Prognostic significance of Bax, Bcl-2, and p53 expressions in cervical squamous cell carcinoma treated by radiotherapy

OBJECTIVE: The objective was to determine the prognostic significance of the immunohistochemical expressions of Bax, Bcl-2, and p53 in squamous cell carcinoma of the uterine cervix treated by radiotherapy alone. METHODS: One hundred and seventy-four cases of squamous cell carcinoma of the cervix (stage Ib-IVa) diagnosed between January 1996 and December 1998 were investigated for Bax, Bcl-2, and p53 expressions and were correlated to the patients' survival. RESULTS: The mean age of the patients was 54.1 with a range of 29-82 years. There were 23 cases with stage I (13.2%), 99 stage II (56.9%), 51 stage III (29.3%), and 1 case with stage IV (0.6%). The 5-year disease-free survival (DFS) was 70.50% and overall survival (OS) was 65.95%. Bax, Bcl-2, and p53 expressions were seen in 68.4%, 25.9%, and 77.6% of cases, respectively. In multivariate analysis by Cox's regression, age, stage, Bax, and Bcl-2 expressions appeared to be independent prognostic predictors of DFS. Bax expression was associated with good survival (hazard ratio, 0.47) while Bcl-2 expression was associated with poor survival (HR, 2.51). In addition, a combination of Bcl-2+/Bax+ was significantly associated with poorer DFS compared to Bcl-2-/Bax+ (HR 3.55). However, none of the markers or combinations was associated with OS. CONCLUSIONS: Evaluation of Bax and Bcl-2 expressions and their co-expression provide independent prognostic information for the clinical course of the disease and therefore could be developed as a prognostic indicator for cervical cancer.     

Psychiatric symptoms as predictors of mortality in continuing care geriatric inpatients

All patients (N = 74) in continuing care geriatric beds in a London health district were screened for psychiatric morbidity and physical dependency in 1990. The sample was followed up 1 year after screening, forty-four percent were dead at follow-up. The relationship between individual psychiatric symptoms and mortality is reported. Using these associations, two scales to predict mortality were constructed and their usefulness is discussed.     

The association of hormonal contraceptive use and HPV prevalence

Women diagnosed with cervical cancer report longer duration and more recent use of combined oral contraceptives (COCs). It is unclear whether COC use is associated with upstream events of human papillomavirus (HPV) infection prior to development of clinical disease. The objective of our study was to assess the association of contraceptive use on the risk for prevalent HPV infection in a cohort of long‐term hormonal contraceptive (HC) users. One thousand and seventy (n = 1,070) HIV‐negative women aged 20–37 from Thailand enrolled in a prospective study of the natural history of HPV. Baseline HPV genotype information, recency and duration of HC use, sexual behavior, other sexually transmitted infection (STI) information and cervical cytology and histology were assessed. At enrollment, 19.8% and 11.5% of women were infected with any HPV or any high‐risk (HR)‐HPV, respectively. After adjustment for age, current and past sexual risk behaviors, STI history and cytology, the use of COCs for >6 years was found to be associated with an increased risk of infection with any HPV [prevalence ratio (PR): 1.88 (1.21, 2.90)] and any HR‐HPV [PR: 2.68 (1.47, 4.88)] as compared to never users. Recent, long‐term COC use was associated with an increased risk for prevalent HPV infection independent of sexual behavior and cervical abnormalities. No similar association was observed for recent or long duration use of progestin‐only contraceptives (i.e., depomedroxyprogesterone acetate). These data suggest that COC use may impact early upstream events in the natural history of HPV infection.     

Physical dependency and dementia in nhs continuing care wards and contracted nhs beds in voluntary nursing homes

All patients in hospital based and voluntary nursing home based National Health Service (NHS) continuing care geriatric beds in one London Health District were screened for psychiatric morbidity and physical dependency. They were followed-up at one year. Patients in hospital based continuing care beds had more severe dementia and physical dependency and higher mortality rates than those in voluntary nursing home based NHS continuing care beds. The implications of these findings are discussed in the light of governmental policy to encourage growth of private and voluntary sector nursing homes.     

Psychiatric morbidity among continuing care geriatric inpatients

This study examines the point prevalence of psychiatric morbidity among continuing care geriatric inpatients and the performance of screening questionnaires in detecting such morbidity. From a sample of 74 patients it was possible to carry out complete dementia ratings in 53 patients and depression ratings in 52 patients. Eighty-three per cent of the patients assessed had dementia and 48% had significant depressive symptoms. Screening for dementia with the Mini Mental State Examination (MMSE) had 100% sensitivity and 78% specificity. The Geriatric Depression Scale (GDS) had 80% sensitivity and 64% specificity at the conventional cutoff of 10/11. Receiver operating characteristics curve analysis suggested that a 12/13 cutoff gave the best sensitivity (75%) and specificity (73%) values for depressive symptoms. Among patients with dementia a cutoff score of 12/13 on the GDS also gave optimal sensitivity, specificity and positive predictive values. The GDS revealed good test–retest stability in the whole sample (tau = +0.55, p < 0.001) and the demented subgroup (tau = +0.52, p < 0.001).     

Assessment of kendrick cognitive tests for the elderly

The Kendrick cognitive tests for the elderly were administered to 42 elderly patients with SDAT, 32 normal elderly, 10 patients with depression and 20 elderly patients with multi-infract dementia. The scores on KDCT and KOLT revealed significant differences between those who had dementia and those who had non-dementing illness. However, initial test patterns for KOLT and KDCT and test-retest patterns revealed some overlap. For diagnosis of dementia, if one uses the test-retest patterns assigned by Kendrick to the various diagnostic categories, the tests have a specificity of 100% and a sensitivity of only 39% thus suggesting that they are of limited value in predicting the presence or absence of dementia in an individual.     

Non-puerperal uterine inversion and uterine sarcoma (malignant mixed müllerian tumor): report of an unusual case

A 45-year-old woman with a history of cervical cancer (stage IIa), who had received complete radiation treatment 16 years previously, presented with a huge mass protruding from her vaginal introitus. She had had the condition for about 1 week. Diagnosis was difficult, and she elected to have a diagnostic laparoscopic procedure plus tumor removal. The pathologic investigation revealed a malignant mixed müllerian tumor of the endometrium. Post-operative course was uneventful. She underwent postoperative pelvic radiation. No recurrence was found during the 13 months follow up period. This rare case of chronic non-puerperal uterine inversion due to malignant mixed müllerian tumor (MMMT) is herein reported.     

Lack of effect of perioperative blood transfusion during radical hysterectomy with lymph node dissection on the prognosis of cervical cancer stage Ib

The aim of this retrospective study was to analyze the effects of perioperative blood transfusion during radical hysterectomy with lymph node dissection on the prognosis of cervical cancer stage Ib. A total of 295 patients who had undergone surgery from 1987-2002 were included. Forty seven patients underwent conization before definite surgery, and 2 patients were subsequently lost to follow up. Among the remaining 246 patients, 97 received allogenic blood transfusion, 38 received autologous blood transfusion, and 111 received no transfusion. The clinicopathologic finding of these three groups were reviewed and analyzed. There was no significant difference among three groups in age, chief complaints, duration of symptoms, size of lesion, histopathology, grade, margin or parametrium involvement, node status or postoperative adjuvant treatment. The most prominent presenting symptoms were abnormal vaginal discharge, abnormal vaginal bleeding, and postcoital bleeding. Although the 5-year disease-free survival (DFS) (and 95% CI) for autologous blood transfused group was 90.9% (74.4-97.0%), falling to 88.1% (77.8-93.8%) in untransfused blood group and 81.7% (71.3-88.6%) in allogenic transfused blood group, there were no significant differences among three groups (P = 0.699). In multivariate analyses, only age (P = 0.046), size of lesion (P = 0.024) and histology (P = 0.046) were statistically significantly associated with DFS, whereas transfusion status was not. In conclusion, there is no evidence that perioperative blood transfusion affects DFS of patients undergoing radical hysterectomy and pelvic lymphadenectomy. Only age, size of lesion and histology were statistically significantly associated with DFS.