Optimal therapy for pelvic recurrence after radical hysterectomy for early-stage cervical cancer

Forty-eight patients with pelvic recurrence after radical hysterectomy were evaluated. The influence of location of pelvic recurrence (sidewall versus central), histological grade, histological type, and interval from hysterectomy to recurrence had no influence upon curability by radiotherapy. Ten of twenty-eight patients treated by primary radiation therapy for recurrent disease remain without evidence of disease a minimum of 12 months post-therapy, with a projected 5-year disease-free survival in excess of 30%. No patient treated with adjuvant radiation after initial surgery was rendered disease free by subsequent treatment with radiotherapy. Eleven patients were explored for exenterative surgery. Three of six in whom exenteration was technically feasible remain alive without evidence of disease. None of 15 patients treated with chemotherapy remain free of disease. Radiation therapy remains the treatment of choice in post-radical hysterectomy recurrences confined to the pelvis. As exenterative therapy will result in the cure of a small number of patients with disease confined to the pelvis, exenteration should be considered in patients treated previously by radiotherapy. If these efforts fail, chemotherapy is unlikely to result in cure.     

Role of endocervical curettage in colposcopy

Two-thousand three-hundred and four patients with abnormal cervical cytology were evaluated by colposcopy, cervical biopsy, and endocervical curettage. The endocervical curettage was more accurate than the cervical biopsy in 1.2% of patients with satisfactory colposcopic examinations, 15.7% of patients with unsatisfactory examinations, and 30.5% of patients with no lesions observed. The endocervical curettage contained neoplastic epithelium in all 15 of the patients with invasive cancer and in seven patients it was the only diagnostic parameter that indicated invasion. The information from the endocervical curettage, when correlated with the cervical cytology, colposcopic findings, and cervical biopsy, eliminated the need to do a diagnostic conization in 76% of patients with unsatisfactory examinations and 79% of patients with no lesion identified. It is recommended that the endocervical curettage be a part of every colposcopic examination.     

Cataract surgery in allogeneic bone marrow transplant recipients with graft-versus-host disease(1)

PURPOSE: To study the outcomes of cataract surgery in allogeneic bone marrow transplant recipients with documented graft-versus-host disease (GVHD) and to elucidate the concomitant ocular surface problems often encountered in these patients. SETTING: W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA. METHODS: This retrospective study comprised 12 cataract surgeries in 7 patients with GVHD) after allogeneic bone marrow transplantation. In particular, visual acuity improvement, surgical complications, and problems associated with concomitant ocular surface disease were reviewed. RESULTS: The mean visual acuity improved significantly from 20/46 (logMAR 0.32) preoperatively to 20/21 (logMAR 0.02) postoperatively (P <.005). The mean postoperative follow-up was 23 months (range 3 to 48 months). All patients had dry eyes, and 3 had conjunctival cicatrization with mild keratinization. No patient had postoperative corneal breakdown. CONCLUSION: With aggressive management of dry eyes and other ocular surface problems, cataract surgery had excellent outcomes in patients with GVHD.     

Polymorphism in the mitochondrial cytochrome B gene in Koreans. An additional marker for individual identification

Sequencing the mitochondrial control region is very useful for individual identification when conventional DNA typing using autosomal STRs is unavailable. However, low discriminatory power is a problem and another polymorphic locus within the mitochondrial genome is necessary. The cytochrome B (MTCYB) gene, which has undergone several changes during evolution, may be a good candidate for this purpose. Here the sequencing data of the MTCYB gene of 98 unrelated Koreans is presented. A total of 30 polymorphic sites were found which were distributed evenly along the gene. All were nucleotide substitutions and no insertions/deletions were noted. A total of 22 different MTCYB lineages were revealed. Out of 22 different control region lineages with 79 samples which shared the same D-loop sequence with some others within a lineage, 10 lineages with 37 samples could be sub-grouped according to different MTCYB sequences. Some issues concerning the MTCYB gene polymorphism are discussed. Received: 10 January 2001 / Accepted: 29 May 2001     

Paroxysmal kinesigenic dyskinesia and infantile convulsions: clinical and linkage studies

OBJECTIVE: To clinically characterize affected individuals in families with paroxysmal kinesigenic dyskinesia (PKD), examine the association with infantile convulsions, and confirm linkage to a pericentromeric chromosome 16 locus. BACKGROUND: PKD is characterized by frequent, recurrent attacks of involuntary movement or posturing in response to sudden movement, stress, or excitement. Recently, an autosomal dominant PKD locus on chromosome 16 was identified. METHODS: The authors studied 11 previously unreported families of diverse ethnic background with PKD with or without infantile convulsions and performed linkage analysis with markers spanning the chromosome 16 locus. Detailed clinical questionnaires and interviews were conducted with affected and unaffected family members. RESULTS: Clinical characterization and sampling of 95 individuals in 11 families revealed 44 individuals with paroxysmal dyskinesia, infantile convulsions, or both. Infantile convulsions were surprisingly common, occurring in 9 of 11 families. In only two individuals did generalized seizures occur in later childhood or adulthood. The authors defined a 26-cM region using linkage data in 11 families (maximum lod score 6.63 at theta = 0). Affected individuals in one family showed no evidence for a shared haplotype in this region, implying locus heterogeneity. CONCLUSIONS: Identification and characterization of the PKD/infantile convulsions gene will provide new insight into the pathophysiology of this disorder, which spans the phenotypic spectrum between epilepsy and movement disorder.     

Resensitization of blood pressure response to mu-opioid peptide agonists after acute desensitization

IV administration of mu-opioid peptide agonists (DAMGO, DALDA, and [Dmt(1)]DALDA) results in a transient, naloxone-sensitive, increase in blood pressure in awake sheep. Despite significant differences in pharmacokinetics, these blood pressure responses all last < 15 min. The lack of correlation between half-life and duration of action suggested rapid desensitization. When a second dose of the same agonist was repeated 30 min later, the response was completely abolished. An increase in blood pressure and rapid desensitization was also observed with the kappa-opioid agonist (U50488H), whereas delta-agonists (DPDPE and DELT) had no effect on blood pressure. The response to DAMGO was abolished after prior exposure to DAMGO or DALDA, but there was no evidence of cross-desensitization between mu and delta, or mu and kappa, opioid agonists. Full resensitization of the blood pressure response occurred by 4 h for DAMGO (t(1/2) = 15 min) and by 48 h for [Dmt(1)]DALDA (t(1/2) = 1.8 h). These data support our hypothesis that the transient nature of the blood pressure response to mu-opioid agonists is caused by rapid desensitization and suggest that the rate of resensitization is dependent on the pharmacokinetics of the agonist.     

Tumor Vascular Pattern and Blood Flow Impedance in the Differential Diagnosis of Leiomyoma and Adenomyosis by Color Doppler Sonography

Purpose: Our objective was to evaluate the differences between leiomyoma and adenomyosis by color Doppler sonography with new criteria. Methods: A total of 78 patients with symptomatic uterine nodularities who were sonographically suspected to have leiomyoma or adenomyosis without other coexisting pathologic conditions was enrolled in the study. All patients underwent transvaginal color Doppler sonography (7.0-MHz vaginal probe) or transabdominal color Doppler sonography (5.0 MHz) during the early follicular phase. The morphology, tumor vascular pattern, and blood flow impedance of the uterine tumors were measured. All of the patients underwent surgery and the pathologic reports were used as references. Results: The mean age was not statistically significant in patients with adenomyosis versus leiomyoma (P > 0.05). The morphologic criteria for adenomyosis and leiomyoma by sonography detected 79% of adenomyosis and 84% of leiomyoma. Adenomyosis had 87% randomly scattered vessels or intratumoral signals and 88% of leiomyomas showed peripheral scattered vessels or outer feeding vessels. Eighty-two percent of adenomyoses had a pulsitility index (PI) of arteries within or around uterine tumors >1.17 and 84% of leiomyomas had a PI 1.17. The reliability test of tumor vascular pattern and blood flow impedance were better than that of using morphological criteria alone. Conclusions: With the aid of color Doppler sonography, tumor vascular pattern and blood flow impedance of the arteries within or around uterine tumors could more accurately diagnose adenomyosis and leiomyoma in addition to the morphologic criteria on transvaginal sonography.     

Results of modified laparoscopically assisted neovaginoplasty in 18 patients with congenital absence of vagina

Construction of a neovagina using pelvic peritoneum via a laparoscopicallyassisted approach was used in 18 patients with congenital absenceof the vagina. A better operative procedure is reported, whichwas modified from our preliminary technique, and the resultsof treatment are evaluated. Pelvic peritoneum was used for constructionof a vagina, replacing a laparotomy by a minimally invasivelaparoscopic approach. During follow-up, the advantages of ourprocedures are: (i) minimal likelihood of ‘poor take’or later contraction because an autograft peritoneal epithelialline is used; (ii) minimal short and long term care is required;(iii) the technique is simple in experienced hands and has allthe well-recognized benefits of minimal invasive surgery; (iv)the average length of neovagina is adequate and patency anddepth can be maintained with minimal dilatation; (v) the neovagina,with epithelial lining resembling that of a normal vagina, facilitatescomfortable sexual intercourse; (vi) the procedure is unaccompaniedby dyspareunia or scarring, which are frequently associatedwith other techniques; (vii) less emotional stress and bettercosmetic and economic benefits are noted.