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Objectives To report a case of paraganglioma arising from the hypoglossal nerve and review the anatomy, clinical features, and literature to date. Study design Case report and review of the literature. Methods Case records including paper and electronic chart and imaging reports were reviewed and summarized for the index case. A literature search was performed using pubmed keywords paraganglioma, hypoglossal, chemodactoma, carotid body, and glomus tumor. The available literature on the topic was reviewed and summarized. Results Paragangliomas associated with the hypoglossal nerve were reported in 4 cases over the past 47 years. Our index case presented with similar clinical features compared to those reported in the literature. Imaging with computed tomography and angiography showed a hypervascular mass at the carotid bifurcation, splaying the internal and external carotid arteries. As in previously reported cases, the source of the paraganglioma was only identified intraoperatively. The current case differs from prior reported literature in that the tumor was dissected from the associated hypoglossal nerve which was preserved. The patient clinically had no deficits in articulation or deglutination following excision of the lesion and was able to return to a normal diet within 24 hours of surgery. Conclusions Hypoglossal paraganglioma is a neck mass that may not be distinguishable from more common carotid body or vagus tumors despite the use of multiple imaging modalities. Although XIIth nerve sacrifice may be requires in some instances, nerve preserving surgery, when possible, allows for complete recovery without functional deficits.

A relatively simple and efficient ventricular programmed electrical stimulation (PES) protocol was developed, capable of achieving high degrees of sensitivity and specificity. In a series of 481 subjects, 1, 2, and 3 extrastimuli (ES) were used successively during sinus rhythm and ventricular pacing at two drive cycle lengths, at one or more ventricular sites, together with rapid ventricular pacing, and other maneuvers such as isoproterenol infusion. Three ES were used immediately after two ES at each drive rate, rather than returning after completion of the protocol with two ES. Using the protocol, appropriate arrhythmias could be induced in 88% of all patients with ventricular fibrillation, 84% of all patients with sustained ventricular tachycardia (91% with underlying coronary disease), and 58% of patients with severe nonsustained ventricular tachycardia. There were significant differences in inducibility between patients whose ventricular arrhythmias were due to coronary artery disease and other causes. In contrast, sustained ventricular arrhythmias (all ventricular fibrillation) could be induced in only 5% of a control group of control patients, for a specificity of 95%. The protocol described is simpler and more efficient than those that use exhaustive testing of two ES before going to three ES. Three ES during sinus rhythm proved to be the most productive step, with a higher yield ratio (true: false-positives) than two ES or three ES during pacing, especially at faster rates. Greater efficiency is also achieved by leaving the timing of an extrastimulus just beyond its effective refractory period when an additional extrastimulus is to be added, compared to protocols in which the extrastimulus is moved later in the cycle and then decremented in tandem with the additional extrastimulus. Coupling intervals less than 200 msec produced some false-positives, but fewer overall than intervals greater than or equal to 200 msec, and with yield ratios comparable to other protocol steps. The protocol described meets NASPE standards for ventricular programmed stimulation protocols, and with its demonstrated specificity and relative simplicity and efficiency may be useful as a model for groups not yet committed to an alternative protocol.

Ein 9jahriges Madchen wurde in die senologische Sprechstunde uberwiesen wegen einer seit 3 Monaten bestehenden Schwellung und lividen Verfarbung der linken Mamille, welche trotz lokaler antibiotischer, antimykotischer und Steroid-Therapie persistierte. Ipsilateral in der Axilla fanden sich einige vergroserte dolente Lymphknoten. Die genaue Anamneseerhebung ergab, das das Machen 4 Wochen vor Auftreten der Mamillenveranderung an der linken Mamma von einer Zecke gebissen wurde. Die Borrelien-Serologie ergab folgende Werte: IF-Abs-Test 5120 (normal bis 40), IF abs IgM 80, P39 EIA grenzwertig. Der Western-Blod auf Borrelia burgdorferi fiel im IgG- und IgM-Bereich positiv aus, wodurch eine Borreliose serologisch gesichert war. Histologisch konnte bei einer aus der linken Mamille entnommenen Probebiopsie die klinische Diagnose einer Lymphadenosis cutis benigna Bafverstedt nach Zeckenbis bestatigt werden. Unter systemischer antibotischer Therapie mit Fenoxypen 3x1 Mio/die wahrend 14 Tagen bildete sich die lokale Symptomatik deutlich zuruck.

Abstract #6104 Background: The addition of bevacizumab to weekly paclitaxel as primary chemotherapy for HER-2 negative metastatic breast cancer (MBC) prolongs progression-free survival without relevant increase of toxicity. However, the health economic implications of this costly treatment option have not yet been assessed. Material and Methods: We constructed a Markov model comprising three health-states: stable or responsive disease, disease progression and death. Markov cohort simulation was used to follow the clinical course of typical patients with MBC. Cycle length was one month. Information on response rates, major adverse effects was derived, and transition probabilities were estimated, based on the results of the E2100 clinical trial. Direct costs of treatment, major adverse events, laboratory tests, and disease progression were assessed from the perspective of a Swiss statutory health insurance perspective. Utilities for health states were obtained from the literature. Costs are reported in 2008 Euros (EUR). Results: Over the patients' lifetime, the addition of bevacizumab to weekly paclitaxel until disease progression is estimated to cost an additional 35'564 EUR and to yield a gain of 0.22 quality-adjusted life years (QALYs), resulting in an incremental cost-utility ratio of 164'921 EUR/QALY. In univariate and probabilistic sensitivity analyses, results showed a 95% CI from 117'998 to 484'251 EUR/QALY and were most sensitive to the cost of bevacizumab. Subgroup analysis indicated a more favourable cost-utility ratio (136'177 EUR/QALY, 95 % CI 97'999-435'823) in the age group < 50 years. Discussion: Compared with commonly accepted willingness to pay thresholds in oncology, the addition 10 mg of bevacizumab per kilogram [body weight] to paclitaxel in MBC patients is expensive given the clinical benefit in terms of QALYs gained. Further research should consider patient age and alternative dosages for a more cost-effective utilisation of bevacizumab. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6104.

Apart from long-term cardiovascular and metabolic effects of intrauterine deficiency or oversupply situations of the fetus, cerebral, renal and reproductive functions also seem to be influenced by a disturbed intrauterine environment.

Oncological safety and preservation of a patient's physical integrity are the milestones of modern breast cancer therapy. This can be achieved by an optimized combination of therapy modalities, such as surgery, radiation therapy and systemic (chemo-)therapy. In this context the gynaecological oncologist is of central importance.

Most ecologists use statistical methods as their main analytical tools when analyzing data to identify relationships between a response and a set of predictors; thus, they treat all analyses as hypothesis tests or exercises in parameter estimation. However, little or no prior knowledge about a system can lead to creation of a statistical model or models that do not accurately describe major sources of variation in the response variable. We suggest that under such circumstances data mining is more appropriate for analysis. In this paper we 1) present the distinctions between data-mining (usually exploratory) analyses and parametric statistical (confirmatory) analyses, 2) illustrate 3 strengths of data-mining tools for generating hypotheses from data, and 3) suggest useful ways in which data mining and statistical analyses can be integrated into a thorough analysis of data to facilitate rapid creation of accurate models and to guide further research.

5043 Background: The incidence of intraepithelial neoplasia (IN) of the lower anogenital tract is increasing. Due to small case-series, the malignant potential of treated high-grade IN is not well defined and risk factors for progression are not established. Methods: Patients with IN of the vulva (VIN), vagina (VAIN) and perianal skin (PAIN) were identified in the electronic databases of three university colposcopy clinics. Inclusion criteria were biopsy proven IN grade 2–3 (high-grade) and no history of vaginal, vulvar or anorectal cancer. Excluded were patients with the diagnosis of invasive disease within one year from initial diagnosis of IN. Results: 442 patients were identified from 1977 to 2005 with a mean follow up of 69.9 ± 56.1 months. Initial diagnosis was VIN III in 75.3%, VIN II in 17.2%, VAIN II in 4.3%, VAIN III in 2%, and PAIN II/III in 1.1% of patients. Mean age at initial diagnosis was 47.1 ± 14.1 (range, 18–102). Initial treatment was biopsy and laser evaporation in 61.5%, surgical excision in 32.8%, and other locally destructive methods in 3.1% of patients. 9 patients refused any treatment (2.0%). In the 433 treated patients, recurrent disease (e.g. diagnosed >1 year after initial diagnosis) occurred in 32.2%. In patients with a follow up longer than 5 years, 14.4 % were still experiencing recurrences. In multivariate analysis, immunosuppression (OR: 2.33, 95% CI 1.06–5.06, p = 0.035) was associated with recurrence but not smoking, age or histological grade. Progression to invasive disease occurred in 3.8% of treated patients within a mean time of 7.9 ± 6.8 years (range, 1.3–24.5). In multivariate analysis, immunosuppression (OR:3.31, 95% CI 1.01–10.93, p = 0.049) and smoking (OR:3.12, 95% CI 1.07–9.08, p = 0.037) were independent risk factors for progression. Conclusions: Anogenital IN is a chronic disease in a substantial proportion of patients. The malignant potential is remarkably high despite repeated treatments. Therefore, long lasting surveillance is mandatory, especially in immunosuppressed or smoking patients. No significant financial relationships to disclose.

There is a controversial discussion on the risks and benefits of hormonal replacement therapy (HRT), and many women and doctors have revised their opinions of HRT over the last few years. Complementary and alternative therapies can be considered an option to treat menopausal symptoms. The following issue summarizes the actual knowledge of treatment options of menopausal symptoms.

The Stewart-Treves syndrome is an angiosarcoma that occurs due to chronic lymphoedema which in most cases is a complication after mastectomy with axillary node dissection and postoperative radiation. Prognosis for this rare tumour is poor. The best therapy is early and radical excision. Chronic lymphoedema seems to be an important pathogenetic factor. We report on a 70-year old patient with early stage lymphangiosarcoma who had a lumpectomy with axillary node dissection and postoperative radiation five years ago.

798 Background: Tumor cell expression of estrogen receptors (ER), progesterone receptors (PR), and Her2/neu/c-erbB-2 receptors (Her2) are generally accepted predictive factors used for choosing treatment in breast cancer. It is believed that chemotherapy has no effect on ER, PR, and/or Her2 expression although this has not been thoroughly investigated. Methods: We compared predictive factors determined on pretreatment core biopsy material with determinations on the definitive surgical specimens in 24 consecutive patients (pts) treated with neoadjuvant chemotherapy for locally advanced breast cancer. Three pts were excluded due to insufficient pretreatment material (2), or complete pathologic remission (1) precluding comparison. The 21 evaluable pts had a median age = 48 (31–65); invasive ductal/lobular = 14/7; G1/G2/G3 = 1/11/9. Pretreatment stage: cT2/T3/T4/ unknown = 3/9/8/1; cN0/N1/N2/unknown = 5/12/3/1; cM0/cM1 = 17/4. Chemotherapy: Fluorouracil-Epirubicin(Epi)-Cyclophosphamid/Epi-docetaxel(doc)/both/...

Anti-glycan antibodies represent a vast and yet insufficiently investigated subpopulation of naturally occurring and adaptive antibodies in humans. Recently, a variety of glycan-based microarrays emerged, allowing high-throughput profiling of a large repertoire of antibodies. As there are no direct approaches for comparison and evaluation of multi-glycan assays we compared three glycan-based immunoassays, namely printed glycan array (PGA), fluorescent microsphere-based suspension array (SA) and ELISA for their efficacy and selectivity in profiling anti-glycan antibodies in a cohort of 48 patients with and without ovarian cancer. The ABO blood group glycan antigens were selected as well recognized ligands for sensitivity and specificity assessments. As another ligand we selected P-1, a member of the P blood group system recently identified by PGA as a potential ovarian cancer biomarker. All three glyco-immunoassays reflected the known ABO blood groups with high performance. In contrast, anti-P-1 antibody binding profiles displayed much lower concordance. Whilst anti-P-1 antibody levels between benign controls and ovarian cancer patients were significantly discriminated using PGA (p = 0.004), we got only similar results using SA (p = 0.03) but not for ELISA. Our findings demonstrate that whilst assays were largely positively correlated, each presents unique characteristic features and should be validated by an independent patient cohort rather than another array technique. The variety between methods presumably reflects the differences in glycan presentation and the antigen/antibody ratio, assay conditions and detection technique. This indicates that the glycan-antibody interaction of interest has to guide the assay selection.

Background Epigenetic regulation is an important mechanism leading to cancer initiation and promotion. Histone acetylation by histone deacetylases (HDACs) represents an important part of it. The development of HDAC inhibitors has identified the utility of HDACs as a therapeutic target. Little is known about the epigenetic regulation of vulvar intraepithelial neoplasia (VIN) and vulvar squamous cell cancer (VSCC). In this study, the expression of class I HDACs (HDAC 1, 2 and 3) was compared in a series of VIN and VSCC tissues. Methods A tissue micro array (TMA) with specimens from 106 patients with high-grade VIN and 59 patients with vulvar cancer was constructed. The expression of HDACs 1, 2 and 3 were analyzed with immunohistochemistry (IHC). The nuclear expression pattern was evaluated in terms of intensity and percentage of stained nuclei and was compared between vulvar preinvasive lesions and vulvar cancer. Results HDAC 2 expression was significantly higher in VIN than in VSCC (p < 0.001, Fisher's test). Also, 88.7% (n = 94/106) of VIN samples and only 54.5% (n = 31/57) of VSCC samples were scored at the maximum level. Conversely, HDAC 3 expression was significantly higher in VSCC (93%, 53/57) compared to VIN (73.6%, 78/106, p = 0.003), whereas only a small difference in the expression of HDAC 1 was found between these two entities of vulvar neoplasia. Conclusions These results suggest that epigenetic regulation plays a considerable role in the transformation of VIN to invasive vulvar neoplasia.

Background Because higher survival of follicles during the freezing/thawing procedure improves the quality of cryopreserved tissue reimplanted after oncological therapies, defining an optimal method for human ovarian tissue cryopreservation remains a major issue in this field. One option to improve the cryopreservation procedure is to use better materials, i.e., vials with better conductivity. The aim of this study was to compare polypropylene (PP) with quartz vials. Between September 2012 and January 2013, eight patients were recruited. The ovarian cortex was cut into 3 slices, assigned randomly to a fresh and a cryopreserved group in PP (method B) or quartz vials (method C). Histological and immunohistochemical (IHC) analysis were used. For IHC three antibodies were analyzed: Ki67 (proliferation index), Bcl2 (anti apoptotic index) and Hsp70 (stress index). Results The majority of GCs showed positive staining for Bcl2 in both cryopreservation device, with higher expression in group C than in group B. Oocytes and their nuclei showed intense positive staining for ki67 in both methods B and C, and also a patch positive stromal cells staining for Ki67. Expression of hsp70 was not increased after cryopreservation. Conclusions Cryopreservation using quartz vials led to larger numbers of good follicles while maintaining consistent preservation for stromal cells and vessels., Journal of Ovarian Research, 9, ISSN:1757-2215

Coordinating management among multiple landowners and jurisdictional agencies is one of the greatest challenges confronting conservation planning. In this study, we assessed the impacts on recovery progress of the people and property involved in recovery plan development and implementation. We compared indices of recovery progress among endangered species whose primary habitat falls into one of four federal jurisdiction categories: nonfederal land only, 50% but not all federal land, and all federal land. Species found exclusively on federal land are more likely to be improving in status. This may result from the fact that overall implementation of recovery tasks is lower among species occurring exclusively on nonfederal lands. Revision status, the existence of a centralized database, the designation of a person or committee to coordinate plan implementation, the parties involved in drafting the plan, and those designated as responsible for implementing recovery tasks are also significant factors in determining recovery plan implementation. Specifically, diversity of recovery team membership and the average number of participants increase with increasing federal jurisdiction, and tasks are more likely to be completed when more parties are involved in developing recovery plans. However, fewer recovery tasks are completed as the number of parties involved in implementation increases, suggesting that species on federal lands may benefit from less division of labor among agencies. Differences in drafting plans and administering their implementation appear to be stronger determinants of the observed variation in recovery success than differences in the kinds of threats facing species and their habitats.

Background Specific knowledge of urinary incontinence (UI) and its interrelation with physical and cognitive health is essential to working towards prevention of UI and to improving quality of treatment and care. The purpose of this study was to determine the association between UI and the activities of daily living (ADL) hierarchy scale, the cognitive performance scale (CPS) and comorbid conditions. Methods The cross-sectional retrospective analysis of 357 nursing homes in Switzerland was based on data of the Minimum Data Set of the Resident Assessment Instrument 2.0 (RAI-MDS). The analysis examined the effect of ADL hierarchy scale, CPS, joint motion and comorbidities on UI. Women ≥65 years were included (n = 44’811; January 2005 to September 2014) at the time of admission to a nursing home. Statistical analysis was done by means of descriptive statistics and logistic regression analysis. Results The prevalence of UI was 54.7%, the mean ADL hierarchy scale (± SD) 2.42 ± 3.26 (range = 0–6), the mean CPS 1.95 ± 1.67 (range = 0–6). There was a gradual increase in the odds ratio (OR) for UI depending on the ADL hierarchy scale, from the hierarchy scales of “supervised” to “total dependence” of 1.43 – 30.25. For CPS, the OR for UI from “borderline intact” to “very severe impairment” was 1.35 – 5.99. Considering the interaction between ADL and CPS, all ADL hierarchies remained significantly associated with UI, however for CPS this was the case only in the lower hierarchies. Of the 11 examined comorbid conditions, only diabetes mellitus (OR 1.19), dementia (OR 1.01) and arthrosis/arthritis (OR 1.53) were significantly associated with UI. Conclusion The study indicated that impairment in ADL performance is strongly associated with UI, more than CPS performance and comorbidities. Physical more than cognitive training in order to improve or at least stabilize ADL performance could be a way to prevent or reduce the process of developing UI.

Cet article porte sur une analyse des recours exercés par les personnes détenues en établissement pénitentiaire en France visant à contester leurs conditions de détention pendant la crise sanitaire. Grâce à un accès à la base de données Ariane archives du Conseil d’État, 117 décisions rendues par les tribunaux administratifs, les cours administratives d’appel et le Conseil d’État ont pu être recueillies. L’analyse de ces décisions met en évidence la faible concrétisation du droit à la santé des personnes détenues pendant la crise sanitaire, ainsi que les lacunes du contrôle juridictionnel exercé, le juge administratif ne prononçant quasiment jamais de mesures pour contrôler effectivement les conditions de détention, et s’en tenant aux allégations de l’administration. Ces constats viennent conforter les deux hypothèses retenues : la gestion de la COVID-19 en prison est paradigmatique des contradictions inhérentes au droit à la santé en milieu carcéral d’une part, et son contrôle révèle une hiérarchisation entre individus selon leur statut d’autre part., This article concerns the complaints brought forth in France during the COVID-19 pandemic by certain prisoners seeking to challenge the conditions of their imprisonment. With direct access to the administrative decision databases, a full analysis of the complaints lodged by prisoners before the administrative courts reveals two key aspects : poor protection of the right to health of prisoners, and the weakness of the judicial control exercised by administrative judges. This socio-legal inquiry supports two hypotheses : that COVID-19 pandemic governance reveals the contradictions inherent to the right to health in prisons, and that the control of contagion underpins a hierarchy between individuals with regard to their legal statuses., Este artículo presenta un análisis de los recursos interpuestos por las personas detenidas en los establecimientos penitenciarios de Francia encaminados a impugnar sus condiciones de detención durante la crisis sanitaria. Gracias al acceso a la base de datos Ariane, archivos del Consejo de Estado, se recogieron 117 decisiones dictadas por tribunales administrativos, tribunales administrativos de apelación y por el Consejo de Estado. El análisis de estas decisiones pone de manifiesto la escasa concretización del derecho a la salud de los detenidos durante la crisis sanitaria así como las lagunas del control jurisdiccional ejercido, ya que el juez administrativo casi nunca adopta medidas para controlar efectivamente las condiciones de detención y se limita a atenerse a las alegaciones de la administración. Estos resultados apoyan las dos hipótesis : la gestión de la Covid-19 en la cárcel es paradigmática de las contradicciones inherentes al derecho a la salud en las prisiones, y su control revela una jerarquía entre los individuos según su estatus.