Whole abdominal radiotherapy following second-look laparotomy for ovarian carcinoma.

AIM: The safety and efficacy of whole abdominal radiotherapy was evaluated as salvage or consolidation treatment for ovarian cancer patients treated with primary surgery and chemotherapy, followed by second-look laparotomy (SLL). Overall survival and acute and late toxicity of treated patients were assessed. METHODS: Patients were recruited between April 1981 and June 1994. All patients had SLL performed at Royal Prince Alfred Hospital after completion of primary chemotherapy. Data collected included demographic details, diagnosis, tumor stage, histology, grade, adjuvant chemotherapy, and radiotherapy. Radiation dose and fractionation, field size, boost volume and dose, failure to complete treatment and treatment interruptions, renal dose, and acute and late toxicity were recorded. RESULTS: Fifty-one patients were evaluated; the median age was 51 years. Median follow-up for patients still alive was 62 months. Prior to 1988, chemotherapy comprised oral chlorambucil, with or without cisplatin (n = 25), while after this date all patients (n = 26) received primary cisplatin-based therapy. A radiation dose of 22. 5 Gy over 22 fractions was planned to the whole abdomen followed by a pelvic boost of 22 Gy in 11 fractions. Radiotherapy was completed in 37 (73%) patients. Treatment interruptions were necessary in 12 (24%) patients. Thrombocytopenia, neutropenia, nausea, vomiting, and diarrhea were the main causes of incomplete or interrupted treatment. Late bowel toxicity was seen in 6 (12%) patients, 2 of whom required laparotomy to relieve obstruction. There were no treatment-related deaths. Seven of the 51 patients are alive and free of disease, 2 died from other causes, and 2 are alive with evidence of recurrent or progressive disease. Mean follow-up time for surviving patients is 78.5 months. Overall survival at 2, 5, and 10 years was 65, 27, and 10%, respectively. Residual disease after primary surgery, smaller preirradiation tumor residuum, and completion of radiotherapy were independently associated with improved overall survival. CONCLUSION: In this poor-prognosis group of patients, a combined approach of surgery, chemotherapy, and radiotherapy, while associated with acceptable toxicity, may not afford a prolongation of survival.     

Spinal extradural meningeal cysts that contain nerve fibers: case report

We describe a case of extradural meningeal cysts of the lumbar spine that contain nerve fibers. These lesions are anatomically distinct from both perineurial and meningeal cysts. Drainage and suturing of the cyst walls to the dorsal dura mater was effective in relieving the clinical symptoms.     

Poor binocular coordination of saccades in dyslexic children

Aim To examine the quality of binocular coordination of saccades in dyslexic children in single word reading and in a task requiring fixation of single LED. Methods Eighteen children with dyslexia (11.4 ± 2 years old) and 13 non-dyslexic children of matched age were studied. Horizontal saccades from both eyes were recorded with a photoelectric system (Oculomotor-Bouis). Results Binocular coordination during and after the saccade in dyslexics is worse than that of non-dyslexic children; the disconjugacy does not depend on the condition. Moreover, dyslexics do not show the stereotyped pattern of disconjugacy (divergence during the saccade and convergence after the saccade). The conjugate post-saccadic drift is larger in dyslexics for both conditions. Conclusion Poor quality of binocular coordination of saccades and drift of the eyes after the saccade, regardless of the task, indicates an intrinsic ocular motor deficiency. Such a deficiency could be related to immaturity of the normal ocular motor learning mechanisms via which ocular motor coordination and stable fixation are achieved. Learning could be based on the interaction between the saccade and vergence subsystems. The cerebellum, but also cortical areas of the magnocellular stream such as the parietal cortex, could be the sites of ocular motor learning.     

A behavioral mechanism for resting site selection by pupae in three mosquito species

Pupae of Aedes aegypti, Ae. triseriatus and Culex restuans dive less frequently when resting in a concave meniscus than when resting in open water. They also tend to terminate diving after contacting submerged vertical surfaces, increasing their chances of surfacing in a concave meniscus. As a result pupae tend to rest in concave menisci associated with emergent vertical surfaces, a behavioral adaptation by which they probably conserve energy and avoid predation.     

Distinguishing malignant mesothelioma from pulmonary adenocarcinoma: an immuno-histochemical approach using a panel of monoclonal antibodies

A panel of six monoclonal antibodies (MAbs) was employed to evaluate antigen expression in pulmonary adenocarcinomas and mesotheliomas. Monoclonal anti-human milk fat globulin (HMFG-2), anti-carcinoembryonic antigen (NP-2), anti-epithelial membrane antigen (EMA), anti-cytokeratin (PKK-1), anti-tumor-associated antigen 72 (B72.3), and anti-human myelomonocytic antigen (Leu M-1) antibodies were used to localize their respective antigens in formalin-fixed, paraffin-embedded tumors by using the avidin-biotin-complex immunoperoxidase technique. In all, 28 mesotheliomas obtained from Ohio State University Anatomic Pathology files and from a Southwest Oncology Group (SWOG) protocol were compared to 22 pulmonary adenocarcinomas by using this MAb panel. None of the mesotheliomas demonstrated positive staining with MAbs NP-2 (anti-CEA) or Leu M-1. However, 95% (21/22) of adenocarcinomas stained with one of these two antibodies. Although neither of these two MAbs stained all adenocarcinomas, each antibody demonstrated positive immunostaining in more than 90% of the adenocarcinomas studied. Therefore, MABs NP-2 and Leu M-1 are, individually, quite useful for distinguishing mesothelioma from adenocarcinoma. However, in our study, no single MAb could be used to distinguish these two tumor types in every case. MAb B72.3 stained 91% (20/21) adenocarcinomas but also stained 7% (2/28) of mesotheliomas. MAb HMFG-2 reacted positively with 95% of adenocarcinomas, but also stained 39% of the mesotheliomas, usually in a membranous pattern. MAbs EMA and PKK-1 were not found useful in distinguishing mesothelioma from adenocarcinoma. We conclude that MAbs Leu M-1 and NP-2 were both useful in distinguishing mesothelioma from pulmonary adenocarcinoma in that positive staining was demonstrated in adenocarcinomas and not mesotheliomas.     

Value of magnetic resonance imaging in the evaluation of sex-reassignment surgery in male-to-female transsexuals

Background: We investigated the value of magnetic resonance imaging (MRI) in the evaluation of sex-reassignment surgery in male-to-female transsexual patients.Methods: Ten male-to-female transsexual patients who underwent sex-reassignment surgery with inversion of combined penile and scrotal skin flaps for vaginoplasty were examined after surgery with MRI. Turbo spin-echo T2-weighted and spin-echo T1-weighted images were obtained in sagittal, coronal, and axial planes with a 1.5-T superconductive magnet. Images were acquired with and without an inflatable silicon vaginal tutor. The following parameters were evaluated: neovaginal depth, neovaginal inclination in the sagittal plane, presence of remnants of the corpus spongiosum and corpora cavernosa, and thickness of the rectovaginal septum.Results: The average neovaginal depth was 7.9 cm (range = 5–10 cm). The neovagina had a correct oblique inclination in the sagittal plane in four patients, no inclination in five, and an incorrect inclination in one. In seven patients, MRI showed remnants of the corpora cavernosa and/or of the corpus spongiosum; in three patients, no remnants were detected. The average thickness of the rectovaginal septum was 4 mm (range = 3–6 mm).Conclusion: MRI allows a detailed assessment of the pelvic anatomy after genital reconfiguration and provides information that can help the surgeon to adopt the most correct surgical approach.