Biofeedback training has a limited therapeutic effect on patients suffering from anismus. BTX-A injection seems to be successful for temporary treatment of anismus.

PurposeThe purpose of this review is to illustrate and discuss the seldom used technique of three-dimensional (3D) saline infusion sonohysterography (SIS) based on instillation of sterile saline through a catheter into the uterus under real-time vaginal transducer observation for assessment of the endometrial cavity.Material and methodsThe cases for this pictorial review were selected from the imaging material collected at the Ultrasound Unit, Clinical Imaging Department, Women’s Hospital of Hamad Medical Corporation during a seven-year period from 2011 to 2017. This was a retrospective collection of 216 consecutive cases that underwent two-dimensional (2D) and 3D SIS for evaluation of the uterine cavity, followed by verification of results with histopathology. An open-sided speculum is inserted into the vagina. An intrauterine catheter is then threaded into the endometrial cavity. After that, the speculum is removed carefully, and a vaginal transducer is inserted. Using a 60-ml syringe attached to the catheter, saline solution is instilled under direct real-time observation (2D SIS). Subsequently, reconstruction of the three-dimensional anatomy of the intrauterine cavity is performed.Pictorial reviewThe review presents the most common indication for SIS, like abnormal bleeding in pre- and postmenopausal patients. SIS allows us to distinguish between focal lesions and global endometrial thickening. SIS should be supported as a second-line diagnostic procedure for abnormal uterine bleeding, when findings from transvaginal ultrasound are inconclusive.ConclusionsThe addition of 3D techniques to SIS procedure helps in the distinction between endometrial and myometrial lesions, also it facilitates delineation of uterine anatomy, resulting in more precise and accurate diagnosis.

Background: Elective dissection of cervical lymph nodes in oral cavity cancers gives very precious data on its pathological state, judge for adjuvant therapy requirement plus its therapeutic effect but it has its morbidities that cannot be condoned. Tumor thickness (TT) in oral cavity cancers show an increasing value to be one of the most important and reliable factors that have a great relationship to regional node involvement.Methods: Forty-three patients with T1, T2 oral cavity squamous cell carcinoma with clinically and radiologically negative cervical L.Ns underwent elective neck dissection and the relation between the tumor thickness and the nodal metastasis was monitored. Tumor thickness was estimated preoperatively by using the intra-oral ultrasound and confirmed by histopathology postoperatively.Results: Only 12 out of 43 neck dissections (27.9%) showed positive L.Ns metastasis of primary tumor. The excised number of L.Ns ranged from 15 to 31 with mean±SD (21.58±3.59) L.Ns. The (TT) ranged from 1.4 mm to 7.8 mm. Our statistical results showed that there is a cutoff point which was 4 mm where (TT) > 4 mm showed significant results with histologically found positive cervical node metastasis compared to (TT) ≤4 mm specimens.Conclusions: Relationship of tumor thickness to lymph node metastasis was found to be significant as shown by this study. Our results clearly demonstrate that conservative elective neck dissection is indicated in patients with stage I/II oral cavity carcinoma whose tumors are > 4 mm in thickness as they mostly have latent metastasis.

Aim:The aim of our study was to determine to what extent serial carcinoembryonic antigen (CEA) is helpful in detecting colorectal cancer recurrence. Second major objectives of this study were to evaluate tissue staining with CEA monoclonal antibody and its pattern of distribution in malignant tissue as regards its relation to prognostic value.Patients and Methods: 30 colorectal cancer patients undergoing clinically curative operations were studied. Primary tumors were evaluated for tissue CEA using immunohistochemical staining with CEA monoclonal antibody. Preoperative serum CEA level was measured as well as in follow-up monitoring of the patients. Results:The exact preoperative serum CEA value did not correlate with tumor stage, grade and immunohistochemical intensity or pattern. In the ten patients who developed recurrent cancer, the serum CEA at recurrence was greater than 5 ng/ml in 80%. All such patients with recurrent tumor had CEA present in their primary tumor.There was no correlation with exact preoperative serum CEA, the intensity of the primary tissue CEA, or localization of such CEA. Conclusion:Tissue CEA is a useful marker in prediction of tumor recurrence. Also serum CEA is a useful marker in detection of recurrent colorectal cancer. ZusammenfassungZielsetzung: Das Ziel unserer Untersuchung war die Bestimmung, inwieweit serienmäßiges karzinoembryonales Antigen (CEA) bei der Entdeckung von kolorektalen Karzinomrezidiven hilfreich ist. Die zweite große Zielsetzung dieser Untersuchung war die Bewertung von Gewebeeinfärbungen mit monoklonalen CEA-Antikörpern und ihrem Verteilungsmuster in malignem Gewebe im Hinblick auf ihren Voraussagewert.Patienten und Methoden: Wir untersuchten 30 Patienten mit kolorektalen Karzinomen, die sich klinisch kurativen Operationen unterzogen. Primärtumoren wurden im Hinblick auf das Gewebe-CEA mittels immunhistochemischer Einfärbungen mit monoklonalen CEA-Antikörpern bewertet. Die CEA-Serumspiegel wurden präoperativ ebenso gemessen wie bei den folgenden Nachuntersuchungen der Patienten.Ergebnisse: Die genauen präoperativen CEA-Serumwerte korrelierten nicht mit dem Tumorstadium, dem Tumorgrad und der immunhistochemischen Stärke oder dem Muster. Bei 80% der zehn Patienten, die ein Rezidiv entwickelten, war der CEA-Serumspiegel zum Rezidivzeitpunkt höher als 5 ng/ml. Bei allen Patienten mit einen Tumorrezidiv war zum Zeitpunkt des Primärtumors CEA vorhanden. Es bestand keine Korrelation mit dem genauen Serum-CEA, der Intensität des primären Gewebe-CEA oder der Lokalisation des CEA.Schlussfolgerung: Gewebe-CEA ist ein nützlicher Marker bei der Vorhersage eines Tumorrezidivs. Das Serum-CEA ist ebenfalls ein nützlicher Marker bei der Entdeckung von rezidivierenden kolorektalen Karzinomen.

: Radiation sterilization is a promising method of obtaining sterile active pharmaceutical ingredients (API), excipients and formulations. One of the best methods of sterilization is to use ionizing radiation. The greatest advantage of ionizing radiation is fact that can be conducted at room temperature or lower. Therefore this procedure of sterilization is reserved for drugs sensitive to the high temperature of autoclaving. Solutions of parenterally administered antibiotics must be absolutely aseptic. Most of the antibiotics are susceptible for the degradation at increased temperature and humidity so radiation is often used to obtain sterile bactericidal drugs.