Selective pelvic and periaortic lymphadenectomy does not increase morbidity in surgical staging of endometrial carcinoma.

OBJECTIVE: The objective of this study was to retrospectively assess whether there was increased morbidity associated with the addition of selective pelvic and periaortic lymphadenectomy to hysterectomy in patients with endometrial carcinoma. STUDY DESIGN: From 1977 through 1988, 196 patients undergoing selective pelvic and periaortic lymphadenectomy plus hysterectomy were compared with 104 patients who underwent hysterectomy alone for endometrial adenocarcinoma. RESULTS: Only after adjusting for covariates was selective pelvic and periaortic lymphadenectomy associated with a higher estimated blood loss, which increased linearly with weight and was higher for black than for white women. The transfusion rate was similar for the two groups (selective pelvic and periaortic lymphadenectomy 6%, hysterectomy 10%). The mean blood loss was significantly different among the four gynecologic oncology surgeons (range 343 to 652 ml). The operating time primarily depended on patient weight and race, surgeon, and estimated blood loss. Postoperative hospital stay increased significantly with age, surgeon, wound infections, thrombotic events, and serious complications. Selective pelvic and periaortic lymphadenectomy had no effect on wound infections, which were directly related to operating time. Seventy-five (38%) of the selective pelvic and periaortic lymphadenectomy group and 19 (18%) of the hysterectomy group (p < 0.01) received whole-pelvic radiation with no difference in bowel complications (selective pelvic and periaortic lymphadenectomy 2/75, hysterectomy 1/19). The risk of serious complications was associated only with increasing age. CONCLUSION: Selective pelvic and periaortic lymphadenectomy in patients with endometrial carcinoma does not significantly add to morbidity from hysterectomy, which is related primarily to other factors such as patient weight, age, and race; operating time; and surgeon.     

FEARS AND WORRIES OF YOUNG CHILDREN AS EXPRESSED IN A CONTEXTUAL PLAY SETTING

One hundred 5- and 6-year-old children were studied with a contextual play technique in order to gain insight into their fears and worries. Sex differences and differences relating to questioning procedure were examined. The discussion included the potential usefulness of the method and some implications for parents and teachers.     

Oral ifosfamide/mesna versus intravenous ifosfamide/mesna in non-small-cell lung cancer: A randomized phase II trial of the EORTC lung cancer cooperative group

BACKGROUND:: Chronic oral administration of anticancer drugs may offer therapeuticadvantages. PATIENTS AND METHODS:: A total of 68 patients with advanced non-small-cell lung cancer,not previously treated by chemotherapy, were randomized to receiveeither ifosfamide given orally (OSI) at a dose of 1 g/day for14 days every 4 weeks, or as a 1-hour intravenous infusion (IVI)at a dose of 1.6 g/m²/day for 5 days every 4 weeks. Accordingto the route of ifosfamide administration, patients receivedeither mesna i.v. or mesna film-coated tablets for uroprotection. RESULTS:: Eight patients were found to be ineligible for the study andtherefore excluded for all analyses. Thirty-three patients receivedIVI, and 27 patients OSI. One patient randomized to OSI diedbefore treatment was initiated, leaving 59 patients fully evaluablefor toxicity. Hematological toxicity was less severe for patientson OSI, but CNS toxicity was reported more frequently on OSI(39%; 12% grade III/IV), than on 1VI (15%; 9% grade III/IV),which caused the premature close of the study. Other non-hematologicaladverse events were of modest clinical significance and comparablein both arms. Forty-nine patients were considered evaluablefor response: in the IVI arm, 5 (17%) of the 29 evaluable patientsobtained a partial remission, and 7 patients a no change (24%).In the OSI arm, 2 (10%) of the 20 evaluable patients obtaineda partial remission, and 11(52%) a stable disease. CONCLUSION:: Both arms have some activity in non-small-cell lung cancer;while OSI was less myelosuppressive than IVI, it was associatedwith a higher incidence of CNS toxicity. Oral administrationof ifosfamide, in the schedule and daily dose tested here cannotbe recommended. chemotherapy, ifosfamide, non-small-cell lung cancer, phase II trial     

Alagille's syndrome associated with cystic renal disease

Although renal abnormalities have been described in children with Alagille's syndrome, cystic kidney disease has not often been documented, and then usually only at necropsy. Three children with Alagille's syndrome are described, in two of whom a unilateral multicystic dysplastic kidney was detected by prenatal ultrasound; in the other, a solitary cortical cyst was found later in childhood. All have normal renal function, growth, and liver synthetic function but continue to have clinical and biochemical signs of cholestasis. These cases show that unilateral cystic kidney disease with or without renal dysplasia may be associated with Alagille's syndrome, that the clinical course is not necessarily unfavourable, and that Alagille's syndrome should be included in the differential diagnosis of cystic kidney disorders associated with cholestatic liver disease. Patients with Alagille's syndrome should be evaluated by renal ultrasound.     

Phase II Trial of Cystemustine,a New Nitrosourea,as Treatment of High-grade Brain Tumors in Adults

This study included 39 patients (37 evaluable, of whom 30 patients with recurrent gliomas and 7 patients with gliomas untreated by radiotherapy); they were enrolled into a phase II trial using a new nitrosourea, cystemustine, administrated every 2 weeks at 60mg/m² as a 15min-infusion. Pathology at inclusion was (WHO classification): 14 glioblastomas, 20 grade 3–4 astrocytomas and 3 grade 3 oligodendrogliomas. Four partial responses have been obtained, giving an overall response rate of 10.8%. Four additional patients had a partial response, which for various reasons was not confirmed 4 weeks later; 12 patients had a stable disease for at least 8 weeks, 15 patients had progressive disease. Of the 4 responses, 2 were with a grade 3 oligodendroglioma and 2 glioblastoma. Toxicity (WHO grading) was mainly hematological: leukopenia (16.2% grade 3–4), neutropenia (29.7% grade 3–4), thrombopenia (27% grade 3–4). No other toxicity greater than grade 2 was observed. In conclusion, cystemustine at 60mg/m² has moderate clinical activity in relapsing glioma. Our results warrant further investigation of this agent with an increased dose or modified scheme.     

Quantitative neuropathologic correlates of changes in ratio of N-acetylaspartate to creatine in macaque brain

PURPOSE: To elucidate the neuropathologic basis of transient changes in the ratio of N-acetylaspartate (NAA) to creatine (Cr) in the primate brain by using a simian immunodeficiency virus (SIV)-infected macaque model of the neurologic manifestation of acquired immune deficiency syndrome. MATERIALS AND METHODS: This study was approved by the Massachusetts General Hospital Subcommittee on Research and Animal Care and the Institutional Animal Care and Use Committee of Harvard University. Rhesus macaques infected with SIV were evaluated during the 1st month of infection. A total of 11 animals were studied, including four control animals, three animals sacrificed 12 days after infection, three animals sacrificed 14 days after infection, and one animal sacrificed 28 days after infection. All animals underwent in vivo proton ((1)H) magnetic resonance (MR) spectroscopy, and postmortem frontal lobe tissue was investigated by using high-spectral-resolution (1)H MR spectroscopy of brain extracts. In addition, quantitative neuropathologic analyses were performed. Stereologic analysis was performed to determine neuronal counts, and immunohistochemical analysis was performed to analyze three neuronal markers: synaptophysin, microtubule-associated protein 2 (MAP2), and calbindin. Analysis of variance (ANOVA) was used to determine substantial changes in neuropathologic and MR spectroscopic markers. Spearman rank correlations were calculated between plasma viral load and neuropathologic and spectroscopic markers. RESULTS: During acute infection with SIV, the macaque brain exhibited significant changes in NAA/Cr (P < .02, ANOVA) and synaptophysin (P < .013, ANOVA). There was no significant change in the concentration of Cr. No significant changes were found in neuronal counts or other immunohistochemical neuronal markers. With the Spearman rank test, a significant direct correlation was detected between synaptophysin and ex vivo NAA/Cr (r(s) = 0.72, P < .013). No correlation between NAA/Cr and neuronal counts, calbindin, or MAP2 was found. CONCLUSION: NAA/Cr is a sensitive marker of neuronal injury, not necessarily neuronal loss, and best correlates with synaptophysin, a marker of synaptodendritic dysfunction.