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Radiation therapy is the standard of care treatment for locally advanced cervical cancer in the United States. In 1999 the addition of concomitant chemotherapy to radical radiotherapy became standard. The addition of cisplatin (CDDP) with or without 5-fluorouracil (5-FU) chemotherapy to radiation therapy was based on the near simultaneous reporting of five randomized, controlled clinical trials which all showed an improvement in survival with a magnitude of approximately 35%. The purpose of our study was to test the hypothesis that the addition of chemotherapy improved survival in our patients. We identified 291 patients treated with primary 'intent-to-cure' radiation therapy for locally advanced carcinoma of the cervix between 1985 and 2000. We analyzed patients using a stepwise Cox regression, including as possible predictors: clinical stage, age at diagnosis, use of concurrent chemotherapy with radiation and method of teletherapy delivery. We also examined survival as a function of CRT with a CDDP and/or 5-FU containing regimen using the Kaplan-Meier estimates of overall survival. The use of concurrent CDDP and/or 5-FU chemotherapy with radiation (CRT) was not associated with an increase in disease free survival (p=0.734) or overall survival (p=0.989). In this retrospective study there was no disease free or overall survival benefit from the addition of CDDP and/or 5-FU chemotherapy to radical radiotherapy for the treatment of locally advanced cervical carcinoma, although there was a trend favoring CRT.

BACKGROUND: Micturition syncope is a relatively uncommon cause of sudden and temporary loss of consciousness. Most prevalent in older males, this condition is extremely rare in women. CASES: Two pregnant women presented with recurrent syncope. The syncopal events were more common in the early morning and were precipitated by the presence of a distended bladder, urinary urgency, assuming a standing position after either being supine or sitting, or associated with travel motion. Extensive neurology and cardiology evaluations were negative, and the events were considered consistent with micturition syncope. Both patients responded favorably to conservative voiding behavior modification measures throughout the remainder of pregnancy. CONCLUSION: Micturition syncope during pregnancy may not be a rare occurrence. This potentially dangerous condition is amenable to voiding behavior modification measures.

Dandy-Walker malformation accounts for approximately 5% to 10% of congenital hydrocephalus cases and consists of 3 major abnormalities: cystic dilatation of the fourth ventricle, complete or partial agenesis of the cerebellarvermis, and hydrocephalus. 1,2 It appears that the development of this condition is primarily a delay or total failure of the foramen of Magendie to open, allowing a buildup of cerebrospinal fluid with development of the cystic dilatation of the fourth ventricle. Dandy-Walker malformation has been reported in a wide variety of syndromes, including various mendelian disorders, chromosome abnormalities (trisomies 9, 13, 18, and 21, triploidy, and others), and antenatal exposure to teratogens (rubella, cytomegalovirus, toxoplasmosis, warfarin sodium, alcohol, isotretinoin, and maternal diabetes).2 Associated structural anomalies, which may occur in between 69% and 75% of cases, include intracranial abnormalities (agenesis of the corpus callosum and defects of neuronal migration), congenital cardiac disease (atrial and ventricular septal defects, atrioventricular canal defect, and pulmonary stenosis), renal anomalies, facial clefts, and syndactyly. 3,4 We present an unusual case in which Dandy-Walker malformation was diagnosed ultrasonographically in a fetus at 34 weeks' gestation, who subsequently had a large unilateral intraventricular hemorrhage and marked neonatal thrombocytopenia after cesarean delivery. The association of an antepartum intraventricular hemorrhage in a fetus with Dandy-Walker malformation is unusual and may be worthy of further investigation.