PREDICT-GTN 1: Can we improve the FIGO scoring system in gestational trophoblastic neoplasia?

Gestational trophoblastic neoplasia (GTN) patients are treated according to the eight-variable International Federation of Gynaecology and Obstetrics (FIGO) scoring system, that aims to predict first-line single-agent chemotherapy resistance. FIGO is imperfect with one-third of low-risk patients developing disease resistance to first-line single-agent chemotherapy. We aimed to generate simplified models that improve upon FIGO. Logistic regression (LR) and multilayer perceptron (MLP) modelling (n = 4191) generated six models (M1-6). M1, all eight FIGO variables (scored data); M2, all eight FIGO variables (scored and raw data); M3, nonimaging variables (scored data); M4, nonimaging variables (scored and raw data); M5, imaging variables (scored data); and M6, pretreatment hCG (raw data) + imaging variables (scored data). Performance was compared to FIGO using true and false positive rates, positive and negative predictive values, diagnostic odds ratio, receiver operating characteristic (ROC) curves, Bland-Altman calibration plots, decision curve analysis and contingency tables. M1-6 were calibrated and outperformed FIGO on true positive rate and positive predictive value. Using LR and MLP, M1, M2 and M4 generated small improvements to the ROC curve and decision curve analysis. M3, M5 and M6 matched FIGO or performed less well. Compared to FIGO, most (excluding LR M4 and MLP M5) had significant discordance in patient classification (McNemar's test P < .05); 55-112 undertreated, 46-206 overtreated. Statistical modelling yielded only small gains over FIGO performance, arising through recategorisation of treatment-resistant patients, with a significant proportion of under/overtreatment as the available data have been used a priori to allocate primary chemotherapy. Streamlining FIGO should now be the focus.     

Imaging in secondary tumors of the ovary

Abdominal Radiology - Metastatic involvement of the ovaries is not rare. The most common tumor types metastasizing to the ovaries, from non-gynecological organs, are breast, colorectal, gastric,...     

Acute generalized exanthematous pustulosis due to ceftriaxone: Report of a pediatric case with recurrence after positive patch test

Acute generalized exanthematous pustulosis (AGEP) is seen uncommonly in children and sometimes shows atypical clinical features in this population. Patch testing can be used effectively in children for the confirmation of the culprit drug in cases of multiple drug use. Here, we report a rare, pediatric case of ceftriaxone‐induced AGEP confirmed by patch testing with subsequent recurrence of the skin eruption.     

Clinical response of hard tissue replacement (HTR) polymer as an implant material in oral surgery patients.

This study evaluated the performance of a synthetic implant material, Hard Tissue Replacement Polymer, for: (1) ease of handling, (2) compatibility with bone and soft tissue, (3) stability of augmentation over time, and (4) development of untoward effects. HTR (a registered trademark of HTR Sciences, a division of United States Surgical Corporation, Norwalk, CT 06856) was implanted into 34 patients by means of five different surgical procedures. The material was found to be easy to manipulate during surgery. Tissue and bone compatibility, defined as absence of inflammation, was present in 32/34 surgical sites (94%). In extraction sites during the 18-month follow-up, no measurable decrease in bone height or width was seen. One patient with a large periodontal endodontic defect developed a post-operative infection necessitating extraction of the tooth. No induction of bone was seen in response to placement of HTR material.     

A review of 43 cases of tetanus neonatorum.

Forty-three patients with neonatal tetanus admitted to the Infectious Diseases Ward of the Istanbul University Faculty of Medicine Children's Hospital at Capa from 1982-1989 are presented. Thirty-two (74.4%) of the subjects were boys. The overall mortality was found to be 60 percent and the mean incubation period 6.1 +/- 20 days. The mean period between onset of symptoms and hospital admission was 1.7 days. Thirty-nine (90.7%) of the 43 patients were unhygienic home deliveries and only two cases were delivered with a midwife in attendance. None of the mothers of the children in our series had been immunized with tetanus toxoid. The incidence of neonatal tetanus in Turkey is on the decline, but a fraction of the population, the so-called urban poor, is still at high risk for preventable diseases. Every contact an unvaccinated person has with a health care professional should be viewed as an opportunity for tetanus immunization.     

The role of surgery in intraabdominal Burkitt's lymphoma in children.

The role of surgery in intraabdominal Burkitt's lymphoma remains controversial and different opinions are present in the literature. In our institution, forty patients (30 boys and 10 girls) with intraabdominal Burkitt's lymphoma with ages ranging from 3 to 12 years have been treated and followed from 1989 through 2000. In ten cases, the patients underwent surgery because of their acute abdominal diseases (intestinal obstruction in 5, intussusception in 3, intestinal perforation in one, and acute appendicitis in one). The remaining thirty patients were referred to our clinic because of their abdominal masses, pain, anorexia and fatigue. Twelve children had localized tumors and total resection could be performed. There was one death in this group due to central nervous system involvement during chemotherapy. In the remaining 28 children, extensive intraabdominal diseases were detected. In four of them, debulking procedures were performed, while in 24 children only biopsies could be made; 8 of them underwent a second-look operation. In the debulking procedures group, two children were lost (50 %) due to tumorlysis and acute renal failure. In the biopsy group, there were six deaths (25 %). All patients received chemotherapy after operative recovery. In conclusion, our results suggest that when the tumor is localized, total resection results in a good outcome. However, in the presence of extensive intraabdominal diseases instead of resection, the operation should be limited to biopsy only.     

Traumatic rupture of hydatid cyst with unusual localization without liver involvement: a case report.

Primary hydatid disease of the intestinal mesentery is rare. We report on a 12-year-old male patient who presented with abdominal pain and urticaria lesions after blunt abdominal trauma. At laparotomy the cyst was found to be ruptured and was totally removed from the surrounding mesenteric tissue.The postoperative course was uneventful. This case is the first child reported with traumatic rupture of a hydatid cyst in a mesenteric location.     

Detection of Vi-negative Salmonella enterica serovar typhi in the peripheral blood of patients with typhoid fever in the Faisalabad region of Pakistan

The synthesis and transportation proteins of the Vi capsular polysaccharide of Salmonella enterica serovar Typhi (serovar Typhi) are encoded by the viaB operon, which resides on a 134-kb pathogenicity island known as SPI-7. In recent years, Vi-negative strains of serovar Typhi have been reported in regions where typhoid fever is endemic. However, because Vi negativity can arise during in vitro passage, the clinical significance of Vi-negative serovar Typhi is not clear. To investigate the loss of Vi expression at the genetic level, 60 stored strains of serovar Typhi from the Faisalabad region of Pakistan were analyzed by PCR for the presence of SPI-7 and two genes essential for Vi production: tviA and tviB. Nine of the sixty strains analyzed (15%) tested negative for both tviA and tviB; only two of these strains lacked SPI-7. In order to investigate whether this phenomenon occurred in vivo, blood samples from patients with the clinical symptoms of typhoid fever were also investigated. Of 48 blood samples tested, 42 tested positive by fliC PCR for serovar Typhi; 4 of these were negative for tviA and tviB. Three of these samples tested positive for SPI-7. These results demonstrate that viaB-negative, SPI-7-positive serovar Typhi is naturally occurring and can be detected by PCR in the peripheral blood of typhoid patients in this region. The method described here can be used to monitor the incidence of Vi-negative serovar Typhi in regions where the Vi vaccine is used.