Microbial mats on the Orkney Islands revisited: microenvironment and microbial community composition

The microenvironment and community composition of microbial mats developing on beaches in Scapa Flow (Orkney Islands) were investigated. Analysis of characteristic biomarkers (major fatty acids, hydrocarbons, alcohols, and alkenones) revealed the presence of different groups of bacteria and microalgae in mats from Waulkmill and Swanbister beach, including diatoms, Haptophyceae, cyanobacteria, and sulfate-reducing bacteria. These analyses also indicated the presence of methanogens, especially in Swanbister beach mats, and therefore a possible role of methanogenesis for the carbon cycle of these sediments. High amounts of algal lipids and slightly higher numbers (genera, abundances) of cyanobacteria were found in Waulkmill Bay mats. However, overall only a few genera and low numbers of unicellular and filamentous cyanobacteria were present in mats from Waulkmill and Swanbister beach, as deduced from CLSM (confocal laser scanning microscopy) analysis. Spectral scalar irradiance measurements with fiber-optic microprobes indicated a pronounced heterogeneity concerning zonation and density of mainly anoxygenic phototrophs in Swanbister Bay mats. By microsensor and T-RFLP (terminal restriction fragment length polymorphism) analysis in Swanbister beach mats, the depth distribution of different populations of purple and sulfate-reducing bacteria could be related to the microenvironmental conditions. Oxygen, but also sulfide and other (inorganic and organic) sulfur compounds, seems to play an important role in the stratification and diversity of these two major bacterial groups involved in sulfur cycling in Swanbister beach mats.

Effect of sperm number and oxygenation state of the storage media on in vitro fertility of bovine sperm stored at ambient temperature

The effects of storage time and the oxygenation state of the storage medium on motility, viability, and in vitro fertility of stored diluted sperm were investigated. Oocytes collected from abattoir material were matured and fertilized in vitro on defined days with sperm stored for up to 11 days in a citrate-based commercial diluent. The proportions of oocytes fertilized and developing to the blastocyst stage were used to assess the quality of the stored semen. In vitro fertility of sperm declined with storage time. There was no significant effect of the oxygenation state of the medium on in vitro fertility of stored sperm. Increased sperm-to-oocyte ratios resulted in a significant elevation of the proportion of oocytes fertilized on day 0 of storage and the proportion of fertilized oocytes developing to the blastocyst stage on days 0 and 3 of storage, suggesting some form of sperm competition or egg selection of sperm based on the ability of sperm to induce normal development.

Associations between smoking and adenocarcinomas and squamous cell carcinomas of the uterine cervix (United States)

OBJECTIVES

Few studies of smoking and cervical carcinoma have addressed the rare cervical adenocarcinomas or used DNA-based tests to control for human papillomavirus (HPV) infection.

METHODS

This multicenter case-control study included 124 adenocarcinoma cases, 307 community controls (matched on age, race, and residence to adenocarcinoma cases), and 139 squamous carcinoma cases (matched on age, diagnosis date, clinic, and disease stage to adenocarcinoma cases). Participants completed risk-factor interviews and volunteered cervical samples for PCR-based HPV testing. Polychotomous logistic regression generated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for both histologic types.

RESULTS

Eighteen percent of adenocarcinoma cases, 43% of squamous carcinoma cases, and 22% of controls were current smokers. After control for HPV and other questionnaire data, adenocarcinomas were consistently inversely associated with smoking (e.g. current: OR = 0.6, 95% CI 0.3-1.1; > or = 1 pack per day: OR = 0.7, 95% CI 0.4-1.3), while squamous carcinomas were positively associated with smoking (e.g. current: OR = 1.6, 95% CI 0.9-2.9; > or = 1 pack per day: OR = 1.8, 95% CI 1.0-3.3). Results in analyses restricted to HPV-positive controls were similar.

CONCLUSION

Smoking has opposite associations with cervical adenocarcinomas and squamous carcinomas. Although both histologic types are caused by HPV and arise in the cervix, etiologic co-factors for these tumors may differ.

Evaluation of self-collected cervicovaginal cell samples for human papillomavirus testing by polymerase chain reaction

As human papillomavirus (HPV) becomes accepted as the central cause of cervical cancer, longitudinal studies are shifting focus away from causality to a more detailed investigation of the natural history of HPV infections. These studies commonly require repeated samples for HPV testing over several years, usually collected during a pelvic exam, which is inconvenient to the participants and costly to the study. To alleviate the inconvenience and cost of repeated clinic visits, it has been proposed that women collect cervicovaginal cells themselves, hopefully increasing participation in the natural history studies. We evaluated the technical feasibility of self-collection of cervicovaginal cells using a Dacron swab for HPV DNA detection. We compared the self-collected swab sample and two clinician-administered swab samples (one from the endocervix and another from the ectocervix) from a total of 268 women participating in a case-control study of adenocarcinoma and squamous cell carcinomas of the uterine cervix (111 cases and 157 controls). HPV DNA was detected and genotyped using an L1 consensus PCR assay. The overall agreement between the clinician- and self-collected swabs was excellent [88.1%; kappa = 0.73 (95% confidence interval (CI), 0.61-0.85)]. The correlation was highest between the two clinician-administered swabs [kappa = 0.81 (95% CI, 0.69-0.93)] but was still excellent when comparing either clinician-administered swab to the self-administered sample [kappa = 0.75 (95% CI, 0.63-0.87) and 0.67 (95% CI, 0.55-0.79) for ectocervix and endocervix, respectively]. The type-specific agreement between samples was higher for high-risk, or cancer-associated, HPV genotypes than for low risk, noncancer-associated HPV genotypes when comparing the self-administered swab sample to the clinician-administered swab sample (kappa = 0.78 for high-risk versus 0.66 for low-risk HPV infections, t = -1.45, P = 0.15). The decrease in agreement for low risk types was largely attributable to an increased detection of these types in the self-administered sample (McNemar's chi2 = 6.25, P = 0.01 for clinician- versus self-administered swab comparisons). The agreement did not vary significantly by age, menopausal status, case status, or clinic center. We have demonstrated that a self-collected Dacron swab sample of cervicovaginal cells is a technically feasible alternative to clinician-administered cervical cell collection in natural history studies of HPV and cervical cancer.

Use of hormone replacement therapy and adenocarcinomas and squamous cell carcinomas of the uterine cervix

INTRODUCTION

Exogenous hormones may influence the development of cervical adenocarcinomas. Incidence rates of adenocarcinomas and use of noncontraceptive hormones have increased since the 1970s, but few studies have investigated this potential relationship.

METHODS

We conducted a multicenter case-control study of 124 women with adenocarcinomas, 139 women with squamous cell carcinomas matched on age, diagnosis date, clinic, and stage of disease (in situ or invasive) to adenocarcinoma cases, and 307 healthy community controls who were also matched on age, ethnicity, and residence to adenocarcinoma cases. Participants completed in-person interviews regarding exogenous hormone use before diagnosis and other risk factors and volunteered cervical samples for human papillomavirus (HPV) testing via a PCR-based method. Odds ratios (ORs) with 95% confidence intervals (CIs) estimated relative risks.

RESULTS

Only 13 adenocarcinoma cases (10.5%), 7 squamous carcinoma cases (5%), and 20 controls (6.5%) had used noncontraceptive hormones for menopausal symptoms, irregular periods, or disease prevention; most use was short-term, former use. Ever-use was associated with adenocarcinomas (OR = 2.1, 95% CI 0.95-4.6) but not squamous carcinomas (OR = 0.85, 95% CI 0.34-2.1). No trends were seen with duration of use or ages at first use, but unopposed estrogens were positively associated with adenocarcinomas (OR = 2.7). Unopposed estrogens remained associated with adenocarcinomas (OR = 2.0) when analyses were restricted to the HPV-positive controls. Menopausal status was not associated with adenocarcinomas or squamous carcinomas and did not modify the other associations.

CONCLUSION

Although small numbers warrant tentative conclusions, exogenous estrogens, especially unopposed estrogens, were positively associated with adenocarcinomas. Noncontraceptive hormones were negatively but weakly associated with squamous carcinomas.

Oral contraceptives as risk factors for cervical adenocarcinomas and squamous cell carcinomas

To assess the hypothesis that oral contraceptives (OCs) increase the risk of cervical adenocarcinomas, we conducted a six-center case-control study of 124 patients with adenocarcinomas, 139 with squamous cell carcinomas, and 307 population controls. Women between the ages of 18 and 69 who were newly diagnosed with cervical adenocarcinomas between 1992 and 1996 were eligible. Healthy female controls and a second case group of incident cervical squamous cell carcinomas were matched to the adenocarcinoma cases. All participants were interviewed regarding OCs, other risk factors for cervical carcinoma, and utilization of cytological screening, and a PCR-based test determined HPV genotype of cervical samples for both case groups and controls. Use of OCs was positively and significantly associated with adenocarcinomas and positively but weakly associated with squamous cell carcinomas. Associations between OCs and invasive adenocarcinomas (n = 91), squamous cell carcinoma in situ (n = 48), and invasive squamous cell carcinomas (n = 91) disappeared after accounting for HPV infection, sexual history, and cytological screening, but a positive association remained between current use of OCs and cervical adenocarcinoma in situ (n = 33). This association persisted after stratification by screening and sexual history and after restriction according to HPV status, but small numbers made it difficult to exclude detection bias, selection bias, or residual confounding by HPV as potential explanations Current OC use was associated with cervical adenocarcinomas in situ, but we saw no other evidence that OCs independently increase the risk of cervical carcinomas.

An investigation of hospital generated pharmaceutical care when patients are discharged home from hospital

AIMS

To investigate how seamless pharmaceutical care could be delivered.

METHODS

Elderly patients discharged from hospital, to their own home, were randomized into control and study groups. Control and study group patients received the normal discharge information. The study group were also counselled about their medicines and informed about their pharmaceutical care plan. Copies of the plan were given to the study patients. All patients received a domiciliary visit between 7 and 10 days after discharge. Their current medication was compared with that on discharge and contact was made with the General Practitioner as appropriate.

RESULTS

Twenty-eight study and 25 control patients with a mean (s.d.) age of 77.5 (7.3) and 77.6 (6.1) years completed the study. A pharmaceutical domiciliary visit was necessary for 21 (75%) and 24 (96%) of the study and control patients respectively. Compliance was better (P < 0.01) in the study group. Unintentional changes to the medication of 31 (14 study and 17 control) patients were found during the visit and after contact with the prescriber all but one prescription was restored to that on discharge.

CONCLUSIONS

At present it is difficult to ensure seamless pharmaceutical care. A pharmaceutical domiciliary visit may be useful to ensure seamless therapeutic care and thus avoid unnecessary healthcare events and costs after a patient is discharged home.

Microinvasion in low malignant potential tumors of the ovary

The presence of microinvasion (Mi) has not previously been investigated in nonserous low malignant potential (LMP) tumors of the ovary. In serous LMP tumors (SLMP), Mi has not worsened the prognosis compared with usual SLMP in previous reports. In a retrospective clinicopathologic review of 126 cases of serous and mucinous LMP (MLMP) tumors of the ovary, the authors identified 14 cases with Mi: seven of 72 SLMP, four of 44 mucinous intestinal LMP (MILMP), and three of 10 mucinous müllerian LMP (MMLMP). Tumors with Mi resembled usual LMP histologically except for small foci (up to 0.2 cm) in the stroma consisting predominantly of single cells or small clusters of cells, sometimes in a cribriform pattern. In SLMP-Mi, the cells had eosinophilic cytoplasm, and the stromal reaction was minimal/absent. In MILMP-Mi and MMLMP-Mi, nuclear staining was paler; the stroma often showed a fibrous reaction or edema, especially in MILMP-Mi. All 14 patients had follow-up (2.2 to 18.6 years) and were without evidence of disease. Careful screening of both mucinous and serous ovarian LMP can show Mi. Mi foci should be distinguished from true stromal invasion, pseudoinvasion, endothelial cells, decidual cells and histiocytes, and pseudomyxoma in mucinous LMP. Mi does not seem to worsen prognosis in MLMP and SLMP tumors of the ovary.

Ovarian mucinous tumors of low malignant potential: a clinicopathologic study of 54 tumors of intestinal and müllerian type

We have reviewed 44 mucinous intestinal (MI) and 10 mucinous mullerian (MM) tumors of low malignant potential (LMP) seen at The George Washington University Medical Center. As previously reported by Rutgers and Scully, MMLMP tumors occurred in younger women, were generally smaller and more frequently bilateral, had a papillary rather than multicystic appearance, and lacked goblet cells. All patients with MMLMP tumors were recurrence-free at last follow-up, including three whose tumors were microinvasive. Patients with MILMP tumors also all did well regardless of tumor grade, with the exception of a single patient with bilateral grade 1 ovarian tumors, an appendiceal villous adenoma, and pseudomyxoma peritonei. Microinvasion was also seen in four of these tumors, none of which recurred. Review of the literature suggests that MILMP tumors without stromal invasion but with either prominent cell stratification or marked nuclear atypia may have a worse prognosis than those lacking these features, but probably largely because of a correlation with higher stage disease. We believe that tumors of this sort should not be diagnosed as "noninvasive carcinomas," but should be sectioned more extensively for evidence of stromal invasion and subjected to careful staging. If the tumor is still noninvasive and in stage I after these procedures, the likelihood of treatment failure appears to be in the range of 1-3%.

The management of elderly patients with gynecologic cancer

Although the cause of ovarian cancer is unknown, the risk of developing the disease increases with age. Postmenopausal uterine bleeding is assumed to be caused by endometrial cancer until proven otherwise by adequate cytologic or histologic sampling of the endometrium. Older women need to be educated as to the benefits of regular pelvic examinations and Papanicolaou smears.

Rates and risks of ovarian cancer in subgroups of white women in the United States. The Collaborative Ovarian Cancer Group

OBJECTIVE

To provide estimates of the age-adjusted incidence and lifetime risk of ovarian cancer in subgroups of women defined by key risk factors.

METHODS

We combined data from seven case-control studies (1122 cases and 5359 controls) with Surveillance, Epidemiology, and End Results incidence data to estimate the incidence rate and probability of developing ovarian cancer within subgroups of women defined according to the three major known risk factors: a history of ovarian cancer in the mother or sister, years of oral contraceptive (OC) use, and number of term pregnancies.

RESULTS

Among women with no family history of ovarian cancer, the risk at age 65 varied from 0.3% among those who had had three or more term pregnancies and 4 or more years of OC use, to 1.6% among nulliparous women with no OC use. Among women with a positive family history, the risk of developing ovarian cancer by age 65 was estimated as 4.4% and the lifetime risk as 9.4%. The data were too sparse to estimate the risks associated with OC use and pregnancy among women with a positive family history.

CONCLUSIONS

The risk of developing ovarian cancer within the total population of white women can be divided informatively into component risks within subpopulations. At birth, the estimated risk of developing ovarian cancer before age 65 for the total population is 0.8%, but the component risks vary 15-fold, from 0.3 to 4.4%.

Adjuvant intraperitoneal chromic phosphate therapy in a woman with early ovarian carcinoma and pelvic infection with resulting catastrophic complications

Women diagnosed with early stage ovarian cancer may be considered for adjuvant therapy. Intraperitoneal chromic phosphate (P-32) is commonly used in these patients with few complications. A woman found to have early stage ovarian cancer was given intraperitoneal P-32 in the presence of a lingering pelvic infection, which is usually not mentioned as a contraindication to its use. Radiation damage to the small bowel and cecum developed as did damage to the ureter and bladder, which then required surgery.

Patterns of care in carcinoma of the ovary

BACKGROUND

During an epidemiologic study of women with ovarian cancer, the type of incision, intraoperative evaluation of the extent of disease, frequency of mistaken diagnosis, and ovarian cancer occurring in women who had a prior hysterectomy were reviewed.

METHODS

The thoroughness of intraoperative evaluation of the extent of disease as well as the type of incision in 291 women with ovarian cancer was investigated. Within this group 41 women had undergone hysterectomy with retention of one or both ovaries before the diagnosis of ovarian cancer. An additional 43 women were discovered not to have primary carcinoma of the ovary.

RESULTS

Seventy-one percent of the women with transverse incisions had incomplete intraoperative evaluations of the extent of disease compared with 42% of the vertical incision group. Medical record documentation revealed that 97% of the cases operated on by gynecologic oncologist had complete staging evaluations performed, but only 52% and 35% of cases operated on by obstetricians/gynecologists and general surgeons, respectively, were evaluated adequately. Of the 43 women discovered not to have primary carcinoma of the ovary, 5% had benign ovarian tumors, 3% had primary carcinoma of the peritoneum, and 5% had primary carcinoma of the intestines. Women who had their ovaries retained at hysterectomy and later had invasive ovarian cancer had approximately an 80% mortality.

CONCLUSIONS

The mistaken diagnosis of carcinoma of the ovary can be reduced if surgeons and pathologists improve communications between themselves. The greater use of preoperative second opinions by gynecologic oncologists in women suspected of ovarian cancer should enhance quality of care.

The mistaken diagnosis of carcinoma of the ovary

The primary site of carcinoma was investigated in 339 women diagnosed as having carcinoma of the ovary. After a review of medical records and microscopic slides, 43 women were discovered not to have a primary carcinoma of the ovary. Of these 43 women, 15 had benign ovarian tumors, 13 had primary carcinoma of the peritoneum and 15 had primary carcinoma of the intestines. Review of the medical records of 15 women found to have benign ovarian tumors disclosed the original pathologic interpretation of cancer was not supported by clinical or operative observations and no second opinion pathologic review was noted in the records. Until our review, 13 women who were diagnosed as having carcinoma of the ovary had primary peritoneal tumors. Nine of these women either had normal ovaries removed previously or had normal results of biopsies of the ovary done intraoperatively. Of those women entering the study with a diagnosis of carcinoma of the ovary, but in whom our review noted carcinoma of the intestines, 14 of 15 had intestinal complaints before operation. More than one-half of the patients did not have the intestine studied preoperatively, most had diffuse disease at operation and almost one-half of the women had normal sized ovaries at operation. By not performing gastrointestinal roentgenographic studies and suspecting the possibility of metastasis and by misleading the pathologist by presenting the specimen as an ovarian tumor, patients were erroneously diagnosed as having primary carcinoma of the ovary.

Pathology of the ovary

Recent medical articles on pathology of the ovary have contributed to a better understanding of ovarian cancer. Postmenopausal women with ovarian neoplasms, especially bilateral ones, are at great risk that they are malignant. Methods for histologic and frozen-section sampling of ovarian neoplasms may vary from one pathology laboratory to another. Primary peritoneal cancer is a distinct clinical entity and all physicians operating on women with pelvic cancers should be alert for its presence. Serum CA 125 analysis may be of value in determining whether to carry out a second-look operation in women with epithelial ovarian cancer. The influence of rupture of the capsule of epithelial ovarian tumors, hydronephrosis, and disease limited to the ovaries and survival are discussed.

A case-control study of epithelial ovarian cancer

With data from a study of 296 patients with primary epithelial ovarian cancer and 343 patients hospitalized because of other conditions, we estimated ovarian cancer risk in accordance with reproductive and other factors. Risk was greatest among women of lower parity, especially among women who said they planned to have children but could not. The protective effect of oral contraceptives seen in other studies was observed only in subgroups of our study population. Women who had breastfed their children had decreased risk, but the number of months of breastfeeding was not related to risk. Incomplete pregnancies did not provide the protection seen for live births. A family history of ovarian cancer and a medical history of breast cancer were both strong risk factors. None of the nonreproductive factors that we examined, including childhood illnesses, tobacco and alcohol consumption, obesity, and selected adult diseases, was convincingly associated with risk.

Epidemiology of ovarian cancer

What factors influence a woman's chances of developing or avoiding ovarian cancer? Because early diagnosis is so difficult and this disease is usually diagnosed only in the late stages where treatment usually fails, physicians and women are becoming increasingly interested in answering this question. As a result of two studies conducted over the last fifteen years, certain risk factors have been identified, showing that a woman has a greater chance of developing ovarian cancer if she is white, married, has a family history of the disease, has no children or has a history of difficulty in conceiving, and has menopausal hot flashes. Chances of developing the disease are also greater in women who have a primary breast or colon tumor. Clinical conditions were utilization of these risk factors may contribute to the reduction of morbidity and mortality of ovarian cancer are suggested.

Menopause and ovarian cancer

Using data from a study of 296 patients diagnosed in greater Washington, D.C., from 1978 to 1981 with primary epithelial ovarian cancer and 343 patients hospitalized for other conditions, the authors estimated the rate ratios according to various characteristics of the menopause. Menopause induced by hysterectomy with preservation of both ovaries was associated with a 30 per cent reduction in risk of later development of ovarian cancer. Age at natural menopause was not consistently related to risk. Women who used menopausal estrogens showed a 40 per cent decreased risk.

Paraaortic lymph node irradiation in cervical carcinoma without prior lymphadenectomy

A study of complications associated with paraaortic irradiation was undertaken in patients with uterine cervical cancer who had not undergone prior lymphadenectomy. Between 1975 and 1984, 29 highly selected patients received paraaortic irradiation as part of their definitive treatment for cervical carcinoma. Paraaortic fields were irradiated to a total dose of 4,200-5,000 rad (42-50 Gy), in fractions of 150-180 rad (1.5-1.8 Gy). An anteroposterior-posteroanterior technique was generally used. All fields were treated every day. There were no instances of small-bowel obstruction or other major complications, surgical procedures, or deaths caused by paraaortic irradiation. Eleven patients (38%) have no evidence of recurrent disease 23-120 months after completion of therapy. Paraaortic irradiation was well tolerated in this patient group without prior staging lymphadenectomy. Thus, in selected patients and with appropriate techniques, paraaortic irradiation for cervical carcinoma may be used with relative safety.