Preoperative irradiation therapy and radical hysterectomy: prognostic value of tumor regression after initial irradiation of squamous cell carcinoma of the cervix

OBJECTIVE: To investigate the role of tumor persistence in patients submitted to irradiation therapy and radical hysterectomy. DESIGN: A retrospective analysis of prognostic factors. LOCATION: Hospital A.C. Camargo, S?o Paulo, Brazil, a private non-profitmaking foundation and tertiary referral centre. PATIENTS: A total of 629 cases of invasive squamous cell carcinoma of the cervix were studied. Criteria for inclusion in the study were: confirmed histological diagnosis of squamous cell carcinoma and no previous treatment (except for preoperative radiotherapy carried out at the Hospital A.C. Camargo itself). At the end of the follow-up period, 410 patients (65%) had no evidence of disease and 219 (34.8%) had died because of the tumor. INTERVENTION: The patients were submitted to radical surgery and radiation therapy, separately or in combination between 1953 and 1982. MAIN OUTCOMES MEASURES: Multivariate analysis of the different variables was performed according to the Cox regression method. RESULTS: The variables of prognostic value were, in decreasing order of importance: the decade of patient admission (p = 0.0001), the modality of therapy employed (p = 0.0005), the presence of residual tumor in the surgical specimens (p = 0.0055) and the clinical stage of the disease (p = 0.0575). CONCLUSION: Radiation therapy controlled a considerable number of local tumors and pelvic lymph nodes but not all of them in every patient. There is a specific group of patients for whom radical surgery is necessary to achieve control of the disease.     

High-dose busulfan, melphalan, thiotepa and peripheral blood stem cell infusion for the treatment of metastatic breast cancer

The purpose of this study was to determine the outcome of patients with metastatic breast cancer treated with high-dose busulfan (Bu), melphalan (Mel) and thiotepa (TT) followed by peripheral blood stem cell (PBSC) infusion. Fifty-one patients with chemotherapy refractory (n = 32) or responsive (n = 19) metastatic breast cancer received Bu (12 mg/kg), Mel (100 mg/m2) and TT (500 mg/m2) followed by PBSC collected after chemotherapy and growth factor (n = 43) or growth factor alone (n = 8). The 100 day treatment-related mortality was 8% including one death from cytomegalovirus pneumonia, one from aspiration pneumonia and two from regimen-related toxicity (RRT). Seven of 28 refractory (25%) and 5/7 (71%) responsive patients with evaluable disease achieved a complete response of all measurable disease or all soft tissue disease with at least improvement in bone lesions (PR*). Fifteen of 51 patients (29%) are alive and progression-free a median of 423 days (range 353-934) after treatment, 5/32 (16%) with refractory disease and 10/19 (53%) with responsive disease. The probabilities of progression-free survival (PFS) at 1.5 years for the patients with refractory (n = 32) and responsive (n = 19) disease were 0.24 and 0.53, respectively. These preliminary data suggest that high-dose Bu/Mel/TT has significant activity in patients with advanced breast cancer and may be superior to some previously published regimens.     

PET: a proton/electron telescope for studies of magnetospheric,solar, and galactic particles

The proton/electron telescope (PET) on SAMPEX (Solar, Anomalous, and Magnetospheric Particle Explorer) is designed to provide measurements of energetic electrons and light nuclei from solar, Galactic, and magnetospheric sources. PET is an all solid-state system that will measure the differential energy spectra of electrons from ~1 to ~30 MeV and H and He nuclei from ~20 to ~300 MeV/nucleon, with isotope resolution of H and He extending from ~20 to ~80 MeV/nucleon. As SAMPEX scans all local times and geomagnetic cutoffs over the course of its near-polar orbit, PET will characterize precipitating relativistic electron events during periods of declining solar activity, and it will examine whether the production rate of odd nitrogen and hydrogen molecules in the middle atmosphere by precipitating electrons is sufficient to affect O₃ depletion. In addition, PET will complement studies of the elemental and isotopic composition of energetic heavy (Z>2) nuclei on SAMPEX by providing measurements of H, He, and electrons. Finally, PET has limited capability to identify energetic positrons from potential natural and man-made sources     

Prolonged expression of zinc finger immediate-early gene mRNAs and decreased protein synthesis following kainic acid induced seizures

STUDY DESIGN: A high-resolution strain measurement technique was applied to axially loaded parasagittal sections from thoracic spinal segments. OBJECTIVES: To establish a new experimental technique, develop data analysis procedures, characterize intrasample shear strain distributions, and measure intersample variability within a group of morphologically diverse samples. SUMMARY OF BACKGROUND DATA: Compression of intact vertebral bodies yields structural stiffness and strength, but not strain patterns within the trabecular bone. Finite element models yield trabecular strains but require uncertain boundary conditions and material properties. METHODS: Six spinal segments (T8-T10) were sliced in parasagittal sections 6-mm thick. Axial compression was applied in 25-N increments up to sample failure, then the load was removed. Contact radiographs of the samples were made at each loading level. Strain distributions within the central vertebral body were measured from the contact radiographs by an image correlation procedure. RESULTS: Intrasample shear strain probability distributions were log-normal at all load levels. Shear strains were concentrated directly inferior to the superior end-plate and adjacent to the anterior cortex, in regions where fractures are commonly seen clinically. Load removal restored overall sample shape, but measurable residual strains remained. CONCLUSIONS: This experimental model is a suitable means of studying low-energy vertebral fractures. The methods of data interpretation are consistent and reliable, and strain patterns correlate with clinical fracture patterns. Quantification of intersample variability provides guidelines for the design of future experiments, and the strain patterns form a basis for validation of finite element models. The results imply that strain uniformity is an important criterion in assessing risk of vertebral failure.     

Laparoscopic vesicopsoas hitch for infiltrative ureteral endometriosis

Type-specific serologic assays for herpes simplex virus (HSV) types 1 and 2 based on glycoprotein G-1 (gG-1) (HSV-1) and gG-2 (HSV-2) discriminate between antibodies against HSV-1 and HSV-2. We previously developed a Western blot assay using gG-1 and gG-2 expressed in baculovirus, performed extensive validation studies, and determined that it was both sensitive and specific for type-specific detection of HSV antibody. Here we report that, among a cohort of Thai military recruits, the serostatus of some individuals changed from positive to negative over time (6.6% among those ever positive for HSV-1, and 14.9% among those ever positive for HSV-2). We tested a subset of these specimens in three other gG-based assays: an enzyme-linked immunosorbent assay, an immunoblot strip assay, and a Western blot assay. Positive-to-negative shifts occurred in every assay; the frequency of the shifts ranged from 6. 1% to 21.2% of the specimen sets tested. There was only limited agreement among the assays concerning which individuals lost reactivity. This inaccuracy, exhibited by all of the assay protocols, was not predicted by validation studies employing specimens from cross-sectional studies and was most pronounced in HSV-2 testing. This argues for the inclusion of serial blood specimens in serologic assay validation procedures.     

A theoretical treatment of void electromigration in the strip geometry

The void electromigration process in the strip geometry is investigated analytically and numerically. The void is assumed to travel either along the axis of symmetry of the metal strip or at the boundary. In each case, the shape, the velocity of the void and the characteristic electrical current are predicted.     

The effect of exercise and rehabilitation on anterior-posterior knee displacements after anterior cruciate ligament autograft reconstruction

We studied the effect of rehabilitation strength training and return to activities on anterior-posterior knee displacements after patellar tendon autogenous anterior cruciate ligament reconstruction. A total of 938 measurements were sequentially collected for 142 patients with the KT-2000 arthrometer. Rehabilitation included immediate knee motion and early weightbearing, light sports at 6 months, and competitive sports at 8 months or later. At a minimum of 2 years after surgery, 121 patients (85%) had normal displacements (less than 3 mm of increase at 134 N), 14 (10%) had 3 to 5.5 mm of increase (partial function), and 7 (5%) had more than 5.5 mm of increase (failed). There was no association found between the initial onset of the abnormal displacements in the 21 knees and either the amount of time after surgery or the rehabilitation program. Six of the seven grafts that failed did so in the 1st postoperative year. Serial displacement measurements allow early detection of graft stretching and subsequent modification of rehabilitation or delay in return to strenuous activities. These measurements showed that the rehabilitation program used in this study was not itself injurious and resulted in an acceptable failure rate of 5%.