Wilmss' tumor: The northern israel oncology institute experience

Between 1971 and 1992, 42 children (median age = 2 years) with histologically proven Wilms' tumor were evaluated at the Northern Israel Oncology Institute. Most patients were staged according to National Wilms' Tumor Study (NWTS) criteria by which 18 were clinical stage I-II and 24 were III-IV. Combined therapy (surgery, chemotherapy, and radiotherapy) was given with a change to lower dose radiotherapy (<2,000cG) after 1981. The pre-1981 group (13 patients) suffered six relapses, most of which were pulmonary, whereas the 1981-1992 group (29 patients) had three relapses. The actuarial 5-year survival rate using Kaplan-Meier tables was 79% for the entire group but 100% for the 1981-1992 group and 38% for the 1971-1980 group. One case of immediate hepatic toxicity and one sudden death, unknown cause, of a patient in remission occurred in the group. Late deleterious effects were seen in five other patients; four had scoliosis and one developed osteoid osteoma of a rib. Despite these encouraging results, the necessity of ongoing monitoring for further longterm toxicities is apparent.     

Exactness of mortality statistics by external and natural causes of death with medico-legal intervention in Catalonia, 1996

OBJECTIVE: Deaths due to external and natural causes with forensic intervention require medical-legal autopsy. In order to be included in the mortality statistics the results are reported in the statistical document MNP52. The accuracy of cause of death depends on the characteristics of the document, the point at which it is completed (after the death or after the autopsy) and the person that completes it. The objective is to determine the accuracy of external and natural causes of death with forensic intervention, reported in the official statistical documents by a medical-legal autopsy report of these deaths occurred in Catalonia in 1996. METHODS: Two samplings were undertaken--one for natural causes and another for external causes--that were stratified by sex and judicial district. The information sources were the Mortality Register of Catalonia for the statistical documents and the criminal courts for the medical-legal autopsy, toxicological and pathological reports. We calculated the index of agreement, the sensitivity or detection rate (DR) and the positive predictive value of confirmation rate (CR), and their respective 95% confidence intervals. RESULTS: The index of agreement was 72.3% (IC 95%: 68.7-75.9). The DR for external causes groups was 65.9% (60.6-71.2) and the CR was 69% (63.6-71.2). For natural causes the DR was 79.4% (74.7-84.2) and the CR was 75.5% (70.7-80.5). CONCLUSION: In deaths with forensic intervention, the official statistical documents do not correctly report external causes of death, and statistics for natural causes of death approach acceptable levels of accuracy. The results are mainly due to deficits in reporting and certifying these causes in the official statistics.     

The effects of female age on the outcome of testicular sperm extraction and intracytoplasmic sperm injection in infertile patient with azoospermia

Introduction: Testicular sperm extraction (TESE) is well-defined procedure for surgical sperm retrieval in obstructive and non-obstructive azoospermia. This study was focused on the effectiveness of testicular sperm extraction and intracytoplasmic sperm injection (ICSI) for azoospermic men with different female age subgroups.Materials and methods: A total of 107 men with azoospermia underwent TESE and ICSI treatment. The women were examined in three groups 20–29, 30–34 and 35 years or older. The main outcome in this study was fertilization and pregnancy rates with TESE and ICSI.Results: Spermatozoa were successfully retrieved during 97 of 107 (90.7%) TESE attempts, resulting in the fertilization of 286 of 563 (50.4%) injected metaphase II oocytes. Two hundred and fifty-five of them were transferred (89.8%). The clinical pregnancy rate and ongoing pregnancy rate per embryo transfer were 22.5% and 20.6% respectively. When comparing the fertilization and pregnancy rates, it was observed that women between the ages of 20–29 years had significantly higher pregnancy rates than women over 34 years of age (p < 0.05).Conclusion: The female age is a major factor in determining successful implantation in ICSI.     

Beta2-microglobulin and hypertensive complications in pregnant women at risk

BACKGROUND AND AIM: Beta2-microglobulin (beta2-m) is a polypeptide, which is freely filtered through the glomerular basement membrane and absorbed almost entirely by the proximal tubular cells. Preeclampsia, a common complication of pregnancy, is characterized by pathological renal changes, mainly glomerular lesions. The aim of the present study was to investigate whether serum beta2-m measured in the early stages of pregnancy could be used as a marker to predict hypertensive complications in women at increased risk. PATIENTS AND METHODS: Serum beta2-m concentrations were prospectively measured in 75 pregnant women with history of chronic hypertension, chronic renal disease, chronic vascular disease or preeclampsia and compared with those in 16 healthy pregnant women. RESULTS: Of the 75 women in the study group, 10 (13%) developed preeclampsia and 20 (26%) had other complications, such as intrauterine growth restriction (n = 8), fetal or neonatal loss (n = 9) and delivery before 30 weeks of gestation (n = 8). Gestational age at delivery, birth weight and cesarean section rate were significantly worse in the patients with complications than in those without and in the healthy controls. No significant difference was detected in early serum beta2-m concentrations between the women who later developed preeclampsia or other complications and those who did not. There was a significant positive correlation of beta2-m concentrations with serum creatinine level (R2 = 0.394, p < 0.001), but not with gestational week at blood collection. CONCLUSION: Serum beta2-m concentrations are not predictive of the development of preeclampsia or other complications in woman at risk.     

Burden of illness in irritable bowel syndrome comparing Rome I and Rome II criteria

OBJECTIVES: To evaluate the burden of illness in irritable bowel syndrome (IBS), in terms of resource utilisation (direct and indirect) and health-related quality of life (HR-QOL), in individuals with IBS who meet Rome I and Rome II criteria. METHODS: A cross-sectional study, carried out by personal interview, on a representative sample (n = 2000) of the Spanish population. Individuals with suspected IBS were identified via a screening question and subsequently given an epidemiological questionnaire to complete. The questionnaire collected information on IBS symptoms, resource utilisation, and HR-QOL [Medical Outcomes Study 36-item Short Form (SF-36)]. RESULTS: Sixty-five individuals met Rome II criteria for IBS, while 146 individuals met exclusively Rome I criteria. Of Rome II individuals, 67.7% had consulted some type of healthcare professional in the previous 12 months, compared with only 41.8% of those individuals meeting exclusively Rome I criteria (p vs 17.1%); 'drug consumption' (70.8 vs 45.2%); and 'reduced performance in main activity' (60 vs 27.4%). Compared with the general population, the study sample reported significantly worse HR-QOL scores in four dimensions of the SF-36 ('bodily pain', 'vitality', 'social functioning' and 'role-emotional'. Additionally, individuals meeting Rome II criteria reported worse HR-QOL scores than those individuals meeting exclusively Rome I criteria, especially in the 'bodily pain' and 'general health' dimensions. CONCLUSIONS: The burden of illness in IBS is important and correlated to the diagnostic criteria employed. Individuals who met Rome II criteria reported a higher level of resource utilisation and worse HR-QOL than individuals meeting exclusively Rome I criteria.     

A histomorphometric study of osteocytic lacunae in interradicular bone with periodontal disease

Previous studies report on the differences in volume of osteocytic lacunae that are associated to different local and systemic bone pathologies. Alterations have also been reported in rats with periodontal disease. The aim of the present study was to assess the histomorphometric pattern of osteocytic lacunae of the interradicular septum in human molars with periodontal disease (PD). We took samples of the interradicular septum of 31 molars with indication of extraction of male and female patients, 18-55 years old, who attend the Department of Surgery II of the Faculty of Dentistry, National University of Cordoba and private centers. Clinical records were prepared for each patient. The corresponding radiographs were taken for all the patients. We studied 11 samples of molars with slight PD and 12 control molars free from PD. Ten samples of healthy bone corticals of vestibular or lingual tables obtained from histopathology archives were also assessed. Following extraction with atraumatic pincers, the interradicular septum was removed. The samples were fixed in buffered formaline, decalcified in EDTA and embedded in paraffin. Ten micrometer sections were stained with H&E and Masson's trichromic technique. The sections were analyzed by light microscopy. A minimum of 50 lacunae were selected at random in each sample for histomorphometric evaluation. Semi-automatic evaluation of the area and diameters of the lacunae was performed employing an image analyzer and the PRO IMAGE PLUS software. The data showed that the volume of osteocytic lacunae of interradicular bone is larger than that of the cortical bone of the vestibular or lingual tables. The latter are more ribbon-shaped and their minor diameter is smaller. No differences were found between the osteocytic lacunae of the interradicular bone of healthy molars and that of molars with slight periodontal disease. Given that the experimental data evidenced volume changes in osteocytic lacunae of severe, inflammatory periodontal lesions, it would be interesting to examine the volume changes in osteocytic lacunae in patients with varying degrees of periodontal disease to examine the role of osteocytes in the development and progression of periodontal disease.     

The first heart-lung transplantation in a Hungarian patient with cystic fibrosis

INTRODUCTION: Progressive lung disease and respiratory insufficiency is the leading cause of early death for patients with cystic fibrosis. METHOD: Successful heart-lung transplantation was performed in the 24 years old man with cystic fibrosis for end stage lung diseases and for concomitant dilatative cardiomyopathy. RESULTS: Six months following the operation the patient returned to full-time his job, and leads an active life like other fellow-men of his age. CONCLUSIONS: The attention is called with this case report to a rarely necessary intervention available for Hungarian patients as well. The criteria of the lung transplantation in cystic fibrosis, the preoperative screening and the tasks of the postoperative care are summarised.     

The role of membrane glycoproteins CD46, CD55 and CD59 in protection of tumor cells against complement lysis

Utilization of the complement system offers potential for the elimination of tumor cells by monoclonal antibodies (mAb) immunotherapy. Activation of the complement system causes tumor cell destruction by inducing complement lysis and promoting cell-mediated killing. In addition, complement can induce a strong inflammatory response, which might enhance other antitumor effector mechanisms. An important targets for mAb immunotherapy, however, are membrane bound complement regulatory glycoprotein: CD46, CD55 and CD59, which have been found to be expressed on most tumor cells in vivo and in vitro. Blocking or down regulation of these inhibitors could be an important step in the advancement of mAb immunotherapy.