The Effects of Involuntary Respiratory Contractions on Cerebral Blood Flow during Maximal Apnoea in Trained Divers

The effects of involuntary respiratory contractions on the cerebral blood flow response to maximal apnoea is presently unclear. We hypothesised that while respiratory contractions may augment left ventricular stroke volume, cardiac output and ultimately cerebral blood flow during the struggle phase, these contractions would simultaneously cause marked ‘respiratory’ variability in blood flow to the brain. Respiratory, cardiovascular and cerebrovascular parameters were measured in ten trained, male apnoea divers during maximal ‘dry’ breath holding. Intrathoracic pressure was estimated via oesophageal pressure. Left ventricular stroke volume, cardiac output and mean arterial pressure were monitored using finger photoplethysmography, and cerebral blood flow velocity was obtained using transcranial ultrasound. The increasingly negative inspiratory intrathoracic pressure swings of the struggle phase significantly influenced the rise in left ventricular stroke volume (R² = 0.63, P<0.05), thereby contributing to the increase in cerebral blood flow velocity throughout this phase of apnoea. However, these contractions also caused marked respiratory variability in left ventricular stroke volume, cardiac output, mean arterial pressure and cerebral blood flow velocity during the struggle phase (R² = 0.99, P<0.05). Interestingly, the magnitude of respiratory variability in cerebral blood flow velocity was inversely correlated with struggle phase duration (R² = 0.71, P<0.05). This study confirms the hypothesis that, on the one hand, involuntary respiratory contractions facilitate cerebral haemodynamics during the struggle phase while, on the other, these contractions produce marked respiratory variability in blood flow to the brain. In addition, our findings indicate that such variability in cerebral blood flow negatively impacts on struggle phase duration, and thus impairs breath holding performance.

The effects of antihistamines with varying anticholinergic properties on voluntary and involuntary movement

OBJECTIVE

Recent evidence indicates that antihistamines can affect movement, which is most likely due to altered neurotransmission in cholinergic and histaminergic pathways. The purpose of this study was to determine if antihistamines with varying anticholinergic properties differentially affect voluntary and involuntary movement control.

METHODS

Eleven healthy subjects were enlisted into a human double blind, placebo-controlled, five-way crossover study. Drowsiness, reaction time, and physiological tremor were examined 1-, 2-, and 3-hr post-ingestion of antihistamines with known anticholinergic profiles. These were the first-generation promethazine, and second-generation loratadine, desloratadine, and fexofenadine. Hyoscine butylbromide was used in an additional experiment to determine how a peripheral antimuscarinic drug influenced neuromotor function.

RESULTS

Promethazine, desloratadine and fexofenadine increased drowsiness. Promethazine increased simple and choice reaction time and reduced tremor. Desloratadine increased choice reaction time and tremor, while loratadine slowed simple and choice reaction time.

CONCLUSION

Central anticholinergic and antihistaminergic properties of antihistamines potentially contribute to movement dysfunction.

SIGNIFICANCE

Second-generation antihistamines have provided the consumer with a safer alternative to the first-generation sedating antihistamine. However, the results of this study suggest that loratadine and desloratadine have the potential to affect movement control, and further research is warranted to understand the clinical relevance of these findings.

Bilateral tremor responses to unilateral loading and fatiguing muscle contractions

Although physiological tremor has been extensively studied within a single limb, tremor relationships between limbs are not well understood. Early investigations proposed that tremor in each limb is driven by CNS oscillators operating in parallel. However, recent evidence suggests that tremor in both limbs arises from shared neural inputs and is more likely to be observed under perturbed conditions. In the present study, postural tremor about the elbow joint and elbow flexor EMG activity were examined on both sides of the body in response to unilateral loading and fatiguing muscle contractions. Applying loads of 0.5, 1.0, 1.5, and 3.0 kg to a single limb increased tremor and muscle activity in the loaded limb but did not affect the unloaded limb, indicating that manipulating the inertial characteristics of a limb does not evoke bilateral tremor responses. In contrast, maximal-effort unilateral isometric contractions resulted in increased tremor and muscle activity in both the active limb and the nonactive limb without any changes in between-limb tremor or muscle coupling. When unilateral contractions were repeated intermittently, to the extent that maximum torque generation about the elbow joint declined by 50%, different tremor profiles were observed in each limb. Specifically, unilateral fatigue altered coupling between limbs and generated a bilateral response such that tremor and brachioradialis EMG decreased for the fatigued limb and increased in the contralateral nonfatigued limb. Our results demonstrate that activity in the nonactive limb may be due to a "spillover" effect rather than directly coupled neural output to both arms and that between-limb coupling for tremor and muscle activity is only altered under considerably perturbed conditions, such as fatigue-inducing contractions.

Low dosage promethazine and loratadine negatively affect neuromotor function

OBJECTIVES

Determine how the sedating antihistamine promethazine and non-sedating antihistamine loratadine at a dose of 10mg influence voluntary and involuntary motor processes in the hours following ingestion and the morning after ingestion.

METHODS

Eight healthy young adults were recruited into a human double-blind, placebo-controlled, three-way crossover study. Neuromotor function was examined using a battery of controlled reaction time, postural tremor, and heart rate variability measures. Neuromotor function was assessed 4 times for each of the promethazine, loratadine and placebo interventions; pre-ingestion, 1h post-ingestion, 2h post-ingestion, and the following day.

RESULTS

Self-perceived levels of drowsiness increased only after ingestion of promethazine. However, both antihistamines had negative effects on simple reaction time, choice reaction time, the RMS and peak power amplitude of postural tremor, and autonomic cardiac regulation.

CONCLUSIONS

The presence of selective neuromotor deficits following ingestion of promethazine and loratadine suggest that sedating and non-sedating antihistamines alter neuromotor function. It is possible that the H(1) antagonists used in this study have antimuscarinic effects, which may impact on the central dopaminergic system that plays a role in modulating several CNS processes associated with movement.

SIGNIFICANCE

Antihistamines are one of the most commonly procured over-the-counter medications. The current study suggests that taking non-sedating antihistamines to avoid the adverse drug reaction of drowsiness may not avoid unwanted motor control side-effects.

Recurrence patterns and prognosis of endometrial stromal sarcoma and the potential of tyrosine kinase-inhibiting therapy

OBJECTIVE

Endometrial stromal sarcoma (ESS) is a rare uterine malignancy. The current treatment approaches yield unsatisfactory results, and potential therapeutic targets need exploration.

METHODS

We reviewed the electronic medical records of 74 patients with low-grade ESS who had been evaluated at the University of Texas MD Anderson Cancer Center between 1995 and 2006. Using immunohistochemistry, we tested the expression of targets in paraffin-embedded tissue samples taken from 13 of the patients.

RESULTS

Forty-seven patients (64%) had a recurrence, and 16 (22%) had died of their disease at last follow-up. The 10-year progression-free survival (PFS) rate was 43% (median PFS duration, 108months), and the overall survival (OS) rate was 85% (median OS, 288months). Patients who received hormonal therapy had an overall response rate of 27%; another 53% had stable disease, with a median time to progression of 24months. No complete response or partial response was observed among patients who received radiotherapy or chemotherapy. In the paraffin-embedded specimens we tested, c-abl was expressed universally. Expression of PDGF-α, PDGF-β, VEGF, and c-Kit was detected in 33%, 36%, 54%, and 8%, of specimens, respectively. EGFR and HER-2 were not detectable in any specimens.

CONCLUSIONS

Our study suggests that ESS is a hormone-dependent malignancy, with hormonal therapy having activity in recurrent disease. Targeted therapy, specifically targeting c-abl may be a potential treatment for this disease.

Differences in rapid initiation and termination of voluntary postural sway associated with ageing and falls-risk

The authors examined differences between young adults (n = 25) and healthy older adults (n = 48) in reaction time and the relations between center of pressure (COP) and center of mass (COM) motions during rapid initiation and termination of voluntary postural sway. Older adults were divided into low and high falls-risk groups based on Physiological Profile Assessment scores of sensorimotor function. Low falls-risk older adults had slower reaction times during anteroposterior sway initiation and decreased COP-COM separation during anteroposterior and medialateral sway initiation and anteroposterior continuous voluntary sway compared with young adults. High falls-risk older adults had slower initiation and termination reaction times in all response directions and decreased COP-COM separation during sway initiation and continuous voluntary sway in the anteroposterior and medialateral directions compared with young adults. Compared with low falls-risk older adults, high falls-risk older adults had slower initiation and termination reaction times in all response directions and decreased COP-COM separation during medialateral continuous voluntary sway. Reaction time and COP-COM measures significantly predicted group status in discriminant models with sensitivities and specificities of 72-100%. Overall, these findings highlight important associations of age-related declines in sensorimotor function related to an increased risk of falling with slower postural reaction time and reduced postural stability.

What is the benefit of bevacizumab combined with chemotherapy in patients with recurrent ovarian, fallopian tube or primary peritoneal malignancies?

The aim of this retrospective analysis was to investigate the efficacy and adverse effects of the monoclonal antivascular endothelial growth factor antibody bevacizumab (Avastin(R)) combined with chemotherapeutic agents in non-protocol patients with recurrent ovarian, fallopian tube, or primary peritoneal malignancies. Using our databases, we identified patients treated with bevacizumab combination therapy since June 2005. Responses were evaluated with Response evaluation Criteria in Solid tumors and serum CA125 Rustin criteria. Toxicity was assessed according to the Common toxicity Criteria (CTC) v.3.0. Data from 64 patients were included. The median patient age was 58 years, and they had undergone a median of 4.5 (range, 1-10) prior cytotoxic chemotherapy regimens. The median length of follow-up was 8 months (range, 2-29). The most commonly used combinations were bevacizumab plus taxanes (26.6%) and plus cyclophosphamide (26.6%). A median of 4 cycles of therapy with a median bevacizumab dose of 3,600 mg (range, 500-18,240) were administered. An overall response rate of 21.3% was observed in 13 patients with partial response, and another 42.6% of patients had stable disease. Among the patients with elevated pretreatment serum CA125 concentration, an overall response rate of 46.3% (25/54) was observed according to modification of the Rustin criteria. Fifteen (23.4%) patients had grades 3 or 4 adverse events. Gastrointestinal perforations occurred in 2 (3.1%) patients. Seventeen (26.6%) patients had improved performance status scores. Bevacizumab combined with chemotherapy showed promising clinical benefits, with significant response of serum CA125 concentration and moderate adverse effects.

Lower trunk motion and speed-dependence during walking

BACKGROUND

There is a limited understanding about how gait speed influences the control of upper body motion during walking. Therefore, the primary purpose of this study was to examine how gait speed influences healthy individual's lower trunk motion during overground walking. The secondary purpose was to assess if Principal Component Analysis (PCA) can be used to gain further insight into postural responses that occur at different walking speeds.

METHODS

Thirteen healthy subjects (23 +/- 3 years) performed 5 straight-line walking trials at self selected slow, preferred, and fast walking speeds. Accelerations of the lower trunk were measured in the anterior-posterior (AP), vertical (VT), and mediolateral (ML) directions using a triaxial accelerometer. Stride-to-stride acceleration amplitude, regularity and repeatability were examined with RMS acceleration, Approximate Entropy and Coefficient of Multiple determination respectively. Coupling between acceleration directions were calculated using Cross Approximate Entropy. PCA was used to reveal the dimensionality of trunk accelerations during walking at slow and preferred speeds, and preferred and fast speeds.

RESULTS

RMS acceleration amplitude increased with gait speed in all directions. ML and VT trunk accelerations had less signal regularity and repeatability during the slow compared to preferred speed. However, stride-to-stride acceleration regularity and repeatability did not differ between the preferred and fast walking speed conditions, partly due to an increase in coupling between frontal plane accelerations. The percentage of variance accounted for by each trunk acceleration Principal Component (PC) did not differ between grouped slow and preferred, and preferred and fast walking speed acceleration data.

CONCLUSION

The main finding of this study was that walking at speeds slower than preferred primarily alters lower trunk accelerations in the frontal plane. Despite greater amplitudes of trunk acceleration at fast speeds, the lack of regularity and repeatability differences between preferred and fast speeds suggest that features of trunk motion are preserved between the same conditions. While PCA indicated that features of trunk motion are preserved between slow and preferred, and preferred and fast speeds, the discriminatory ability of PCA to detect speed-dependent differences in walking patterns is limited compared to measures of signal regularity, repeatability, and coupling.

Aromatase inhibitors in ovarian cancer: is there a role?

Estrogen plays a role in ovarian tumorigenesis. Aromatase is the enzyme required for the synthesis of estrogen via conversion of androgen to estrogen, which is the major source of estrogen in postmenopausal women. Aromatase is present in normal ovaries and other tissues (e.g., fat and muscle) as well as in 33-81% tumor tissues of ovarian cancer. Aromatase inhibitors (AIs) block estrogen synthesis by inhibiting aromatase activity. In patients with recurrent ovarian cancer, single-agent AI therapy has been shown to elicit clinical response rates of up to 35.7% and stable disease rates of 20-42%. Given the limited treatment options for recurrent ovarian cancer and the favorable safety profile and convenient use, AI is a rational option for prolonging platinum-free interval in recurrent ovarian cancer. Further studies are required to determine the efficacy of combination treatment with AIs and biological agents, determine the benefit of AIs for treating special types of ovarian cancer (e.g., endometrioid type), and identify biomarkers for targeted patient selection. This review summarizes the current epidemiologic, preclinical, and clinical data regarding estrogen's role in ovarian cancer, the expression and regulation of aromatase in this disease, the development and characteristics of the three generations of AIs, and the preclinical and clinical studies of AIs in the treatment of ovarian cancer.

Accelerometry: a technique for quantifying movement patterns during walking

The popularity of using accelerometer-based systems to quantify human movement patterns has increased in recent years for clinicians and researchers alike. The benefits of using accelerometers compared to more traditional gait analysis instruments include low cost; testing is not restricted to a laboratory environment; accelerometers are small, therefore walking is relatively unrestricted; and direct measurement of 3D accelerations eliminate errors associated with differentiating displacement and velocity data. However, accelerometry is not without its disadvantages, an issue which is scarcely reported in gait analysis literature. This paper reviews the use of accelerometer technology to investigate gait-related movement patterns, and addresses issues of acceleration measurement important for experimental design. An overview of accelerometer mechanics is provided before illustrating specific experimental conditions necessary to ensure the accuracy of gait-related acceleration measurement. A literature review is presented on how accelerometry has been used to examine basic temporospatial gait parameters, shock attenuation, and segmental accelerations of the body during walking. The output of accelerometers attached to the upper body has provided useful insights into the motor control of normal walking, age-related differences in dynamic postural control, and gait patterns in people with movement disorders.

Age-related differences in postural reaction time and coordination during voluntary sway movements

The elderly are known to exhibit declines in postural control during standing and walking, however little is known about how the elderly react under time-critical and challenging postural situations. The purpose of this study was to examine age-related differences in reaction time (RT) and the pattern of temporal coordination between center of pressure (COP), trunk and head motion during voluntary postural sway movements. Healthy young (n=10; mean=24 years; SD=5 years) and elderly men (n=8; mean=75 years; SD=2 years) stood on a force plate with tri-axial accelerometers attached to the head and lower trunk. Participants were required to generate sway in the anterior-posterior (AP) or medial-lateral (ML) direction in response to an auditory cue during two different testing conditions called Static reaction and Dynamic reaction. Static reactions involved the initiation of voluntary sway in either the AP or ML direction from quiet stance. Dynamic reactions involved an orthogonal switch of voluntary sway between the AP and ML directions. Compared to the young, elderly individuals exhibited slower RT during both Static and Dynamic reaction, and smaller differences in RT and phasing between COP, trunk, and head motion. The results of this study suggest that the elderly adopted more rigid coordination strategies compared to the young when executing a rapid change in direction of whole body motion. The rigid movement strategy of the elderly was presumably generated in an effort to compensate for increased challenge to the maintenance of stability.

Chemotherapy for gynecological malignancies in organ transplantation patients: report of two cases

Long-term risk of gynecological malignancies in organ transplantation patients has increased compared with that of the general population owing to the use of immunosuppressive agents. Treatment, especially chemotherapy, in these patients should take into consideration their renal function and the effects of immunosuppressive agents. We here present two case reports of patients with chemotherapy-treated gynecological malignancies who had previously received organ transplantation. The first case, a rare occurrence of simultaneous carcinomas of the uterine corpus and ovary, is the first such report in the English literature describing chemotherapy for concurrent serous papillary ovarian carcinoma and endometrioid endometrial carcinoma in a renal transplant patient. The second case report, describing chemotherapy for cervical cancer following two organ transplantation, also rare, is the first such report in the English literature and the first report of cervical cancer after heart-kidney transplantation.

Phase II multicenter open-label study of karenitecin in previously treated epithelial ovarian and primary peritoneal cancer: a Gynecologic Oncology Group Study

The topoisomerase I agents are established as a therapy in recurrent ovarian cancer. Karenitecin, an analog of topotecan with solubility and pharmacologic advantages, was tested in a phase II trial in previously treated patients with recurrent or persistent ovarian cancer. The drug was administered intravenously over 1 h at a dose of 1.0 mg/m(2) daily for 5 days every 21 days. Patients were treated until disease progression, intolerable toxicity, or voluntary withdrawal. Response was evaluated according to modified RECIST criteria. Twenty-seven patients were entered into the study. One patient was inevaluable for not receiving any treatment. Of the 26 evaluable patients, there were two partial responses and one complete response for a total response rate of 12%. This response rate was insufficient to justify accrual to the second stage. The most common grade 3 or 4 toxicities were neutropenia (19%) and gastrointestinal (15%). Karenitecin is a well-tolerated topoisomerase compound but has minimal activity in extensively pretreated ovarian cancer with the dose-schedule employed.

Ovarian endometriosis associated with carcinoma and sarcoma: case report

Endometriosis is a common clinical disorder that shares certain characteristics, metastasis and recurrence, with malignant neoplasms. Most malignant ovarian tumors arising from endometriosis are clear cell carcinoma or endometrioid adenocarcinoma. Few reports exist of sarcoma associated with endometriosis, and even fewer exist of multiple types of malignancies occurring simultaneously. Here, we report the case of a 32-year-old woman who presented with infertility and a pelvic mass. She underwent exploratory laparotomy and bilateral salpingo-oophorectomy. She was then referred to our institution for treatment recommendation. The pathologic findings revealed bilateral endometrioid adenofibroma of low malignant potential, which was associated with endometrioid intraepithelial carcinoma in the left ovary and high-grade sarcoma in the right ovary. Both tumors seemed to have arisen from endometriosis. She was treated with 75 mg/m2 of doxorubicin and 10 g/m2 of ifosfamide every three weeks for eight courses. She was later found to have bilateral brain metastases, which were resected and treated by whole-brain irradiation. She was again treated with doxorubicin and ifosfamide. The optimal treatment for endometriosis-associated ovarian cancer depends on the type of malignancy; simultaneously occurring multiple tumor types should be treated individually.

Tamoxifen is safe and effective in gynecological cancer patients with renal dysfunction

Tamoxifen has been found to be safe and effective in gynecological cancer patients with normal renal function. However, to our knowledge, no data exist regarding its effectiveness and toxicity in gynecological cancer patients with chronic kidney disease (CKD). Therefore, we retrospectively evaluated the effects of tamoxifen in patients with recurrent gynecological cancer and CKD. We collected clinical and demographic data for all patients. CKD was defined as a creatinine clearance (CrCl) level of less than 90 mL/min/1.73 m(2), in accordance with the National Kidney Foundation Kidney and Dialysis Outcomes Quality Initiative, and further categorized as mild, moderate, or severe (CrCl levels of 60-89, 30-59, and <30 mL/min/1.73 m(2), respectively). Twenty-nine patients were included in the study--22 with epithelial ovarian cancer, 4 with peritoneal cancer, and 3 with fallopian tube cancer. Thirteen patients had mild CKD, 13 had moderate, and 3 had severe. Most patients had been treated with 20 mg/day of tamoxifen every 4 weeks. The median duration of treatment was 5 months (range, 1-52 months). The overall complete response, partial response, stable disease, and disease progression rates were 0%, 10%, 41%, and 48%, respectively. Twenty-one percent of patients experienced hot flashes, and 7% experienced nausea. No major adverse reactions occurred. These findings were similar to those for gynecological cancer patients with normal renal function. In conclusion, 20 mg/day of tamoxifen is safe and effective in gynecological cancer patients with CKD.

Erosive osteoarthritis during treatment with bevacizumab and paclitaxel in a patient with recurrent papillary serous carcinoma of the ovary

Bevacizumab (BVC) is currently used in recurrent ovarian cancer and as part of the initial treatment for ovarian cancer. The most serious toxicities associated with BVC include gastrointestinal perforations, delayed wound healing, and hemorrhage. Arthritis had never been addressed in patients who received BVC treatment. This is the first case report of arthritis emergence linked to BVC administration. A 59-year-old female with recurrent ovarian cancer received multiple hormonal and cytotoxic regimens for 5 years and then developed erosive osteoarthritis of the hands secondary to BVC and paclitaxel. This effect was confirmed by a significant improvement in her symptoms and signs, after treatment was discontinued.

Systemic anticancer therapy in gynecological cancer patients with renal dysfunction

Chronic kidney disease is a common occurrence in patients with gynecological cancer. Systemic anticancer treatment in such patients is a challenge for clinicians because of altered drug pharmacokinetics. For those drugs that are excreted mainly by the kidneys, decreased renal function may lead to increased systemic exposure and increased toxicity. Dose adjustment based on pharmacokinetic changes is required in this situation to avoid life-threatening toxicity. In this review, we summarize the nephrotoxicity and pharmacokinetic data of agents commonly used in systemic anticancer treatment of gynecological cancers and dose adjustment guidelines in the presence of impaired renal function. We review 17 medications that need dose adjustment (cisplatin, carboplatin, doxorubicin, epirubicin, cyclophosphamide, ifosfamide, topotecan, irinotecan, etoposide, capecitabine, bleomycin, methotrexate, actinomycin D, granulocyte-macrophage colony-stimulating factor, metoclopramide, cimetidine, and diphenhydramine) as well as 27 drugs that do not (paclitaxel, docetaxel, pegylated liposomal doxorubicin, gemcitabine, oxaliplatin, fluorouracil, vincristine, letrozole, anastrozole, tamoxifen, leuprorelin, megestrol, gefitinib, erlotinib, trastuzumab, leucovorin, granulocyte colony-stimulating factor, erythropoietin, ondansetron, granisetron, palonosetron, tropisetron, dolasetron, aprepitant, dexamethasone, lorazepam, and diazepam). We also review the formulae commonly used to estimate creatinine clearance, including Cockcroft-Gault, Chatelut, Jelliffe, Wright, and the Modification of Diet in Renal Disease study formulae.

Hormonal therapy in ovarian cancer

Ovarian carcinoma continues to be the leading cause of death due to gynecological malignancy. Epidemiologic studies indicate that steroid hormones play roles in ovarian carcinogenesis. Gonadotropins, estrogen, and androgen may be causative factors, while gonadotropin-releasing hormone and progesterone may be protective factors in ovarian cancer pathogenesis. Experimental studies have shown that hormonal receptors are expressed in ovarian cancer cells and mediate the growth-stimulatory or growth-inhibitory effects of the hormones on these cells. Hormonal therapeutic agents have been evaluated in several clinical trials. Most of these trials were conducted in patients with recurrent or refractory ovarian cancer, with modest efficacy and few side effects. Better understanding of the mechanisms through which hormones affect cell growth may improve the efficacy of hormonal therapy. Molecular markers that can reliably predict major clinical outcomes should be investigated further in well-designed trials.

Immunobiology of gestational trophoblastic diseases

Gestational trophoblastic diseases (GTDs) comprise a group of interrelated diseases characterized by development after gestation, widespread metastases, and high curability with chemotherapy. The good prognosis of GTDs is considered partly a result of the host immune response to paternal antigens expressed on trophoblastic cells. In this study, we review current understanding of the immunobiology of GTDs. First of all, we describe the microenvironment between trophoblastic cells and subpopulation of immune cells. Second, immunogenetics, immune microenvironment around abnormal trophoblast, and mechanism of GTDs escaping from maternal immune system surveillance were also discussed. Third, we propose the possible immunotherapy for persistent GTDs, particularly the vaccine designed on human chorionic gonadotrophin, which is generally accepted as a tumor marker for GTDs diagnosis. Due to the low incidence of GTDs and high response to chemotherapy, there have been few literatures about immunobiologic characteristics of GTDs compared with the other gynecologic malignancies, such as ovarian cancer, but the immunologic behavior of GTDs should be explored for further understanding of the etiology of these diseases and to help designing immunotherapeutic strategies for persistent GTDs.

Lumbar and cervical erector spinae fatigue elicit compensatory postural responses to assist in maintaining head stability during walking

The purpose of this study was to examine how inducing fatigue of the 1) lumbar erector spinae and 2) cervical erector spinae (CES) muscles affected the ability to maintain head stability during walking. Triaxial accelerometers were attached to the head, upper trunk, and lower trunk to measure accelerations in the vertical, anterior-posterior, and mediolateral directions during walking. Using three accelerometers enabled two adjacent upper body segments to be defined: the neck segment and trunk segment. A transfer function was applied to root mean square acceleration, peak power, and harmonic data derived from spectral analysis of accelerations to quantify segmental gain. The structure of upper body accelerations were examined using measures of signal regularity and smoothness. The main findings were that head stability was only affected in the anterior-posterior direction, as accelerations of the head were less regular following CES fatigue. Furthermore, following CES fatigue, the central nervous system altered the attenuation properties of the trunk segment in the anterior-posterior direction, presumably to enhance head stability. Following lumbar erector spinae fatigue, the trunk segment had greater gain and increased regularity and smoothness of accelerations in the mediolateral direction. Overall, the results of this study suggest that erector spinae fatigue differentially altered segmental attenuation during walking, according to the level of the upper body that was fatigued and the direction that oscillations were attenuated. A compensatory postural response was not only elicited in the sagittal plane, where greater segmental attenuation occurred, but also in the frontal plane, where greater segmental gain occurred.

Clinical application of oxaliplatin in epithelial ovarian cancer

Platinum remains the most active drug class in ovarian cancer treatment; however, new single-agent and combination therapies are needed to improve the clinical outcome of ovarian cancer therapies. Oxaliplatin, a third-generation platinum derivative, has shown effective antitumor activity and a favorable toxicity profile in epithelial ovarian cancer. Preclinical evidence of the synergistic cytotoxic effect of oxaliplatin in combination with several other chemotherapeutic agents and clinical evidence of the absence of any dose-limiting hematologic toxicity associated with this agent have made oxaliplatin an attractive compound for combination agent therapy. This article reviews the current status of the clinical application of oxaliplatin alone and in a combination regimen in epithelial ovarian cancer treatment.

Metastasis to sigmoid colon mucosa and submucosa from serous borderline ovarian tumor: response to hormone therapy

Distant metastasis to sites other than lymph nodes of borderline ovarian tumor is rare. We describe a case metastasized to sigmoid colon mucosa and submucosa. The metastatic lesion was detected incidentally by screening colonoscopy 7 years after the patient was treated for the primary tumor. The metastatic lesion responded well to treatment with oral Arimidex 1 mg/day. A follow-up colonoscopy with biopsy and imaging studies after 3 months of treatment revealed no evidence of disease in the sigmoid colon. This case showed that the sigmoid colon mucosa and submucosa should be considered as one of distant metastatic sites of a serous borderline ovarian tumor and the favorable response to Arimidex provides support the use of hormone therapy in women with serous borderline ovarian tumor.

Benign multicystic peritoneal mesothelioma: cases reports in the family with diverticulosis and literature review

We report on benign multicystic peritoneal mesothelioma in two siblings whose family had a history of multiple familial diseases including diverticulosis. After a genetic evaluation and a chromosomal analysis, we were not able to identify a specific genetic cause of the family's pattern of disease. We assumed that previous surgical procedures and the chronic inflammatory process from diverticulitis were the underlying etiology. Both patients had multiple recurrences with indolent courses similar to those reported in other cases. After the recurrences, one patient was treated with cystic aspiration and the other with hormones. The cysts in both cases regressed partially but the patients were relieved of their clinical symptoms, for 2 years after cystic drainage in one case and for 5 years after hormonal treatment in the other.

Response of recurrent uterine high-grade malignant mixed müllerian tumor to letrozole

Uterine malignant mixed müllerian tumor (MMMT) is a rare malignancy occurring most often in postmenopausal women. Despite the use of multimodality treatments including surgery, chemotherapy, and radiotherapy, prognosis is still poor in most cases. We report the case of a 69-year-old woman with recurrent metastatic high-grade MMMT that responded to letrozole, an aromatase inhibitor. At the initial diagnosis of high-grade uterine MMMT in February 2001, the patient underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, and postoperative pelvic radiotherapy. Two years later, an asymptomatic retroperitoneal mass was discovered on surveillance abdominal computed tomography scanning. The 3.5- x 3.0-cm mass was considered inoperable owing to its location near the aorta at the level of the renal vessels. The patient declined radiation or chemotherapy. Treatment with letrozole was begun at 2.5 mg daily. Serial computed tomography scans demonstrated marked tumor shrinkage; after 11 months of letrozole therapy, the tumor had shrunk to less than 25% of its original volume. Further study of letrozole for high-grade uterine MMMT is warranted.

Venous thromboembolism syndrome in gynecological cancer

Venous thromboembolism (VTE) could be presented as an initial clinical feature in some cancer patients or a complication followed by various cancer treatments, which all indicates a poor outcome. This review focuses on elucidating the relationship of VTE and the main gynecological cancers including ovarian, endometrial, and cervical cancers. First, the general VTE information about gynecological cancer are introduced; second, the risk factors of VTE developing in gynecological cancer were discussed; third, we do a retrospective analysis on a novel treatment targeting coagulation cascade; and last, we analyze VTE as a remarkable complication followed by recombinant human erythropoietin and anti-vascular endothelial growth factor treatment in gynecological cancer patients. In summary, the interaction between the coagulation system and cancer progression is a novel promising area to be explored in the study of VTE in patients with gynecological cancer.

Multi-institutional phase 2 study of TLK286 (TELCYTA, a glutathione S-transferase P1-1 activated glutathione analog prodrug) in patients with platinum and paclitaxel refractory or resistant ovarian cancer

The purpose of this study was to determine the safety and efficacy of TLK286 (TELCYTA(TM)), a glutathione analog prodrug, in patients with platinum and paclitaxel refractory or resistant ovarian carcinoma. Thirty-six patients with measurable disease were enrolled. TLK286 was administered at 1000 mg/m2 intravenously every 3 weeks. The endpoints were objective response rate assessed by Response Evaluation Criteria in Solid Tumors (RECIST) and survival. Adverse events were graded using the National Cancer Institute Common Toxicity Criteria. Thirty-four platinum refractory or resistant patients (94%) were evaluable for objective tumor response. Five patients (15%) had objective tumor responses, including one durable complete response (CR) of greater than 3 years and continuing. The disease stabilization rate was 50%, including one CR (3%), four partial responses (12%), and 12 durable disease stabilizations (35%). Responses were accompanied by improvement in clinical symptoms and Eastern Cooperative Oncology Group Performance Status (ECOG PS) and decline in CA125 levels. Median survival was 423 days with survival of 60% at 1 year and 40% at 18 months. TLK286 was well tolerated in this population. TLK286 is an active agent in chemotherapy-resistant ovarian cancer. Further studies of TLK286 in platinum and paclitaxel refractory or resistant ovarian cancer are in progress.

Age-related differences in head and trunk coordination during walking

The purpose of this study was to examine the effect of ageing on the pattern and structure of head and trunk accelerations during walking. Head and trunk accelerations of young (n=8; mean=23 years, SD=4 years) and elderly (n=8; mean=74 years, SD=3 years) individuals were measured using triaxial accelerometers while performing preferred speed walking. Accelerations were examined using power-spectral analysis and measures of signal smoothness, regularity and coupling. No differences in walking speed or signal regularity were detected between age groups. Compared to the young participants, the elderly had (1) a greater proportion of signal power above 6 Hz for the trunk, (2) a smaller difference in signal smoothness between the trunk and head, (3) less signal smoothness in the mediolateral direction, and (4) a greater degree of directional coupling for the head compared to the trunk. Overall these results suggest that the pattern of head accelerations was relatively unaffected by age, and that both age groups achieved similar levels of head stability despite differences in trunk acceleration characteristics. The manner in which head stability was achieved differed between age groups, with the elderly employing an upper body coordination strategy that enhanced coupling between acceleration directions of the head compared to the trunk. The findings of this study also suggest that an absence of age-related differences in signal complexity at one level of postural system, combined with differences at another level, may provide information about the way in which the motor system prioritises postural control during gait.

Expression of HER-2/neu, epidermal growth factor receptor, vascular endothelial growth factor, cyclooxygenase-2, estrogen receptor, and progesterone receptor in small cell and large cell neuroendocrine carcinoma of the uterine cervix: a clinicopathologic and prognostic study

We studied the immunohistochemical expression of HER-2/neu, epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF), cyclooxygenase-2 (COX-2), estrogen receptor (ER), and progesterone receptor (PR) in uterine cervical small cell and large cell neuroendocrine carcinomas (SCNECs and LCNECs) from 24 patients seen at The University of Texas M.D. Anderson Cancer Center. The objectives were to determine their expression and prognostic role in survival. Twenty-three cases (95.8%) expressed VEGF. The tumors expressing EGFR, HER-2/neu, and COX-2 were modest in numbers: eight (33.3%), 10 (41.7%), and seven (29.2%), respectively. Only one tumor (4.2%) expressed ER, and only two tumors (8.3%) expressed PR. No significant differences in the expression of these factors were found between SCNECs and LCNECs or between stage I and stage II-III tumors. The median overall survival was 21.1 months (95% confidence interval [CI], 17.2-25.0 months). Only HER-2/neu expression was significantly associated with survival. Patients with negative HER-2/neu expression tumors had significantly shorter survival than those whose tumors were positive, 14.2 months (95% CI, 10.6-17.7 months) versus 33.1 months (95% CI, 0-76.92 months) (P = 0.03). There was a trend toward worse survival in patients with EGFR expression, but this finding was not significant. The combination of negative HER-2/neu expression and positive EGFR expression had the worst impact on survival.

Profiling of differentially expressed genes in human uterine leiomyomas

Uterine leiomyomas are very common benign tumors resulting in clinically serious gynecological problems in women of reproductive age. Approximately, 1% of leiomyosarcoma was reported to arise in a preexisting leiomyoma. However, the molecular basis of these tumors is poorly understood. To understand the molecular changes during leiomyoma development, we profiled differentially expressed genes in ten paired leiomyoma and normal myometrial tissues using cDNA microarray chip analysis. We identified 67 genes (27 overexpressed and 40 underexpressed) which were scored as differentially expressed at least twofold in at least eight of ten patients. Eighteen of 67 genes have been already reported to be differentially expressed without their established functions in uterine leiomyoma and others have never been reported. Subsequently, the relative expression levels of representative genes from identified 67 genes were confirmed by reverse-transcriptase polymerase chain reaction and immunohistochemistry and were found to be consistent with the microarray data. This study could provide a new insight into the understanding of leiomyoma and leiomyosarcoma.

Retrospective review: re-treatment of patients with ovarian cancer with carboplatin after platinum resistance

The objective of the analysis was to determine the effectiveness of re-treating patients with ovarian cancer, primary peritoneal cancer, and fallopian tube cancer with carboplatin after being deemed platinum resistant. From a database period January 1, 1996, to December 12, 2002, 34 patients were identified who received nonplatinum agents before resuming treatment with carboplatin. The median age was 65 years, and a median of two nonplatinum chemotherapy (range 1-5) prior to re-treatment with carboplatin was received. The median platinum-free interval from the time platinum was last received to re-treatment with carboplatin was 15.2 months (95% confidence interval [CI] 12.6-17.9; range 6.2-47.0). A median number of four cycles of carboplatin (range 1-11) was received. Two patients (5.9%) achieved partial response, while 21 patients (61.7%) achieved stable disease. The median time to progression for these 23 patients after re-treatment with carboplatin was 5.7 months (95% CI 5.2-6.3; range 1.8-15.3). Twenty-seven patients have died, and all patients have progressed. Seven patients are still receiving salvage therapy. The median overall survival from the time deemed to be platinum resistant is 23.2 months (95% CI 20.1-26.4). Patients who have been deemed platinum resistant may still benefit from platinum re-treatment after an interval of treatment with nonplatinum agents.

Coordination of head and trunk accelerations during walking

The purpose of this study was to investigate the relationship between oscillatory dynamics of the head and trunk in each plane of motion during walking. Head and trunk accelerations of ten healthy subjects (age: 23 +/- 4 years) were measured in the vertical (VT), anterior-posterior (AP) and mediolateral (ML) directions using a pair of tri-axial accelerometers. All subjects performed five walking trials along a level 20 m walkway at their preferred gait velocity (1.30 +/- 0.15 m s(-1)). Acceleration data were analysed using power spectral, harmonic and regularity measures. Results indicated that: (1) oscillations of the head were smoother, with a greater proportion of power at lower frequencies than oscillations of the trunk, (2) differences in power spectral properties between the head and trunk were most pronounced in the ML direction, (3) coupling between VT-AP, VT-ML, and AP-ML accelerations were greater for the head than trunk, and (4) for both segments, the weakest coupling was observed for AP-ML acceleration relations. Overall, the results of this study suggest that accelerations of the head are significantly attenuated, and more tightly controlled, compared to accelerations of the lower trunk. This attenuation process was particularly evident for the ML direction, whereby head accelerations showed the greatest differences compared to ML accelerations at the trunk.

Upper body accelerations during walking in healthy young and elderly men

The purpose of the present study was to assess whether any differences existed in the upper body accelerations of young and elderly subjects during natural speed walking. Head and trunk accelerations in eight young subjects (aged 23+/-4 years) and eight healthy elderly subjects (aged 74+/-3 years) were measured during level walking on a 20 m walkway using a pair of tri-axial accelerometers. Heel contact and toe-off events were determined using a footswitch system embedded in the innersole of the right shoe. Gait measures assessed included; stride, stance and swing durations, cadence, gait velocity, step length and 3D head and trunk accelerations. All acceleration variables were normalised to walking speed before statistical analysis. The main findings of this study were: (1) the peak positive anterior-posterior (AP) trunk acceleration associated with push-off was significantly lower for elderly subjects, (2) the peak negative AP head and trunk accelerations following heel contact was significantly higher for elderly subjects, and (3) the time delay between trunk and head accelerations experienced in the AP direction was significantly lower for the elderly compared to the young group. Together, these results suggest that elderly subjects exhibit different patterns of upper body motion in the direction of travel compared to younger subjects. These differences are probably motivated by the need to maximise dynamic stability during critical parts of the gait cycle.

Role of surgical resection for lung, liver, and central nervous system metastases in patients with gynecological cancer: a literature review

Many reports of ovarian, cervical, and uterine cancers metastatic to lung, liver, and brain have been published. A fewer number of them focused on the surgical treatment for these patients. We reviewed the published literature, regarding surgical management of metastatic disease in patients with gynecological cancer. Some prognostic factors in the patients with metastatic lesions from these three different cancers were found in common. Favorable prognostic factors for a prolonged survival were good performance status of the patients, long disease-free interval, absence of other systemic disease, and the resectability, preferably with a clear margin. These factors should be considered as the criteria for surgery. In well-selected patients, survival could be extended from the surgical procedure with minimal complications. Other types of treatment such as radiation therapy or chemotherapy could also be given in conjunction with surgery, depending on tumor type and disease status of the primary cancer, other systemic diseases, and residual metastatic lesions after surgery.

Third-line chemotherapy in platinum- and paclitaxel-resistant ovarian, fallopian tube, and primary peritoneal carcinoma patients

Ovarian carcinoma is a malignant disease with a high rate of recurrence, necessitating repeated chemotherapy treatments. We conducted a retrospective study in patients with platinum- and paclitaxel-resistant ovarian, fallopian tubes and primary peritoneal carcinoma patients treated at M.D. Anderson Cancer Center. We evaluated the responses, progression-free intervals, and overall survival duration of 51 patients after third-line chemotherapy treatment. The overall response rate was 16% (eight cases) with 2% complete response rate (one case) and 14% partial response rate (seven cases). Stable disease was achieved in 31% (16 cases). The progression-free intervals of 24 patients who had response and stable disease was 7.4 months (range, 1.4-18.4 months). The median overall survival of all patients was 15.8 months (95% CI, 8.1-23.4 months). The median survival duration of eight responders was not significantly different from that of 43 nonresponders, 18.9 months (95% CI, 2.4-35.4 months) versus 15.8 months (95% CI, 6.4-25.2 months), respectively (P = 0.73). In conclusion, third-line chemotherapy in our study results in a modest response and prolongation of progression-free interval without obvious impact on survival. The decision to utilize third-line chemotherapy will be a balance of the limited efficacy, toxicity of the agents, and the expertise of the clinician.

Targeted therapy for epithelial ovarian cancer: Current status and future prospects

Despite advances in surgery and chemotherapy, less than 20% of patients with stage III or IV ovarian cancer survive long-term. In the past, cytotoxic regimens have been developed empirically, combining active agents at maximally tolerated doses, often without a clear rationale for their interaction. Advances in understanding the biology of ovarian cancer have identified multiple molecular targets that differ in normal and malignant cells. Targets include cell cycle regulators, growth factor receptors, signal transduction pathways, molecules that confer drug resistance, and angiogenic mechanisms. A number of targeted agents have entered clinical trials. Small molecular weight inhibitors, monoclonal antibodies, and antisense and gene therapy are all being evaluated alone and in combination with cytotoxic drugs. In contrast to earlier studies, the impact of each agent on the designated target can be assessed and agents can be matched to the genotype and phenotype of malignant and normal cells. In the long run, this should facilitate individualization of more effective, less toxic therapy for women with ovarian cancer.

Langerhans cell histiocytosis of the female genital tract: a literature review

Langerhans cell histiocytosis (LCH) is a rare malignant disease involving the accumulation of a monoclonal proliferation of cells in various organs, that phenotypically resemble Langerhans cells (LC). LCH is not merely a hyperplasia of LC, as it typically affects organs that are outside of their normal physiologic distribution. Normal Langerhans cells are bone marrow-derived dendritic cells that populate the epidermis and are distinguished by the presence of Birbeck granules and cell surface protein CD1a. LC act as sentinels; they recognize, internalize, and process antigens encountered in the skin. Upon encountering an antigen, LC become activated with subsequent maturation and induction of their migratory capacity. Langerhans cells in patients with LCH are aberrant and profoundly differ from normal LC. The clinical spectrum of LCH is quite diverse; multiple organs can be affected. "Pure" genital Langerhans cell histiocytosis is a rare presentation, with only 12 previously reported cases. Due to the rarity of this disease, treatment of genital LCH is still very diverse. No modality is proven to be superior in improving patient outcome, and relapses frequently occur after surgery. Dramatic responses of cutaneous and ano-genital lesions to thalidomide and interferons have been reported. We advocate the use of immuno-modulating agents in LCH of the female genital tract first, rather than surgery.

Thiotepa in combination with cisplatin for primary epithelial ovarian cancer: a phase II study

The objectives of this phase II protocol were: 1) to determine the clinical activity of thiotepa combined with cisplatin in suboptimally debulked advanced epithelial ovarian carcinoma as first-line chemotherapy, 2) to determine by surgery the response after 6 courses of chemotherapy, and 3) to identify the regimen's qualitative and quantitative toxicities. Patients with FIGO stage IIIC or IV epithelial ovarian cancer were eligible to receive cisplatin (50 mg/m2) followed by thiotepa (40 mg/m2) on an every 4-week schedule. Patients showing no evidence of disease after six cycles of chemotherapy underwent surgical reassessment. Thirty-one patients were evaluable for toxicity and response. Myelosuppression was the major toxicity and hematologic toxicities prompted all dose reductions. No growth factor support was given in this trial. Thirty-nine percent of patients (12/31) had a clinical complete response. Of these, 16% (5/31) had complete pathologic response and 19% (6/31) had partial pathologic response. One long-term survivor declined reassessment laparotomy. Including the 16% of patients with a partial response, the overall response rate was 55% (17/31). Five patients are currently alive 8 years after enrollment. Median survival was 16.8 months for all patients, 21.5 months for patients with partial response, and 60.8 months for patients with complete pathologic response. A normalization or >50% decrease in CA125 level occurred in 93% of patients. This study indicates that first-line treatment with thiotepa and cisplatin produces significant long-term responses when tumors are sensitive. Such treatment is a reasonable option when paclitaxel is not available.

Proteomics in cancer research

With the human genome sequence now determined, the field of molecular medicine is moving beyond genomics to proteomics. In the field of cancer research, the key question is: how can oncologists best use techniques of proteomics in basic research and clinical application? In the postgenomic era, proteomics promises the discovery of biomarkers and tumor markers for early detection and diagnosis, novel protein-based drug targets for anticancer therapy, and new endpoints for the assessment of therapeutic efficacy and toxicity. This review paper will explore key themes in proteomics and their application in clinical cancer research.

Activity of ALRT 1550, a new retinoid, with interferon-gamma on ovarian cancer cell lines

Retinoids have been shown to be effective regulators of cell proliferation and differentiation in many human cancers. The major biologic activity of the retinoids is mediated by two families of nuclear receptors: retinoic acid receptors (RARs) and retinoid X receptors (RXRs). ALRT 1550 is one of the most potent RAR selective retinoids discovered to date, with 10-100 times more activity than ATRA in competitive binding and cotransfection assays and 300 times more inhibiting activity against proliferation of cervical carcinoma cell. To evaluate the role of ALRT 1550 in ovarian cancer, the growth inhibitory activity of ALRT 1550 was determined in the ATRA-resistant ovarian cancer cell line SKOV-3 and ovarian cancer cell line 2774 after exposure to concentrations of 0.1, 1, 2.5, 5, and 10 microM for 7 days. SKOV-3 showed 51%, 53%, and 68% cell growth inhibition after treatment with ALRT 1550 at concentrations of 2.5, 5, and 10 microM, respectively, and the 2774 cell line showed 46% inhibition after treatment at 10 microM. Because interferon (IFN)-gamma was found to synergistically amplify the growth inhibition of retinoids in cultured breast cancer cells, we investigated the combination of ALRT 1550 with IFN-gamma in two ovarian cancer cell lines. ALRT 1550 (5 microM) in combination with IFN-gamma at a concentration of 500 U/ml inhibited cell growth of SKOV-3 by as much as 81% (CI = 1.88). This is a 28% greater effect than with ALRT alone. Cell line 2774 showed a 69% cell growth inhibitory effect with ALRT 1550 (5 microM) in combination with IFN-gamma at a concentration of 1000 U/ml (CI = 1.03). ALRT 1550 and IFN-gamma may act synergistically in the SKOV-3 ovarian cancer cell line and additively in the 2774 cell line. In conclusion, ALRT 1550 may be a promising drug with a high biologic modulating activity against ovarian cancer. In combination with IFN-gamma, additive and perhaps synergistic effects may be seen in some ovarian cancer cell lines. Combining these two biologic modifiers for the treatment of ovarian cancer may lower the effective dose of the retinoids, thus decreasing their side effects.

Phase II study of carboplatin and liposomal doxorubicin in patients with recurrent squamous cell carcinoma of the cervix

BACKGROUND

The activity of the combination of carboplatin and liposomal doxorubicin was tested in a Phase II study of patients with recurrent cervical carcinoma.

METHODS

The combination of carboplatin (area under the concentration curve [AUC], 5) and liposomal doxorubicin (Doxil; starting dose, 40 mg/m(2)) was administered intravenously every 28 days to 37 patients with recurrent squamous cell cervical carcinoma to determine antitumor activity and toxicity profile.

RESULTS

Twenty-nine patients were assessable for response, and 35 patients were assessable for toxicity. The overall response rate was 38%, the median time to response was 10 weeks, the median duration of response was 26 weeks, and the median survival was 37 weeks. The main toxic effect was myelosuppression, with Grade 3 and 4 neutropenia in 16 patients, anemia in 12 patients, thrombocytopenia in 11 patients, and neutropenic fever in 3 patients. Four patients had five infusion-related reactions during the infusion of liposomal doxorubicin, leading to treatment discontinuation in three patients. Grade > or = 2 nonhematologic toxicity included nausea in 17 patients, emesis in 14 patients, fatigue in 9 patients, mucositis and/or stomatitis in 8 patients, constipation in 6 patients, weight loss in 5 patients, hand-foot syndrome in 2 patients, and skin reactions in 3 patients.

CONCLUSIONS

The combination of carboplatin and liposomal doxorubicin has modest activity in patients with recurrent cervical carcinoma.

Vulvar melanoma at the M. D. Anderson Cancer Center: 25 years later

The purpose of this study was to review the clinical course of patients diagnosed with vulvar melanoma. Charts of patients diagnosed between 1970 and 1997 were reviewed for demographics, lesion characteristics, disease duration and extent, and treatments. Actuarial survival curves were computed by the Kaplan Meier method and compared by Cox proportional hazards regressions. Fifty-one patients (median age 54) with vulvar melanoma presented with a vulvar mass (39%), pain (30%), bleeding (24%), and itching (20%). Anatomical distribution was mucosa of the vulva (65%), vulvar epidermal site (21%), or unspecified vulva (14%), with 20% having multifocal disease at diagnosis. Histologic types were superficial spreading or nodular (50% each). Median lesion characteristics were diameter 2 cm, Breslow index 4.4 mm, and Clark level IV. Distribution of patients per American Joint Committee on Cancer (AJCC) stage was 29%, 50%, 16%, and 7% for stages I, II, III and IV, respectively. Inguinal node metastases were unilateral in 16% and bilateral in 7%. Despite complete surgical resection, 32 patients (63%) recurred. Median survival for all patients was 41 months (range, 5-324), with 91% 5-year survival for patients with stage I and 31% for stage >or= IIA (P = 0.0002). As with cutaneous melanoma, the AJCC classification, Breslow's thickness, and Clark's levels are the major predictors of overall survival (P = 0.0001 each) and disease-free survival (P <or= 0.0001, 0.0004, and 0.0002, respectively). Surgical techniques do not seem to alter the prognosis. Because vulvar melanoma carries a poor prognosis at early stages, the use of adjuvant therapies needs to be studied prospectively in women affected with this disease.

Estrogen replacement therapy and ovarian cancer

Estrogen replacement therapy (ERT) has been shown to be of benefit for menopausal women, especially in prevention of coronary heart disease and osteoporotic fractures. Cancer fear is an important obstacle to use of ERT. From our literature review, there is a weak or no association between ERT and ovarian cancer risk. Individual risk of cancer should be considered before ERT use. The second issue in this review is ERT in patients with ovarian cancer. The majority of patients with ovarian cancer are postmenopausal or become menopausal after surgery. ERT is considered by many physicians to be contraindicated in patients with cancer. However, there is evidence that ERT in selected cancer patients may be of benefit for survival and quality of life. After weighing the evidence from studies on ERT in patients with ovarian, breast or endometrial cancer, we propose the use of ERT in selected ovarian cancer patients who are suffering from or are at a high risk of debilitating menopausal symptoms, osteoporosis, and coronary heart disease. The benefit of ERT to selected patient's health and quality of life appears to outweigh the risk of cancer recurrence.

Increased expression of fascin, motility associated protein, in cell cultures derived from ovarian cancer and in borderline and carcinomatous ovarian tumors

Fascin bundles actin microfilaments within dynamic cellular structures such as microspikes, stress fibers and membrane ruffles. Fascin overexpression induces membrane protrusions and increased cell motility, and is highly expressed in various transformed cells, and in specialized normal cells including neuronal, endothelial and dendritic cells. In breast cancer, fascin expression correlates with high-grade tumors. To investigate whether fascin might be a predictor factor for ovarian cancer progression, eighteen cell cultures derived from ovarian cancer, and thirty four archival paraffin-embedded material of normal versus borderline and carcinomatous ovaries were stained by immunocytochemistry and immunohistochemistry with fascin Mab 55K-2. Overall expression of the fascin protein was found in 50% (9/18) of cell cultures derived from original samples of ovarian tumors. Expression of fascin protein was found in 67% (6/9) of cell cultures derived from patients diagnosed with stage IV disease, and 33% (3/9) of cell cultures from patients diagnosed with stage II/III. There was no clear relationship between fascin expression and histologic types, tumor grade, or DNA ploidy. However, 75% of cell cultures, which developed into a xenograft after intraperitoneal inoculation, showed fascin expression, while 86% of non-tumorigenic cell cultures did not show fascin expression. Expression of fascin in these established ovarian tumor cell cultures was significantly associated with the ability for these cells to grow intraperitoneally (P < 0.05). Furthermore, fascin was never expressed in normal epithelial ovarian tissues, but was present in all pathologic ovaries. Both diffuse and focal patterns were observed in borderline ovarian tumors (67% and 33%), advanced primary ovarian cancer (67% and 33%) and metastatic ovarian cancer (89% and 11%). Therefore, our data suggest that fascin could serve as a prognostic factor for abnormal ovarian epithelial pathology and could be a novel target for the treatment of ovarian cancer.