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Purpose Despite the establishment of radical surgery for therapy of cervical cancer, data on quality of life and patient-reported outcomes are scarce. The aim of this retrospective cohort study was to evaluate bladder, bowel and sexual function in women who underwent minimally invasive surgery for early-stage cervical cancer. Methods From 2007-2013, 261 women underwent laparoscopically assisted radical vaginal hysterectomy (LARVH = 45), vaginally assisted laparoscopic or robotic radical hysterectomy (VALRRH = 61) or laparoscopic total mesometrial resection (TMMR = 25) and 131 of them completed the validated German version of the Australian Pelvic Floor Questionnaire (PFQ). Results were compared with controls recruited from gynecological clinics (n = 24) and with urogynecological patients (n = 63). Results Groups were similar regarding age, BMI and parity. The TMMR group had significantly shorter median follow-up (16 months versus 70 and 36 months). Postoperatively, deterioration of bladder function was reported by 70%, 57% and 44% in the LARVH, VARRVH and TMMR groups, respectively (p = 0.734). Bowel function was significantly worse after TMMR with a higher deterioration rate in 72 versus 43% (LARVH) and 47% (VARRVH) with a correspondingly higher bowel dysfunction score of 2.9 versus 1.5 and 1.8, respectively and 1.8 in urogynaecological patients. Sexual dysfunction was common in all surgical groups. 38% considered their vagina too short which was significantly associated with deep dyspareunia. Compared with controls, surgical groups had significantly increased PFQ scores. Conclusion Pelvic floor dysfunction commonly deteriorates and negatively impacts on quality of life after minimally invasive radical hysterectomy, especially bowel function after TMMR. Pelvic floor symptoms should routinely be addressed pre- and postoperatively.

Purpose For many decades, endometrial cancer (EC) has been considered as a homogenous tumor entity with good prognosis. The currently valid risk stratification considers clinical and pathological factors. Treatment recommendations differ considerably from country to country. Materials and methods The Cancer Genome Atlas (TCGA) Research Network has shown that ECs should be reclassified into four novel molecular prognostic groups, with the potential of changing adjuvant management of EC patients: ultra-mutated, hyper-mutated, copy-number low, and copy-number high. Clinical examples are shown, and the available literature has been highlighted. The European Society of Gynaecological Oncology (ESGO) guideline for endometrial cancer takes the new classification system into consideration for adjuvant treatment decisions and will be published this year. Results In the near future, we expect new treatment recommendations that may differ considerably from the clinicopathologically driven recommendations on the basis of our deeper insight and better understanding of molecular markers in endometrial cancer. The PORTEC 4a study is the only recruiting study which randomizes patients to adjuvant or no adjuvant treatment on the basis of the aforementioned new classification system. Conclusion The aim of the new classification is a more personalized adjuvant radio(chemo)therapy decision and better oncologic outcomes or avoidance of overtreatment.

Objective This study aimed to evaluate subjective and objective hearing loss in cervical cancer patients after chemoradiation with cisplatin (mono). Patients and methods A total of 51 cervical cancer patients with indication for chemoradiation were included. Pure tone and impedance audiometry were performed before and after chemoradiation. Hearing loss was scaled according to ASHA criteria. Subjective hearing was assessed with the Oldenburger Sentence Test. To consider age-dependent changes, hearing loss was corrected for age and the time interval between measurements. Results Median age at diagnosis was 46 years, 46% were active/former smokers (n=24), 28 (54%) patients were never-smokers. Median total weekly cisplatin dose was 70 +/- 14.2mg. Cumulative doses of cisplatin during chemoradiation ranged between 115.2 and 400mg cisplatin (mean 336.1mg, median 342 +/- 52.7mg). The median interval between last chemotherapy and second audiometry was 320 +/- 538 days (35-2262 days). Changes in hearing threshold >= 20dB were experienced by 32/52 patients (62%) following chemoradiation, 55% of them for frequencies >= 6000Hz. No statistically significant hearing loss remained after chemoradiation upon correction for age and time interval. Patients >40 years had a higher risk of hearing loss than younger patients. Objective data on hearing function did not correlate with subjective hearing loss and did not impair daily activity in any patient. Conclusion Chemoradiation with cumulative cisplatin doses up to 400mg did not lead to significant impairment of objective or subjective hearing. For cervical cancer patients undergoing chemoradiation, standard audiometry is not indicated.

Purpose For endometrial cancer (EC), clinical and pathological risk factors are taken to triage patients and estimate their prognosis. Lymph node involvement (pN+), lymphovascular space involvement (LSVI), grading, age of the patients, and T classification are internationally accepted parameters for treatment decisions. Materials and methods Studies on adjuvant radiation, chemotherapy, and chemoradiation are discussed against the background of risk stratification and clinical decision-making in early-to-advanced stage endometrial cancer. Recent publications on adjuvant treatment in high-risk disease and its implications for the patients with regard to expected oncologic benefit and treatment-related toxicity are discussed. Results Surgery is the mainstay of treatment of EC patients. Well-differentiated tumors and early disease (FIGO IA) should be followed up without further treatment. In FIGO I stage without risk factors, VBT remains the standard treatment after surgery. FIGO I, II patients with one or more risk factors (MI >= 50%, Grading[G]3, age >60 years, LVSI) benefit from external beam radiotherapy (EBRT) in terms of survival. There are no data of acceptable quality demonstrating that chemotherapy is superior to radiation in locally advanced carcinomas. Therefore, even in locally advanced disease (FIGO III, IV), EBRT remains the standard of care after surgery. EBRT contributes to the very low rate of local relapses and better DFS in these patients and should not be replaced by chemotherapy only. Whether and which subgroups of patients benefit from an additional (concomitant and/or adjuvant) chemotherapy in terms of disease-free survival remains a controversial issue. The recently published PORTEC-3 trial could not create clear evidence. With a high rate of isolated tumors cells and micrometastases in the specimens, the increasing use of unvalidated sentinel concepts in endometrial cancer raises more questions with regard to indications for adjuvant treatment.

A significant logistic factor as to the successful clinical application of the autologous tissue engineering concept is efficient transportation: the donor cells need to be delivered to tissue processing facilities which in most cases requires air transportation. This study was designed to evaluate how human chondrocytes react to X-ray exposure. Primary cell cultures were established, cultured, incubated and exposed to different doses and time periods of radiation. Subsequently, quantitative cell proliferation assays were done and qualitative evaluation of cellular protein production were performed. Our results show that after irradiation of chondrocytes with different doses, no significant differences in terms of cellular viability occurred compared with the control group. These results were obtained when chondrocytes were exposed to luggage transillumination doses as well as exposure to clinically used radiation doses. Any damage affecting cell growth or quality was not observed in our study. However, information about damage of cellular DNA remains incomplete

Liposuction is one of the most common aesthetic procedure used in plastic surgery. Reports are available on the results, the probable complications, and the feedback of patients. However, systematic studies dealing with these aspects using reliable large-enough data are still needed. The data comprised 116 procedures during a 6-year period up to 2005. The data were processed and categories of results were formed. Furthermore, a follow-up examination and a survey on the feedback of patients were carried out. Significant differences were identified in indications, results, and complications. The follow-up examinations and the survey showed satisfying results. In the majority of cases, surgeons were satisfied with the operations. In conclusion, if conducted by qualified surgeons in appropriate surgical conditions and postoperative care possibilities, liposuction may be considered as a reliable surgical procedure. The success of this procedure depends, however, on suitable infrastructure and operative competence

The objective of this investigation was to evaluate the indications for and the functional and cosmetic results of mandible reconstruction using free vascularized fibular flaps. It was also designed to assess the patients' quality of life, daily activities, and self-esteem, with special emphasis on patient satisfaction. We conducted a retrospective chart review of all patients who underwent osseus or osteocutaneous free flap reconstruction of the mandible over a 10-year period (1992-2002). Those in whom a vascularized fibular flap was used were included in the study and invited for a follow-up comprehensive physical examination and x-ray evaluation. A questionnaire was also administered to evaluate patient satisfaction. Twenty-six patients were included in the study. Fourteen patients died after an average of 2years and 9months postoperatively due to their prognosis despite surgical intervention and adjuvant therapy. Of the remaining 12 patients, 6 appeared for the follow-up evaluation, 2 were unavailable for follow-up, and 4 denied participating. Of these 6 patients, all experienced a decrease in pain and were satisfied with their results. At the time of the latest follow-up, they experienced some difficulties swallowing, and in 3 patients, their articulation was impaired. All 6 patients would undergo the procedure again. Reconstruction of the mandible using a vascularized fibular graft produces satisfactory functional and cosmetic results. In benign lesions, the procedure is highly indicated. However, in the case of malignancy, most patients do not survive their primary tumor. Given the patients limited life expectancy, the improvement in their quality of life as a result of the improved appearance and function of the reconstructed mandible needs to be weighed against the potential morbidity of the operative intervention on an individual basis

Designed for volunteers in Olympic College's Adult Education Volunteer Classroom Assistant Project, this handbook discusses volunteer tutors' roles, characteristics of Adult Basic Education (ABE) and English as a Second Language (ESL) students, suggested teaching techniques, tips for working with instructors, and college policies and regulations. The first section provides profiles of the types of people enrolled in ABE/ESL programs at Olympic College and offers statistics on the need for ABE/ESL instruction in the surrounding counties. The next section provides an overview of ABE education at the college and literacy efforts undertaken by other community groups. The need for volunteers to alleviate funding problems and excessively large classes is underscored prior to a discussion of the roles volunteers can play in the classroom (e.g., individual or small group tutoring, overseeing students in problem solving and special study, and conducting supervised group sessions or drill work) and outside the classroom (e.g., recruiting other volunteers, volunteering to tutor in students' homes, and voicing concerns to legislators). Next, a job description is provided for ABE/ESL classroom volunteers and the steps involved in program participation are outlined. Then, routine procedures are outlined for documenting time; keeping in touch with the teacher, other volunteers, and the volunteer coordinator; and using campus services. A list of classroom tips and 2 sample log sheets conclude the manual. (AYC)

Designed for Adult Basic Education (ABE) and English as a Second Language (ESL) instructors at Olympic College, this handbook provides information on the college's efforts to train volunteers as classroom assistants in ABE/ESL education, as well as guidelines for working with volunteers. The first section of the handbook provides background on the Adult Education Volunteer Classroom Assistant Project, the purposes of the handbook, the magnitude of the functional illiteracy problems in Kitsap and Mason Counties, and the potential benefits of using volunteers to meet instructional needs. The next section describes how volunteers are recruited and selected for Olympic College classroom work, focusing on the volunteer orientation program and its objectives. The next section indicates what volunteers may be expected to do and includes a volunteer job description. A discussion of the need to plan specific activities for volunteers is followed by guidelines for supervising volunteers, which present information on volunteer time-keeping, attendances, and use of instructional resources; the visits of volunteer coordinators to the classroom; evaluation of volunteer services, and supervisory tips. Following a list of the rights and responsibilities of volunteers, the handbook concludes with a discussion of ways of recognizing their contributions. An evaluation form for ABE/ESL volunteers is included. (AYC)