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Preoperative serum CA-125 levels were evaluated in 38 patients who underwent primary surgery for epithelial ovarian tumors of borderline malignancy at the Brigham and Women's Hospital and Massachusetts General Hospital between 1981 and 1990. Surgical staging was Stage I in 25 (66%) patients, Stage II in 2 (5%) patients, Stage III in 10 (26%) patients, and Stage IV in 1 (3%) patient. The mean sizes of mucinous and serous ovarian tumors were 21.9 and 10.3 cm, respectively (P = 0.0002). All 13 patients (100%) with mucinous tumors had Stage I disease, while 12 (50%) of 24 patients with serous tumors were Stage I. Combining all cell types, 10 (40%) of 25 patients with Stage I disease had an elevated preoperative CA-125 level, while 2 (100%) of 2, 9 (90%) of 10, and 1 (100%) of 1 patient with Stage II, III, and IV disease, respectively, had increased preoperative levels. Among patients with serous tumors, 3 (25%) of 12 Stage I patients had an elevated preoperative CA-125 level, while 11 (92%) of 12 Stage II-IV tumors had elevated levels (P less than 0.001). These data suggest that preoperative CA-125 level correlates with stage of disease in patients with serous borderline ovarian tumors.

We treated 40 patients with superficial bladder cancer via intravesical bacillus Calmette-Guerin for 1) prophylaxis against tumor recurrence, 2) residual carcinoma or 3) flat carcinoma in situ. A single course of intravesical bacillus Calmette-Guerin therapy was successful in 6 of 11 patients (55 per cent) treated for residual carcinoma and 6 of 12 (50 per cent) treated for carcinoma in situ. Of 17 patients receiving a single course of bacillus Calmette-Guerin for prophylaxis 11 remained free of tumor during short-term followup. A second course of therapy was administered to failures in each treatment category, which resulted in favorable responses in 5 of 6 patients treated for prophylaxis, 2 of 5 treated for residual tumor and 3 of 6 treated for carcinoma in situ. Over-all complete responses were achieved in 16 of 17 patients (94 per cent) treated for prophylaxis, 8 of 11 (73 per cent) for residual carcinoma and 8 of 12 (66 per cent) for carcinoma in situ, with a mean followup from the final treatment of 9.3, 12.3 and 7.9 months, respectively. Favorable results occurred more frequently among patients who exhibited a granulomatous inflammatory response in the bladder and delayed hypersensitivity skin test response to purified protein derivative. Marked variability in viability of bacillus Calmette-Guerin organisms was observed among different lots of bacillus Calmette-Guerin, and a direct relationship was observed between bacillus Calmette-Guerin vaccine viability and therapeutic efficacy. Most patients who failed initial therapy with a low viability lot of bacillus Calmette-Guerin responded favorably to re-treatment with a higher viability lot. The results suggest that the level of viability of each lot of bacillus Calmette-Guerin vaccine should be verified before clinical use.

We have provided pathologic documentation of vascular anastomoses across fused, dichorionic placentas. These placental anastomoses resulted in the twin transfusion syndrome.

THE provision of international telecommunications services-mainly telephone, telegram, and telex-is in the domain of a highly concentrated, regulated industry. The Communications Satellite Corporation, American Telephone and Telegraph, and a half-dozen record carrier companies are the sole facility and/or service providers on the U.S. end of the internationally connected voice and data circuits.1 International operations of these companies are regulated by the Federal Communications Commission as to authorized rates that may be charged and facilities that may be constructed. A reasonably complete and accurate analysis of the demand for international communications services is important for both the operating companies and their regulators. Operating companies need accurate demand forecasts in order to meet their quality-of-service and profit goals over time. Regulators require these estimates to make facility construction authorization decisions that properly balance the need for adequate service capabilities and the public benefits of avoiding excessive investment that arise when private construction incentives deviate from socially optimal levels. The latter problem is highlighted by the continual problem of balancing satellite and cable investment proposals.2 Knowledge of the structure of demand, especially price elasticities, is necessary for properly determining rates that yield the operating companies a 'fair return on a fair base' after recovery of expenses and depreciation. Published studies concerning the demand for international telecommunications are few in number. Telephone, telegraph, and telex have been studied by P. G. Yatrakis [i9] for a sample of 46 countries for I967 and by A. M. Lago [7] in an intertemporal cross-sectional analysis of 23 countries for the period I962-64. Demand for telephone services between the continental United States and Hawaii has been analyzed by C. H. Luke and P. G. Yatrakis [8] for the years I96I-69. The results of these studies indicate that

Hydropic chorionic villi are found in hydropic abortuses, partial hydatidiform moles (PM), and complete hydatidiform moles. Partial and complete moles have the potential for persistent trophoblastic disease. The vast majority of partial moles are triploid and generally follow a benign clinical course. Complete moles are diploid and distant metastasis and choriocarcinoma may develop. The authors determined the nuclear ploidy by flow cytometry of 31 placentas, 19 of which appeared hydropic either on obstetric ultrasonography or gross examination. Of ten complete moles classified by histologic criteria, ten were diploid, whereas five of seven histologically classified PM were triploid. The remaining two cases classified as PM were diploid; one most likely represented a regressing complete mole; the other a hydropic abortus. All 14 control placentas were diploid. In all cases in which karyotypic analysis was performed, the flow cytometric determination of ploidy was confirmed. It was concluded that DNA flow cytometric analysis is a rapid, accurate, and cost-effective means for assaying nuclear ploidy in these tissues, and as such, offers an informative supplement to the histological interpretation of hydropic placentas.

Das Potential fur beidseitig vorteilhafte Zollverhandlungen zwischen den Vereinigten Staaten und fortgeschrittenen EntwicklungslAndern. — Dieser Aufsatz versucht, das Potential fur beidseitig vorteilhafte Zollsenkungen zwischen den Vereinigten Staaten und einer Auswahl ihrer gro\ten Handelspartner unter den EntwicklungslAndern zu bestimmen. Ein partielles DreiLAnder-Gleichgewichtsmodell wird benutzt, um die direkten und indirekten Wirkungen auf den Au\enhandel abzuschAtzen, wenn die ZollsAtze bei den Gutern gesenkt Єrden, fur die jedes Land Hauptlieferant ist. Diese SchAtzungen bestAtigen die bedeutenden potentiellen Vorteile von Zollsenkungen; jedoch zeigt eine eingehende Produktanalyse, da\ die Mehrheit der in Betracht kommenden Guter von amerikanischen Politikern bereits als »import-sensibel« angesehen wird.

The ability of UV light, mitomycin C and ionizing radiation to induce the formation of sister chromatid exchanges (SCEs) at the same locus in successive cell generations was investigated in human lymphocytes. Cells were exposed to the DNA damaging agents after they had completed their first round of DNA replication, and SCEs were examined at the third division in chromosomes that had been differentially stained three ways. Although some of these treatments induced long-lived lesions that increased the frequency of SCEs in successive cell generations, none of the lesions led to the formation of consecutive SCEs at the same locus in successive cell generations. This observation seriously challenges the hypothesis that SCE cancellation results as a consequence of persistence of the lesions induced by these agents.

A radiochemical procedure developed by the authors for neutron activation analysis of As, Cd, Cu, Sn, and Zn in beef extract samples is described, based on combined precipitation steps to isolate the elements to be determined. Nuclides are separated with high degree of purity and good chemical yields. Interferences from threshold reactions are discussed and calculated. Results are shown for analysis of six samples.

Lipodystrophies are a group of diseases mainly characterized by a loss of adipose tissue and frequently associated with insulin resistance, hypertriglyceridemia, and hepatic steatosis. In uncommon lipodystrophies, these complications frequently are difficult to control with conventional therapeutic approaches. This retrospective study addressed the effectiveness of recombinant methionyl leptin (metreleptin) for improving glucose metabolism, lipid profile, and hepatic steatosis in patients with genetic lipodystrophic syndromes. We studied nine patients (five females and four males) with genetic lipodystrophies [seven with Berardinelli-Seip syndrome, one with atypical progeroid syndrome, and one with type 2 familial partial lipodystrophy (FPLD)]. Six patients were children under age 9 years, and all patients had baseline triglycerides levels >2.26 mmol/L and hepatic steatosis; six had poorly controlled diabetes mellitus. Metreleptin was self-administered subcutaneously daily at a final dose that ranged between 0.05 and 0.24 mg/(kg day) [median: 0.08 mg/(kg day)] according to the body weight. The duration of treatment ranged from 9 months to 5 years, 9 months (median: 3 years). Plasma glucose, hemoglobin A1c (Hb A1c), lipid profile, plasma insulin and leptin, and hepatic enzymes were evaluated at baseline and at least every 6 months. Except for the patient with FPLD, metreleptin replacement significantly improved metabolic control (Hb A1c: from 10.4 to 7.1 %, p < 0.05). Plasma triglycerides were reduced 76 % on average, and hepatic enzymes decreased more than 65 %. This study extends knowledge about metreleptin replacement in genetic lipodystrophies, bearing out its effectiveness for long periods of time.

We propose a method to determine the isoscalar \bar K N scattering length on the lattice. Our method represents the generalization of L\"uscher's approach in the presence of inelastic channels (complex scattering length). In addition, the proposed approach allows one to find the position of the S-matrix pole corresponding the the Lambda(1405) resonance., Comment: 8 pages, 3 eps figures

Complete transposition of the external genitalia is a rare abnormality that occasionally is associated with the caudal regression syndrome. We report the pathological findings of this abnormality in a male stillborn and a female newborn. The male stillborn had extensive urogenital anomalies as well as complete transposition of the external genitalia and agenesis of the lumbar spine. The female patient had renal tract anomalies and ambiguous external genitalia with a phallic structure in the gluteal cleft. In surviving infants with transposition of the external genitalia immediate evaluation of the urogenital system is necessary to identify the full extent of any associated internal defects.

This paper describes two cases of an unusual renal abnormality discovered in anuric siblings (one male, one female) who were born at 36 and 34 weeks of gestation and died of systemic complications secondary to severe pulmonary hypoplasia shortly after birth. Both gestations were complicated by marked oligohydramnios. Antenatal ultrasound examinations showed slightly enlarged kidneys in the first case and normal kidneys in the second case, with no evidence of hydronephrosis or cystic disease in either. With the exception of enlargement of the first infant's kidneys, autopsies revealed grossly unremarkable kidneys and ureters. Microscopy, however, demonstrated increased glomerulogenesis with normal glomeruli and global immaturity of renal tubules and ducts without concomitant features of dysplasia. Immunoperoxidase staining for epithelial membrane antigen revealed the immaturity or complete absence of proximal convoluted tubules. This precise constellation of findings had not been described previously. One other similar family has been documented in a report implicating genetic factors. In the present cases, the possibility of a cocaine-associated etiology is also addressed.

Fifteen patients with repetitive hydatidiform mole were followed at the New England Trophoblastic Disease Center between 1965-1988. The medical records were examined to determine the patients' age, gravidity, parity, clinical presentation, development of post-molar tumor, and subsequent pregnancy experience. Each molar tissue was reviewed pathologically. Seven patients had repetitive complete hydatidiform mole and three developed persistent post-molar disease after their later mole. Five patients had an initial complete hydatidiform mole followed by a partial hydatidiform mole; two developed persistent post-molar disease after the partial mole. One patient had an initial partial hydatidiform mole followed by a complete hydatidiform mole and required chemotherapy after her complete mole. Two patients had repetitive partial hydatidiform mole, and neither developed post-molar disease. Four of the patients with repetitive mole later achieved a normal viable pregnancy. Molar pregnancies must be categorized as either complete or partial to provide meaningful data concerning repetitive hydatidiform mole.

A preterm infant had an amniotic band sequence. Anomalies included left leg amputation and digital anomalies of the hands. The umbilical cord was short, and histologic sections of the placenta demonstrated partial avulsion of the amnion and fibrosis of the underlying chorion. Ultrasound at 21 weeks was normal, there was no history of trauma during the pregnancy, and no amniocentesis had been performed. Despite isolated case reports of amniotic band sequence associated with amniocentesis, we doubt that amniotic band formation is a significant risk after second-trimester amniocentesis.

Meconium peritonitis is a sterile, chemical peritonitis resulting from perforation of the bowel in perinatal life. In stillbirths meconium peritonitis is extremely rare. We report the autopsy findings in three fetuses ranging from 21-39 weeks gestation in which meconium peritonitis was identified. Maternal history in two cases was suggestive of possible fetal hypoxia. No family history of cystic fibrosis was discerned. One fetus was hydropic and abdominal calcifications were noted on postmortem radiograph. Gross evidence of meconium in the peritoneal cavity, visceral adhesions, and serosal nodules were noted in two fetuses. Nodules of calcified meconium seen by microscopy were the only clues to diagnosis in the third fetus. The discovery of meconium peritonitis at autopsy may be the only residual evidence of antecedent bowel perforation. We suggest that intrauterine hypoxia may play a role in the development of meconium peritonitis in some cases.

We report the morphological effects of intravesical bacillus Calmette-Guerin therapy on early post-treatment biopsies of the bladder in 39 patients with superficial transitional cell carcinoma (stage Ta, T1 or Tis) of the bladder. Although submucosal granulomatous inflammation in bladder biopsies of patients receiving intravesical bacillus Calmette-Guerin treatment has been described previously, a complete morphological description of the early effects of bacillus Calmette-Guerin on all bladder layers and the prostatic urethra has not been reported. In the majority of cases the superficial epithelium was eroded and the edematous submucosa contained noncaseating granulomas with a surrounding lymphoplasmocytic and eosinophilic infiltrate. Langhans' giant cells occasionally were found, and acid-fast bacilli were demonstrated only rarely by special stains in the 6-week post-treatment biopsy. In some cases the prostatic urethra and muscle bundles contained noncaseating granulomas. Features distinguishing epithelial atypia resulting from bacillus Calmette-Guerin treatment and superficial cancer include the presence of epithelial maturation, preserved nuclear/cytoplasmic ratio, smooth nuclear contours and lack of nuclear pleomorphism, nucleoli or cytomegaly.

We identified three cases of tetraploid hydatidiform moles (HM). A complete hydatidiform mole (CM) had a 92,XXXX karyotype. The two partial hydatidiform moles (PM) had karyotypes of 69,XXY/90,XXXY,−11,−13 and 92,XXYY, respectively. Study of chromosomal heteromorphisms in the 92,XXYY PM revealed two maternal and two paternal haploid sets. Flow cytometric analysis of nuclear DNA content from fresh placental tissue from the 69,XXY/90,XXXY,−11,−13 PM demonstrated distinct peaks in the triploid and tetraploid regions and an octaploid G2M peak. Flow cytometric analysis of paraffin-embedded, fixed tissue was diagnostic of tetraploidy in the 92,XXXX CM and consistent with tetraploidy in the 92,XXYY PM. All three patients achieved spontaneous remission of elevated gonadotropin levels. These three cases of tetraploid HM do not fit into the usual patterns of diploid CM and triploid PM. We conclude that flow cytometric analysis of nuclear DNA may be used to identify polyploidy in fresh and paraffin-embedded, fixed placental tissues. Categorization of all molar placentas on the basis of ploid presents are opportunities to study the biology and natural history of gestational trophoblastic disease in tetraploid HM.

Little is known about the role of the attentional, motor and non-planning impulsivities in motor timing tasks. The aim of this study was to correlate the motor performance in a motor timing task with the performance in neuropsychological tests of twenty two volunteers. Before the execution of the motor task, participant wore a headphone and heard five times each temporal reference (2,500 and 3,500 msec) that consisted of two “bips”. After, the motor timing task was performed in five trials of each temporal reference. The task consisted in transporting tennis balls in a pre-defined sequence in each criterion time. It was evaluated: reaction time, movement time, constant error and absolute error. The neuropsychological tests IGT and CPT-II were applied to the evaluation of impulsivities. The findings indicated that attentional impulsivity was more related to the motor performance than the motor and non-planning impulsivities.Key Words: Impulsivity, motor control, motor timing task.Â

Leptin, the product of the Ob gene, is a polypeptide hormone expressed in adipocytes which acts as a signalling factor from the adipose tissue to the central nervous system, regulating food intake and energy expenditure. It has been reported that circulating leptin levels are higher in women than in men, even after correction for body fat. This gender-based difference may be conditioned by differences in the levels of androgenic hormones. To explore this possibility, a systematic in vitro study with organ cultures from human omental adipose tissue, either stimulated or not with androgens (1 microM), was undertaken in samples obtained from surgery on 44 non-obese donors (21 women and 23 men). The assay was standardized in periods of 24 h, ending at 96 h, with no apparent tissue damage. Leptin results are expressed as the mean+/-s.e.m. of the integrated secretion into the medium, expressed as ng leptin/g tissue per 48 h. Spontaneous leptin secretion in samples from female donors (4149+/-301) was significantly higher (P

These comments on a previous correspondence show that the method exposed is a trivial consequence of Lill's method. Furthermore, the Hurwitz restriction is removed from the polynomial.

A UNIQUE feature of the Kennedy Round of the General Agreement on Tariffs and Trade (GATT) Negotiations (1964-1967) was the use of the "linear" technique of reducing tariffs. Under a linear approach each participant agrees to make a uniform across-theboard percentage cut in import duties, subject only to a bare minimum of exceptions and to the condition that the country achieves overall reciprocity. This approach was adopted in an effort both to reduce the time and effort involved in traditional item-by-item negotiations and to achieve a deeper average duty-cut for all participants. In prior negotiations under the GATT, the bargaining technique was essentially bilateral. Request and offer lists were exchanged between all pairs of countries and bargaining then proceeded on a two-by-two basis. In order to make this type of negotiation feasible, the so-called principal supplier rule was followed. A country's offer list to another country covered only those items for which the other country was the principal or at least, a very important import supplier.1 This procedure minimized the problem of conducting simultaneous negotiations on the same item by different country teams. At times during the negotiations, however, information concerning concessions tentatively agreed upon in the independent bilateral negotiations was made available to all pair-wise teams so that each might evaluate the indirect effects of the other negotiations on its bilateral balance of concessions. Finally, when each pair of countries had reached a mutually satisfactory balance of concessions, the list of offers by a country to each other country was combined into a single tariff reduction list that applied to all countries. Just what constituted a satisfactory balance of concessions or reciprocity was never openly defined, but it came to mean that a country would achieve an approximately equal increase in exports from the concessions it obtained as the increase in imports from the concessions it granted.2 The main concern of negotiators was to achieve this reciprocity on the total trade of their country with the rest of the world. However, since the negotiations were conducted mainly on a bilateral basis, the notion of reciprocity also tended to dominate the pair-wise negotiations between countries. As became increasingly apparent through successive GATT negotiating rounds, following the principal supplier rule and imposing a condition of approximate bilateral balance for changes in the volume of trade considerably limited the set of feasible total increases in exports and imports. The early hopes of many Kennedy Round negotiators that most of the difficulties connected with the item-by-item, bilateral negotiating technique would be eliminated by following a linear-cut rule proved to be much too optimistic. Some industrial countries, namely Canada and Australia, as well as all the less developed countries did not accept the linear rule. More disappointing, however, was the reluctance of most major countries to cut agricultural duties on a linear basis and the insistence of the European Economic Community (EEC) on a special rule to handle "significant disparities" in tariff rates of various countries on the same item.3 Lists of exceptions for certain countries also proved to be larger than was hoped for initially. Once it became apparent that reciprocity could not be achieved by bargaining on a