Conservative medical management of advanced cervical ectopic pregnancies

Cervical ectopic pregnancy is the rarest form of ectopic gestation. Viable cervical ectopic pregnancies of 10 weeks' gestation or more are even rarer. It is unclear whether these advanced cervical ectopic gestations should be managed primarily by surgical evacuation or by more conservative medical management with chemotherapeutic agents. Cases of medical treatment of viable cervical ectopic gestations reported in the literature are reviewed. An additional case of a 10.6 weeks of gestation, viable cervical ectopic pregnancy treated with methotrexate, intrafetal potassium chloride, and intramuscular methotrexate is added to the previously reported literature. Advanced cervical ectopic pregnancies with fetal cardiac activity at 10 or more weeks' gestation may be successfully managed with chemotherapeutic agents. Ultrasound-guided intrafetal injection of feticidal agents may be preferable to maternal systemic chemotherapy alone.     

Prognostic effect of epithelial cell adhesion molecule overexpression in untreated node-negative breast cancer

PURPOSE: Epithelial cell adhesion molecule (Ep-CAM) recently received increased attention not only as a prognostic factor in breast cancer but also as a potential target for immunotherapy. We examined Ep-CAM expression in 402 consecutive node-negative breast cancer patients with long-term follow-up not treated in the adjuvant setting. EXPERIMENTAL DESIGN: Ep-CAM expression was evaluated by immunostaining. Its prognostic effect was estimated relative to overexpression/amplification of HER-2, histologic grade, tumor size, age, and hormone receptor expression. RESULTS: Ep-CAM status was positive in 106 (26.4%) patients. In multivariate analysis, Ep-CAM status was associated with disease-free survival independent of age, pT stage, histologic grade, estrogen receptor (ER), progesterone receptor (PR), as well as HER2 status (P = 0.028; hazard ratio, 1.60; 95% confidence interval, 1.05-2.44). Recently, so-called triple-negative (HER-2, ER, and PR) breast cancer has received increased attention. We noticed a similar association of Ep-CAM with disease-free survival in the triple-negative group as for the entire cohort. CONCLUSION: In this study of untreated breast cancer patients, Ep-CAM overexpression was associated with poor survival in the entire cohort and in the subgroup of triple-negative breast cancer. This suggests that Ep-CAM may be a well-suited target for specific therapies particularly in HER-2-, ER-, and PR-negative tumors.     

Repair of O6-methylguanine in DNA by demethylation is lacking in Mer- human tumor cell strains

The ability of extracts of human tumor cells to demethylateO6-methylguanine (O⁶-MeG) in DNA was assayed using the syntheticDNA polymer poly(dC,dG,m⁶dG). Cell strains proficient in repairof O⁶-MeG in vivo (Mer+ phenotype) contained a methyltransferaseactivity while repair deficient cells (Mer^– phenotype)had little or no activity. Mixing extracts of different Mer^–strains did not result in the appearance of the activity. Extractsof Mer^– cells did not inhibit the activity in extractsof Mer⁺ cells. Both Mer⁺ and Mer^– strains contained methylnitrosourea-damage-specificendonudease activity. The data suggest that the Mer⁺ strainsare deficient in methyltransferase and that this is the fundamentalreason for their hypersensitivity to the cytotoxic effects ofDNA alkyla-tion. The activity was partially purified from aMer⁺ colon carcinoma cell strain. Its kinetics parallel therepair of O⁶-MeG in DNA in vivo and suggest that the activityis inactivated during repair of DNA.     

Alveolar hydatid disease of the liver with Budd-Chiari syndrome.

Alveolar hydatid disease in man is the intermediate stage in the life cycle of the tapeworm Echinococcus multilocularis. This is a rare disease restricted to very few areas of the world. The occurrence of this disease in India is now described for (so far as the authors are aware) the first time. Some unusual features of the disease are highlighted in this patient. The hepatic lesion had infiltrated into the right atrial wall resembling an atrial tumour. The ostium of the inferior vena cava was occluded, causing Budd-Chiari syndrome. The radiological and haemodynamic study of the hepatic outflow tract in this disease are documented.