Ovarian metastasis from squamocellular cervical cancer, stages IB and IIA

Ovarian metastasis from early stage squamous cervical cancer is rare. In a series of 393 surgically treated patients with squamous cervical cancer, stages IB and IIA, 2 had unsuspected ovarian metastasis. These cases are reported. In younger patients, ovarian extirpation instead of conservation of the ovaries must only be considered in histologically unfavorable tumors extending high up in the endocervix, especially on suspicion of lymph node metastasis.     

Deficiency of factor XII-dependent plasminogen proactivator in prekallikrein-deficient plasma.

Normal human plasma contains a factor XII (Hageman factor)-dependent plasminogen proactivator in its gamma globulin fraction. On the basis of both fibrin plate and clot lysis assays, this plasminogen proactivator activity was shown to be absent from the gamma globulin fraction of prekallikrein (Fletcher factor)-deficient plasma of two unrelated patients. This observation suggests that factor XII-dependent plasminogen proactivator is identical to plasma prekallikrein.     

Accelerated elimination using hemoperfusion in a patient with phenobarbital intoxication

A 44-year-old female was found comatose after attempting suicide. Toxicological screening showed phenobarbital intoxication. The patient was treated symptomatically. After ten days her serum level of phenobarbital still had not decreased and she was not clinically recovered. The patient was transferred to another hospital for hemoperfusion to decrease the level of phenobarbital. After hemoperfusion the level of phenobarbital dropped significantly and the patient recovered neurologically. Phenobarbital has a long elimination half-life and for this reason it is advisable to use means to accelerate clearance until the clinical condition of the patient shows improvement. Multiple-dose activated charcoal effects the elimination of phenobarbital. If elimination needs to be speeded up, then hemoperfusion can be considered. If this technique is unavailable, hemodialysis is a good alternative.     

Age effects in identifying and localising dichotic stimuli: a corpus callosum deficit?

In the present study, dichotic listening performance of 31 older adults was compared with performance of 25 younger adults under free and focused attention conditions. In addition to an age-related general decrease in performance, we observed in the focused attention condition increased asymmetry in the elderly group: the decrease of recall performance was stronger for the left ear (LE) then for the right ear (RE), while the increase of localisation errors were greater for the RE than for LE. Identifying and localising digits appear to be different process mediated predominantly by the left and right hemisphere, respectively. Since age-related reduced performance is strongest for the ear ipsilateral to the hemisphere dominant to that particular function, these finding may be ascribed to decline of corpus callosum functioning resulting in decrease interhemispheric interaction rather than to a selective decline of right hemisphere functions.     

Intraoperative monitoring of brain tissue oxygen and carbon dioxide pressures reveals low oxygenation in peritumoral brain edema

Brain edema and swelling often complicate surgery for brain tumors. Its pathophysiology is unclear, as is the relationship with brain tissue oxygenation. Our hypothesis was that brain edema around tumor is cytotoxic type caused by impaired local tissue oxygenation due to increased local tissue pressure. Therefore, we monitored brain tissue oxygen pressure (p(ti)O2) and carbon dioxide pressure (p(ti)CO2) in 19 patients undergoing craniotomy for removal of a brain tumor and specifically studied the effect of decompression by dura opening and by tumor removal with respect to the presence of brain swelling. Before craniotomy, multiparameter sensors were inserted into the peritumoral brain tissue guided by MRI-based stereotaxy. In eight patients who had severe brain swelling upon opening of the dura mater, p(ti)O2 immediately rose from 7 +/- 8 mm Hg to 24 +/- 15 mm Hg ( < 0.05), whereas in patients who did not have swelling, p(ti)O2 went from 16 +/- 9 to 18 +/- 10 mm Hg after opening of the dura. The mean p(ti)O2 of all patients at the start of resection of the tumor was 18 +/- 11 mm Hg, and increased to 30 +/- 15 mm Hg after resection was completed ( < 0.05). The effect on p(ti)O2 of raising the FiO2 to 1.0 was limited in this group of patients, as an increase greater than 50% was found in only six of twelve patients. Notably, in six patients, sensor malfunctions or associated hardware problems occurred, prohibiting useful data acquisition. We conclude that brain tissue oxygenation is reduced in the peritumoral area and improves after local tissue pressure relief, especially in patients with brain swelling. Thus, ischemic processes may contribute to brain edema around tumors. Intraoperative p(ti)O2 monitoring may enhance the safety of neuroanesthesia, but the high incidence of failures with this type of sensor remains a matter of concern.     

Development of a LC method for pharmaceutical quality control of the antimetastatic ruthenium complex NAMI-A

Imidazolium trans-tetrachloro(dimethylsulfoxide)imidazoleruthenium(III) (NAMI-A) is a novel ruthenium complex with selective activity against metastases currently in Phase I clinical trials in the Netherlands. Pharmaceutical quality control of NAMI-A drug substance and lyophilized product warranted the development of an assay for determination and quantification of NAMI-A and degradation products. A high performance liquid chromatography (HPLC) method was developed, consisting of a C18 column with 0.50 mM sodium dodecylsulfate in 3% methanol at pH 2.5 (acidified using trifluoromethanesulfonic acid) as the mobile phase and UV-detection at 358 nm. The HPLC method was proven to be linear, accurate and precise. Stress testing showed that degradation products were separated from the parent compound. By combining results of nuclear magnetic resonance (NMR) and HPLC experiments, one degradation product was identified as the mono-hydroxy species of NAMI-A. HPLC analysis with off-line detection of the eluate with flameless atomic absorption spectrometry (F-AAS) showed that under most conditions, all ruthenium-containing compounds show a peak in the HPLC chromatogram and that all ruthenium applied to the column is recovered quantitatively. For completely degraded solutions of NAMI-A some ruthenium is retained on the column. Suitability of the HPLC method for the pharmaceutical quality control of NAMI-A lyophilized product was demonstrated.     

Repeated pain assessment in Alzheimer's disease

In previous studies, patients with probable Alzheimer's disease (AD) have indicated that they experienced less pain intensity and affect from their painful conditions than nondemented elderly persons. However, in those studies, pain assessment occurred only once. Therefore, it may be possible that pain which had occurred, for example, a day earlier, could have been forgotten. Therefore, in the present study, AD patients' pain was assessed daily, i.e. once a day and even three times a day, during a longer period. The results parallel those of earlier studies, i.e. compared to elderly persons without dementia, AD patients appear to perceive less pain intensity and pain affect. These findings support the hypothesis that AD is characterized by an alteration in pain experience.