Pattern and clinical predictors of lymph node metastases in epithelial ovarian cancer

Para-aortic lymphadenectomy is part of staging in early epithelial ovarian cancer (EOC) and could be part of therapy in advanced EOC. However, only a minority of patients receive therapy according to guidelines or have attendance to a specialized unit. We analyzed pattern of lymphatic spread of EOC and evaluated if clinical factors and intraoperative findings reliably could predict lymph node involvement, in order to evaluate if patients could be identified in whom lymphadenectomy could be omitted and who should not be referred to a center with capacity of performing extensive gynecological operations. Retrospective analysis was carried out of all patients with EOC who had systematic pelvic and para-aortic lymphadenectomy during primary cytoreductive surgery. One hundred ninety-five patients underwent systematic pelvic and para-aortic lymphadenectomy. Histologic lymph node metastases were found in 53%. The highest frequency was found in the upper left para-aortic region (32% of all patients) and between vena cava inferior and abdominal aorta (36%). Neither intraoperative clinical diagnosis nor frozen section of pelvic nodes could reliably predict para-aortic lymph node metastasis. The pathologic diagnosis of the pelvic nodes, if used as diagnostic tool for para-aortic lymph nodes, showed a sensitivity of only 50% in ovarian cancer confined to the pelvis and 73% in more advanced disease. We could not detect any intraoperative tool that could reliably predict pathologic status of para-aortic lymph nodes. Systematic pelvic and para-aortic lymphadenectomy remains part of staging in EOC. Patients with EOC should be offered the opportunity to receive state-of-the-art treatment including surgery

Cisplatinum rechallenge in relapsed ovarian cancer patients with platinum reinduction therapy and carboplatin hypersensitivity

Hypersensitivity reactions have been reported as limiting side effect in patients re-exposed to carboplatin for relapsed gynecologic malignancy. This study analyzed the incidence, clinical features, management, and outcome of carboplatin-associated hypersensitivity reactions. We performed a retrospective study and analyzed medical records of all gynecological cancer patients treated with carboplatin in our institution from 2000 to 2003. No hypersensitivity reactions were observed in 171 patients during the first carboplatin-containing chemotherapy. All six carboplatin-associated hypersensitivity reactions occurred in 69 patients who were re-exposed to carboplatin (9%). The median number of carboplatin cycles prior to hypersensitivity reaction was nine (range, 8-13). Cisplatin rechallenge was performed in five patients, and no hypersensitivity occurred. An increase in neurotoxicity (National Cancer Institute Common Toxicity Criteria grade 2) was documented in two patients who had residual neurotoxicity grade 1 due to prior taxane treatment. Cisplatinum rechallenge is a feasible strategy to overcome carboplatin hypersensitivity. However, close monitoring of neurotoxicity is necessary, particularly in patients with residual neurotoxicity due to prior platinum- and taxane-containing chemotherapy.

Treatment utilisation and trauma characteristics of child and adolescent inpatients with posttraumatic stress disorder

OBJECTIVE

Few empirical studies have addressed the impact of trauma exposure and posttraumatic stress disorder (PTSD) on treatment utilisation and outcome in South African youth. This study was undertaken to document demographic, clinical, and treatment characteristics of child and adolescent inpatients with PTSD.

DESIGN

A retrospective chart study of all patients presenting to a child and adolescent inpatient unit was conducted between 1994-1996. For children and adolescents diagnosed with PTSD; demographic, diagnostic and treatment variables, including trauma type, family history, and delays in treatment seeking, were documented.

SETTING

Child and Adolescent Psychiatric Inpatient Unit, Tygerberg Hospital, Cape Town.

SUBJECTS

Children and adolescents (2 to 18 years) presenting to an inpatient unit (n = 737).

RESULTS

10.3% (n = 76) met diagnostic criteria for PTSD. Gender differences were clearly evident: PTSD was six times more prevalent in girls (65 with PTSD were female and 11 were male); girls were most likely to have experienced rape or sexual abuse while boys were most likely to have witnessed a killing. Psychotherapy was the most common intervention for PTSD, followed by treatment with a tricyclic antidepressant. 97.4% of children and adolescents who were treated demonstrated significant improvement. Delays in seeking treatment and problems with the primary support group were highly prevalent.

CONCLUSION

PTSD is a common disorder that is responsive to treatment with psychotherapy and/or tricyclic antidepressants in child and adolescent inpatients. These findings underscore the importance of early identification and treatment of childhood PTSD in mental health settings, in particular tertiary service institutions.

Treatment utilisation and trauma characteristics of child and adolescent inpatients with posttraumatic stress disorder

Objective. Few empirical studies have addressed the impact of trauma exposure and posttraumatic stress disorder (PTSD) on treatment utilisation and outcome in South African youth. This study was undertaken to document demographic, clinical, and treatment characteristics of child and adolescent inpatients with PTSD.

Patients presenting with fresh trauma after interpersonal violence. Part II. Assault history

BACKGROUND

Patients presenting with fresh trauma are frequently victims of interpersonal violence. Nevertheless, few South African studies have documented the history surrounding such assaults and their management.

METHODS

Patients presenting with fresh trauma to the Trauma Unit of Tygerberg Hospital were selected in order to provide a representative sample. Where patients were victims of interpersonal violence, a history of the current and previous assault(s) was taken.

RESULTS

Victims of interpersonal violence often reported that they had been involved in such violence on previous occasions. Nevertheless, these patients had rarely received management from psychosocial services. Patients with a previous history of having been assaulted had a number of distinct characteristics, including female gender and increased substance use.

CONCLUSIONS

Trauma has justifiably been described as a recurrent disease. There is an urgent need for effective psychosocial services for victims of interpersonal violence; ideally, this would prevent future multiple hospital admissions.

Patients presenting with fresh trauma after interpersonal violence. Part I. Alcohol and substance abuse

BACKGROUND

Patients presenting with fresh trauma frequently have evidence of substance abuse. Nevertheless, few South African studies have measured the levels of both alcohol and other substances in patients presenting with fresh trauma after interpersonal violence.

METHODS

A representative sample of patients presenting with fresh trauma to the Trauma Unit of Tygerberg Hospital was selected for study. Subjects were questioned about the nature of the trauma and breath alcohol concentrations were determined. Blood and urine samples for analysis of alcohol and other substances were obtained from approximately half the subjects.

RESULTS

Alcohol was found to be present in a majority of patients who presented after interpersonal violence, while other substances were present less commonly. There was a high correlation between clinical history of alcohol use, breath analysis of alcohol and blood alcohol measurement.

CONCLUSIONS

Alcohol use plays a significant role in trauma due to interpersonal violence. It is essential to screen victims of interpersonal violence for a history of alcohol and other substances. Breath analysis for alcohol is a useful adjunct to clinical screening.

Sequence-based identification of T-DNA insertion mutations in Arabidopsis: actin mutants act2-1 and act4-1

A method is presented to facilitate the isolation of mutations in plant genes, which requires knowledge of the target gene or protein sequence, and is independent of mutant phenotype. The polymerase chain reaction was used to amplify the junctions between a T-DNA insert and the gene of interest from pools of mutant plant lines. The approach was used to identify mutations in Arabidopsis thaliana actin genes. The Arabidopsis genome encodes 10 actins in six ancient subclasses each with distinct expression patterns. Primers in the T-DNA border and highly degenerate actin primers, designed from conserved amino acid motifs, were used to prime the amplification. The PCR products were transferred to filters and probed for actin at low stringency. Thus, mutations in all 10 actin genes were screened for simultaneously. Mutations in the vegetative constitutive actin gene, ACT2, and the pollen-specific actin gene, ACT4, were identified in a population of 5300 lines containing approximately 1.5 T-DNA insertions per line. The screen was sensitive enough that actin insertion alleles were easily distinguished among pools of 100 plant lines. PCR techniques were used which accelerated the purification of mutant lines, and segregation, physical mapping, and sequencing of the act2-1 and act4-1 mutations. This strategy should be generally useful in screening mutant libraries made with a variety of plant insertion elements for mutations in any known sequence.

Gadolinium ions inhibit exocytotic vasopressin release from the rat neurohypophysis

Single rat neurointermediate lobes (n.i.l.s) were fixed by their stalks to a platinum wire clip electrode and incubated in oxygenated Krebs-HEPES medium. Vasopressin release int the medium was determined by radioimmunoassay. Vasopressin secretion was increased by different stimuli and the effects of gadolinium (Gd3+) were tested. Electrical stimulation (15 Hz, three times 1 min with 1 min intervals) increased vasopressin release in a calcium-dependent manner. Gd3+ (10 microM to 3 mM) inhibited the evoked release of vasopressin in a concentration-dependent fashion; at 3 mM the inhibition was 98%. The inhibitory effect of Gd3+ up to 300 microM was antagonized by increasing the calcium concentration in the medium up to 6 mM. The effects of 1 and 3 mM-Gd3+ were unaffected by increasing the calcium concentration. Exposure of n.i.l.s to depolarizing concentrations of potassium (high K+, 60 mM, 30 min) increased the vasopressin release more than 33-fold. The elevated vasopressin release remained constant during six consecutive 5 min periods. In the initial 5 min period 300 microM-Gd3+ reduced the evoked vasopressin release by 80% but during the last 5 min period only by 30%. At 3 mM-Gd3+ vasopressin release was completely blocked during the whole time of incubation with high K+. Vasopressin release induced by exposure of n.i.l.s to cold (4 degrees C, 20 min) was completely inhibited by 3 mM-Gd3+, but reduced by only 25% in the presence of 300 microM-Gd3+. Vasopressin release induced by incubation of n.i.l.s with the ionophore X-537A (lasalocid) (10 microM, 30 min) was reduced by 90% in the presence of 300 microM-Gd3+ and completely prevented by 3 mM-Gd3+. 300 microM-Gd3+, added to the incubation medium, had no significant effect on the vasopressin release from crude synaptosomal preparations evoked by high K+. However, when 300 microM-Gd3+ was already present during the tissue homogenization, the evoked vasopressin release from the synaptosomes was completely blocked. It is concluded that Gd3+ inhibits exocytotic vasopressin release at two different sites. First, Gd3+ may block voltage-regulated calcium channels. Secondly, Gd3+ may inhibit the exocytotic release mechanism by an intracellular site of action. It is speculated that contractile proteins may be the intracellular target for Gd3+.

[Quantitative whole-body skeletal scintigraphy with a gamma camera and pinhole collimator]

Quantitative evaluation of whole-body bone scans is valuable for the description of metabolic activity in systemic bone disease and provides parameters of whole-body activity retention up to 24 h after injection of the radiopharmacon, of bone to soft tissue relation and of the activity in the epiphysis and diaphysis. A combination of whole-body imaging by a gamma-camera with pinhole collimator and a series of single pictures evaluated by the ROI technique is able to record these parameters with sufficient precision. This is demonstrated by measuring phantoms, and patients with and without bone disease. In 34 patients with systemic bone disease the quantitative parameters are altered partially, the changes however are insufficient for their differential diagnosis.

Die quantifizierende GanzkörperSkelettszintigraphie mit Gamma-Camera und Pinhole-Kollimator

Die quantitative Auswertung von Ganzkörper-Skelettszintigrammen dient bei generalisierten Skeletterkrankungen der Beschreibung der Skelettstoffwechselaktivität und umfaßt die Parameter Ganzkörperaktivitätsretention möglichst lange Zeit nach Injektion, einen Skelett-Weichteil-Quotienten und eine Aussage über das Verhältnis der Aktivität in Spongiosa und Compacta. Es wird an Phantomversuchen, an Messungen bei Patienten ohne Skeletterkrankung und an Patienten mit Skelettsystemerkrankungen gezeigt, daß eine Aufnahmetechnik des Ganzkörperszintigramms mit Gamma-Camera und Pinhole-Kollimator sowie einer anschließenden Serie von Einzelszintigrammen mit Auswertung in ROI-Technik imstande ist, diese Parameter hinreichend genau zu erfassen. An 34 Patienten mit generalisierten Skeletterkrankungen wird allerdings dargestellt, daß diese Parameter zwar zur Beschreibung von Skelett-Systemerkrankungen, nicht jedoch zu deren Differentialdiagnose geeignet sind.