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Background South Africa is a middle-income country with major discrepancies in wealth and access to care. There is a significant burden of surgical disease and limited access to quality health care for a large proportion of the population. This article quantifies the burden of abdominal surgery over a 6-month period in KwaZulu-Natal (KZN) province and quantifies the emergency to elective (Ee) ratio for these operations. Methods This study describes the abdominal operations conducted at all regional and tertiary hospitals in the public health sector of KZN province for the period of 1 July to December 31, 2015. Operations performed were tabulated in a spreadsheet and categorized as elective, emergency, and trauma. They were further subdivided by anatomical region and by specific predetermined procedures. Uncertain criteria were clarified using a modified Delphi discussion. The Ee ratio was determined using the recently described technique. Results Between June, 1st and December 31, 2015, of 13,282 operations, there were 4580 (34.5%) elective operations, 7777 (58.6%) emergency operations, and 925 (6.9%) trauma-related operations. A total of 5630 abdominal operations were performed of which 2949 were emergency procedures. There were 660 trauma-related abdominal procedures and 2021 elective procedures. There was a heavy weighting toward emergency surgeries with an Ee ratio of 145 for abdominal surgery. The previous sub-Saharan African ratio was estimated to be 62.6. Conclusions An overview of abdominal surgery in KZN reveals a high ratio of emergency to elective surgery. This suggests that the current primary health care program is failing to detect and treat acute surgical disease timeously.

The current surgical workload assessments in KwaZulu-Natal (KZN) are inadequate to inform strategies to improve surgical services. Breast diseases have a well-defined spectrum and surgical treatment options, analysis of which could guide health policy in the field. This project aimed to quantify and analyse the operative workload for breast pathology in KZN.A retrospective review of breast-related operations conducted at public sector hospitals in KwaZulu-Natal province between 1 July and 31 December 2015 was undertaken. Data was collected from theatre operative registers and manually categorised as follows: sepsis, benign pathology, malignant pathology, and by hospital, according to geographic location, and complexity of care to determine factors to improve the service for breast care in the province.In the 6-month study period, 13 282 general surgical procedures were performed of which 776 (5.8%) were breast-related operations. There were 372 (47.9%) operations for breast sepsis, 140 (18%) for benign breast lesions, 17 (2.2%) for cosmetic indications and 27 (3.5%) for diagnostic procedures. There were 223 (28.7%) procedures for nonbenign disease: 21 (2.6%) wide local excisions (WLE), 203 (26.2%) mastectomies of which 161 (72.2%) mastectomies had an axillary lymph node dissection and 26 (11.7%) were performed as onco-plastic procedures. Hospitals in the Durban and Pietermaritzburg metropolitan areas performed 75% of the breast-related procedures. The majority (69.6%) of sepsis-related procedures were performed at secondary/regional facilities, while 58.3% of non-benign breast surgeries were performed at tertiary and quaternary centres.Breast sepsis accounts for almost 50% of the surgery and is mainly dealt with at hospitals above district level. One-third of breast surgery in KZN province is for non-benign disease. There is a paucity of breast-conserving surgery. Elucidation of these observations can guide improvement in the provincial breast care service.

In biology, self-assembly of proteins and energy-consuming reaction cycles are intricately coupled. For example, tubulin is activated and deactivated for assembly by a guanosine triphosphate (GTP)-driven reaction cycle, and the emerging microtubules catalyze this reaction cycle by changing the microenvironment of the activated tubulin. Recently, synthetic analogs of chemically fueled assemblies have emerged, but examples in which assembly and reaction cycles are reciprocally coupled remain rare. In this work, we report a peptide that can be activated and deactivated for self-assembly. The emerging assemblies change the microenvironment of their building blocks, which consequently accelerate the rates of building block deactivation and reactivation. We quantitatively understand the mechanisms at play, and we are thus able to tune the catalysis by molecular design of the peptide precursor.

Introduction Les patients atteints d’une resistance aux hormones thyroidiennes (RHT) presentent classiquement un goitre par hyperstimulation de la glande par la thyreostimuline (TSH). Nous presentons trois cas de complications thyroidiennes chez des patients atteints de RHT avec mutation du recepteur β (RHTB). Observations Monsieur D., 40 ans, presente une RHTB decouverte sur un bilan thyroidien, effectue dans le cadre d’une cardiopathie dilatee severe avec ACFA. Le bilan extensif revele une hyperfixation nodulaire thyroidienne en TEP-FDG, classee EU-TIRADS IV en echographie, dont la ponction est en faveur d’un neoplasme oncocytaire. L’indication d‘une intervention chirurgicale est retenue. Madame C., 53 ans, atteinte de RHTB, presente un goitre multinodulaire de developpement rapide (18 a 33 mL en un an), avec plusieurs nodules classes TIRADS III, et hyperfixation diffuse a la scintigraphie. Le goitre est actuellement stable, surveille annuellement. Madame S., 29 ans, 3 enfants, presente une RHTB diagnostiquee devant l’association d’un goitre et d’hormones libres elevees avec TSH inadaptee. Tandis que le volume thyroidien se majore de 23 a 77 mL en 3 ans, aux depens essentiellement du lobe droit, avec une T4L superieure aux normes, la TSH s’abaisse progressivement. Un nodule extinctif et un retrecissement tracheal minimal a 8 mm sont mis en evidence, justifiant une hemi-thyroidectomie. L’enquete familiale est en cours. Discussion Les complications thyroidiennes des patients atteints de RHTB sont variees. La decision d’un traitement chirurgical est delicate, etant donne les difficultes de suivi et d’adaptation de la substitution. Le TRIAC pourrait permettre une reduction du goitre dans certains cas.

Les hyperthyroidies liees a l’amiodarone ont un pronostic cardiovasculaire grave majorant le risque de mortalite de 30 a 50 % [1] . La thyroidectomie est proposee par l’ETA comme une procedure de sauvetage chez les patients ayant une deterioration de la fonction cardiaque liee a une cardiopathie severe ou une arythmie maligne [2] . Son benefice est prouve chez les patients a FEVG alteree reduisant la mortalite a 10 ans en comparaison avec le traitement medical. Une recuperation cardiaque est decrite avec le retablissement de l’euthyroidie [3] . Nous detaillons ici les modalites de prise en charge perioperatoire de 3 patients thyroidectomises en urgence. Chez les 3 patients, les thyroidectomies ont ete realisees en phase d’hyperthyroidie. Tous presentaient une cardiopathie severe avec une fonction systolique alteree (FEVG ≤ a 40 %) rendant la situation cardiologique instable. Deux patients ont presente une hyperthyroidie de type 1 sur goitre multinodulaire. Le delai entre le diagnostic d’hyperthyroidie et l’introduction d’antithyroidiens de synthese etait de 3 mois. La thyroidectomie a eu lieu 5 et 6 mois apres le debut de l’hyperthyroidie. Le troisieme patient presentait une hyperthyroidie de type 2 traitee par corticotherapie des le diagnostic. La thyroidectomie a ete realisee apres 3 mois de traitement medical. Des seances de plasmapherese ont ete necessaires en preoperatoire. Les suites operatoires ont ete simples. Aucune recuperation de la fonction cardiaque n’etait observee en post operatoire malgre l’euthyroidie. Les deux patients avec hyperthyroidie de type 1 ont beneficie d’une transplantation cardiaque. En resume, malgre une chirurgie a risque, la thyroidectomie n’a pas engendre de complication immediate au decours. En revanche, nous n’avons pas observe d’amelioration cardiaque, peut-etre en raison du retard a l’instauration du traitement medical dans les hyperthyroidies de type 1 et/ou en raison du caractere trop tardif de la thyroidectomie. L’instabilite cardiaque doit donc pousser a une prise en charge rapide de l’hyperthyroidie.

Objective Lymphovascular space invasion (LVSI) is a poor prognostic indicator in uterine cancer, primarily due to its association with lymph node metastases. We sought to determine if LVSI provides any prognostic information for uterine cancer subjects in the absence of nodal disease. Methods A retrospective review was performed using a database of women treated for uterine cancer at MUSC from 2005 to 2012. Subjects with negative nodes after complete staging were identified. Multiple regression modeling was used to adjust for demographic and histopathologic covariates. The C-index was calculated for models of survival that included LVSI and those that did not. Competing risks analysis was conducted to examine factors associated with time to recurrence. Results Two hundred and five subjects were completely staged and had negative nodes, 24 with LVSI and 181 without. Factors significantly associated with survival included age, race, stage, grade, histology, and LVSI. Regression models for recurrence-free survival (RFS) and overall survival (OS) had similar C-indices regardless of whether LVSI was included. Competing risks analysis confirmed no significant difference in time to recurrence for subjects with LVSI compared to those without, after adjusting for other prognostic factors ( P =0.53). Conclusions LVSI is associated with shorter recurrence-free and overall survival in uterine cancer subjects with negative lymph nodes. However, after adjusting for other prognostic factors, LVSI status does not provide additional prognostic information. This finding suggests that recurrence-free and overall survival for uterine cancer patients with negative lymph nodes can be estimated without factoring in LVSI.

Introduction Le syndrome de Goldenhar ou dysplasie oculo-auriculo-vertebrale (DOAV) est un syndrome malformatif en rapport avec des anomalies de developpement du premier arc branchial se manifestant notamment, par une asymetrie du visage avec hypoplasie mandibulaire, une microphtalmie et des malformations rachidiennes. Il n’y a pas d’atteintes endocriniennes decrites ce jour. Observation Nous rapportons le cas d’une patiente de 41 ans presentant un syndrome de Goldenhar avec atteinte principalement rachidienne. Elle ne presente pas d’autres antecedents, notamment l’absence d’episode de pancreatite aigue. Elle declare l’absence de consommation alcolo-tabagique. Sa famille est indemne de toute maladie chronique. Nous la rencontrons pour la decouverte d’un diabete sur syndrome cardinal typique, sans acidocetose au diagnostic, avec une HbA1c a 15,3 %. Cliniquement, la patiente decrit des steatorrhees et une perte de 15 kg en un an (14 % du poids). Les explorations biologiques confirment l’insulinopenie, et ecartent l’hypothese d’un diabete d’origine auto-immune, secondaire a une endocrinopathie ou une lipodystrophie. L’exploration scanographique abdominale revele une pancreatite chronique calcifiante. Un mois apres la decouverte de diabete, la patiente presente un episode de decompensation cardiaque droite secondaire a une pericardite chronique constrictive avec calcifications majeures dont le bilan etiologique reste negatif. Conclusion Aucune association entre pericardite, pancreatite calcifiantes et DOAV, n’est connue a ce jour. Des facteurs environnementaux, d’exposition fœtale ou en post-partum, semblent etre impliques. Une enquete genetique est en cours chez notre patiente (CFTR, SPINK 1, PRSS1, PPARg). Cette decouverte de diabete atypique pourrait nous amener a apprehender une nouvelle forme de la DOAV.

Introduction Les diabetes de type 1 et les diabetes monogeniques constituent habituellement 2 entites distinctes. Observation Melle M, 23 ans, sans antecedent personnel, presente une perte de 20 kg en 1 an, revelant un diabete (glycemie > 2 g/l sans cetose, HbA1c 10,7 %). Son frere, un oncle et une tante sont diabetiques de type 1. Le bilan confirme le diabete auto-immun de type 1 (DT1) (Anticorps anti GAD 6,5 U/ml, IA2 14873 U/ml, ilots de langerhans positifs et Znt8 24,4U/ml, typage HLA DR4Dq3 susceptible pour le DT1). Cependant la presentation clinique de la patiente (pseudo-hypertrophie des mollets, lipoatrophie peri-humerale, visage arrondi erythrosique) et la persistance d’une insulinosecretion (C peptide a 1,7 ng/ml en regard d’une glycemie a 2,29 g/l), evoquent une laminopathie confirmee par l’identification d’un variant heterozygote LMNA p.(Arg482Gln), associe aux lipodystrophies partielles familiales de type 2 (FPLD2). Dix-huit mois plus tard, la patiente est bien equilibree sous insulinotherapie en pompe (HbA1c 6,2 %), sans signe d’insulino-resistance en depit de nombreuses lipodystrophies malgre le changement frequent des pods et capteurs. Une enquete familiale est envisagee. Conclusion Cette observation souleve la question des liens entre diabete, auto-immunite, syndromes lipodystrophiques et laminopathies. L’association DT1 et lipodystrophies generalisees acquises a deja ete decrite. Ces diabetes sont souvent instables et insulino-resistants. L’association DT1 et FPLD2 n’a jamais ete rapportee, a la difference de l’association a des hepatites et des thyropathies autoimmunes. Ceci suggere un effet facilitant des laminopathies/lipodystrophies sur l’auto-immunite, peut-etre par le biais de l’inflammation.

Introduction L’hypophysite granulomateuse est une pathologie rare dont le diagnostic difficile s’appuie sur l’anatomopathologie. Nous rapportons le premier cas de la litterature, l’associant a une rectocolite hemorragique (RCH) dans un contexte de post-partum. Observation Madame M., âgee de 28 ans, ayant comme principal antecedent une RCH compliquee d’une colite aigue grave traitee par colectomie totale. Elle est admise aux urgences 1 semaine apres l’accouchement pour une aggravation des cephalees, evoluant depuis la fin de grossesse, avec apparition de troubles visuels. L’IRM cerebrale objective une volumineuse masse de 22 mm intra- et suprasellaire, avec compression du chiasma optique, en faveur d’un macroadenome. L’exploration hormonale revele une insuffisance corticotrope isolee. Le bilan neuro-ophtalmologique objective une baisse de l’acuite visuelle a 2/10 a droite avec hemianopsie bitemporale, imposant la realisation en urgence d’une exerese neurochirurgicale. A notre surprise, l’anatomopathologie conclut a une hypophysite granulomateuse. Le bilan etiologique realise elimine tuberculose, sarcoidose, histiocytose, granulomatose avec polyangeite et syphilis. La reevaluation a distance objective une recuperation visuelle complete avec diminution de la masse intra- et suprasellaire. Discussion L’association hypophysite granulomateuse et post-partum est rare : 2 cas ont ete rapportes. Un cas associe a une maladie de Crohn a ete decrit, mais aucun ne rapporte l’association entre hypophysite et RCH, confirmee ici lors de la colectomie. Si la prise en charge chirurgicale en cas d’atteinte visuelle est validee, l’indication d’une corticotherapie en urgence est souvent retenue. Encore faudrait-il evoquer l’hypophysite en preoperatoire…

Les mutations du gene LMNA se presentent sous des phenotypes heterogenes s’etendant des cardiopathies (dysrythmies surtout favorisees par les mutations non-R482) aux lipodystrophies dont la forme partielle familiale est caracterisee par une mutation R482 et une augmentation de la graisse intra-abdominale (GIA). L’objectif de cette etude etait de comparer le phenotype metabolique de patients porteurs d’une mutation LMNA-R482, non-R482 et de temoins. Methode Composition corporelle (DEXA/IRM) et parametres metaboliques ont ete compares chez 29 mutes LMNA-non-R482, 29 mutes R482 et 19 temoins sains (Clin.gov2009-AO-1169-48). Resultats L’âge et le sexe ne differaient pas entre les groupes. IMC (p Conclusion Le groupe non-R482 avait l’IMC, le pourcentage de masse grasse et la leptinemie les plus eleves des 3 groupes. Leur rapport GIA/GAT etait intermediaire entre les temoins (non diabetiques) et les R482, deux fois plus souvent diabetiques qu’eux. GIA/GAT etait le marqueur diagnostique le plus specifique permettant de distinguer les 3 groupes, bien correle au syndrome metabolique.

Necrotizing fasciitis and toxic shock syndrome are life-threatening conditions that can be seen after any surgical procedure. With only 4 previous published case reports in the obstetrics and gynecology literature of these two conditions occurring secondary toClostridium septicum, we describe a case of necrotizing fasciitis and toxic shock syndrome occurring after a term cesarean delivery caused by this microorganism, requiring aggressive medical and surgical intervention.

Biochars are adsorptive solids potentially of benefit to soil microbes by providing improved nutrient retention, a carbon substrate and contaminant adsorption. A 28-day incubation experiment gauged the interactive effects of biochar application and contaminants on the microbial biomass and respiration of a sandy loam soil. Soil was amended with 250 mg/kg phenol or p-nitrophenol (two toxic but nevertheless biodegradable organic contaminants) or 50 mg/kg cadmium or copper. Biochar application generally caused increased microbial respiration and biomass relative to non-amended controls. Of the heavy metal-amended soils, Cu effected significant reductions in microbial biomass carbon and basal respiration, which were improved with concurrent biochar amendment. The biochar’s functional groups are likely to have mitigated the metals’ negative effects via complexation and sorption, while the soil’s proportion of negative pH-dependent sites was increased by the pH rise induced by biochar application, allowing more cationic retention. Organic contaminant-spiked soils had higher microbial biomass-specific respiration without biochar amendment, indicating that surviving microbes utilised the compounds and necromass as substrates. Paranitrophenol proved to be particularly toxic without biochar application, causing marked reductions in the microbial quotient and biomass carbon. Remarkably, concurrent biochar and pNP application led to hugely increased microbial biomass carbon and nitrogen, significantly higher than those in contaminant-free replicates. It is likely this arose from biochar sorbing the contaminant and allowing its microbial utilisation as a carbon and nitrogen source, stimulating growth. Biochar application is a highly promising strategy for reducing the soil microbial toxicity of heavy metals and aromatic organic contaminants, particularly p-nitrophenol.

The current recommended treatment for stage Ia2 cervical cancer is a radical or modified radical hysterectomy. Although in the United States the incidence of cervical cancer is low and declining, almost 50% of the >4000 new cases will present in early stages. An estimated 2200 women each year will undergo radical hysterectomy and many will have both early- and late-onset complications. The purpose of this review is to examine if there is still a role for radical hysterectomy in the proper treatment of stage Ia2 cervical cancer given most recent data. Sufficient histological evidence suggests that although parametrial involvement and lymph node metastases can increase the risk for recurrence, they are relatively uncommon at early stages. Worldwide data that challenge radical hysterectomy as standard of care have shown that conservative management of stage Ia2 cervical cancer results in similar survival and recurrence rates. It is the recommendation based on all reviewed data that radical hysterectomy should no longer be considered standard of care in all cases of stage Ia2 cervical cancer.

Cervical cancer classified as stage IA2 and IB1 according to the International Federation of Gynecology and Obstetrics has historically been treated with radical hysterectomy and bilateral lymph node dissection, but recent recommendations suggest more conservative treatment modalities. We report a woman with stage IA2 cervical cancer at low risk for parametrial spread including no lymphovascular space invasion, clear conization margins, and tumor size less than 2 cm, who underwent radical hysterectomy and was found to have a single positive metastatic parametrial lymph node. This case report is an important reminder that parametrial involvement occurs in low-risk early-stage cervical cancers.

Purpose: To evaluate whether Point A asymmetry in low dose-rate (LDR) brachytherapy is associated with local con trol (LC), disease-free survival (DFS) and/or overall survival (OS). Material and methods: Aretrospective analysis of disease control and survival outcomes was conducted for patients who underwent LDR brachytherapy for advanced cervical cancer. Institutional protocol entailed concurrent chemotherapy and whole pelvis radiotherapy (WPRT) over 5 weeks, followed by placement of Fletcher-Suit tandem and colpo stat applicators at weeks 6 and 8. Objective Point A doses, 80-85 Gy, were accomplished by placement of Cesium-137 (Cs-137) sources. Cox proportional hazards regression models were used to assess associations between disease control and survival endpoints with variables of interest. Results: The records of 50 patients with FIGO stage IB1-IVA cervical cancer undergoing LDR brachytherapy at our institution were identified. Thirty of these patients had asymmetry > 2.5%, and 11 patients had asymmetry > 5%. At a me dian survivor follow-up of 20.25 months, 15 patients had experienced disease failure (including 5 cervical/vaginal apex only failures and 2 failures encompassing the local site). Right/left dose asymmetry at Point A was associated with sta tistically significantly inferior LC ( p= 0.035) and inferior DFS ( p= 0.011) for patients with mean Point A dose of > 80 Gy . Insufficient evidence existed to conclude an association with OS. Conclusions: LDR brachytherapy may be associated with clinically significant dose asymmetry. The present study demonstrates that patients with Point A asymmetry have a higher risk of failure for DFS and LC. J Contemp Brachyther 2012; 4, 1: 3-7 DOI: 10.5114/jcb.2012.27945

Objectives A phase II clinical trial compared docetaxel in combination with carboplatin to sequential single agent docetaxel followed by carboplatin for treatment of recurrent platinum-sensitive ovarian, peritoneal, or tubal cancer. This manuscript reports prospectively collected health-related quality of life (HRQL). Methods Participants were randomized to either weekly docetaxel 30mg/m 2 /days 1 and 8 and carboplatin AUC 6/day 1 every 3weeks (cDC) or docetaxel 30mg/m 2 /days 1 and 8, repeated every 3weeks for 6cycles followed by carboplatin AUC 6/day 1 every 3weeks for 6cycles or until disease progression (sDC). The primary HRQL endpoint was the trial outcome index (TOI) score of the Functional Assessment of Cancer Therapy-Ovarian (FACT-O) instrument, and was assessed as an intent-to-treat analysis. The secondary HRQL endpoints included the FACT-O total score, the FACT-General, and several domain scores of the FACT-O instrument (physical well-being (PWB), social/family well-being (SWB), emotional well-being (EWB), functional well-being (FWB), and the ovarian cancer specific (OCS) module). The FACT-O was administered at randomization, prior to each of 6cycles of treatment, and at study endpoint. Results One hundred forty-eight participants were randomized to each group. Sequential docetaxel followed by carboplatin (sDC) was associated with significant improvements in the FACT-O TOI (p=0.013), FACT-O total score (p=0.033), and OCS (p=0.029) compared to the combination docetaxel and carboplatin group (cDC). Conclusions Sequential single agent docetaxel followed by carboplatin is associated with improved HRQL when compared to cDC. The improved progression-free survival observed with cDC should be weighed against lower quality of life during treatment.

BACKGROUND: The aim of this randomized clinical trial was to evaluate the efficacy and safety of combination (cDC) and sequential (sDC) weekly docetaxel and carboplatin in women with recurrent platinum-sensitive epithelial ovarian cancer (EOC). METHODS: Participants were randomized to either weekly docetaxel 30 mg/m2 on days 1 and 8 and carboplatin area under the curve (AUC) = 6 on day 1, every 3 weeks or docetaxel 30 mg/m2 on days 1 and 8, every 3 weeks for 6 cycles followed by carboplatin AUC = 6 on day 1, every 3 weeks for 6 cycles or until disease progression. The primary endpoint was measurable progression-free survival (PFS). RESULTS: Between January 2004 and March 2007, 150 participants were enrolled. The response rate was 55.4% and 43.2% for those treated with cDC and sDC, respectively. The median PFS was 13.7 months (95% confidence interval [CI], 9.9-16.8) for cDC and 8.4 months (95% CI, 7.1-11.0) for sDC. On the basis of an exploratory analysis, patients treated with sDC were at a 62% increased risk of disease progression compared to those treated with cDC (hazard ratio = 1.62; 95% CI, 1.08-2.45; P = .02). The median overall survival time was similar in both groups (33.2 and 30.1 months, P = .2). The incidence of grade 2 or 3 neurotoxicity and grade 3 or 4 neutropenia was higher with cDC than with sDC (11.7% vs 8.5%; 36.8% vs 11.3%). The sDC group demonstrated significant improvements in the Functional Assessment for Cancer Therapy–Ovarian, Quality of Life Trial Outcome Index scores compared with the combination cohort (P = .013). CONCLUSIONS: Both cDC and sDC regimens have activity in recurrent platinum-sensitive EOC with acceptable toxicity profiles. The cDC regimen may provide a PFS advantage over sDC. Cancer 2011. © 2011 American Cancer Society.

BACKGROUND: In a randomized controlled trial (RCT) of patients with recurrent, platinum-sensitive ovarian cancer, the combination weekly docetaxel and carboplatin was associated a with progression-free survival (PFS) of 13.7 months compared with 8.4 months for sequential, single-agent docetaxel followed by carboplatin. The objective of the current study was to construct a cost-utility model to compare these 2 regimens with the incorporation of prospectively collected quality-of-life (QoL) data. METHODS: An RCT of concurrent docetaxel and carboplatin (cDC) versus docetaxel followed by carboplatin (sequential docetaxel and carboplatin [sDC]) was the basis for a Markov decision model, and the primary effectiveness outcome was PFS. Costs were estimated using US dollars based on Medicare reimbursements for chemotherapy regimens, bone marrow support, and management of adverse events. QoL data obtained using the Functional Assessment of Cancer Therapy-General questionnaire were converted to utilities. Costs and incremental cost-effectiveness ratios (ICERs) were reported in US dollars per quality-adjusted life year (QALY). Extensive 1-way sensitivity analyses and a Monte Carlo probabilistic sensitivity analysis were performed. RESULTS: The least expensive strategy was sDC, which cost an average of $20,381, compared with cDC, which cost an average of $25,122. cDC had an ICER of $25,239 per QALY compared with sDC. cDC remained cost-effective, with an ICER

Die Vielzahl der vorhandenen Assessmentinstrumente zur Mobilitatsmessung von beinamputierten Menschen erschwert den Vergleich des Outcomes von Rehabilitationsmasnahmen und Prothesenversorgung sowohl in nationalen als auch in internationalen Studien. Eine interna­tional besetzte Projektgruppe entwickelt derzeit ein ICF-basiertes Assessmentinstrument, das dieses Defizit beheben soll. Eine erste Version wurde auf einer Konsensuskonferenz im Februar 2014 in Shanghai verabschiedet und befindet sich derzeit in der Validierungsphase. Auf dem 9. Weltkongress der ISPRM (Juni 2015 in Berlin) wird das Assessmentinstrument vorgestellt und anschliesend der Allgemeinheit zur Verfugung gestellt.

Introduction La decouverte d’une lesion suprasellaire necessite un bilan etiologique rigoureux comprenant une evaluation hormonale et morphologique. Observation Une patiente de 36 ans est adressee pour bilan etiologique d’une lesion suprasellaire etiquetee adenome hypophysaire. Cette lesion de 31 × 23 × 36 mm avait ete decouverte sur une IRM cerebrale realisee pour acouphenes evoluant depuis 1 mois associee a une diplopie binoculaire. La lesion presentait une extension supra- et latero-sellaire gauche avec envahissement du sinus caverneux homolateral et refoulement du chiasma optique. La lesion etait parfaitement arrondie, homogene a l’injection de gadolinium. Cliniquement, il existait une paralysie du nerf VI gauche et une diplopie binoculaire. Le fond d’œil et le champ visuel etaient normaux. Le bilan hormonal hypophysaire mettait en evidence un deficit thyreotrope et somatotrope associe a une hyperprolactinemie de deconnexion, sans autre hypersecretion hormonale. Une supplementation par hormones thyroidiennes etait instauree. Devant cette lesion « trop parfaite », un angioscanner cerebral etait realise permettant de rectifier le diagnostic initial. Il s’agissait d’un anevrysme carotido-caverneux gauche unique non rompu, envahissant la selle turcique et exercant un effet de masse sur la citerne optochiasmatique et le chiasma optique. L’hypophyse n’etait pas individualisable. La patiente a beneficie d’une prise en charge endovasculaire avec mise en place d’un stent et coiling du sac anevrysmal. Discussion L’anevrysme carotido-caverneux est une cause rare d’hypopituitarisme par compression extrinseque, mais constitue l’un des diagnostics differentiels de l’adenome hypohysaire. La frequence serait de 0,17 % des hypopituitarismes (Heshmati, 2001). Il est notamment caracterise par un vide de signal en T2*.

Introduction L’etat d’hyperhormonemie thyroidienne est parfois difficilement accessible aux antithyroidiens de synthese (ATS). Ces molecules peuvent conduire d’une part, a des effets hematologiques, certes rares mais graves, et d’autre part, a des urticaires generalisees invalidantes, voire des œdemes de Quincke, ce qui pousse a proposer rapidement un traitement radical, par iratherapie par exemple. On connait l’impact des sels de lithium sur la fonction thyroidienne depuis 1973 : ils entrainent une desiodation de la T4, une diminution du relargage hypothalamique de TRH mais aussi une modulation du relargage de l’iode au niveau thyroidien. Materiel Nous rapportons ici notre etude portant sur 17 patients (16 atteints d’une maladie de Basedow et un d’un goitre multiheteronodulaire toxique) traites par lithium avant et pendant l’iratherapie. L’objectif etait de documenter notre pratique et d’evaluer la rapidite de la remission biologique et clinique de l’hyperthyroidie apres traitement. Resultats Nous avons releve les profils des patients au moment du diagnostic (29 % en euthyroidie, 6 recidives, âge median de 61 ans) ainsi que les indications a l’iratherapie (intolerance grave aux ATS [62,5 %], chirurgie contre-indiquee [11,7 %], inefficacite des traitements [17,6 %], autres [8,2 %]). Certains patients etaient traites de facon concomitante par cholestyramine (58,8 %) et/ou par corticotherapie (29 %). Les effets indesirables ont ete repertories. Nous avons ensuite etudie leur bilan thyroidien a 1, 3 et 6 mois. Le delai moyen d’obtention de l’euthyroidie etait de 6 semaines. Discussion Nos resultats etaient comparables aux donnees de la litterature. Le lithium est une des cles de l’optimisation du traitement des hyperthyroidies compliquees.

Introduction L’association d’un adenome hypophysaire avec un craniopharyngiome est extremement rare, avec une dizaine de cas rapportes dans la litterature. Observation Un patient de 48 ans consulte pour une baisse d’acuite visuelle droite. L’examen clinique oriente rapidement vers un hypersomatotropisme, confirme par les resultats biologiques (IGF-1 a 1068 ng/mL [N Discussion Les quelques cas rapportes d’association entre craniopharyngiome et adenome hypophysaire concernent des prolactinomes (Guaraldi et al., Endocrine 2013). Ici, l’hypothese principale repose sur la survenue d’une hypersecretion d’hormone de croissance influencant le developpement d’un craniopharyngiome, probablement preexistant et latent. Des troubles de la differenciation cellulaire, une mutation genetique, des facteurs environnementaux ou encore une association fortuite sont les autres hypotheses physiopathologiques.

Introduction Le SBS est un syndrome lipodystrophique partiel considere comme acquis caracterise par une lipoatrophie cephalothoracique progressive, d’origine mal connue immunologique (complement) ou genetique (LMNB2…). Cette etude avait pour but de preciser le phenotype metabolique du SBS en comparaison a des temoins sains et des syndromes lipodytrophiques partiels familiaux de type 2 (FPLD2) lies a une laminopathie. Patients et methodes Cette etude retrospective monocentrique a compare les parametres metaboliques et anthropometriques (DEXA, IRM) de 6 SBS, 16 femmes FPLD2 et 9 femmes temoins sains appariees pour l’âge. Resultats Cinq femmes et un homme le seul avec C3Nef et nephropathie, tous d’origine caucasienne presentaient un SBS dont quatre, familial. Trois patients avaient un diabete, deux une intolerance, quatre une hypertriglyceridemie, trois une steatose hepatique (10–28 % ; IRM), deux une degenerescence graisseuse musculaire. Les cinq femmes SBS, dont une mutee LMNA , avaient un(e) IMC (29(26–33) vs. 22(20–22)kg/m 2 ; p = 0,0035), glycemie a jeun (0,93(0,91–1,80) vs. 0,83(0,79–0,84)g/L ; p = 0,006), HbA1c (8,7(5,4–12,0) vs. 5(4,9–5,1) % ; p = 0,0098), leptinemie (31(30–32) vs. 10(4–13)ng/mL ; p = 0,002), graisse intra-abdominale (GIA : 122(110–139) vs. 21(19–35)cm 3 ; p = 0,0098), rapport graisse intra-abdominale/abdominale totale (GIA/GAT : 0,39(0,29–0,53) vs. 0,11(0,10–0,18) ; p = 0,0112) et CRP (3(3–4) vs. 0(0)mg/L ; p = 0,0005) augmente(e) compares aux temoins. Lipides, insulinemie et pourcentage de masse grasse (%DEXA) ne differaient pas entre SBS et temoins. Leptinemie (FPLD2 : 6,9(4,4–11,2) ; p = 0,0004) et %DEXA (FPLD2 : 20,7(16,9–27,5) ; p p = 0,0643). Conclusion Le SBS semble plus rare que le FPLD2 et plus souvent familial qu’anterieurement admis. Leptinemie et CRP accrues etaient les meilleurs biomarqueurs des SBS compares aux temoins et FPLD2.

Les pseudo-syndromes de Cushing iatrogenes sont decrits lors de la prise de traitements par glucocorticoides de synthese, dans le metabolisme desquels est implique le cytochrome P450. L’inhibition de ce cytochrome est susceptible d’augmenter la fraction biodisponible et d’entrainer un freinage de l’axe corticotrope. Nous decrivons le cas d’un homme de 58 ans atteint d’une mucoviscidose de revelation tardive, associant une bronchite chronique, une insuffisance pancreatique exocrine, un diabete bien equilibre et une agenesie deferentielle. Une surinfection respiratoire necessite l’introduction d’un traitement par itraconazole et fluticasone. Douze semaines plus tard, le patient est hospitalise pour alteration majeure de l’etat general avec amaigrissement, œdemes des membres inferieurs, amyotrophie, modification facio-tronculaire de la repartition des graisses et erythrose faciale suggerant un syndrome de Cushing. On note un desequilibre glycemique, une hyponatremie (128 mmol/L), une cortisolemie et une ACTH de 8 H effondrees avant prise de fluticasone. L’arret de l’itraconazole permet en 3 mois une disparition complete des symptomes. L’isoforme CYP3A4 du cytochrome P450 est responsable de 50 % du metabolisme des medicaments. L’administration de substances metabolisees par cette enzyme, notamment les corticoides inhales (budesonide, fluticasone) en association a un inhibiteur CYP3A4 entraine une accumulation de ces corticoides, induisant une inhibition de l’axe corticotrope contrastant avec un tableau clinique de Cushing. La prise en charge consiste en l’arret des inhibiteurs du cytochrome tels que valproate, amiodarone, diltiazem, erythromycine, derives azoles (itra-, mi- et keto-conazole), mitotane, ritonavir, tacrolimus, jus de pamplemousse, avec supplementation par hydrocortisone jusque recuperation. Ces pseudo-Cushing ont ete particulierement decrits chez les patients presentant une mucoviscidose, traites par cette association, de surcroit associee a l’azithromycine, les patients traites par antiretroviraux, les transplantes sous inhibiteurs des calcineurines, dont les concentrations d’immunosuppresseurs peuvent se majorer. Une modification de repartition des graisses, l’apparition d’un diabete doit conduire le clinicien averti a rechercher ces interactions medicamenteuses.

The variety of microstructures that form at low solidification speed in peritectic alloys, bands, and islands, or even coupled (or cooperative) growth of the primary α and peritectic β phases, have been previously explained by nucleation-growth mechanisms. In a recent investigation on Cu-Sn, a new growth mechanism was conjectured on the basis of two-dimensional (2-D) optical microscopy and electron backscattered diffraction (EBSD) observations made in longitudinal sections. In the present contribution, synchrotron-based tomographic microscopy has been used to confirm this mechanism: α and β phases totally interconnected in three dimensions and bands (or islands) can result from an overlay mechanism, rather than from a nucleation events sequence. When the lateral growth of a new layer is too fast, an instability can lead to the formation of a lamellar structure as for eutectic alloys.

Flow cytometric analysis of peripheral blood (PB) S + G2/M phase size was performed in 73 adult patients with untreated acute non-lymphoblastic leukaemia, to assess whether the results may correlate to response rate and patient prognosis. All patients were treated with the same induction chemotherapy regimen: ARA-C alone or in combination with an anthracycline antibiotic. Pretreatment PB S + G2/M phase size is significantly correlated to induction response rate (p less than 0.02), duration of response (p less than 0.02) and duration of survival. Patients with low PB S + G2/M phase size experience a longer survival, in patients over and below 50 yr (p less than 0.001). Lastly, early deaths tend to be more frequent in the high median age and high PB S + G2/M phase size group. Our study suggests that PB S + G2/M phase size has prognostic significance in obtaining response and duration of survival.

Primary uterine papillary serous (PS) and clear cell (CC) carcinoma are aggressive histologies characterized by elevated risk of loco-regional recurrence and disease-specific mortality following hysterectomy. The impact of adjuvant radiotherapy remains to be elucidated. The present study is a single institution, retrospective cohort comparison to determine whether post-hysterectomy radiotherapy improves loco-regional control and/or disease-specific survival outcomes in a population of women with PS and/or CC.Between June 1992 and November 2006, 50 women underwent hysterectomy alone (H) or hysterectomy with adjuvant radiotherapy (H+RT) for primary uterine PS and/or CC. RT involved either high dose-rate (HDR) brachytherapy, external beam RT, or both.At a median survivor follow-up of 27 months (range 2.7-137.3) for the H+RT group and 61 months (range 11.9-114.6) for the H group (range 3-137), patients in the H+RT group demonstrated a trend toward superior disease-free survival (not yet attained at 26 months versus 25 months; p=0.0625). For patients withor =24 months of follow-up, disease recurrence was significantly higher in H patients over H+RT patients (45% versus 12.5%; p0.05). Additionally, the H+RT group demonstrated significant improvement in loco-regional control (0% versus 37.5%; p0.001), most pronounced within FIGO stages I-II H+RT patients (0% versus 70%; p0.001). Overall survival was not significantly different between the two cohorts (H=32 months, H+RT=not yet attained at 26 months; p=non-significant).Hysterectomy with adjuvant radiotherapy significantly improves disease-free survival within 2 years post-hysterectomy and significantly reduces loco-regional failures over hysterectomy alone.

Single pan thermal analyses (SPTA) have been performed on Cu-14.5 wt.% Sn, Cu-21.3 wt.% Sri and Cu-26.8 wt.% Sit peritectic alloys. For this purpose, a SPTA assembly has been built and calibrated. As the latent heat is a function of temperature and composition during solidification of alloys, a new heat flow model coupled to a Cu-Sn thermodynamic database has been defined for the calculation of the corresponding evolutions of the solid mass fraction, f(s)(T). To verify the accuracy of this model, a close comparison with a micro-segregation model that includes back-diffusion in the primary alpha-solid phase has also been conducted successfully. The thermal analyses have finally shown that the Cu-Sn phase diagram recently assessed in the review of Liu et al. is the most reliable. (C) 2007 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

International loans, especially those made to foreign sovereign lenders, differ in a number of ways from most loans made by domestic banks to residents of their own country. They are usually larger than most domestic loans, the lender has more difficulty in obtaining reliable data on the borrower, and, most importantly, lender and borrower are under different jurisdictions. This last factor makes enforcing a loan contract considerably more difficult, and provides incentives for the borrower to avoid prompt repayment, even if such repayment is feasible. Guttentag and Herring equate the presence of such incentives loosely with moral hazard. Eaton and Gersovitz develop a formal model of lending (with a single borrower and multiple lenders acting in unison) that explicitly takes debt repudiation into account. In their model, borrowers are inherently dishonest, i.e., they will default on their loans if their expected utility maximization so dictates. We prefer to characterize such behavior by the somewhat more neutral term rational. This paper simultaneously expands and simplifies the Eaton-Gersovitz model and places it in a game theoretic context borrowed from Dixit. We consider only two time periods, the present and the future, and take lending decisions that were made in the past as given. Additional keywords include: One-period and multiple period mathematical models.

An early non-invasive diagnosis of cervical cancer and its metastasis can save lives. We have shown that serum IGF-II levels can be effectively used for a specific early diagnosis of cervical cancer. Here, we shall determine if serum levels of vascular endothelial growth factors B and C (VEGF-A [corrected] VEGF-C) associated with vasculogenic and lymphogenic metastasis may be used for an early diagnosis of advanced metastatic cervical cancer and compare these levels with those of the serum IGF-II and IGF-binding protein 3 (IGF-BP3).(a) Serum levels of IGF-II, IGF-BP3, VEGF-A [corrected] (VEGF(165)) and VEGF-C (ELISA kits) were determined in: 82 controls with normal Pap smears; 29 women with atypical squamous cells of undetermined significance (ASCUS) and normal cervical biopsy; 46 ASCUS and cervical intraepithelial neoplasia (CIN) on biopsy; 8 pre-therapy CIN-I; 23 successfully treated CIN-I; 75 persistent CIN-I; 14 CIN-II/III pre-therapy; 14 successfully treated CIN-II/III; 70 persistent CIN-II/III; 86 pre-therapy cervical cancer; 26 in early grades of cervical cancer; 21 in late grades of cervical cancer; 22 cervical cancer patients in remission; 50 persistent cervical cancer; 18 with ovarian cancer; and 57 with endometrial cancer. (b) Serial serum samples collected over 5 years in 5 women with progressing cervical cancer were also tested. (c) Serum and tissue VEGF-C were enumerated in 20 matched serum (ELISA) and tissue (semi-quantitative immunofluorescent antibody assay) samples from controls, early cervical cancer, late cervical cancer, ovarian cancer and endometrial cancer patients. Student's t test, chi-square analysis and linear regression analysis were used.(a) As anticipated, serum IGF-II levels were elevated as early as ASCUS with CIN on biopsy and continued to be elevated in CIN (all grades; pre-therapy and persistent) and cervical cancer (pre-therapy, early, late and persistent). Serum IGF-II levels were normal in ASCUS with normal biopsy, successfully treated CIN-I, II/III, cervical cancer as well as pre-therapy ovarian and endometrial cancers (therapy efficacy: P0.0001 by chi-square analysis). Serum IGF-BP3 showed a significant decrease with advancing disease. Serum VEGF-A [corrected] levels were the highest in pre-therapy, early, advanced and persistent cervical cancer, as well as in ovarian and endometrial cancers. Serum VEGF-C levels, on the other hand, were the highest in late and persistent cervical cancers, but not in ovarian or endometrial cancers. (b) In the 5 women with serial samples, the serum levels of the growth factors showed similar trends. (c) VEGF-C levels in serum and tissue were elevated in cervical cancers especially in advanced grades, while they were normal in serum and tissue from the controls and women with ovarian and endometrial cancers. There was a highly significant positive correlation between VEGF-C and IGF-II and a negative correlation between IGF-BP3 and VEGF-C (P0.0001).Serum IGF-II up-regulation is specific to cervical cancer and helps in the early diagnosis of malignant proliferation, while serum VEGF-C up-regulation appears to be a unique marker for an early diagnosis of cervical cancer metastasis. VEGF-C and IGF-II systems appear to be interrelated in cervical cancer, contributing to the early malignant cell proliferation and lympho-vascular metastasis. Serum IGF-BP3 and VEGF-A [corrected] appear to be common markers for all gynecological cancers.

Resume Objectif Nous avons etudie les caracteristiques des demandeurs (patients, ayants droit et representants legaux) de dossiers medicaux dans un centre hospitalier universitaire (CHU) selon les nouvelles dispositions mises en place par la loi du 4 mars 2002. Methodes A partir des lettres de demandes d’acces au dossier medical, un formulaire de base de donnees recueille des informations comme l’etat civil des demandeurs, leurs motivations et les modalites d’acces souhaitees. La periode d’analyse s’etend d’octobre 2002 a septembre 2004 (soit 23 mois). Resultats Le nombre de demandes est de 942, dont 64,5 % de patients et 18,5 % d’ayants droit. Les patients demandant acces a leur dossier avaient en moyenne 53 ans, et etaient plutot des hommes. Les ayants droit avaient en moyenne 49 ans et etaient plutot des femmes. Trente pour cent des patients souhaitaient obtenir un complement d’information et 51 % ont demande une copie integrale du dossier. Conclusion Le droit d’acces direct au dossier medical implique, par ses consequences medico-legales, un changement de comportement des professionnels de la sante concernant la tenue de leurs dossiers.

This paper presents a hygrometer setup for measuring the concentration of water vapor in air by means of infrared absorption spectroscopy. Recently developed vertical-cavity surface-emitting lasers (VCSELs) emitting near 1.84 /spl mu/m are used as source of the infrared light. The laser hygrometer is able to calculate the density of water molecules from the measurement of one single light-current characteristic, without any additional reference measurement. The absolute and relative humidity are calculated from the water molecule density and the temperature of the ambient air.

Objective . To determine whether lymph vascular space involvement (LVSI) in women with early cervical carcinoma is an independent prognostic factor. Methods . The literature was reviewed using Medline and known literature to determine if LVSI is an independent risk factor as determined by multivariant analysis with survival being the end point in patients undergoing radical hysterectomy and pelvic lymphadenopathy. Results . A total of 25 articles were identified that satisfied the evaluation criteria. Only three (12%) identified LVSI as an independent risk factor while 88% and 61% of those evaluated, noted lymph node metastasis and tumor size/depth of invasion to be significant risk factors for survival. Conclusions . Using LVSI as the sole determining factor for consideration of post radical hysterectomy radiotherapy appears questionable.

Buried tunnel junction vertical-cavity surface-emitting lasers (BTJ-VCSELs) are demonstrated as light sources in the wavelength range from 1.3 to 2.0 μm. Continuous-wave operation at room temperature could be achieved for the whole wavelength range. This emphasizes not only the sophisticated device design but also the excellent suitability of the material system AlGaInAs/InP. Advantages and restrictions are discussed in this paper. Transmission experiments with single-mode VCSELs at 1.55 μm show error-free data transmission at modulation frequencies up to 10 Gbit/s. At 1.68 and 1.80 μm, gas sensing experiments detecting methane and water, respectively, could be successfully performed.

Type-II superlattices are very attractive as tuning regions in tunable laser diodes exploiting the free-carrier plasma effect. Due to the confining of the electrons and holes in different layers, the recombination of the electron–hole pairs is drastically suppressed. As a result, the carrier density, and hence the tuning efficiency for type-II superlattices, is enhanced by more than an order of magnitude in the small current regime as compared to bulk tuning regions. However, with increasing carrier density the recombination rate increases because of the stronger penetration of the electron and hole wavefunctions into the corresponding barriers. For high carrier densities, the capability of type-II superlattices depends critically on design parameters such as as layer thickness, band offset and strain. Our calculations show that, for an optimized type-II superlattice, the tuning range can be significantly enhanced by more than a factor of 3 for a given current.

Introduction Les tumeurs neuro-endocrines (TNE) sont ubiquitaires de l’organisme. Leur presentation est variable, par leur caractere secretoire ou non, par leur volume, mais aussi par leur localisation. Nous presentons un cas de TNE de l’oreille externe. Observation Monsieur R., ne en 1925, est appareille par protheses auditives depuis une vingtaine d’annees pour une hypoacousie secondaire a une exposition professionnelle. En 2011, il consulte un medecin ORL en raison d’une surdite de l’oreille gauche d’une aggravation rapide. Un petit bourgeon du conduit auditif externe de 5 mm est mis en evidence. Monsieur R. refuse alors toute investigation complementaire. En 2017, en raison d’une otorragie gauche, le bourgeon, mesure a 17 mm, est biopsie : il s’agit d’une TNE sous-cutanee du conduit auditif externe gauche (immunofixation positive pour la synaptophysine et la chromogranine A, ki67 a 2 %). Localement, la logette, la caisse du tympan, l’attique et la mastoide sont infiltres. Des micronodules pulmonaires aspecifiques sont reveles. Discussion Les TNE se developpent a partir de tout tissu de l’organisme. Une centaine de cas de TNE, de l’oreille moyenne ou encore de l’oreille interne, est decrit dans la litterature [1] . Jusqu’a ce jour, le conduit auditif externe n’etait pas une localisation connue pour les TNE. La prise en charge therapeutique de cette TNE reste a debattre face a l’envahissement local, les micronodules aspecifiques et les desirs du patient.

Une alteration du gene TCF2, codant pour HNF1β, entraine un diabete MODY 5 (ou un syndrome RCAD), d’expressivite variable. Une deletion plus large de l’emplacement comportant TCF2 conduit au syndrome 17q12. L’objectif etait de comparer les patients presentant une deletion de TCF2 (incluant les deletions larges de l’emplacement 17q12) aux patients presentant une mutation. Patients et methode L’analyse des dossiers et des resultats paracliniques a ete realisee de maniere multicentrique et retrospective. Nous avons inclus 29 patients presentant une deletion (3 patients avaient une deletion de l’emplacement 17q12) et 8 patients presentant une mutation. Resultats La description de 2 familles illustre nos propos. Les antecedents familiaux de diabete etaient plus presents dans le groupe « deletion » (48 versus 25 %). L’âge au diagnostic etait respectivement de 20 ans et 11 mois et de 2 ans et 4 mois. Une anomalie de la morphologie renale etait presente chez 75 % des patients du groupe « deletion » contre 86 % du groupe « mutation ». Cent pour cent du groupe « mutation » etait indemne de troubles du metabolisme glucidique, versus 51,7 % du groupe « deletion ». Cinquante pour cent du groupe « deletion » presentaient une hypomagnesemie. Dans le groupe « deletion », 38 % des patients presentaient des troubles intellectuels et 70 % avaient des anomalies gynecologiques. Ces deux atteintes etaient absentes dans le groupe « mutation ». Conclusion Il existe des differences phenotypiques selon le type d’anomalie genetique. Une analyse par CGH-Array serait necessaire, a la recherche d’une deletion plus large incluant le gene TCF2.

The thermal resistance of InGaAlAs/InP long-wavelength VCSELs with buried tunnel junctions is investigated by means of a heat flow finite element analysis. Because of the low thermal conductivity of InP based compound layers, a significant improvement is obtained for a top-down mounted structure with a hybrid dielectric-metal back mirror and an InP heat spreading layer. Experimental results for such lasers show cw operation up to 75 °C with a maximum power exceeding 2 mW at room temperature for 17 μm diameter. The temperature behavior of the threshold current indicates a substantial improvement for laser operation at values even far beyond room temperature by adjusting cavity mode and spectral gain.

BACKGROUND: The purpose of this study was to determine the morbidity and survival associated with bowel resection at the time of primary cytoreductive surgery for ovarian cancer. STUDY DESIGN: We reviewed all patients undergoing bowel resection by gynecologic oncology faculty at the time of primary cytoreduction for advanced epithelial ovarian cancer diagnosed between 1983 and 1995. RESULTS: There were 105 patients meeting the above criteria. The median age was 65 years (range 34 to 85 years). There were 76 stage III and 25 stage IV cancers. The primary indication for bowel resection was tumor debulking in 92% of the patients. Seventy patients had segmental resection of the colon only, and 22 patients underwent resections that included the large and small bowels. Mean operating time was 260 minutes and mean estimated blood loss was 1,447 mL. Thirty-three (31%) patients were optimally cytoreduced to less than 1 cm residual disease. Ten patients experienced major complications directly related to bowel resection, including bowel fistula (4 patients), early postoperative bowel obstruction (5 patients), and stomal hernia (1 patient). Other morbidity included ileus for more than 10 days (18 patients), cardiac complications (17 patients), pneumonia (8 patients), sepsis (5 patients), and thromboembolism (4 patients). Six patients died and five patients required reexploration within 30 days of operation. Patients with preoperative bowel obstruction and suboptimal residual disease were more likely to have postoperative morbidity. Median survival in the optimally debulked patients was 35 months compared with 18 months in patients suboptimally cytoreduced (p = 0.006). Multivariate analysis demonstrated that optimal debulking (p = 0.009) and platinum chemotherapy (p = 0.00006) were independently associated with improved survival. Age, International Federation of Gynecologia Oncologists stage, American Society of Anesthesiologists class, and paclitaxel chemotherapy did not influence survival. CONCLUSIONS: In patients undergoing bowel resection at the time of primary cytoreduction for ovarian cancer, optimal cytoreduction to less than 1 cm residual disease results in improved survival. Morbidity is common but is comparable to other published series of ovarian cancer patients undergoing primary cytoreductive surgery without bowel resection. Additionally, patients with preoperative bowel obstruction and suboptimal residual disease are more likely to have serious morbidity.

Objective: To evaluate the efficacy of adjuvant therapy for ovarian germ cell tumors. Methods: We reviewed records of women who had malignant germ cell tumors of the ovary from 1977–1997. Results: Seventy-two women had surgical resections of malignant ovarian germ cell tumors and most received adjuvant therapy. Fifty-six women (78%) presented with stage I disease, and 16 (22%) had more advanced disease. Tumor subtypes included dysgerminoma ( n = 20), yolk sac tumor ( n = 8), immature teratoma ( n = 29) and mixed germ cell tumor ( n = 15). Surgical management of the 56 with stage I disease consisted of total abdominal hysterectomy, bilateral salpingo-oophorectomy, and extensive surgical staging in ten women, whereas a conservative surgical approach, consisting of unilateral adnexectomy with or without comprehensive surgical staging, was adopted in later years ( n = 46). Fifty-six women were treated with postoperative chemotherapy, predominantly platinum-based regimens. The 5-year actuarial survival rate was 93%. None of the 36 women who presented after 1984 have died of disease. Conclusion: These data confirmed that platinum-based adjuvant treatments allow most women with ovarian germ cell malignancies to have conservative surgery without compromising survival.

Dance is a specific expression of human motor behaviour. This artistic physical activity depends upon an effective technical training with important postural components and necessitates the codification of sensory inputs to build mental representations of the action to be produced. Proprioception and vision being two fundamental sensory modalities in classical ballet, this study attempted to determine the importance of the visual input for postural control during the practice of this activity. First, this work compared the performances of 18 professional ballet dancers and 46 non-dancers on a platform of forces during static posturographic tests in open or closed eyes situation. Then, we studied how professional dancers achieve balance in postures specific of classical ballet: on demi-pointe and on pointe. The results indicate that visual inputs are important in classical ballet since dancers only performed better than controls in eyes open conditions. The similar results obtained on pointe with eyes open or closed conversely suggest that training in classical ballet develops specific modalities of balance which are not transferable to posture control in daily life situations.