Single-step maternal serum screening for trisomy 21 in the era of combined or integrated screening

Single-step maternal serum screening (MSS) in the first (1MSS) or second (2MSS) trimester at maternal age > or =35 years was evaluated in the North Belgian region Flanders, where difficulties are encountered in the general introduction of combined or integrated screening algorithms. The fetal aneuploidy screening database of General Medical Laboratory AML in Antwerp was searched for 2MSS tests between 1992 and 1999 (alpha-fetoprotein, beta-human chorionic gonadotropin (beta-HCG) and unconjugated estriol, cut-off 1:300) and for 1MSS tests between 1999 and 2003 (free beta-HCG and pregnancy-associated plasma protein A, cut-off 1:85). At > or =35 years, the detection rate for trisomy 21 (DR) was 93.8% (15/16) for 2MSS and the screen-positive rate (SPR) was 24.5% (504/2061). For 1MSS, these figures were 85.7% (6/7) and 17.7% (109/615) respectively. To detect one trisomy 21, missed by MSS at > or =35 years of age, an additional number of 1,557 and 506 primary invasive procedures would be needed for 2MMS and 1MSS respectively. We conclude that the performance of both single-step 1MSS and 2MSS at maternal age > or =35 years in Flanders is excellent, even without the combination with ultrasound parameters or integration of first and second trimester parameters. The simplicity of both methods allows to consider them valuable options for fetal aneuploidy screening at advanced maternal age, until high quality combined or integrated screening is accessible to all pregnant women in Belgium.     

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Prospective randomized trial comparing flutamide as adjuvant treatment versus observation after radical prostatectomy for locally advanced, lymph node-negative prostate cancer

OBJECTIVE: To assess the efficacy and the tolerability of flutamide as adjuvant treatment after radical prostatectomy for locally advanced, lymph node-negative prostate cancer. METHODS: Men with locally advanced, lymph node-negative prostate cancer were randomized after radical prostatectomy to receive either flutamide 750mg daily or no adjuvant treatment. Recurrence-free and overall survival were the study end points. Recurrence was defined as a PSA value greater than 5ng/ml or two values greater than 2ng/ml more than three months apart with increasing tendency or three values greater than 1ng/ml more than three months apart with increasing tendency or any clinical recurrence. RESULTS: 309 patients (157 in the control arm and 152 in the flutamide arm) were eligible for efficacy analysis. The median follow-up was 6.1 years. Recurrence-free survival was better in the flutamide group ( P=0.0041), there was, however, no detectable difference in overall survival ( p=0.92 ). Moreover, there was a considerable toxicity reported in the flutamide group. CONCLUSION: Although having some effect on disease recurrence, adjuvant flutamide treatment does not improve median-term overall survival after radical prostatectomy for locally advanced, lymph node-negative prostate cancer.     

Different effects of two regeneration regimens on immunological parameters in cyclists

PURPOSE: To investigate the effect of 4-d active regeneration of different duration on immunological parameters after 2 wk of intensive training. METHODS: In a cross-over design 11 male cyclists conducted 13 d of intensive training followed by 4 d of low-intensity cycling for either 1 or 3 h each day (sequence randomized). Before the intensive training (test 1), between training and regeneration (test 2), and after the regeneration period (test 3), subjects were tested in the lab: venous blood sampling (immunological parameters; flow cytometry) and incremental exercise stage test on acycle ergometer. RESULTS: Average values of lymphocytes and natural killer (NK) cells decreased significantly from test 1 to test 2 and were influenced differently by 1- and 3-h cycling (P = 0.018 and 0.039, respectively); 1-h cycling restored values from test 1, whereas 3 h led to a further decrease in lymphocyte and NK cell concentrations. This pattern was resembled by the courses of maximal heart rate and maximal blood lactate concentration during incremental cycling exercise. In leukocytes, tests 2 and 3 differed significantly from test 1 (P = 0.048 and 0.031, respectively), but there was no significant effect of the regeneration duration (P = 039). Neither the concentration of neutrophils nor the neutrophil oxidative burst was significantly influenced by the training period or by one of the regeneration phases. CONCLUSIONS: The present results indicate that low-intensity regenerative training sessions in cyclists should preferably be conducted for shorter durations than 3 h. It was demonstrated that 4-d cycling of 1 h each day reversed ergometric and immunological changes indicative of fatigue after 2 wk of intensive training.     

Surgery after multimodality treatment for non-small-cell lung cancer

Neoadjuvant treatment for Locally advanced non-small-cell lung cancer (NSCLC) stage IIIA and IIIB promises higher resection rates because of a reduction of the primary tumour and sterilisation of mediastinal nodes ("downstaging"). In this study we analyse the perioperative course and the long-term survival of patients with trimodality treatment. Between 03/1991 and 12/2002, 392 patients with NSCLC underwent resection after induction treatment. Included were 266 males and 126 females, age 55.8 +/- 9 (28-74), of whom 218 were stage-IIIA patients, 174 were stage-IIIB patients. Induction treatment included 3 courses of chemotherapy with cisplatin/etoposide or cisplatin/paclitaxel, followed by one course of chemotherapy with cisplatin/etoposide as well as hyperfractionated accelerated radiotherapy of the primary tumour and the mediastinal nodes with 45 Gy, followed by surgery. Before induction treatment all patients underwent mediastinoscopy. In patients with N3 disease mediastinoscopy was repeated before surgery. Resections included 133 pneumonectomies (34%), 15 bilobectomies (4%), 55 sleeve lobectomies (14%), 168 lobectomies (42.5%), 6 segmentectomies (1,5%), and 15 explorative thoracotomies (4%). In-hospital mortality rates amounted to 4.6% (18 patients) while postoperative morbidity ran up to 46% (180 patients). Morbidity and mortality rates were significantly higher in patients with Karnofsky status lower than 80% and patients older than 65 years. Bronchopleural fistulas occurred in 16 patients (3.2%). The protection of the bronchial stump or anastomosis with viable tissue, like pericardial fat, proves to be a significant factor for the reduction of septic complications. For NSCLC, the 5- and 7-year survival rates were 36% and 31%, respectively, for stage IIIA, and 26% for stage IIIB. This intensive trimodality treatment proves to be feasible. Treatment-related toxicities are overall moderate and acceptable. Accurate cardiopulmonary evaluation before surgery and reinforcement of bronchial stump or anastomosis can contribute to reducing complications. Induction treatment demonstrated a "downstaging effect", so that a clear trend for organ-sparing resection was observed. Long-term survival rates for selected groups look very promising when compared to historical controls.     

Clinical significance of increased cardiac troponins T and I in participants of ultra-endurance events

Of 105 asymptomatic finishers of endurance competitive events lasting several hours, increased blood concentrations of cardiac troponins T and I above the 99% upper reference values were found in 24 and 34 subjects, respectively; N-terminal pro-brain natriuretic peptide was also significantly increased. Within 3 months after the events, 21 troponin-positive participants underwent an extensive cardiac examination, which in all but 1 (critical coronary heart disease) revealed no signs of persistent cardiac damage.     

Comparison of interventional versus conservative treatment of isolated ostial lesions of coronary diagonal branch arteries

This study compares percutaneous coronary intervention of isolated ostial stenosis of diagonal branches with a luminal diameter >/=2.0 mm with medical treatment with regard to cardiac events during hospitalization and follow-up. Medical treatment is an alternative to percutaneous intervention without a greater incidence of death or myocardial infarction at 12-month follow-up. Interestingly, patients with isolated ostial stenosis of diagonal branches who were treated interventionally showed a significantly greater probability of rehospitalization for severe angina, recatheterization, and reintervention compared with medically treated patients.