Invasive cervical cancer in young women

Summary. Between 1970 and 1979, 103 women below 35 years of age with invasive cervical cancer were treated at the First Obstetrics and Gynaecology Clinic of the University of Milan. Nine patients were pregnant or less than 3 months postpartum. Estimated 10–year disease–free survival, determined by the life–table method, was 100% in stage IA (37 patients), 79% in stage IB (45 patients), 67% in stage 11 (15 patients), 0% in stages III (5 patients) and IV (1 patient). Prognosis was also strongly associated with lymph–node involvement, 10–year actuarial survival decreasing from 93% in lymph–node–negative to 44% in lymph–node– positive patients ( P 相似文献   

Radiofrequency Catheter Ablation of the Slow Reentrant Pathway of Sustained Ventricular Tachycardia

The article reports the cases of two patients with severe coronary artery disease and associated recurrent sustained ventricular tachycardia successfully treated with radiofrequency catheter ablation. In the first patient, two different types of ventricular tachycardia (one incessant) were eliminated. In all procedures, an area of slow conduction critical for tachycardia maintenance was localized by endocardial mapping techniques. Radiofrequency energy delivered to this area could permanently modify the anatomical substrate of the arrhythmia. After single follow-ups of 19, 14, and 13 months regarding the arrhythmic entities, the patients are well and free from spontaneous recurrences.     

Rhythm Discrimination by Rate Branch and QRS Morphology in Dual Chamber Implantable Cardioverter Defibrillators

BORIANI, G., et al. : Rhythm Discrimination by Rate Branch and QRS Morphology in Dual Chamber Implantable Cardioverter Defibrillators. Morphology Discrimination is a discriminator based on QRS morphology analysis that has been recently implemented in dual chamber implantable cardioverter defibrillators (ICDs). Detected events are initially classified according to median atrial and ventricular rates (Rate Branch). Then, a series of discriminators (Morphology Discrimination, Stability, Sudden Onset) analyze the rhythm according to specific criteria and the number of discriminators required for VT diagnosis (i.e., requiring "any" or "all" of the specific discriminators to indicate VT). The discriminating accuracy of the algorithm was evaluated in 645 detections recorded during the follow-up of 25 patients. The overall specificity for 397 supraventricular arrhythmias was 73.5% (292/397) with the tachycardia diagnosis criteria set to "any" and 90.9% (361/397) with the tachycardia diagnosis criteria set to "all." Sensitivity for VT was 100% and 98.7% (231/234) with the tachycardia diagnosis criteria set to "any" and "all," respectively. With the tachycardia diagnosis criteria set to "any," specificity for atrial fibrillation was 88.6%, for atrial flutter 40.3%, for atrial tachycardia 0%, and for sinus tachycardia 97.0%. With the tachycardia diagnosis criteria set to "all," specificity for atrial fibrillation was 92.40%, for atrial flutter 93.5%, for atrial tachycardia 54.7%, and for sinus tachycardia 99.0%. The contribution of Morphology Discrimination was crucial to improve the specificity of the Rate Branch algorithm. The implementation of Morphology Discrimination in a dual chamber ICD with Rate Branch rhythm classification allows the attainment of high specificity and high sensitivity for ventricular tachyarrhythmias. (PACE 2003; 26[Pt. II]:466–470)     

PRIMARY MERKEL CELL TUMOR: A CLINICAL ANALYSIS OF EIGHT CASES

Background. In recent years, an unusual biologic behavior of Merkel cell tumor (mct ) has been noted. In some patients, the tumor was indolent and well controlled by therapy, while in others it was lethal in a few months. Even though the majority of the reported cases are between these two biologic extremes, it seems evident that there is a high variability in the clinical course of the tumor. Methods. A clinical analysis of eight cases of primary Merkel cell tumor was performed. All the patients presented with similar clinical features: age, tumor staging, duration of the disease, lack of complicating cutaneous or systemic diseases. On the basis of these common findings, which made this group quite homogeneous, our attempt was to identify other clinical signs that could correlate with the local recurrence and/or the onset of metastases. The outcome of our patients, in fact, was quite variable. Results. The tumor size, the clinical aspect at presentation (single, multiple nodules, or plaque), the histologic pattern (all were of the trabecular type), and immunohistology did not correlate with the outcome. Conclusions. We report the rare occurrence of mct in the perianal area, which suggests that it should be included in the differential diagnosis of perianal tumors, the very aggressive behavior of the tumor in two patients (death < 6 months from diagnosis), which confirms how the prognosis for mct is unpredictable even if the diagnosis is established at an incipient stage and the tumor promptly removed.