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What did it mean for eighteen- to twenty-year-old men and women in the nineteenth-century Netherlands to be confirmed--that is, to sit in the front row of the church, dressed in Sunday dress, and be accepted into full church membership? Previous scholarship on confirmation in the Netherlands Reformed Church has mostly focused on theological controversies surrounding the wording of the so-called confirmation questions (three questions about Christian doctrine and morals that confirmants had to answer during the service), treating these controversies as markers of growing struggles between 'wings' or 'parties' in nineteenth-century Dutch Protestantism. Important as these theological controversies were, this article nonetheless approaches confirmation from a different, less frequently explored angle, arguing that confirmation was also, and perhaps especially, a social rite of passage, which symbolically marked transition into a new stage of life, with adult responsibilities in church and society. Drawing on a rich array of published as well as unpublished sources (sermons, booklets, letters, and diaries), the article examines what kind of meanings were associated with this rite of passage, by both clergy and confirmants, and to what extent these meanings changed over the course of the century. It shows that Protestants throughout the nineteenth century tried to hold together, in one way or another, what one may call the 'inward' and the 'outward' aspects of the ritual (expressions of personal conviction and conformation to societal standards of morality). Although they insisted that professions of faith must be made "from the bottom of the heart," they simultaneously equated confirmation with a promise to a virtuous life. Also, while accepting sighs and tears as testifying to the sincerity of a confirmant s profession, many authors explicitly warned against strong emotions that could carry newly confirmed church members away from the narrow path of virtue. [ABSTRACT FROM AUTHOR]

Based on the limited number of reports and our own experience, amyloid involvement of the oral tissues seems to be rather rare, the tongue apparently being the most favoured site. Three such patients have been described in the present treatise. All 3 patients proved to be suffering from multiple mycloma or its prestage. In a previous postmortem study, more than 35% overall incidence of amyloid involvement of the tongue has been reported. In our own postmortem study of 100 tongues not a single case of amyloidosis was encountered. This inconsistency can probably be explained by the different use of stains and their interpretation. Limited experience with immunohistochemical methods for subtyping amyloid has been presented. [ABSTRACT FROM AUTHOR]

Presents the varying views of doctors on the ethics of hymen reconstruction in adolescent girls. Conflicts created by the medical decision on cultural values; Objections on hymen restructuring; Impact of hymen reconstruction on the subjects; Needed medical information regarding the hymen.

Abstract: Objective: Analyse the outcome of pelvic exenteration for gynaecological malignancies in a tertiary referral center. Post-operative in-hospital morbidity, long-term morbidity, disease free and overall survival rates were studied. Study design: Between 1991 and 2004, 42 patients underwent an anterior, total or posterior exenteration for gynaecological malignancies. Follow-up was obtained from patient files; disease free and overall survival were calculated and prognostic factors were studied. Results: A pelvic exenteration was performed in 14 patients for primary and 28 patients for recurrent gynaecological cancers. In-hospital complications occurred in 19 patients (45%) of whom seven patients needed a reoperation (17%). Late complications occurred in 31 patients (75%); 21 reinterventions were performed (50%). Five-year disease free and overall survival was, respectively, 48 and 52%. Age, type of surgery, histology, localisation of the tumour, lateral wall involvement, completeness of resection and primary versus recurrent cancer were not identified as prognostic factors for recurrence or survival. Conclusion: Long-term survival is possible in about 50% of patients after pelvic exenteration for gynaecological cancers, but is associated with significant post-operative morbidity. [Copyright &y& Elsevier]

Traditional clinicopathological features do not predict which patients will develop chemotherapy resistance. TheTP53 gene is frequently altered in ovarian cancer but its prognostic implications are controversial. Little is known on the impact of TP53-downstream genes on prognosis. Using molecular and immunohistochemical analyses we examinedTP53 and its downstream genesp21,BAX and BCL-2 in ovarian tumour tissues and have evaluated the results in relation to clinico-pathological parameters, clinical outcome and response to platinum-based chemotherapy. Associations of tested factors and patient and tumour characteristics were studied by Spearman rank correlation and Pearsons χ[SUP2] test. The Cox proportional hazard model was used for univariate and multivariate analysis. The associations of tested factors with response was tested using logistic regression analysis.TP53 mutation, p21 and BCL-2 expression were not associated with increased rates of progression and death. Expression of TP53 was associated with a shorter overall survival only (relative hazard rate [RHR] 2.01, P = 0.03). Interestingly, when combining TP53 mutation and expression data, this resulted in an increased association with overall survival (P = 0.008). BAX expression was found to be associated with both progression-free (RHR 0.44, P = 0.05) and overall survival (RHR 0.42, P = 0.03). Those patients who simultaneously expressed BAX and BCL-2 had a longer progression-free and overall survival compared to patients whose tumours did not express BCL-2 (P = 0.05 and 0.015 respectively). No relations were observed between tested factors and response to platinum-based chemotherapy. We conclude that BAX expression may represent a prognostic indicator for patients with ovarian cancer and that the combined evaluation of BAX and BCL-2 may provide additional prognostic significance. Traditional clinicopathological features do not predict which patients will develop chemotherapy resistance. TheTP53 gene... [ABSTRACT FROM AUTHOR]

We investigated the potential of weekly cisplatin and daily oral etoposide followed by oral etoposide maintenance therapy in patients with platinum-refractory ovarium cancer. One hundred and seven patients were entered on the study, 98 patients completed the induction therapy consisting of cisplatin at either 50 or 70 mg m(-2) weekly for six administrations plus oral etoposide at a dose of 50 mg daily. Of these 98 patients, 38 had a platinum treatment-free interval of more than 12 months, 32 had an interval between 4 and 12 months, and 28 had progressed during or within 4 months after last platinum therapy. We assessed response rates and time to progression, and also response duration and survival. Analyses were done on the 98 evaluable patients. All 107 patients were considered evaluable for toxicity. Of the 38 patients with a treatment-free interval of more than 12 months, 92% responded, with 63% complete responses. The median progression-free survival in these patients was 14 months, and the median survival was 26 months. Of the 32 patients with an interval of 4-12 months, 91% responded, with 31% complete responses, a median progression-free interval of 8 and a median overall survival of 16 months. Of the 28 patients with platinum-refractory disease, 46% as yet responded, with 29% complete responses, median progression-free interval of 5 and an overall survival of 13 months. Haematologic and non-haematologic, particularly renal toxicity and neurotoxicity, were notably mild. We conclude that this intensive regimen of weekly cisplatin plus daily etoposide is highly effective and well tolerated in patients with ovarian cancer relapsing after conventional platinum-based combination chemotherapy, including patients who have progressed during or within 4 months after platinum treatment. [ABSTRACT FROM AUTHOR]

Immunocytochemical detection of prognostic markers in breast cancer; technical considerationsThe purpose of this study was to establish a good technical procedure for immunocytochemical (IC) staining of prognostic markers in breast cancer specimens. The influence of various preparation, fixation and storage methods on ER, P53 and Ki-67 IC staining was assessed, using cells of two breast cancer cell lines T47D (ER/P53+) and ZR-75-ER (ER+, P53-). In addition we searched for a suitable transport medium. Depending on the technical procedure, great variations in expression of the tested antigens were found. Cytospins fixed and stored according to the Abbott method gave the best results. Histocon appeared to be the medium of choice. A good concordance of IC and immunohistochemical (IH) results was found when the adopted method was tested on material of 10 breast cancers. This study underlines the importance of quality controlled standardization of cell processing, fixation and storage of fine needle aspiration (FNA) aspirates in order to obtain reproducible and consistent IC results. [ABSTRACT FROM AUTHOR]

We investigated the feasibility and the anti-tumour activity of weekly cisplatin and the simultaneous application of local hyperthermia in patients with a pelvic recurrence of cervical cancer in previously irradiated area. Dose levels of cisplatin 60 mg m[SUP-2], 70 mg m[SUP-2]and 80 mg m[SUP-2]were studied. Treatment objective of hyperthermia was the achievement of a tumour temperature of ≥ 42° for 60 min, during cisplatin administration. The protocol advised six weekly cycles of combined treatment. Nineteen patients, median age 47 years (range 26-71), were treated. A total of 89 cycles of combined treatment were administered. Even at the highest dose level of cisplatin, 80 mg m[SUP-2]weekly, no dose-limiting toxicity was observed. Leucocytopenia at scheduled retreatment resulted in 1 or 2 weeks postponement in five cases. Neurotoxicity and renal toxicity were mild or absent. Maximum tumour temperatures achieved ranged 39.7-43.6°C, mean 41.6± 0.7°C. All 19 patients were evaluable for response. One patient achieved a complete response that lasted 20 months, and nine patients achieved a partial response for a median duration of 6 months (range 4-50+ months), for an overall response rate of 53%. One patient subsequently underwent salvage surgery and currently remains free of disease at 4 years. We found that this combined hyperthermia-dose-intensive cisplatin regimen was well-tolerated. The true impact of the combination of cisplatin and locoregional hyperthermia can only be answered in a randomized study. Nonetheless, based on existing data on the poor efficacy of cisplatin in pelvic recurrent cervical cancer, we believe that the combined modality approach of weekly hyperthermia plus dose-intensive cisplatin is an attractive regimen, particularly if subsequent salvage surgery is available. [ABSTRACT FROM AUTHOR]

Background: Women with a BRCA1 or BRCA2 mutation have a high risk of breast cancer and may choose to undergo prophylactic bilateral total mastectomy. We investigated the efficacy of this procedure in such women. Methods: We conducted a prospective study of 139 women with a pathogenic BRCA1 or BRCA2 mutation who were enrolled in a breast-cancer surveillance program at the Rotterdam Family Cancer Clinic. At the time of enrollment, none of the women had a history of breast cancer. Seventy-six of these women eventually underwent prophylactic mastectomy, and the other 63 remained under regular surveillance. The effect of mastectomy on the incidence of breast cancer was analyzed by the Cox proportional-hazards method in which mastectomy was modeled as a time-dependent covariate. Results: No cases of breast cancer were observed after prophylactic mastectomy after a mean (±SE) follow-up of 2.9±1.4 years, whereas eight breast cancers developed in women under regular surveillance after a mean follow-up of 3.0±1.5 years (P=0.003; hazard ratio, 0; 95 percent confidence interval, 0 to 0.36). The actuarial mean five-year incidence of breast cancer among all women in the surveillance group was 17±7 percent. On the basis of an exponential model, the yearly incidence of breast cancer in this group was 2.5 percent. The observed number of breast cancers in the surveillance group was consistent with the expected number (ratio of observed to expected cases, 1.2; 95 percent confidence interval, 0.4 to 3.7; P=0.80). Conclusions: In women with a BRCA1 or BRCA2 mutation, prophylactic bilateral total mastectomy reduces the incidence of breast cancer at three years of follow-up. (N Engl J Med 2001;345:159-64.) [ABSTRACT FROM AUTHOR]

Discusses the case studies of patients with paraneoplastic cerebellar ataxia due to autoantibodies against a glutamate receptor. Types of cerebellar ataxia; Causes, including ataxia due to congenital or metabolic disorders in people with certain forms of cancer; Treatment.