OBJECTS: The purpose of this study was to evaluate the relative usefulness of the morphologic scoring system and spectral doppler ultrasonographic analysis in differentiating between benign and malignant adnexal masses. METHODS: All patients scanned between July 1995 and June 1998 with sonographically identified and pathologically confirmed adnexal masses formed the study group. The adnexal masses were scored as benign or malignant on the basis of their sonographic appearance. Specific categories included inner wall structure, wall thickness, septal structure, and echogenicity. Women whose morphologic findings were suspicious for malignancy underwent doppler sonography. A threshold pulsatility index of 1.0 and resistance index of 0.4 were used to differentiate benign from malignant lesions. The findings were correlated with the presence of malignancy. RESULTS: Two hundred fifty one patients formed the study group; 215 patients were benign and 36 patients were malignant pathologically. Using the morphologic scoring system, 31 of the 36 malignant masses were classified as suggestive of malignant tumor, and 147 of the 215 benign masses were classified as not suggestive of malignant tumor (sensitivity, 86%; specificity, 68%; positive predictive value, 31%; negative predictive value, 97%). Doppler velocimetry was performed on a total of 62 patients, 19 patients with malignant tumors and 43 patients with benign tumors. A mean PI value of 0.85 and RI value of 0.52 for malignant tumors and mean PI value of 2.00 and RI value of 0.75 for benign tumors was shown. The PI value was significantly lower (p 0.001) in malignant than that of in benign masses, but RI value was not significant (p 0.184). The sensitivity and specificity in the detection of malignancy combined with doppler velocimetry was 86% and 67%, respectively. CONCLUSION: Doppler velocimetry studies did not add substantially to the prediction of malignancy using the morphologic scoring system.
Diagnosis* ; Female ; Humans ; Rheology ; Sensitivity and Specificity ; Ultrasonography

Doppler sonography has been introduced to evaluate uterine and ovarian diseases. It has been reported to be used to distinguish benign from malignant adnexal masses. The purpose of this study was to assess the blood flow characteristics of adnexal masses and to determine the optimal cut-off points for the Doppler indices obtained, resistance index and pulsatility index, to best differentiate benign from malignant lesions. We performed pulsed Doppler ultrasound in seventy-eight adnexal masses between February 1989 and June 1994. The pulsatility and resistance index were calculated from the waveforms generated from blood flow within the ovary. There were 51 benign and 27 malignant histologically proved ovarian lesions. All women have been operated on. The results were as follows ; Benign tumors and cysts had a significantly higher pulsatility index(mean, 1.23+/-0.74; range, 4.46-3.36) and resistance index(mean, 0.64+/-0.19; range 0.34-1.43) than did malignant tumors(pulsatility index : mean, 0.87+/-0.49; range, 0.31-2.27; resistance index : mean, 0.50+/-17; range, 0.23-0.8). However, some overlap in individual values for benign and malignant lesions was found. In conclusion, our data suggest that high pulsatility and resistance indices may indicate benign adnexal masses ; however, considerable overlap in pulsatility and resistance indices between benign and malignant lesions were noted, and further work will be needed before the validity of these factors is proved.
Female ; Humans ; Ovarian Diseases ; Ovary ; Ultrasonography

No abstract available.
Ifosfamide*

Previous studies have shown that the cancer cell lines secrete multiple cytokines, such as macrophage colony-stimulating factor(M-CSF), granulocyte-macrophage colony stimulating factor(GM-CSF), interleukin-l(IL-1), interleukin-2(IL-2), interleukin-6(IL-6), and tumor necrosis factor-alpha(TNF-alpha). We evaluated the levels of IL-2, IL-6, and TNF-alpha in the ascites of 23 patients with ovarian cancer. These levels were then compared with cytokine concentration found in 10 patients who had benign ascites and also studied the relation between levels of cytokines and clinical parameters. Enzyme-linked immunosorbent assay(ELISA) was used to determine the levels of cytokines in ascitic fluids. The median age of the group was 56, and the median follow-up time was 24 months. The levels of IL-2 was not elevated in ascites of ovarian cancer(30.5 vs 37.2 pg/ml, p=0.083), 1 he levels of TNF-alpha in the ascites with ovarian cancer were higher when compared with ascites of benign disease and was nearly approached statistically significant(91.0+/-20.7 vs 440.2+/-117.9pg/ml, p=0.058). Significantly higher IL-6 levels were detected in patients ascites compared with ascites with benign disease(354.3+/-42.9 vs 5,605+/-1,137pg/ml, p=0.006). IL-6 and TNF-a levels in ascites did not correlate statistically with tumor volume, histologic type or with survival time. IL-6 levels did not correlated statistically with volume of ascites. IL-6 and TNF-a levels did not correlated either. Circulating platelet counts in patients with ovarian cancer were significantly higher than in patients with benign conditions (282.6+/-5 vs 388.4+/-21.2x-10(9)/l, p=0.003). Thrombocytosis(platelet counts>400x10(9)/l) occured in 35%(8/23) of the cases with ovarian cancer. IL-6 levels in ascites correlated signi-ficantly with circulating platelet counts(R=0.427, p=0.042). This study showed that the patients with ovarian cancer have elevated levels of IL-6 in ascites. IL-6 levels were not correlate with disease status in patients with ovarian cancer. However, the correlation was found between IL-6 levels and thrombocytosis. This observation suggest a role for IL-6 in the development of tumor-associated thrombocytosis. A larger study would help in evaluating the potential biological roles and use of cytokines as tumor markers in ovarian cancer.
Ascites* ; Ascitic Fluid ; Blood Platelets ; Cell Line ; Cytokines ; Follow-Up Studies ; Humans ; Interleukin-2 ; Interleukin-6 ; Macrophages ; Necrosis* ; Ovarian Neoplasms* ; Platelet Count ; Thrombocytosis ; Tumor Burden ; Biomarkers, Tumor ; Tumor Necrosis Factor-alpha

No abstract available.
Germ Cells* ; Neoplasms, Germ Cell and Embryonal* ; Prognosis*

PURPOSE: The purpose of this study was to establish optimal imaging acquisition conditions for the GE Advance(TM) PET imaging system by performing the acceptance tests designed by National Electrical Manufacturers Association (NEMA) protocol and General Electric Medical Systems (GEMS) test procedures. MATERIALS AND METHODS: Performance tests were carried out with 18FDG radioactivity source and phantoms by using a standard acquisition mode. Transaxial resolution and scatter fraction tests were performed with a line source and axial resolution with a point source, respectively. A cylindrical phantom made of polymethylmethacrylate (PMMA) was used to measure sensitivity, count rate losses and randoms, uniformity correction, and attenuation inserts were added to measure remaining tests. The test results were acquired in a diagnostic acquisition mode and analyzed mainly on high sensitivity mode. RESULTS: Transaxial resolution and axial resolution were measured as average of 4.65 mm and 3.98 mm at 0 cm, and 6.02 mm and 6.71 mm at 20 cm on high sensitivity mode, respectively. Average scatter fraction was 9.87%, and sensitivity was 225.8 kcps/micronCi/cc of trues. Activity at 50% deadtime was 4.6 Ci/cc, and the error of count rate correction at that activity was from 1.49% to 3.83%. Average nonuniformity for total slice was 8.37%. The accuracy of scatter correction was -0.95%. The accuracies of attenuation correction were 5.68% for air, 0.04% for water and -6.51% for polytetrafluoroethylene (PTFE). CONCLUSION: The results satisfied most acceptance criteria, indicating that the GE AdvanceTM PET system can be optimally used for clinical applications.
Electrons* ; Fluorodeoxyglucose F18 ; Polymethyl Methacrylate ; Polytetrafluoroethylene ; Positron-Emission Tomography* ; Radioactivity ; Water

The primary malignant tumor of the peritoneum also known as primary peritoneal carcinoma or primary peritoneal papillary serous carcinoma is rare and involves the peritoneum, especially the pelvic peritoneum of female patients. It is difficult to differentiate histologically between papillary mesothelioma, primary ovarian tumor and primary peritoneal carcinoma. We report two cases of the primary peritoneal carcinoma with clinical presentation and histologic characteristics.
Diagnosis, Differential ; Female ; Humans ; Mesothelioma ; Peritoneum*

No abstract available.
Cervix Uteri* ; Female ; Polyarteritis Nodosa*

In our study we estimated mitral orifice area by use of two dimensional echocardiography in 59 patients with mitral stenosis form February 1979 till June 1981. We classified them to 3 subgroups by severity of mitral stenosis as Cope was done in 1975. and investigated correlationship between the severity and other various echo-cardiographic findings indices such as mitral valve calcification, posterior mitral leaflet motion, doming of mitral valve, EF slope, ED amplitude, LA dimension, LA/Ao ratio and especially mitral valve closure index. The following results were obtained. 1) We could accurately estimate mitral orifice area by two dimensional echocardiography. 2) Except EF slope and MVCI, we could find that various echocardiographic findings were poorly correlated with mitral orifice area measured from two-dimensional echocardiography. 3) MVCI was overlapped less frequently than EF slope in severe, moderate and mild mitral stenosis, and we could find that MVCI reflected the extent of mitral stenosis more accurately than EF slope.
Echocardiography* ; Humans ; Mitral Valve ; Mitral Valve Stenosis*

Ovarian mucinous cystadenoma of borderline malignancy was consisted of intestinal mucinous cystadenomas of borderline malignancy and Mullerian mucinous papillary borderline tumors. Mullerian mucinous papillary tumors was lined by mucinous epithelium of endocervical type and characterized by papillae architecturally similar to those of serous borderline tumors. These tumors have clinical and pathologic differences from those of intestinal mucinous cystadenomas of borderline malignancy.We report a case of ovarian Mullerian mucinous papillary cystadenomas of borderline malignancy with review of literature.
Cystadenoma, Mucinous ; Cystadenoma, Papillary* ; Epithelium ; Female ; Mucins* ; Ovary