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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.

To determine the response rate and associated toxicity of weekly CPT-11 in squamous carcinoma of the cervix.From October 1994 to May 1996, the Gynecologic Oncology Group (GOG) conducted a Phase II trial in patients with recurrent squamous cervix carcinoma. The schedule employed weekly x4 intravenous CPT-11 at 125 mg/m2 followed with a 2-week rest, to be repeated until disease progression or unacceptable toxicity. Eligibility criteria were a GOG performance status of 0-2, adequate bone marrow reserve, adequate liver function, and serum creatinine2 mg%. None of the patients had received prior chemotherapy other than radiation sensitizers. Standard GOG toxicity and response criteria were used.Fifty-four patients were entered into the trial. Three patients were ineligible because of wrong cell type (N = 2) or inadequate pathology material (N = 1). Two were inevaluable because of inadequate trial of drug. An additional 4 patients were inevaluable for response. Thus, 49 were evaluable for toxicity and 45 were evaluable for response. The median age of patients was 45 years (range, 29-71 years). The median number of weekly doses delivered was 7 (range, 1-46). The incidence of grade 4 neutropenia and anemia was 6.1 and 4.1%, respectively. Nineteen patients (38.8%) developed gastrointestinal (GI) toxicity including 8 with grade 3 and 11 with grade 4 severity. The overall response rate was 13.3% (6/45). There was 1 patient death from GI toxicity. There was one complete response of 8.8 months duration and 5 partial responses.OFFis schedule of CPT-11 exhibits modest activity with moderate toxicity in patients with recurrent squamous carcinoma of the cervix.

Serum leptin levels are low in untreated anorexia nervosa, but studies of the exact relationship between leptin and body weight and the impact of refeeding in anorectics are limited. Therefore, we studied serum leptin, insulin-like growth factor I, and other endocrine parameters in female anorectics before and after gaining weight and in female normal body weight controls. Leptin levels in untreated anorectics were significantly lower than those in normal body weight controls (3.6 +/- 1.6 vs. 12.0 +/- 6.9 ng/mL; P < 0.001), and they uncoupled from body weight in a nonlinear relationship, suggesting a threshold effect at lowest body weights. Leptin increased significantly with refeeding (5.6 +/- 3.8 ng/mL; P < 0.01). The significant linear correlations of leptin with body mass index in the anorectics after weight gain and in normal body weight controls (r = 0.69; P < 0.001 and r = 0.76; P < 0.001, respectively) are consistent with a normal physiological increase in leptin with weight gain. Leptin and insulin-like growth factor I were highly correlated, even after controlling for body weight (r = 0.63; P = 0.001) during starvation, but were no longer significantly correlated after body weight gain in the anorectics or the normal body weight controls. Further studies are necessary to elucidate the relationship of leptin to neuroendrocrine abnormalities seen in starvation and to determine a possible contribution of leptin to difficulties with weight restoration in anorexia nervosa.

OBJECTIVES: Mutation and overexpression of the p53 tumor suppressor gene in endometrial cancers are associated with advanced stage and poor survival. We sought to determine whether p53 overexpression is an independent variable predictive of poor prognosis in advanced endometrial adenocarcinomas. STUDY DESIGN: Immunohistochemical evaluation was used to examine p53 expression in paraffin blocks from 179 endometrial adenocarcinomas. RESULTS: p53 overexpression was seen in 35% of cancers and was associated with higher stage ( p = 0.004), black race ( p p = 0.02), lack of hormone replacement ( p = 0.04), and older age ( p = 0.05). In addition to a higher frequency of p53 overexpression (57% vs 26%), black women had a lower survival rate than white women ( p = 0.001), but overexpression was associated with poor survival in both races. After we corrected for hormone use, multivariate analysis revealed that older age ( p p p = 0.01), and p53 overexpression ( p = 0.04) were predictive of poor survival. CONCLUSIONS: Overexpression of p53 in advanced-stage endometrial cancers is an independent variable that is associated with poor survival, occurs more frequently in black women, and may contribute to the racial disparity in survival. (Am J Obstet Gynecol 1996;175:1246-52.)

Electrically pumped buried tunnel junction InGaAlAs-InP vertical-cavity surface-emitting lasers (VCSELs) with self-adjusted lateral current and optical confinement and record emission wavelengths beyond 2 /spl mu/m are presented. Front and back side mirrors are realized using 31.5 epitaxial layer pairs of alternating InGaAs-InAlAs and a dielectric 2.5 pair CaF/sub 2/-a-Si layer stack. The devices show single-mode continuous-wave operation up to heat sink temperatures over 80/spl deg/C. The maximum output power at 20/spl deg/C reaches 0.43 mW, threshold current and voltage are as low as 0.66 mA and 0.73 V, respectively. To reach the long emission wavelength, we use an optimized active region comprising heavily strained quantum wells. High-resolution X-ray diffraction and photoluminescence measurements reveal excellent material quality without relaxation in the quantum wells.

Contexte Le cancer thyroidien anaplasique (CTA) et le lymphome primitif thyroidien (LPT) sont les deux pathologies tumorales systematiquement evoquees devant une tumeur thyroidienne rapidement evolutive. Ces tumeurs malignes, toutes deux agressives mais de pronostic different, requierent une prise en charge urgente, d’ou la necessite d’un diagnostic qui repose a ce jour sur une biopsie chirurgicale. Methode Nous avons analyse en retrospectif les caracteristiques de 33 cas de CTA et de 33 cas de LPT consecutifs, pris en charge entre 2000 et 2016 au CHRU de Lille pour rechercher des criteres initiaux (clinique, biologique et radiologique) d’orientation diagnostique. Resultats En faveur du CTA, les criteres les plus informatifs etaient l’hyperleucocytose superieure a 10 000 elements/mL, des polynucleaires superieurs a 7500/mL, la presence de macrocalcification (s) tumorale (s), de metastase (s) et de thrombus de la veine jugulaire interne, avec respectivement les VPP suivantes : 77,3 %, 75 %, 93 %, 80 % et 77,8 %. La presence d’asymetrie de la glande etait un element informatif (VPN a 75 %). En faveur du LPT, les criteres informatifs etaient l’existence d’une thyroidite et l’elevation de la TSH, dont les VPP etaient respectivement de 83 % et de 76,5 %. En analyse multivariee, l’elevation des PNN superieure a 7500/mL, la presence de metastase (s) et la presence d’au moins un signe cervical de compression tumorale etaient significatives, avec respectivement des OR a 6,6, a 7, et a 3,9. Le sexe, un antecedent de cancer, les dimensions et la vascularisation de la tumeur n’etaient pas discriminants. Conclusion Ces criteres constituent des arguments utiles pour differencier les CTA des LPT.

Objective To determine whether mutation in the DNA of the estrogen-receptor gene occurs in endometrial cancer. Methods Polymerase chain reaction amplification and single-stranded conformation polymorphism analysis of the entire coding region (exons 1–8) of the human estrogen-receptor gene, as well as an untranslated region (exon I*) in the gene, were performed on genomic DNA extracted from 56 snap-frozen endometrial cancers. All cancers demonstrating mobility shifts on single-stranded conformation polymorphism suggestive of DNA sequence alteration were subjected to definitive DNA sequencing of the relevant portion of the estrogen-receptor gene. Results In addition to detecting a frequent, previously described polymorphism in exon 1, single-stranded conformation polymorphism analysis of the 56 endometrial cancers identified seven cancers with mobility shifts. Three cancers shifted in exon 3, one cancer each shifted in exons 4 and 7, and two shifted in exon 8. Deoxyribonucleic acid sequencing revealed sequence alterations in all seven cases demonstrating mobility shifts. In six of these seven cases, these alterations were consistent with infrequent silent polymorphisms; in the seventh cancer, the sequence alteration proved to be a somatic missense mutation at codon 537 in the region of the estrogen-receptor gene encoding the hormonebinding domain of the receptor protein. Conclusion The infrequent DNA mutation in the estrogen-receptor gene is unlikely to account for the variation in estrogen-receptor expression observed in endometrial cancer.

An apparatus for speed-of-sound measurements with a spherical resonator was adapted for temperatures up to 42(I K. This included new microphones with a special wiring, a pressure indicator which can be thermostatted to 420 K, and some installations to avoid temperature gradients. Calibration of the radius of the resonator with argon was extended to higher temperatures. Speed-of-sound measurements up to 420 K and 0.5 MPa were done onl,l-dilluoroethane (R152a). 1.l,l-trilluoroethane (R 143a ),l,l,l-chlorodifluoroethane (R 142b ), l,1,1,2-tetralluoroethane (R134a), and 2.2.2-trifluoroethanol. The ideal-gas heat capacities coincide with the statistical mechanical values, except for R134a, where our values as well as recent literature data are below the values calculated from spectroscopy. The reduced second virial coefficients can be interpreted in terms of the dipole moment and the angle between dipole moment and molecular axis. For the associated substance trifluoroethanol values of the third virial coefficient are given, which are appreciably negative at low temperatures.

Expression of the E-cadherin cell adhesion molecule is reduced in several types of human carcinomas, and the protein serves as an invasion suppressor in vitro. To determine if mutations of the E-cadherin gene (on chromosome 16q22) contribute to epithelial tumorigenesis, 135 carcinomas of the endometrium and ovary were examined for alterations in the E-cadherin coding region. Four mutations were identified: one somatic nonsense and one somatic missense mutation, both with retention of the wild-type alleles, and two missense mutations with somatic loss of heterozygosity in the tumour tissue. These data support the classification of E-cadherin as a human tumour suppressor gene.

Since overexpression of mutant p53 protein is a common feature of invasive epithelial ovarian cancers, we investigated whether overexpression of the p53 tumor suppressor gene product occurs in benign and borderline epithelial ovarian tumors. Immunohistochemical staining for p53 was performed in frozen samples of 17 benign tumors and in 49 borderline tumors (4 frozen, 45 paraffin embedded). Overexpression of p53 was observed in 0/17 (0%) benign ovarian tumors and 2/49 (4%) borderline tumors. Overexpression of p53 in borderline tumors was only seen in advanced stage cases; overexpression was seen in 2/8 (25%) stage III cases, but not in any of 41 stage I/II cases. In conclusion, overexpression of p53 is not a feature of benign epithelial ovarian tumors or early-stage borderline ovarian tumors. Similar to invasive epithelial ovarian cancers, however, a fraction of metastatic borderline tumors also overexpress p53.

Objective: To examine the contribution of genetic and environmental factors to disease occurrence in 26 families with two or more members affected with systemic lupus erythematosus (SLE). Methods: Genetic and environmental factors were examined by HLA-A, B, C/DR typing and by determining the presence of lymphocytotoxic antibodies (LCA) in patients and their consanguineous and non-consanguineous relatives. Results: No association between SLE and HLA-A, B, C antigens was found. There was, however, a significant association with HLA-DR2 in white subjects with SLE. The most striking finding was that HLA sharing was increased among the affected members, suggesting genetic similarities. Seven of 14 sib pairs (50%) who had concordant SLE were HLA identical as opposed to an expected 25%. Another interesting finding was that 15/18 (83%) patients with SLE and 11/22 (50%) consanguineous relatives had LCA, while 1/9 (11%) spouses, and 2/42 (5%) healthy controls had these antibodies. Conclusion: Genetic factors have a role in the development and expression of SLE. Environmental factors may trigger the disease in genetically susceptible hosts.

Typhoid is a common reason for seeking medical care in general practice in the developing countries, Use of the Widal and Felix test is frequent in this setting. The purpose of this study carried out in private general medicine clinics in Niamey, Niger was to determine the incidence of typhoid and the predictive value of positive and negative results of the Widal test.We used low published values of sensitivity (67.9%) and specificity (93.8%). Estimation of the incidence of typhoid was based on reports made to the national health information system of Niger by 3 private clinics in Niamey.A total of 1725 persons attended the clinics between 1/12/07 and 31/01/08, including 311 presenting nonspecific signs suggesting typhoid, i.e., at least fever and headache, and 172 presenting typhoid. The incidence was 9.97% in attendees overall and 55.31% in attendees with nonspecific evocative signs. The positive predictive value of the Widal and Felix test was 53.81% and the negative predictive value was 96.35% in attendees overall and 93.13% and 70.25% respectively in patients with clinical signs.Other diagnostic modalities such as PCR, coproculture, and hemoculture can be proposed, but are not available in this setting. The positive predictive value of the Widal test among patients with nonspecific signs suggesting typhoid is high. While not negligible, the negative predictive value in this high-incidence group is relatively low and should indicate monitoring.

Due to the increasing number of patients who need orthopedic interventions, current research focuses progressively more on individualized physiotherapy and postoperative treatment. The restoration and therefore unrestricted movement are strongly connected to the accomplishment of physiotherapeutic exercises (form, repetitions and reproducibility of movement). If exercises are performed at home, less consultation with the therapist and high personal responsibility of the patient is required. In this paper an intelligent cheap and user friendly training system for use in home environment is presented. It evaluates the physiotherapeutic exercise using objective parameters by guiding the patient through the exercise and analyzing his reactions. The system itself was evaluated with 46 persons who performed standard physiotherapeutic exercises. The results show a significant increase in reproducibility of the exercises at home using the training system.

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.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.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$50,000 per QALY, over a range of costs and estimates. In Monte Carlo sensitivity analysis using a $50,000 per QALY willingness-to-pay threshold, cDC was either dominant or cost-effective with an ICER$50,000 per QALY in 83% of simulations.Combined weekly cDC appeared to be cost-effective compared with sDC as treatment strategy for patients with platinum-sensitive ovarian cancer, even when accounting for slightly lower QoL during treatment.

BACKGROUND: The p53 gene encodes a nuclear phosphoprotein present in low levels in normal human cells. The wild-type form of this protein functions to restrain inappropriate cellular proliferation. Approximately one half of human epithelial ovarian cancers have mutations in the p53 gene and overexpress the mutant protein product. Deletion of one allele of the p53 gene also frequently occurs in these cancers. PURPOSE: We sought to define the spectrum of mutations in the p53 gene in epithelial ovarian cancer with respect to both the specific codons involved and the type of mutations observed. We also examined the frequency of allelic deletion of the p53 gene in cancers containing p53 gene mutations. METHODS: Tissue samples from the epithelial ovarian cancers of 62 patients were obtained during initial laparotomy. Histologic examination was done to ensure that the experimental samples used in this study contained more than 75% cancer cells. Total RNA was extracted from these samples and separately from matched control noncancerous regions of the surgical specimen or white blood cells. The purified RNAs were reverse transcribed to generate cDNA copies of exons 4-10 of the p53 gene. Two rounds of polymerase chain reaction (PCR) were conducted to produce enough template for DNA sequence analysis of the regions of interest within the p53 gene. Dideoxy sequencing of at least two independent productions of each amplified DNA template was done to confirm the validity of the mutations found. Allelic deletions were identified by PCR and gel electrophoretic techniques to examine three polymorphisms within the p53 gene in cancer-normal DNA pairs. RESULTS: We identified 45 mutations in exons 5-8 of the p53 gene, where mutations frequently have been found in other cancer types. An additional mutation was identified in exon 4. Overall, 72% of the mutations were transitions, 24% transversions, and 4% microdeletions. Allelic deletion of the other p53 allele was seen in 67% of ovarian cancers in which a p53 mutation was present. Germ-line p53 mutations were not found in any patients whose cancers had p53 mutations. CONCLUSIONS AND IMPLICATIONS: Like p53 mutations in other types of human cancers, those in epithelial ovarian cancers are diverse and occur frequently in exons 5-8. The predominance of transition mutations suggests that p53 mutations in ovarian cancer arise because of spontaneous errors in DNA synthesis and repair rather than the direct interaction of carcinogens with DNA. These molecular data are consistent with data from epidemiologic studies that have failed to demonstrate a convincing relationship between exposure to environmental carcinogens and the development of ovarian cancer.

The Cognitive Difficulties Scale (CDS, McNair and Kahn, 1984) was used to assess memory complaints in 1648 subjects devoid of severe medical or psychiatric disorder. The subjects, aged 45–75 years, were recruited when visiting their general practitioner. The CDS was well accepted and showed a good and stable factorial structure. A weak correlation was found between CDS score and the results of a short neuropsychological battery. A high CDS score was associated with advancing age, low educational level, and psychological motives for visiting. A reduced 26-item version is proposed to shorten the time required to fill in the scale.

It has been shown that the monoclonal antibody Ki-67 reacts with a nuclear antigen that is expressed only by proliferating cells. The feasibility of using image analysis to quantitate Ki-67 staining (proliferation index [PI]) of epithelial ovarian cancers was investigated. The PI was determined in 50 advanced-stage primary ovarian cancers. Frozen sections were immunostained with the Ki-67 monoclonal antibody, and the PI was calculated using static image analysis. Among 35 stage III ovarian carcinomas, the median PI was 8.9%, compared with 17.7% in 15 stage IV cancers (P = 0.06). There was no relationship between PI and histologic grade. The median survival time of 32 patients whose cancers had a high Ki-67 expression (> or = 7.5%) was 16.8 months, which differed significantly (P < 0.01) from the median survival of 31.5 months observed in patients whose tumors demonstrated low Ki-67 expression (< 7.5%). Quantitative image analysis of Ki-67-stained fresh-frozen ovarian cancers may provide useful prognostic information. Further studies are warranted to investigate the relationship between Ki-67 expression and other known clinicopathologic and genetic features of ovarian cancer.

Objectives Tandem placement as part of low-dose-rate (LDR) brachytherapy boost for cervical cancer may be complicated by uterine perforation. The objective of this study was to describe a 10-year experience of using intraoperative ultrasound guidance in an attempt to minimize the risk of uterine perforation. Methods Operative and inpatient records were reviewed to identify cases in which intraoperative ultrasound guidance was employed in order to assist tandem placement, and to determine whether clinical or radiographic findings subsequently suggested uterine perforation. Demographic factors were collected in order to determine the baseline risk of perforation within this population. Results Between 1998 and 2008, 71 patients underwent 110 ultrasound-guided placements of tandem applicators. The median age was 48 (range, 26–88) years, and 20% were older than 60 years. Disease stage was FIGO IB1 (n = 10), IB2 (n = 13), IIA (n = 4), IIB (n = 19), IIIA (n = 2), IIIB (n = 16), IVA (n = 5) and IVB (n = 2). The median gravidity was 3 (range 1–10) and median parity was 3 (range 0–10). Seven patients had a preimplant history of pelvic infection, four had a history of intrauterine contraceptive device use, and 10 had a prior history of Cesarean section delivery. Only one patient experienced infection that may have been attributable to tandem placement-associated uterine perforation. At median survivor follow-up of 34 months, 19 patients had died. The estimated 3-year disease-free and overall survival rates for the entire population were 60% and 66%, respectively. Conclusions Within the present population, intraoperative ultrasound guidance of tandem placement was associated with no confirmed cases of uterine perforation. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.

BACKGROUND: It has been suggested that multiple sites of epithelial ovarian carcinoma on the peritoneal surface reflect polyclonal disease arising from multiple primary tumors in the peritoneal mesothelium, rather than monoclonal disease spread by metastases from one primary ovarian cancer. PURPOSE: The purpose of this study was to investigate whether ovarian cancer has a monoclonal or polyclonal origin. METHODS: DNA specimens were obtained from peripheral blood lymphocytes (normal DNA) and from multiple tumor deposits of 17 women with epithelial ovarian carcinoma: primary tumors, metastatic deposits, and ascites. The clonal origin of each tumor was determined by performing (a) analysis to detect loss of heterozygosity at five loci on chromosomes 5, 11, 13, and 17; (b) sequencing of exons 5-8 of the p53 gene; and (c) X-chromosome inactivation analysis of the phosphoglycerate kinase (PGK) gene. RESULTS: In 15 of the 17 cases analyzed, there was clear evidence of monoclonal origin. The probability that the genetic events documented in these 15 cases occurred as independent events in each tumor deposit ranged from 2.5 x 10(-1) to 3.7 x 10(-16). In two cases, the pattern of allelic deletion and p53 gene mutation was compatible with either a monoclonal origin or origin from two primary ovarian tumors. CONCLUSIONS: The results did not support the hypothesis that ovarian cancer is a multifocal, polyclonal disease. Instead, the data suggest that sporadic epithelial ovarian carcinoma has either a monoclonal or a dual primary origin. IMPLICATIONS: These findings have important implications for understanding of the natural history of ovarian cancer and for clinical strategies aimed at prevention and early detection. Further studies will be required to determine the clonal origin of familial hereditary ovarian cancer.

Excess volumes of the binary liquid mixtures of 2-chloro-2-methylpropane (tert-butyl chloride) or chlorobenzene +2,2,4-trimethylpentane (isooctane) have been determined at 293.15 and 313.15 K from density measurements at atmospheric pressure. The excess enthalpies, at 293.15 K, and the excess isobaric heat capacities, at 293.15 K and 313.15 K, have been measured using Picker calorimeters at atmospheric pressure

A significantly improved InP-based vertical-cavity surface-emitting laser with record device performance is demonstrated. Utilizing a twofold epitaxial growth process, self-adjusted lateral current confinement and index guiding are accomplished by means of a buried InGa(Al)As tunnel junction. Front and back mirrors are realized by 35 epitaxial InGaAlAs/InAlAs layer pairs and a 1.5 MgF2/a-Si layer pair, respectively. At room temperature and under continuous wave condition, lasers with small aperture diameters of only 13 μm exhibit record output powers of 1.6 mW with quantum efficiencies around 25%. For these devices, threshold current and voltage are as low as 4 mA and 1.2 V, respectively, because of low series resistances around 70 Ω.

Classification and payment systems that incorporate a functional measure used in routine clinical practice can only be as accurate as the underlying functional measure. The test-retest reliability in clinical practice of the individual item scores of the Functional Independence Measure (FIM), a functional measure used in classification and payment systems has been investigate. The aim of this study was to analyse paired measurements of FIM item scores carried out in routine clinical practice for patients transferred from one Rehabilitation Unit to another, and to determine the interrater reliability using standard measures of agreement and bias.Patients who were transferred between two rehabilitation units between August 2006 and October 2007 had a FIM scored on discharge from the original unit and a FIM scored on admission to the second unit. A short time between score and re-score reduced the probability of significant functional change. A retrospective analysis was performed.Paired FIM item scores from143 patients were included in the review. Raw agreement between the two scores for each FIM item was low, with a mean of 54 + 18 pairs (%) matching. The range of difference between scores was wide. Weighted kappa values were generally in the fair agreement range as were the intraclass correlation coefficients. Tests for bias and homogeneity showed that just over half of the items had significant differences in the two sets of scores. Weighted k showed only fair agreement for FIM items. Contributing factors for this could include incomplete FIM training of some staff, insufficient attention to accurate scoring, actual clinical changes, differences between patient performance in different settings, and variation in scoring because of the large number of staff involved in scoring the FIM in the multidisciplinary team within our settings.Caution needs to be exercised when utilizing the FIM individual item scores in clinical practice as part of clinical or funding classifications or in benchmarking as this study indicates only fair inter-rater reliability of these scores in clinical practice.

After a single iv bolus injection of 2 g ceftazidime, concentrations were measured in serum and urine in volunteers and in serum, bone, bile and tissue fluid in patients. The serum half-life was 171 min in volunteers (n=6, average age 26 years) and 221 min in patients (n=12, average age 58 years). The peripheral volumes of distribution were also different, being 7.81 in volunteers and 11.31 in patients. Urinary recovery from the volunteers averaged 92% of the dose. Bone samples free from blood and taken from the femoral head, the pelvis or the femoral shaft contained an average of 24.1 mg ceftazidime per litre of organic bone at 30 min after injection and 19.7 mg/l at 2 h. Samples of fluid from the periprosthetic space after hip replacement contained 25.6 mg/l at 2 h and were above 8 mg/l at 10 h. Bile concentrations reached 36.4 mg/l at 90 min and were above 8 mg/l for over 8 h. Peritoneal fluid samples contained 27.6 mg/l at 1 h and 8.0 mg/l at 8 h. These concentrations are considered sufficient to treat most aerobic infections associated with surgery.

Two women developed apparently isolated recurrences of ovarian carcinoma involving prior incisions after receiving intraperitoneal radioactive chromic phosphate (P-32) adjuvant therapy for early epithelial ovarian carcinoma. Both are alive without evidence of disease at second-look laparotomy after surgical resection of the abdominal wall metastases and cisplatin-based combination chemotherapy. Mechanisms of cutaneous and incisional implantation metastases are discussed. Adjuvant therapy with intraperitoneal P-32 is unable to provide systemic therapy for occult metastatic disease. The favorable outcome in these cases probably reflects limited tumor burden at the time of recurrence and stands in stark contrast to other cases of soft tissue recurrences of ovarian carcinoma reported previously.

The excess volumes (at 293.15 and 313.15 K) of the binary lisuid mixtures of ethanenitrile (acetonitrile) or 2-butanone (ethyl methyl ketone) + 2,2,4-trimetylpentane (isoctane) have been determined from density measurements at atmospheric pressure. The excess enthalpies (at 293.15 K) and the isobaric heat capacities (at 293.15 and 313.15 K) of the same mixtures have been measured by means of Picker calorimeters at atmospheric pressure

A recently developed model for 1-alkanol+alkane mixtures is extended to methanol mixtures and to the non-polar mixing partners tetrachloromethane and benzene. The model contains chemical and physical terms, which are combined in a thermodynamically consistent way. For our calculations on methanol mixtures, we have measured g E of methanol+ hexane via static vapor pressure measurements. In order to check the model predictions for systems with higher alkanols and alkanes, we have also determined g E of 1-octanol+tetradecane by measuring the melting curve. The reproduction of the excess properties of methanol+hexane, the agreement between predicted and measured values of g E for 1-octanol+ tetradecane, and the capability to deal also with other non-polar mixing partners demonstrate the power and reliability of the model.

Hysterectomy and bilateral salpingo-oophorectomy have long been acknowledged to be the centerpiece of therapy for carcinoma of the endometrium. However, 30 years ago, realization of the metastatic potential of this disease, particularly to regional lymph nodes, led many clinicians to include lymphadenectomy in the surgical management of uterine cancer. Retrospective studies have since demonstrated that lymphadenectomy is associated with an acceptably low level of surgical morbidity. The incorporation of lymphadenectomy into the surgical management of uterine cancer has accompanied a dramatic reduction in the use of peri-operative radiotherapy. Though not confirmed by prospective data, retrospective series have associated complete lymphadenectomy with an improvement in survival, even in node-negative patients. Contributing to a reduction in the use of postoperative radiation in endometrial cancer have been several randomized trials demonstrating a reduction in locoregional recurrence, but at the cost of significant radiation-induced toxicity and no improvement in overall survival.

The Batschinski-Hildebrand relation is improved by plotting the fluidity versus the molar volume minus the hard-core volume of the molecules, the latter given by equation of state calculations. The relation can be cast in a corresponding states form by reducing the fluidity by the molar mass, the critical temperature, and the critical volume and by reducing the volume by the zero temperature hard-core volume. The random close-packed volume, where the fluidity is zero, is in reasonable agreement with theoretical considerations of hard spheres. The small deviations from corresponding states for liquids are interpreted either by polarity or by nonconvexity of the molecules.

Resume Le suivi des malades traites par polychimiotherapie sequentielle dans les services de medecine interne orientes vers l'hematologie represente une lourde charge de travail pour l'ensemble de l'equipe soignante. Certains protocoles de chimiotherapie etablis sur de nombreux mois sont difficiles a gerer. Les possibilites d'erreur, en particulier dans les prescriptions medicales et la prise en charge, ne sont pas negligeables, exposant a des complications iatrogenes et a des rehospitalisations et des prolongations de sejours hospitaliers. La conception d'un systeme d'aide a la decision medicale et au suivi therapeutique doit pouvoir permettre de garantir un gain de temps pour le personnel soignant et la qualite et securite des prescriptions mais aussi une fiabilite des evaluations therapeutiques et une meilleure gestion hospitaliere. Le systeme decrit dans cet article est developpe sur Macintosh avec 4D, un gestionnaire de base de donnees relationnelle. Il comporte une base de donnees, une base de connaissances elaboree par l'expert clinicien comprenant des connaissances de type «declaratif et des regles de deduction qui representent le raisonnement de l'expert et determinent les conduites a tenir, et une interface entre les deux. Ce systeme est parametrable de facon tres souple, permettant en particulier une mise a jour des connaissances medicales et des attitudes therapeutiques.

A novel approach for long-wavelength InP-based verticalcavity surface-emitting laser diodes using buried tunnel junctions is presented. A laterally structured tunnel junction with subsequent regrowth results both in efficient current confinement and sharply reduced series resistance because of the substitution of high-resisistive p-doped layers by low-resistive n-doped layers. Furthermore, strong optical confinement is achieved because of the laterally differing cavity length. Significantly improved performance with respect to output power (>1 mW), quantum efficiency (>20%), series resistance (

High-performance InP-based Vertical-Cavity Surface-Emitting Lasers for the 1.45–1.85 μm wavelength range have been fabricated applying the buried-tunnel-junction structure on the InGaAlAs-InP material system. With this technique very small thermal and electrical resistances can be achieved enabling the continuous-wave operation up to 90° C. Record stationary parameters have been demonstrated, such as sub-mA threshold currents, low electrical resistances of 30–60 Ω for 5–10 μm diameter, 0.9 V threshold voltage at 1.55 μm wavelength and stably polarized single-mode operation with side-mode suppression of the order of 50 dB.

Introduction Le catheterisme veineux surrenalien (CVS) permet de differencier le caractere secretoire uni ou bilateral d’un hyperaldosteronisme primaire (HAP). Ses complications sont rares [1] et nous rapportons l’une d’entre elles. Observation Il s’agit d’une patiente de 49 ans presentant un HAP. Le traitement fut initialement medical (Spironolactone) mais en raison de la severite de l’hypokaliemie et de l’intolerance medicamenteuse, une chirurgie a ete envisagee et un CVS realise. Le scanner surrenalien retrouvait un nodule gauche de 8 mm, hypodense. Le CVS a ete difficile avec echec du catheterisme a droite mais c’est du cote de l’hypochondre gauche que la patiente a d’emblee decrit des douleurs allant crescendo. L’imagerie a mis en evidence une ischemie surrenalienne liee a une thrombose veineuse surrenalienne (TVS) gauche. Secondairement, sous heparinotherapie a dose curative depuis 32 heures, est survenu un hematome surrenalien gauche de 40 mm. Par la suite, le bilan hormonal a montre un tableau d’hyporeninisme-hypoaldosteronisme ayant necessite le recours a la fludrocortisone pendant 9 mois. La patiente reste actuellement normotendue et guerie de son HAP. Discussion La frequence des complications varie entre 0,61 % (rupture de veine surrenalienne) [1] , a 5 % (ischemie surrenalienne, TVS, hematome surrenalien). Une hypercoagulabilite liee a l’hyperhormonemie n’est pas exclue. Un hyporeninisme-hypoaldosteronisme resolutif en quelques mois a egalement ete observe, comme cela est parfois decrit apres une surrenalectomie pour adenome de Conn.

Cervical cancer is a major gynecologic malignancy around the world. However, current diagnostic methods such as Pap smear and human papilloma virus (HPV) testing are insufficient for an early diagnosis of cervical cancer, follow-up on therapy efficacy or to identify the women who might progress to cervical cancer (only about 1-5% of the HPV-positive women will develop cervical cancer). Patients with atypical squamous cells of undetermined significance (ASC-US) clearly need a better screening test. Developing a non-invasive method for early diagnosis of cervical cancer is essential. Our in vitro and translational research data support the hypothesis that: 1. Squamous cell cervical cancer is related to specific upregulation of tissue and serum Insulin-like Growth Factor-II levels (IGF-II; 100% sensitivity and 100% specificity). Serum IGF-I, but not IGF-II levels are elevated in other gynecological, breast, lung and prostate cancers. Serum IGF-II test helps in diagnosing cervical cancer as early as ASC-US or cervical intraepithelial neoplasia (CIN)-I and in monitoring therapy efficacy (p < 0.001 by Student's 't' test and Chi-square analysis). 2. Concomittant to increased serum IGF-II levels, IGF-Binding Protein 3 (IGF-BP3) levels are significantly decreased in persistent CIN and cervical cancer (p < 0.0001). As IGF-BP3 modulates IGF-II biological activity, significantly decreased serum IGF-BP3 levels (levels normalize after therapy; p < 0.001) may indicate a poor prognosis. Similar to serum IGF-II, serum IGF-BP3 levels help monitoring therapy efficacy in cervical cancer and advanced CIN. Measurement of serum IGF-II levels will help in early diagnosis of cervical cancer and monitoring of therapy outcome. Serum IGF-BP3 in conjunction with IGF-II levels may help in predicting prognosis as well as monitoring therapy efficacy.

Summary Pemphigus foliaceus (PF) is an autoimmune bullous epidermal disease, characterized by autoantibodies specific to the desmosomal protein desmoglein 1 (dsg1) and by acantholysis, the rupture of the cellular junctions among keratinocytes. Known also as fogo selvagem (wild fire) in Brazil, the disease has distinct epidemiological characteristics, being endemic in certain regions of South America. It is a multifactorial (complex) disease, with oligo- or polygenic disease susceptibility. In view of the previously reported evidences of a role for apoptosis dysregulation in pemphigus pathogenesis, we hypothesized that genetic variants of molecules participating in apoptosis may contribute to interindividual variation of susceptibility to PF. The TP53 12139(G,C) and the BAX−248(G,A) single nucleotide polymorphisms (SNP) were analysed in a genetic association study. The allelic, genotypic and allele carrier frequencies for these SNPs did not differ statistically between the patient and the control groups, for both the Euro- and the Afro-Brazilian population strata. The results of this study lead us to conclude that, although the TP53 and BAX alleles analysed differ functionally, this variation does not alter the functionality of the molecules in a way that would interfere with the development of the disease.

Background. Tuberous sclerosis is a neurocutaneous syndrome characterized by benign tumors that can affect many organs. Juvenile granulosa cell tumors of the ovary are rare neoplasms that typically occur in the first three decades of life and have excellent prognosis for early-staged disease. Case report. We report the first case of an 8-year-old white female with tuberous sclerosis and juvenile granulosa cell tumor of the ovary. She presented with a 20 × 22 cm pelvic mass and received a right salpingo-oophorectomy. Three months later, she recurred and underwent a left salpingo-oophorectomy, lymphadenectomy, and omentectomy followed by four cycles of Bleomycin, Etoposide, and Cisplatin chemotherapy. She is currently free of disease 8 years after her recurrence. Conclusion. Treatment options and a review of the literature pertaining to juvenile ovarian granulosa cell tumors and tuberous sclerosis are discussed.

Objective The purpose of this study was to evaluate patients with uterine papillary serous carcinoma (UPSC), clear cell (CC), and grade 3 endometrioid (G3) surgically stage I endometrial cancer. Methods The 25th Annual Report (AR) of FIGO was used to identify patients with endometrial cancers who were surgically staged. For comparison, all cancers reported were evaluated with particular interest in patients with stage I UPSC, CC, and G3. Incidence, substage, post-surgical treatment, and survival were identified. Results Of 5694 endometrial cancer patients reported to the AR, 3996 (70%) were surgically stage I. There were 148 UPSC, 59 CC, and 325 with G3 lesions. UPSC and CC represent 5.2% of all stage I cancers while 8.1% are G3. Although there were greater number of UPSC, CC, and G3 with extrauterine disease, about 50% of UPSC and CC were stage I. This compares to 81% for G1, 68% for G2, and only 42% for G3. There were more IA cancers with UPSC and CC than G3 (22%, 33%, and 17%, respectively). Survival (5 years) for UPSC and CC was 72% and 81%, respectively, compared to 76% for G3 lesions. Postoperative radiation improved survival somewhat (6–8%) but the difference was not significant. Conclusion UPSC and CC histotypes when diagnosed as stage I have a better survival than commonly perceived and equal to G3 endometrioid cancers. Postoperative radiation improves survival but not significantly so. The role of chemotherapy has not been defined.

We aimed to further document that elevated levels of circulating insulin-like growth factor II (IGF-II) are associated with cervical cancer and to test the hypothesis that there may be an inverse association between IGF-II and IGF-binding protein 3 (IGF-BP3).Serum IGF-II and IGF-BP3 levels were measured, using ELISA kits (Diagnostic Systems Laboratories), in 23 controls; 16 ASC-US with normal biopsies; 14 ASC-US with advanced CIN; 2 pretherapy CIN-I; 8 successfully treated CIN-I; 24 persistent CIN I; 14 pretherapy CIN II/III; 10 posttherapy CIN II/III with normal biopsies; 18 persistent CIN-II/III; 7 with pretherapy cervical cancer; 19 with posttherapy cervical cancer under remission; 15 with posttherapy persistent/recurrent cervical cancer; 10 with persistent ovarian or endometrial cancer; and 3 with endometrial or vulvar with cervical cancer. Student's t test and linear regression analysis were used.Compared to controls (493 +/- 90 ng/ml) and women with other gynecological cancers, serum IGF-II levels were significantly increased in women with ASC-US, with advanced CIN on biopsy (P0.0001), persistent CIN-I (993 +/- 262 ng/ml; P0.0001), pretherapy advanced CIN (1086 +/- 240; P0.0001), pretherapy cervical cancer patients (1746 +/- 318 ng/ml; P0.0001) and posttherapy persistent/recurrent CIN (1094 +/- 300; P0.0001); and cervical cancer (1395 +/- 189; P0.0001). After therapy, the IGF-II levels returned to normal in both CIN and cervical cancer patients under remission. Elevated serum IGF-II levels had 100% sensitivity and 87% specificity for cervical cancer and 81% sensitivity and 82% specificity for CIN. The levels of IGF-BP3 were significantly reduced in women with CIN before and after therapy (P0.0001) and in cervical cancer patients before and after therapy (P0.001). There was an inverse relationship between serum IGF-II and BP-3 levels (P0.01). Decreased serum IGF-BP3 levels had a sensitivity of 72% and specificity of 75% for cervical cancer and 81% sensitivity and 83% specificity for CIN. When both markers were considered together the sensitivity was 72% and specificity 84% for cervical cancer, while for CIN, the sensitivity was 57% and specificity 81%.Serum IGF-II may be a reliable marker for early diagnosis and monitoring therapy efficacy (sensitivity and specificity of 100% versus normal controls), while IGF-BP3 levels can be reliably used to predict prognosis.

This paper presents VCSELs in the InGaAlAs-InP system that have been realized from 1.31 /spl mu/m to 1.8 /spl mu/m enabling the buried tunnel junction technology with particular emphasis on output power, operation temperature and modulation speed at 1.55 /spl mu/m, aiming for 10 Gbit/s transmission.

Buried tunnel junction (BTJ) vertical-cavity surface-emitting lasers (VCSELs) for 1.55 /spl mu/m wavelength were fabricated on InP with significantly improved stationary and dynamic lasing characteristics such as CW output powers >7 mW (at 20/spl deg/C), maximum CW operating temperature >110/spl deg/C, threshold currents and voltages below 1 mA and 0.9 V, respectively, and modulation bandwidths exceeding 2.5 Gb/s.

A novel approach for VCSELs in the 1.5-1.8 /spl mu/m wavelength range has been presented yielding submilliamp lasing in CW operation to beyond room temperature, optical powers in excess of 1 mW and single mode operation.