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Evening exposure to short-wavelength light has disruptive effects on circadian rhythms and sleep. These effects can be mitigated by blocking short-wavelength (blue) frequencies, which has led to the development of evening blue-depleted light environments (BDLEs). We have previously reported that residing 5 days in an evening BDLE, compared with residing in a normal indoor light environment of similar photopic lux, advances circadian rhythms and increases the duration of rapid eye movement (REM) sleep in a randomized cross-over trial with twelve healthy participants. The current study extends these findings by testing whether residing in the evening BDLE affects the consolidation and microstructure of REM sleep in the same sample. Evening BDLE significantly reduces the fragmentation of REM sleep (p = 0.0003), and REM sleep microarousals in (p = 0.0493) without significantly changing REM density or the latency to first REM sleep episode. Moreover, the increased accumulation of REM sleep is not at the expense of NREM stage 3 sleep. BDLE further has a unique effect on REM sleep fragmentation (p = 0.0479) over and above that of circadian rhythms phase-shift, indicating a non-circadian effect of BDLE. If these effects can be replicated in clinical populations, this may have a therapeutic potential in disorders characterized by fragmented REM sleep.
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Sueño REM , Sueño de Onda Lenta , Ritmo Circadiano , Humanos , Luz , SueñoRESUMEN
OBJECTIVE/BACKGROUND: The objective was to observe for 1 year all patients in Norway operated on for symptomatic carotid stenosis with respect to (i) the time from the index event to surgery and neurological events during this time; (ii) the level in the healthcare system causing delay of surgical treatment; and (iii) the possible relationship between peri-operative use of platelet inhibitors and neurological events while awaiting surgery. METHODS: This was a prospective national multicentre study of a consecutive series of symptomatic patients. Patients were eligible for inclusion when referred for surgery. An index event was defined as the neurological event prompting contact with the healthcare system. All 15 departments in Norway performing carotid endarterectomy (CEA) participated. RESULTS: Three hundred and seventy one patients were eligible for inclusion between 1 April 2014 and 31 March 2015, and 368 patients (99.2%) were included. Fifty-four percent of the patients contacted their general practitioner on the day of the index event. Primary healthcare referred 84.2% of the patients to hospital on the same day as examined. In hospital median time from admission to referral for vascular surgery was 3 days. Median time between referral to the operating unit and actual CEA was 5 days. Overall, 61.7% of the patients were operated on within 2 weeks of the index event. Twelve patients (3.3%) suffered a new neurological event while awaiting surgery. The percentage of patients on dual antiplatelet therapy was lower (25.0%) in this group than among the other patients (62.6%) (p = .008). The combined 30 day mortality and stroke rate was 3.8%. CONCLUSION: This national study with almost complete inclusion and follow-up shows that the delays occur mainly at patient level and in hospital. The delay is associated with new neurological events. Dual antiplatelet therapy is associated with reduced risk of having a new neurological event before surgery.
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Estenosis Carotídea , Endarterectomía Carotidea/métodos , Ataque Isquémico Transitorio , Inhibidores de Agregación Plaquetaria/uso terapéutico , Accidente Cerebrovascular , Tiempo de Tratamiento , Anciano , Estenosis Carotídea/complicaciones , Estenosis Carotídea/diagnóstico , Estenosis Carotídea/epidemiología , Estenosis Carotídea/fisiopatología , Endarterectomía Carotidea/estadística & datos numéricos , Humanos , Ataque Isquémico Transitorio/epidemiología , Ataque Isquémico Transitorio/etiología , Ataque Isquémico Transitorio/prevención & control , Masculino , Persona de Mediana Edad , Evaluación de Necesidades , Noruega/epidemiología , Estudios Prospectivos , Medición de Riesgo/métodos , Índice de Severidad de la Enfermedad , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & control , Evaluación de Síntomas/estadística & datos numéricos , Tiempo de Tratamiento/normas , Tiempo de Tratamiento/estadística & datos numéricosRESUMEN
OBJECTIVES: To evaluate non-invasive indexes measuring systolic and diastolic ventricular function. Eleven coronary artery bypass grafting (CABG) patients were investigated in order to assess the ability of preoperative ejection fraction (EF) and end diastolic pressure (EDP) to predict left ventricular function determined non-invasively at surgery. DESIGN: End-systolic elastance (Ees) was assessed perioperatively using transoesophageal echocardiographic area estimation and arterial pressure monitoring during preload variations (caval balloon). Diastolic function was evaluated using three different echo/Doppler indexes. RESULTS: EF correlated positively to Ees (r = 0.69, p = 0.03). No correlations were found between EDP and the perioperative diastolic indexes. Ees fell from pre-bypass to post-bypass (from 9.0 +/- 2.7 to 4.7 +/- 1.7 mmHg/cm2, mean +/- SD, p < 0.001), but no alterations in diastolic parameters occurred. CONCLUSIONS: A positive correlation was found between preoperative EF and Ees at surgery. The semi-invasive Ees detected a systolic "stunning" after cardiopulmonary bypass and is promising as a surveillance tool for left ventricular perioperative function and treatment. No correlations between preoperative EDP and non-invasive diastolic indexes were found, and assessment of perioperative diastolic function needs further refinement.
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Puente de Arteria Coronaria , Función Ventricular Izquierda , Anciano , Diástole , Ecocardiografía Doppler de Pulso , Ecocardiografía Transesofágica , Humanos , Masculino , Persona de Mediana Edad , Atención Perioperativa , SístoleRESUMEN
The purpose of this study was to assess the efficacy and toxicity of single agent paclitaxel administered biweekly to patients with relapse of epithelial ovarian cancer previously treated with platinum-based regimen. Forty patients received an initial paclitaxel dose of 134 mg/m2 administered intravenously over three hours every two weeks. 283 cycles were given. All 40 patients were evaluable for toxicity, which mainly consisted of granulocytopenia, myalgia/arthralgia, and peripheral neuropathy. Two patients developed severe hypersensitivity reactions. Dose escalation was possible by one level in 11 patients and by two levels in 12 patients, dose reductions were not necessary. Thirty-five patients were evaluated for response. Five obtained complete response (14%), eight obtained partial response (23%), and nine had stable disease (26%), while 11 patients showed progression (31%). The overall response rate was 37% (95% confidence interval 22-57%). The median duration of responses (complete and partial) was six months. Overall median time to progression and overall median survival for eligible patients (n = 35) was 4.3 months and 11 months, respectively. We conclude that biweekly administration of paclitaxel in recurrent epithelial ovarian carcinoma was active with manageable toxicity.
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BACKGROUND: To establish the prognosis, metastatic pattern, sites of treatment failure, and effect of various treatment modalities, a large series of patients with endometrial clear cell carcinomas (ECCC) was analyzed. METHODS: Between 1970 and 1992, 181 patients with ECCC were treated. All pathologic slides and medical journals were reviewed. Clinical and histopathologic characteristics and type of treatment were analyzed with the univariate log rank test and multivariate Cox analysis. RESULTS: The 5- and 10-year actuarial disease free survival rates were 43% and 39%, respectively. Pathologic stage, clinical stage, age, and myometrial invasion were the only significant prognostic variables in the univariate analysis. In the multivariate analysis, pathologic stage and age were the sole independent prognostic factors. Two-thirds of the patients with relapse relapsed outside the pelvis. The most frequent extrapelvic sites of relapse were the upper abdomen, lungs, and liver. Four of six patients treated with platinum-containing combination chemotherapy showed response, whereas none of the patients treated with single agent alkylating chemotherapy or progestagens responded. CONCLUSIONS: Pathologic stage and age were the two most important prognostic factors in clear cell carcinoma of the endometrium. In Stage I disease, depth of myometrial invasion, age, and subtype of clear cell carcinoma were the sole independent prognostic factors. Two-thirds of the patients relapsed outside the pelvis.
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Adenocarcinoma de Células Claras/terapia , Neoplasias Endometriales/terapia , Análisis Actuarial , Adenocarcinoma de Células Claras/mortalidad , Adenocarcinoma de Células Claras/patología , Adulto , Anciano , Anciano de 80 o más Años , Terapia Combinada , Supervivencia sin Enfermedad , Neoplasias Endometriales/mortalidad , Neoplasias Endometriales/patología , Femenino , Humanos , Persona de Mediana Edad , Metástasis de la Neoplasia , Estadificación de Neoplasias , Evaluación de Resultado en la Atención de Salud , Pronóstico , Análisis de SupervivenciaRESUMEN
The present study was undertaken to characterize the export of cGMP from human erythrocytes at 37 degrees C. Inside-out membrane vesicles were exposed to cGMP and [3H]-cGMP in the presence and absence of 2 mmol l-1 ATP. In the absence of ATP, an equilibrium was reached within 15 min for the lowest tested concentration (0.65 mumol l-1), and the amount of cGMP in the vesicles was linearly correlated to the cGMP concentrations in the incubate. These observations suggest that the ATP-independent process represents passive diffusion or non-saturated binding to membrane components. In the presence of ATP, cGMP accumulated linearly during the test period (up to 120 min) and the transport into the inside-out vesicles was dependent on both low- and high-Km transport. The kinetic parameters for the low-Km process were determined after 5 and 120 min, the Km values being 4.6 (SD 1.9) and 4.7 (SD 1.1) mumol l-1 (n = 3), respectively. The corresponding Vmax values were 400 (SD 50) and 440 (SD 70) fmol mg-1 min-1. The high-Km process was characterized by Km = 170 (SD 50) mumol-1 and Vmax = 1610 (SD 280) fmol mg-1 min-1 (n = 5). The present data demonstrate an ATP-requiring saturable transport system for cGMP in human erythrocytes.
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GMP Cíclico/metabolismo , Membrana Eritrocítica/metabolismo , Adenosina Trifosfato/farmacología , Transporte Biológico , Cromatografía en Capa Delgada , Membrana Eritrocítica/efectos de los fármacos , Humanos , CinéticaRESUMEN
To investigate whether surgery or radiotherapy should be preferred in the early stages of carcinoma of the cervix a randomized study was performed in which operable patients with small FIGO stage 2 squamous cell carcinoma were included. Of these patients, 122 were in stage 2A and 20 in stage 2B. The patients were treated with intracavitary radium, followed by either radical surgery with pelvic lymphadenectomy (Group A, 72 patients) or high-voltage external irradiation 40 Gy to a pelvic field (Group B, 70 patients). Postoperative irradiation 40 to 50 Gy was given in Group A if lymph node metastases were found at operation. Fourteen patients in Group A and 23 in Group B died of recurrent disease. The 5-, 10-, and 20-year survival in Group A was 87, 84 and 81% respectively compared with 72, 69, and 68% in Group B, p < 0.05. Twenty-three (34%) of 67 radically operated patients had metastases to pelvic lymph nodes. A high rate of pelvic and para-aortic recurrences accounts for the difference between Groups A and B. Young patients (<40 years) with large tumours had a high risk of recurrent disease. Severe urinary and gastrointestinal complications were more common in Group A, especially among patients given postoperative radiotherapy. Lymphoedema was seen almost exclusively in Group A. Two patients in Group A and one in Group B died of complications to treatment. The corrected 10-year survival of 69.5% as achieved in the radiotherapy arm of this series is comparable to other reported studies. The high survival rate in the operated group, despite a very high metastases rate, suggests that surgery is applicable also in stage 2 patients.
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Braquiterapia , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirugía , Neoplasias del Cuello Uterino/radioterapia , Neoplasias del Cuello Uterino/cirugía , Adulto , Carcinoma de Células Escamosas/mortalidad , Femenino , Humanos , Histerectomía , Estudios Longitudinales , Escisión del Ganglio Linfático , Metástasis Linfática , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Radioterapia de Alta Energía , Distribución Aleatoria , Resultado del Tratamiento , Neoplasias del Cuello Uterino/mortalidadRESUMEN
Elevated extracellular cGMP levels have been observed in various clinical conditions, and the analyte has been proposed as a diagnostic marker of cardiovascular as well as malignant diseases. However, the use of extracellular cGMP as a pathophysiological marker requires detailed knowledge about the cellular biokinetics of cGMP (synthesis, metabolic conversion and export). In the present study the transport of cGMP in human erythrocytes has been further characterized. The uptake of cGMP was dependent on a concentration gradient and was temperature-sensitive, compatible with passive diffusion. The cGMP export was temperature-sensitive, saturable (Km = 3.4 +/- 1.0 mu mol l-1), inhibited by probenecid and verapamil and stimulated by progesterone. The results show that human erythrocytes possess a cGMP transport system similar to that found in other cells and that extracellular levels of cGMP are dependent on intracellular levels, membrane transport and influenced by physiological factors and pharmacological agents.
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GMP Cíclico/metabolismo , Eritrocitos/metabolismo , Probenecid/farmacología , Progesterona/farmacología , Verapamilo/farmacología , Transporte Biológico/efectos de los fármacos , Transporte Biológico/fisiología , Proteínas Portadoras/metabolismo , Humanos , Cinética , TemperaturaRESUMEN
The ratio between extracellular levels of cGMP and cAMP (cGMPex/cAMPex) has been proposed as diagnostic tool in many forms of malignancies. In vitro and in vivo studies have shown that sex steroids effect extracellular levels of cyclic nucleotides. Cyclic changes of these hormones in premenopausal women may disturb the interpretation of the diagnostic marker. C4-I cells grew in the presence of beta-estradiol and progesterone in a chemically defined medium. Cells were sampled during the logarithmic growth phase. Cyclic nucleotide levels were determined by RIA. Receptor status was evaluated by immunocytochemistry. Progesterone increased the cGMPex/cAMPex at all cell densities tested. This effect resulted from increased cGMP and reduced cAMP extrusion. Estradiol had no clear effect on cGMPex/cAMPex even when inhibition of cAMP extrusion was observed at low cell density. Receptors for steroids were not detectable. Sex steroids interact with cyclic nucleotides in C4-I cells in a non-genomic manner.
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Carcinoma de Células Escamosas/química , AMP Cíclico/análisis , GMP Cíclico/análisis , Estradiol/farmacología , Progesterona/farmacología , Neoplasias del Cuello Uterino/química , Carcinoma de Células Escamosas/patología , Recuento de Células , Membrana Celular/química , Femenino , Humanos , Células Tumorales Cultivadas , Neoplasias del Cuello Uterino/patologíaRESUMEN
The extracellular cGMP levels or the ratio between extracellular levels of cGMP and cAMP (cGMP(ex)/cAMP(ex)) have been proposed as tumor marker for premalignant and malignant diseases of the uterine cervix. More than 50% of cervical cancers occur in premenopausal women and detailed information about hormonal and drug effects on the extracellular levels of cyclic nucleotides is of importance. In the present study we have investigated the effect of progesterone (0.1-100 mu M), theophylline (1-1000 mu M), probenecid (0.1-100 mu M) and verapamil (0.1-100 mu M) on cGMP(ex)/cAMP(ex) of C4-I cells (a human cell line derived from a squamous carcinoma of the uterine cervix). Within 30 min progesterone caused a concentration-dependent elevation of cGMP(ex)/cAMP(ex), whereas the other compounds had no marked effect. Identical results were obtained for C4-I cells in monolayer and in suspension. The effects were explained by the observation that progesterone stimulated cGMP efflux, but inhibited the cAMP efflux. The other compounds inhibited the export of both nucleotides to a similar degree. The present data suggest that progesterone affects the export of cyclic nucleotides in non-genomic manner and may hamper the interpretation of cGMP(ex)/cAMP(ex) in the luteal phase in premenopausal women with cancer of the uterine cervix.
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Late radiation enteropathy (LRE) is a serious disorder, and therapeutic progress has thus far been hampered by insufficient understanding of the pathogenesis. This prospective study addresses whether alterations in proximal intestinal motility can predict the clinical severity of this disorder. Forty-one consecutive patients with chronic abdominal complaints after radiotherapy for gynecological cancer were examined by prolonged ambulatory manometry. Twenty-seven healthy adults served as controls. Impaired fasting motility was found in 12 of 41 patients (29%), and attenuated postprandial motor response after a liquid-solid meal was seen in 10 of 41 patients (24%). Postprandial delay of the migrating motor complex (MMC) was a good predictor of the degree of malnutrition (Cox regression, P < 0.01), and intensity of the MMC and postprandial motility index explained 69% (P < 0.001, multiple regression) of the variability in degree of malnutrition, assessed by weight loss and serum albumin level. The typical presentation of severe LRE was clinical symptoms suggesting intestinal pseudoobstruction, malnutrition, failure of a liquid-solid meal to induce postprandial motility, and delayed initiation and reduced intensity of MMC during nocturnal fasting. Prolonged ambulatory manometry was useful for detection of dysmotility in patients with symptoms of LRE and impaired motility of proximal small intestine seems to be a key factor in the pathogenesis of severe LRE.
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Motilidad Gastrointestinal , Enfermedades Intestinales/fisiopatología , Intestino Delgado/fisiopatología , Traumatismos por Radiación/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Neoplasias de los Genitales Femeninos/radioterapia , Humanos , Enfermedades Intestinales/complicaciones , Manometría , Persona de Mediana Edad , Monitoreo Ambulatorio , Complejo Mioeléctrico Migratorio , Trastornos Nutricionales/diagnóstico , Trastornos Nutricionales/etiología , Estudios Prospectivos , Radioterapia/efectos adversosRESUMEN
BACKGROUND: Small cell carcinoma of the cervix is a rare and aggressive tumor. Most gynecologic oncology centers have little experience with this tumor, and only small series have been published. METHODS: Twenty-six patients with small cell carcinoma of the uterine cervix were treated at the Norwegian Radium Hospital. Clinical data, immunohistochemical characteristics, and infection with human papillomavirus were studied. RESULTS: Twelve tumors were of oat cell type and 14 of intermediate cell type. Twelve tumors were associated with other forms of carcinoma: squamous cell carcinoma (6 tumors), adenocarcinoma (5 tumors), and adenocarcinoma in situ (1 tumor). Neuroendocrine differentiation was expressed in 79% of the tumors. Human papillomavirus (HPV)-18 was detected in 40% of the tumors and HPV-16 in 28%. Fifteen patients had Stage I disease, 7 had Stage II, 2 had Stage III, and 3 had Stage IV. Fourteen patients with Stage I and II disease underwent radical hysterectomy with pelvic lymph node dissection. In four, the operation was preceded by intracavitary radiation treatment. The patients with Stage II, III, and IV disease were treated with a combination of intracavitary radium, external beam radiation therapy, and chemotherapy. The 5-year survival rate was 14%. Four patients are alive, one with recurrent disease 50 months after diagnosis. Three patients free of disease have been followed up 26, 54, and 101 months, respectively. CONCLUSIONS: Small cell carcinoma of the cervix is an aggressive tumor with a propensity for rapid recurrence; it is associated with high mortality.
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Carcinoma de Células Pequeñas/patología , Neoplasias del Cuello Uterino/patología , Adenocarcinoma/patología , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma in Situ/patología , Carcinoma de Células Pequeñas/mortalidad , Carcinoma de Células Pequeñas/terapia , Carcinoma de Células Escamosas/patología , Terapia Combinada , Femenino , Humanos , Hibridación in Situ , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias Primarias Múltiples/patología , Papillomaviridae , Infecciones por Papillomavirus/complicaciones , Tasa de Supervivencia , Neoplasias del Cuello Uterino/mortalidad , Neoplasias del Cuello Uterino/terapiaRESUMEN
One hundred and twenty-seven patients with leiomyosarcoma (LSS) or endometrial stromal sarcoma (ESS) were treated at the Norwegian Radium Hospital during the 10-year period 1976-1985. After a review of the histologic slides 14 of the original tumors were reclassified, three as carcinomas and in 11 cases no malignant criteria were found. Five-year survival was 67% and 39% for ESS and LSS, respectively. Malignancy grade was the most powerful prognostic criterion in patients who were considered radically treated with surgery. Patients with grade 1 and 2 tumors had a prognosis similar to patients with endometrial carcinoma in contrast to the very gloomy outlook for patients with grade 3 and 4 (5-year survival 33%). For ESS the mitotic index also influenced the outcome. Despite widespread use of chemotherapy there is no clear indication that the prognosis for patients with the more aggressive types of sarcoma has improved in the period studied.
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A phase II trial of single-agent carboplatin in advanced ovarian cancer was performed by 19 institutions from 10 European countries. A total of 260 patients were treated, with a median age of 55 (range: 20-79) years. Karnofsky performance status was 80-100 in about two-thirds of the patients. Prior therapy consisted of surgery only in 31 patients, irradiation in 9, chemotherapy without cisplatin in 45, and with cisplatin in 175. Carboplatin was administered as second-line therapy in about one-half and as third-line or more in one additional third of the study population. Initial dose was 400 mg/m2 in 90, 360 mg/m2 in 152, and 320 mg/m2 or less in 18 patients. A total of 971 courses (mean 3.7, median 2, range: 1-13) of therapy were administered. A total of 16 complete and 46 partial responses were observed in 226 evaluable patients, for an objective response rate of 27%. Efficacy was greater in chemotherapy-untreated patients (51% vs. 23%, p = 0.002). In cisplatin-pretreated patients activity was significantly higher in non-refractory patients (26% vs. 4%, p = 0.015). Myelosuppression was the most significant side effect. However, low hematologic counts seldom translated into clinically significant complications. Patients with impaired baseline creatinine clearance and poor performance status were at higher risk of developing severe myelosuppression during the initial course of treatment. Non hematologic side effects were rare and mild, except for emesis. Carboplatin has a definite role in the treatment of ovarian cancer, but almost complete cross-resistance with the parent compound was observed clinically.
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Carboplatino/uso terapéutico , Neoplasias Ováricas/tratamiento farmacológico , Adulto , Anciano , Recuento de Células Sanguíneas/efectos de los fármacos , Carboplatino/efectos adversos , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Evaluación de Medicamentos , Femenino , Humanos , Persona de Mediana EdadRESUMEN
A series of 123 patients with histologically confirmed cervical intraepithelial neoplasia (CIN) with satisfactory colposcopy were treated with outpatient laser excision of the transformation zone. Punch biopsy and/or endocervical curettage proved CIN III in 111 patients (90%). Histology of the laser excision specimen showed microinvasive disease in 3 patients. Operative hemorrhage occurred in 2 patients. The follow-up ranged from 12 to 59 months (median, 30 months). Four patients were found to have residual/recurrent CIN during the observation period, resulting in a cure rate of 97%. All patients with recurrence are free of disease after a second laser treatment. Only 1 patient out of 26 with involved resection margins relapsed. Laser excision of the transformation zone is proposed as a suitable replacement for laser vaporization in patients with CIN with satisfactory colposcopy, offering the major advantage of providing a histological specimen without an increase in morbidity.
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Carcinoma in Situ/cirugía , Colposcopía , Terapia por Láser , Neoplasias del Cuello Uterino/cirugía , Adolescente , Adulto , Procedimientos Quirúrgicos Ambulatorios , Carcinoma in Situ/patología , Femenino , Humanos , Terapia por Láser/métodos , Persona de Mediana Edad , Neoplasias del Cuello Uterino/patologíaRESUMEN
In this study, 347 patients with epithelial ovarian cancer without residual tumor after primary laparotomy, were assigned randomly to receive either intraperitoneal instillation of radioactive phosphorus (32P) or six courses of cisplatin (50 mg/m2). Patients randomized to receive 32P with extensive intraperitoneal adhesions were treated with whole-abdomen irradiation instead of 32P (n = 28). The median follow-up was 62 months. Crude and disease-free survival were similar in all groups. Late bowel complications occurred more often in patients treated with 32P compared with the cisplatin group. The estimated 5-year crude survival rate was as high as 95% in patients with borderline or well-differentiated tumors in Stage I. It is suggested that these patients can be treated adequately by operation alone. Patients with moderately or poorly differentiated cancers in Stage I disease had a 5-year crude survival rate of 75%. In these patients, the relapse risk was high enough to warrant postoperative treatment. The efficacy of adjuvant treatment in this subgroup of patients can only be established in a prospective randomized study comparing postoperative adjuvant treatment with a no-treatment arm. Because of the high number of late bowel complications after 32P treatment, it was recommended that cisplatin be used as standard adjuvant treatment for subsequent controlled studies.
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Cisplatino/uso terapéutico , Neoplasias Ováricas/cirugía , Radioisótopos de Fósforo/uso terapéutico , Cisplatino/efectos adversos , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Ováricas/patología , Neoplasias Ováricas/radioterapia , RecurrenciaRESUMEN
In a histopathological review of a total population, 1974 cases of endometrial carcinoma were found from 1970 to 1977. Of these 1566 (79.3%) were adenocarcinomas of the endometrioid type, 181 (9.2%) adenoacanthomas, 97 (4.9%) clear cell carcinomas, 74 (3.7%) adenosquamous carcinomas, 31 (1.6%) undifferentiated carcinomas, 22 (1.1%) serous papillary carcinomas and 3 (0.1%) squamous cell carcinomas. Thirty percent of the tumors were well differentiated, 44% moderately and 25.9% poorly differentiated. The mean age at diagnosis was 62.0 years (range 32-93 years). Age was clearly related to histologic type, grade and extent of myometrial infiltration. Crude 5- and 10-year survival rates for the entire group were 73.1 and 61%. For the different subtypes of endometrial carcinoma the 5- and 10-year crude survival rates were as follows: adenoacanthoma 91.2 and 79.6%, adenocarcinoma of the endometrioid type 74.1 and 62.2%, adenosquamous carcinoma 64.9 and 52.7%, undifferentiated carcinoma 58 and 48%, clear cell carcinoma 42.3 and 30.9% and serous papillary carcinoma 27 and 14%. All three patients with squamous cell carcinoma died within a year. The 5- and 10-year survival rates were 87.8 and 79.7% for grade 1 tumors, 76.6 and 62.1% for grade 2, and 60.1 and 48.6% for grade 3. The extent of myometrial infiltration was a string predictor of prognosis. The 5- and 10-year survival rates of patients with intramucosal tumors and tumors infiltrating the inner half of the myometrium were, respectively 89.6 and 82.5%, and 84.7 and 72.7%. Only 48.3 and 29.3% of the patients with tumors reaching the serosa survived, respectively 5 and 10 years. Patients without demonstrable vessel invasion had a significantly better prognosis than those with vessel invasion with a survival rate of 83.5 and 61.1% at 5- and 10-years, compared with 64.5 and 53.8%, respectively. Age at the time of diagnosis was an important prognostic factor for crude survival. Surgico-pathological staging was significantly better than clinical staging in predicting prognosis only in advanced stages.
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In a histopathologic review of all cases of endometrial carcinoma diagnosed in Norway between 1970 and 1978, 255 cases of adenocarcinoma with squamous cell differentiation were found among the 1985 cases reviewed. One hundred eighty-one (9.1%) were adenoacanthoma and 74 (3.7%) adenosquamous carcinoma. The mean age for patients with adenoacanthoma was 57.7 years (range, 32 to 85 years) and for adenosquamous carcinoma, 62.8 years (range, 43 to 84 years). Five-year and 10-year survival rates for all patients were 83.5% and 71.8%, respectively. For patients with adenosquamous carcinoma, corresponding figures were 64.9% and 52.7%, and for those with adenoacanthoma, the figures were 91.2% and 79.6%, respectively. When stratified for grade and depth of myometrial infiltration, there was no difference in survival rates between patients with adenoacanthoma and adenosquamous carcinoma, provided hysterectomy was part of the primary treatment. In patients who had surgery, myometrial infiltration was the most important single prognostic factor. It is recommended that the terms adenoacanthoma and adenosquamous carcinoma be replaced by the descriptive term adenocarcinoma with squamous cell differentiation.
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Adenocarcinoma/patología , Carcinoma de Células Escamosas/patología , Neoplasias Endometriales/patología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Persona de Mediana Edad , Invasividad Neoplásica , Análisis de SupervivenciaRESUMEN
In some patients with severe hypothyroidism, thyroxine replacement therapy precipitates or aggravates angina pectoris, whereas in other patients angina pectoris is ameliorated or even cured. Cardiac function in eight severely hypothyroid patients was studied by means of radionuclide ventriculography (RNV) at rest and during supine bicycle exercise before thyroxine treatment, and repeated during treatment before and after administration of 160 mg of oral verapamil. There was an exercise-induced fall in left ventricular ejection fraction (LVEF) in two patients before therapy, and in two additional subjects after 17 d on suboptimal doses of thyroxine. Verapamil attenuated the fall and induced a significant increase in LVEF during exercise (P less than 0.014). No abnormal regional cardiac wall movement (RWM) was observed. After 2 months of thyroxine treatment, LVEF increased significantly during exercise both before and after verapamil (P less than 0.012 and P less than 0.005). These findings are indicative of reversible coronary artery dysfunction. We recommend that, if feasible, thyroxine should be supplemented with verapamil during the early phase of treatment.
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Hipotiroidismo/tratamiento farmacológico , Hipotiroidismo/fisiopatología , Tiroxina/uso terapéutico , Función Ventricular Izquierda , Adulto , Anciano , Prueba de Esfuerzo/efectos de los fármacos , Femenino , Imagen de Acumulación Sanguínea de Compuerta , Humanos , Masculino , Persona de Mediana Edad , Volumen Sistólico/efectos de los fármacos , Función Ventricular Izquierda/efectos de los fármacos , VerapamiloRESUMEN
We describe the detection of eight genital human papillomavirus (HPV) types, including HPV16 and HPV18, by PCR amplification of a 323 base-pair region of the genome within the L1 open reading frame (ORF). The primer sequences are: TGYAAATATCCWGATTWTWT and GTATCWACMACAGTAACAAA. The method will detect purified HPV16 DNA down to a concentration of as little as a single molecule in 100 microliters. The method is also applicable to purified DNA and crude lysates from tumour biopsies. Typing of the PCR product can be achieved with specific oligonucleotide probes.