complications due to the primary disease. 22 (52.3%) of surgically treated patients received further therapy. 45 out of 62 patients (77.4%) died of progressive cancer and 14 (22.6%) of ileus. Surgical intervention had a positive effect on survival time, but only a marginal effect on life quality.

Asunto(s)

RESUMEN

Among 2096 patients treated for cervical cancer between 1985-1995, genital fistulas developed in 38 cases (1.8%). 16 patients were affected by rectovaginal, 13 patients had rectovesicovaginal and 9 patients had vesicovaginal fistulas. Median age at time of first presentation of the fistulas was 54.8 years. Fistula size ranged from 0.1 to 2.0 cm in diameter. Faecal or urinary leakage through the vagina (44.7%), bleeding (31.5%) and local pain (5.3%) were major clinical symptoms. 10 patients had surgery for the fistula, the remaining patients were managed conservatively.

Asunto(s)

RESUMEN

The relation between expression of several splicing variants of the CD 44 glycoprotein by tumor cells and the increased risk of metastases was discussed recently. By means of an immunocytochemical study (imprint cytology specimens from 94 invasive cervical carcinomas) we have shown a significant correlation between expression of CD 44 v6 and invasion of lymphatic vessels, lymphangiosis carcinomatosa in the primary tumor and the total number of positive pelvic lymph nodes. Expression of CD 44 v6 was not correlated with staging, grading and histological type. CD 44 v6 could therefore be considered as a predictor of lymphatic metastases in cervical carcinoma.

Asunto(s)