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BACKGROUND: Cognitive functions are altered in patients with CKD. However, it is suggested that cognitive functions improve after kidney transplantation, at least partially. A possible cause for this improvement could be the reduction of uremic retention solutes after transplantation. This study assessed the association between the changes in uremic toxin concentration with the changes in cognitive function in patients after kidney transplantation. METHODS: Ten recipients of kidney transplants were compared with 18 controls (nine patients on hemodialysis, and nine patients with CKD stage 4 or 5 [eGFR

Antes de considerar particularmente el tratamiento del carcinoma del cuello, es necesario referirnos brevemente a los métodos de diagnóstico y la clasificación del proceso en varias etapas. Nuestra interpretación del diagnóstico, así como su clasificación tiene una influencia muy importante en nuestra elección del tratamiento en cada caso individual. Cn el uso tan desarrollado de la citología y la biopsia, muchos casos tempranos pueden ser descubiertos, los cuales no hubieran sido reconocidos diez o más años atrás. Algunos de estos están en la etapa preinvasiva cuando la enfermedad es todavía curable en un 100%.

1.1. During the past seven years, approximately 700 cases of functional bleeding have been seen in the gynecologic out-patient department of the Johns Hopkins Hospital. During this same period, 104 young women with severe symptoms have been selected from the general dispensary for referral to the special functional bleeding clinic. Thus, only about one case in seven was severe enough symptomatically or in the proper age group to require conservative therapy other than curettage. 2.2. When 104 cases of functional uterine bleeding were classified according to the endometrial diagnosis of the original curettings, 66 per cent were hyperplastic, 16 per cent interval nonsecretory, 12 per cent secretory, and the remaining 6 per cent were chronic endometritis and atrophic types. 3.3. A total of 234 curettements was done on these 104 patients. Sixty-three per cent of the repeated curettages performed for a recurrence of symptoms showed no change in the endometrial pattern. Of the remaining 36 per cent of patients who showed a variation in pattern, none of the untreated varied from the nonsecretory type to secretory.The patients showing endometrial hyperplasia and other types of nonsecretory endometrium were clinically similar and on subsequent curettages showed the endometrial patterns to be mutually interchangeable. For this reason, no differentiation has been made between these groups in the evaluation of therapy. 4.4. Seventy-four of the 91 patients showing nonsecretory endometrium were considered suitable for cyclic progesterogen therapy in that they constituted a group of young women with severe symptoms which did not respond to other forms of treatment. In 72 cases, the bleeding symptoms were satisfactorily controlled. A patient with an ovarian neoplasm and another with gonorrheal cervicitis and an associated pelvic inflammatory disease failed to respond to therapy. Thirty-one patients had no recurrence of symptoms following the initial three-month cyclic course of medication. Sixteen of these thirty-one patients had no adjunctive therapy. Recurrences which occurred in forty patients were successfully treated again with progesterone. 5.5. Oral progeninolone has been as satisfactory as intramuscular progesterone in the present series, in approximately 90 per cent of the patients. 6.6. Estrogen has been used in conjunction with progesterone only in the two cases of bleeding associated with an atrophic type of endometrium. 7.7. There were thirteen cases showing secretory endometrium and originally considered to be truly functional in type. Of these, however, only four proved to have uncomplicated functional bleeding. These cases had a disturbance in the menstrual interval. In the other nine cases there were prolonged, profuse, but regular menses, although some of these had spotting during the menstrual interval. Six patients in this group showing secretory endometrium were treated with progesterone and none responded to therapy. It has been assumed, therefore, that although progesterogen therapy is excellent in functional bleeding associated with nonsecretory endometrium, it is unsatisfactory in those patients who have abnormal bleeding associated with secretory endometrial patterns.

A clinical and pathologic study of bleeding after the menopause shows that in more than half the patients the cause of the bleeding is malignancy of the generative tract. This being a proved fact, the logical deduction is that a complete investigation of each case is imperative. In many cases this includes an examination of biopsied tissue by a competent gynecologic pathologist. There are, it is true, many benign causes of postmenopausal bleeding, most of which are easily cured, but pathologic studies indicate that the only safe assumption is that malignancy is responsible for the bleeding until unequivocally proved otherwise.

IN THE TREATMENT of patients with menopausal symptoms, estrogen replacement therapy has earned for itself a well-established place. The procedure of administering the hormone parenterally two or three times a week, in order to maintain a sufficient level in the tissues, has decided disadvantages; it is time-consuming for both the patient and the physician, and the frequent hypodermic injections are disagreeable. In order to circumvent the inconvenience and unpleasantness of administration, the use of the orally active estrogen, stilbestrol, has become widespread among gynecologists and practitioners. There can be no doubt of the effectiveness of stilbestrol in controlling menopausal symptoms, but its administration is often associated with undesirable side effects. We have found that 12.5 per cent of 32 patients in the dispensary, and a much higher percentage among private patients, who were treated with oral stilbestrol, were required to discontinue it because of nausea and vomiting. It has been demonstr...

YOU HAVE ASKED me to write the story of the discovery of carcinoma in situ of the cervix, and I am glad to do so, for I believe it represents an important link in our chain of knowledge concerning cervical malignancy. Twenty-five years ago, cervical cancer had a mortality rate of approximately 75 per cent. Today, with cytology and the correct interpretation of biopsies, the disease is almost 100 per cent curable. In 1900, Cullenl published his classic book on cancer of the uterus. In that volume is an excellent picture of what is today recognized as carcinoma in situ (Fig. 41, p. 57). This picture was taken at the margin of an extensive cervical cancer, The legend to the figure is: “Suspicious changes in the epithelium along the outer margin of a squamous cell carcinoma of the cervix.” I knew Cullen very well, and he had no conception of carcinoma in situ. Schauensteir? in 1908, Pronai3 in 1909, and Schottlaender and Krrmauner” in 1912 pictured similar lesions on the periphery of gross invasive cervical cancers. They called the lesions “Zuckerguss” (sugar icing) carcinoma, believing it to be a method of spread of invasive cancer in some instances. In 1910, Isador Rubin, while studying gynecologic pathology in Vienna, reported 3 cases of “incipient” cervical cancer. His pictures are typical of those recognized as cancer in situ today. I am sure Dr.

Intra-abdominal rupture of a pelvic abscess is a serious complication of pelvic inflammatory disease but not so frequent as to indicate operative treatment of all cases of pelvic inflammatory disease. A modern method of treatment has been presented that has lowered the mortality from 90 to 12 per cent at the Johns Hopkins Hospital. Vigorous treatment of shock, antibiotic therapy, deflation of the distended stomach and bowel by the Cantor or Miller-Abbott tube are important preoperative measures. Removal of the pelvic source of infection by subtotal hysterectomy with bilateral salpingo-oophorectomy is usually the operation of choice. This should be done promptly and followed by continued therapy of the type instituted preoperatively.

The investigations of Hitschmann and Adler, 1 which have been confirmed in all essential respects by subsequent workers, have established quite definitely the histologic changes occurring in the endometrium at various phases of the menstrual cycle. There is little or no difference of opinion at the present day concerning the histologic characteristics of the postmenstrual, the interval, and the premenstrual stages. With reference to the menstrual phase, i. e., the phase of actual menstrual bleeding, opinion is not nearly so unanimous. Knowing the picture just before the onset of the period as well as that found just after its close, one might logically assume that the chief feature of the menstrual phase is a transition from the premenstrual high point of development to the low point so characteristic of the postmenstrual phase. Since both the premenstrual and the postmenstrual stages are characterized by an intact endometrial surface, one might further

Every one with any surgical experience will agree that difficulties in voiding play a major role in post-operative discomfort. The closer the field of operation approaches the bladder region, the greater the difficulty in voiding spontaneously and the greater the discomfort from overdistention. Hence, the postoperative care of the bladder concerns the gynecologist more than any other surgeon. In recounting their hospital experiences, patients frequently mention the discomfort from overdistention or from catheterization among their most unpleasant memories. There is, however, an even more important reason than the patient's comfort for the proper handling of the bladder after operation. Many chronic and serious urinary tract lesions have their origin in mismanagement of the bladder at this time. In our experience in female urologic conditions we have been struck with the frequency with which patients date their illnesses from trouble in emptying the bladder after operation. In 1925 a routine was

The principle of estrogen replacement therapy in the management of the menopausal syndrome is well established as sound. Estrogen preparations of proved potency have become available during the past decade, and many satisfactory therapeutic results have been reported. The standard method of administration of these estrogen preparations, however, is far from satisfactory as it requires frequent hypodermic or intramuscular injections of the hormone preparations, usually in oil solutions, repeated as often as two to three times each week. Obviously, if it was possible to supply a patient's estrogen requirement for weeks or even months with a single injection, the ideal method of replacement therapy would be more nearly attained. An approach toward such an ideal method came to hand in 1937 when Deanesly and Parkes 1 announced a new technic in hormone administration whereby solid pellets of crystalline hormone were implanted subcutaneously to be absorbed slowly over a long period

In 1934 James Brawner and I1undertook a study of the treatment of gonococcic vaginitis with estrogenic substance, using amniotin in the various forms that were available at that time. Since our paper published in 1935 we have treated a much larger group of patients, and sufficient time has now elapsed to permit a more seasoned judgment of this treatment. The mode of action of estrogen in curing the disease, the permanence of the cure and the ultimate effect on these young patients have been studied, so that we can now give a more extensive report and arrive at a general evaluation of this method of therapy. For persons not familiar with the earlier work, a brief review of it is given here. Our work followed that of Lewis,2who conceived the idea that estrogen might be of value in treating gonococcic vaginitis in children. Having used the