Argument for the surgical staging of apparent early endometrial cancer

Cancer of the uterine corpus, commonly referred to as cancer of the endometrium or cancer of the uterus, continues to be the most common pelvic genital malignancy affecting western women (1). In 1998 in the United States 36,100 women were diagnosed with this cancer, and there were 6,300 deaths from this condition in that year. Of concern is that despite a relatively stable incidence over the last decade, the annual number of deaths since 1987 from endometrial cancer has more than doubled (2). Many controversies exist in the management of apparent early endometrial cancer. These include: 1. The role of surgical staging which includes pelvic lymphadenectomy. 2. The role of the subspecialist gynaecological oncologist in primary surgical treatment. 3. Indications for vaginal and external beam radiotherapy. 4. Who is at risk for recurrence? 5. The role of laparoscopic approach to the management of this disease. Despite their importance, these and other issues have not been appropriately addressed by prospective randomized studies. Treatment strategies and algorithms have thus been based upon a combination of clinicopathological studies and uncontrolled reviews. The views expressed in this clinical opinion are those of the Sydney Gynaecologic Oncology Group and reflect our philosophy on the current management of this tumour, supported by recent and appropriate peer reviewed scientific literature.     

Relationship of cesarean delivery to lower birth weight-specific neonatal mortality in singleton breech infants in the United States

It has been implied douching causes chlamydial infection, acute salpingitis, ectopic pregnancy, and reduced fertility. However, the incriminating articles do not represent a vast accumulation of data from diverging sources; rather, most reflect repetitive analysis of data from a limited population base by an institutionally interrelated group of investigators. The conclusions reached were reintroduced periodically into the literature in different journals. An equally plausible alternate hypothesis is that douching is a marker for increased probability of one or more sexually transmitted diseases and their sequelae. Review of microbiologic rather than epidemiologic data published on douching revealed that douching with a preparation containing acetic acid caused a small reduction in total bacterial counts. Most of that change was attributable to washing. When povidone-iodine was present, significant reductions occurred, but these were short-lived. The first bacteria to recover are usually the lactobacilli, which might explain partial efficacy of prolonged douching with commercial preparations of povidone-iodine.     

17 alpha androstenediol inhibition of breast tumor cell proliferation in estrogen receptor-positive and -negative cell lines

Androstene-3beta, 17alpha-diol (17alpha-AED) inhibits DNA synthesis and induces apoptosis in several myeloid cancer cell lines. The purpose of this study was to determine if 17alpha-AED inhibition of human breast carcinoma cell proliferation is dependent on the estrogen or androgen receptor. At concentrations of 12.5 to 50 x 10(-9) M 17alpha-AED inhibited the proliferation of ZR75-1, estrogen receptor-positive (ER+) cells, by 54% to 68%. Further, 17alpha-AED inhibited MDA-MB231, estrogen receptor-negative (ER-) cells, by 33.6% to 56.0%. The inhibitory effect was dose dependent with a minimal effective inhibitory dose at 12.5x10(-9) M for both cell lines. Both 17beta-AED and estradiol potentiate the inhibitory effect of 17alpha-AED on ER+ cells at lower doses (3.13 to 6.25 x 10(-9) M) where 17alpha-AED alone was not inhibitory. The inhibitory action of 17alpha-AED on human mammary carcinomas appears to be independent of either the alpha estrogen or the androgen receptors.     

The two-stage ipsilateral fibular transfer for tibial defect following tumour excision

Method. We performed a two-stage vascularized ipsilateral fibular graft transfer for segmental tibial defect following excision of malignant bone tumours.Results. We report 10 patients who had this procedure with an average follow-up of 116 months.The graft was transposed medialy on its vascular pedicle by two-stage surgery. Full weight bearing was achieved in six patients at 8-43 months postoperatively, but every patient had a significant complication.Discussion. The use of this method in isolation is not recommended for reconstruction of the tibia following tumour excision.     

Care Quality and Spending Among Commercially Insured Children With Disabilities

Objective

To identify opportunities to improve care value for children with disabilities (CWD), we examined CWD prevalence within a commercially insured population and compared outpatient care quality and annual health plan spending levels for CWD relative to children with complex medical conditions without disabilities; children with chronic conditions that are not complex; and children without disabling, complex, or chronic conditions.

Phakomatous choristoma of the orbit: a case report.

We report the case of a 3-month-old infant with a rare phakomatous choristoma of the orbit. This lesion is believed to be a congenital neoplasm of lenticular anlage. The clinical, radiological, and histopathological findings are presented.