To assess the capability of magnetic resonance (MR) imaging to enable differentiation of adenomyosis from leiomyoma, a prospective study was performed in 21 premenopausal patients with a strong clinical suggestion of adenomyosis. Histologic findings from hysterectomy (19 patients) and biopsy specimens (two patients) showed that eight patients had adenomyosis (three focal, five diffuse) and 12 had leiomyomas (five of the 12 also had microscopic foci of adenomyosis); one patient had a normal uterus. All eight cases of adenomyosis were correctly diagnosed from MR images. On T2-weighted MR images, diffuse adenomyosis appeared as a thickening of the junctional zone, whereas focal adenomyosis appeared as a low-signal-intensity mass poorly marginated from the adjacent myometrium. Ten of the 12 leiomyomas were correctly diagnosed from MR images. In the other two cases of leiomyoma, differentiation between focal adenomyosis and leiomyoma was not possible. Microscopic foci of adenomyosis were not demonstrated with MR imaging.

Magnetic resonance (MR) imaging, symptoms, and pathologic findings were correlated in 59 uterine leiomyomas from 23 patients. The tumors varied from less than 1 cm to 18 cm in diameter. Fifty-seven leiomyomas were identified in the corpus uterus, one was located within the broad ligament, and another was detected in the cervix. Among the corpus lesions, 9 were correctly identified on MR images as subserosal and 37 as intramural. Of 11 tumors assigned at surgery to the submucosal group, 10 had been accurately defined with MR. On MR, myomas associated with hypermenorrhea produced an anatomic disruption of the "junctional zone" (the low-intensity band seen at the myometrium-endometrium junction on T2 contrast images). Long TR (2 sec) and TE (56 msec) parameters (T2 contrast images) yielded the best contrast resolution between leiomyoma and surrounding myometrium. Correlation of MR with histologic features demonstrated 2 groups of lesions. Leiomyomas free of degenerative changes emitted homogeneous signals of low intensity. Contrast between tumor and myometrium was -16% on the T1 contrast image and increased to -44 +/- 16% on the T2 contrast image. Leiomyomas with hyaline, myxomatous, or fatty degeneration demonstrated various degrees of inhomogeneity, best seen on images obtained with long TR and TE. It is concluded that MR is an accurate modality for imaging uterine leiomyomas, since it clearly demonstrates tumor number, size, location, and the presence and extent of degeneration.

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BackgroundApproximately 300,000 people suffer sudden cardiac arrest (SCA) annually in the United States. Less than 30% of out-of-hospital victims receive cardiopulmonary resuscitation (CPR) despite the American Heart Association training over 12 million laypersons annually to conduct CPR. New engaging learning methods are needed for CPR education, especially in schools. Massively multiplayer virtual worlds (MMVW) offer platforms for serious games that are promising learning methods that take advantage of the computer capabilities of today’s youth (ie, the digital native generation).ObjectiveOur main aim was to assess the feasibility of cardiopulmonary resuscitation training in high school students by using avatars in MMVM. We also analyzed experiences, self-efficacy, and concentration in response to training.MethodsIn this prospective international collaborative study, an e-learning method was used with high school students in Sweden and the United States. A software game platform was modified for use as a serious game to train in emergency medical situations. Using MMVW technology, participants in teams of 3 were engaged in virtual-world scenarios to learn how to treat victims suffering cardiac arrest. Short debriefings were carried out after each scenario. A total of 36 high school students (Sweden, n=12; United States, n=24) participated. Their self-efficacy and concentration (task motivation) were assessed. An exit questionnaire was used to solicit experiences and attitudes toward this type of training. Among the Swedish students, a follow-up was carried out after 6 months. Depending on the distributions, t tests or Mann-Whitney tests were used. Correlation between variables was assessed by using Spearman rank correlation. Regression analyses were used for time-dependent variables.ResultsThe participants enjoyed the training and reported a self-perceived benefit as a consequence of training. The mean rating for self-efficacy increased from 5.8/7 (SD 0.72) to 6.5/7 (SD 0.57, P<.001). In the Swedish follow-up, it subsequently increased from 5.7/7 (SD 0.56) to 6.3/7 (SD 0.38, P=.006). In the Swedish group, the mean concentration value increased from 52.4/100 (SD 9.8) to 62.7/100 (SD 8.9, P=.05); in the US group, the concentration value increased from 70.8/100 (SD 7.9) to 82.5/100 (SD 4.7, P<.001). We found a significant positive correlation (P<.001) between self-efficacy and concentration scores. Overall, the participants were moderately or highly immersed and the software was easy to use.ConclusionsBy using online MMVWs, team training in CPR is feasible and reliable for this international group of high school students (Sweden and United States). A high level of appreciation was reported among these adolescents and their self-efficacy increased significantly. The described training is a novel and interesting way to learn CPR teamwork, and in the future could be combined with psychomotor skills training.

The inhibition of the pregnenolone Δ⁵–3Β-hydroxysteroid dehydrogenase-Δ^5-4 isomerase systems in microsomes of human placenta or corpus luteum of pregnancy has been investigated using three steroidal substances: 2Α-cyano- 4,4,17Β-trimethylandrost-5-en-17Α-ol-3-one (cyanoketone), 2- hydroxymethylene, 17Α-methyl-5Α-androstan-17Β-ol-3-one (oxymetholone), and estradiol 17Β. The inhibition is of the competitive type with the synthetic steroids. The apparent K_i’s are approximately 0.3xl0^-5 M and 0.2xI0^-5 m for cyanoketone in the placental and ovarian systems, respectively, and the apparent K_i produced by oxymetholone is 0.6x10^-6 m in the ovarian system, however, that for the placental system is much smaller, 5.5xl0^-8 M. Approximately 50% inhibition was obtained in both systems with 2–5xl0^-5 M estradiol-17Β. Oxymetholone may be useful for the inhibition of corpora luteal function in women.