Preoperative concurrent chemotherapy and radiation therapy in cervix cancer: preliminary results

This is a retrospective study of patients treated for cervix cancer staged IB2, IIA or IIB with bulky tumor (> 4cm). Treatment was concurrent radiotherapy (45Gy with 1,8Gy daily fraction) and chemotherapy (5 cycles of Platinum 40mg/m2/week). All patients underwent Brachytherapy (15Gy on the reference isodose according to Paris system) followed by surgery (radical abdominal hysterectomy and bilateral pelvic lymphadenectomy: Piver 3) Between October 1999 and December 2002, forty five patients were treated in this protocol. Median age was 46 years (21- 68). Histology was squamous cell carcinoma in 93% and glandular carcinoma in 7%. Average external radiation dose was 44Gy (20-50). Ninety three percent of patients had at least 3 cycles of chemotherapy and 46,5% received the planned 5 cycles. On the operative specimens, there was 62,5% complete response and only 7 pelvic node involvement (17,5%). Four postoperative complications were noted (one vascular injury, one urinary fistula, one phlebitis and one lymph collection). Preoperative combined radiotherapy and chemotherapy in the early bulky stages of uterine cervix cancer is well tolerated and "gives" a high rate of sterilisation. There was no increase in surgical morbidity.     

Impact of food intake on urodynamic features of orthotopic urinary reservoirs

PURPOSE: The inconsistency of urodynamic characteristics among patients with similar, well detubularized urinary reservoirs together with the persistence of nocturnal incontinence in almost a third of such patients has motivated many groups to study in depth the inherent physiological characters of the intestinal segments used. One of the most critical criteria is the effect of food intake on such isolated segments. We determined the effect of food intake on the urodynamic behavior of urinary intestinal reservoirs. MATERIALS AND METHODS: A total of 50 male patients with well detubularized orthotopic reservoirs (hemiKock or W neobladders) after radical cystectomy underwent medium fill enterocystometry while fasting for 8 hours. Patients were then given a standardized caloric diet and the test was repeated 2 hours after food intake. Comparisons were made in the whole group of patients and subsets according to continence status, reservoir configuration and reservoir duration. RESULTS: The only significant and consistent finding was the decrease in maximum enterocystometric capacity. This decrease was statistically significant when calculated for the fasting and postprandial states in the whole group (mean +/- SD 539.1 +/- 155.7 and 495.9 +/- 146.2 ml), in continent patients (538 +/- 177 and 505 +/- 168.5 ml) and in patients with enuresis (539 +/- 177 and 481 +/- 106.8 ml, respectively). While the frequency and amplitude of phasic contractions were notably increased postprandially, baseline pressure at mid and maximum capacity were observed to be lowered. However, neither effect achieved statistical significance. CONCLUSIONS: Definite urodynamic changes occur in intestinal urinary reservoirs in response to food intake, denoting that these detubularized intestinal segments retain at least in part their native behavior in response to eating. The consistent decrease in maximum capacity together with increased phasic motor activity in a subset of these patients may explain their incontinence episodes. Changing food composition and habits may improve the continence state in this subset of patients.     

T and B lymphocytes in alpha-chain disease.

The patients studied were diagnosed as suffering from alpha-chain disease by their clinicopathological features, malabsorption findings, X-ray, and presence of abnormal alpha-chain protein in their serum. The objective of the study was to determine any possible defect of the immune system in such patients. The rosette technique and surface immunofluorescence were used to enumerate the circulating T and B lymphocytes in these patients. They were also skin-tested with tuberculin and given sensitizing doses of dinitrochlorobenzene. Their serum immunoglobulins were also quantitated. It was found that the proportion of circulating B lymphocytes was much higher than normal, whereas that of T lymphocytes was lower than normal. Furthermore, they could not be sensitized to DNCB and their skin test to tuberculin was negative. It was concluded that the disease was a B-cell disease of IgA type, associated with low level of cellular immunity.     

A comparative study between ciliary count and the degree of opacity of paranasal sinus CT scans in chronic sinusitis pre and post FESS

OBJECTIVE: To investigate the relationship between the extent of sinus disease in chronic sinusitis as detected radiologically by computed tomography (CT) scan and the population of cilia (ciliary area) both before and after functional endoscopic sinus surgery (FESS). In a simple way this is a trial to statistically prove that the CT scan could be a valid indicator and a mirror of the histological status of the sinus mucosa. DESIGN: Twenty adult patients were enrolled in this study. Radiological extension of the sinus disease was quantitated using the classification proposed by Kennedy in 1992 and the ciliary population was studied using scanning electron microscopy and image analysis softwares. RESULTS AND CONCLUSION: The more advanced the sinusitis, as evidenced by CT scans, the more the expected reduction in the ciliary area (CA) and in the ciliary count. But after FESS the degree of ciliary regeneration does not depend statistically on the radiological condition of the sinuses and the degree of opacity prior to intervention, i.e. a statistically valid inverse relationship exists between the radiological stage of sinusitis and the ciliary population pre-operatively but the same relation does not extend to the ciliary population post-operatively.     

Canine ureteral replacement with long acellular matrix tube: is it clinically applicable?

PURPOSE: We evaluated the effectiveness of acellular matrix used as a tube for replacement of a relatively long segment of the canine ureter. MATERIALS AND METHODS: Acellular matrix was obtained by excision of the whole ureter of donor dogs that were sacrificed and not included in the study group. Retrieved ureters were treated to have complete cell lysis, while maintaining the fiber framework. The study included 10 mongrel dogs in which a 3 cm segment was excised from 1 ureter and replaced by a tube of acellular matrix of the same length and width. The new tube was sutured proximal and distal by watertight interrupted sutures around a 5Fr Double-J stent (Medical Engineering Corp., New York, New York) that remained for 6 weeks. Excretory urography was done 1 and 2 weeks after stent removal and the dogs were then sacrificed. Before sacrifice the ureter was exposed and carefully examined, and the whole specimen was excised for histopathological examination. RESULTS: All dogs survived surgery except 1, which died 1 week postoperatively of a malpositioned stent and urinary ascites. There was no clinically apparent postoperative complications during the presence or after the removal of the ureteral stents. One week after stent removal excretory urography showed ipsilateral mild to moderate hydroureteronephrosis in 3 dogs and no dye excretion in 6 with a normal contralateral kidney. One week later no dye excretion was detected in all except 1 dog, which showed more radiological deterioration. At the time of sacrifice there was moderate to marked hydroureteronephrosis above the level of the new tube in all dogs. Although the graft was intact in all subjects, marked shrinkage was observed. On ureteral calibration there was significant narrowing of the lumen up to complete occlusion. At 8 weeks histopathological examination showed extensive fibrosis. CONCLUSIONS: An acellular matrix tube is not able to replace a 3 cm segment of the canine ureter.