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PubMed2001

Oncology nurses' knowledge, practice, and educational needs regarding cancer genetics.

This study evaluated oncology nurses' knowledge of cancer genetics and related topics, and identified current practice patterns and perceived educational needs in this area. A 54-item study questionnaire was mailed to a random sample of 1,200 Oncology Nursing Society (ONS) members and 75 members of the ONS-Cancer Genetics Special Interest Group; 656 (51%) of those eligible responded. After exclusions, we analyzed 573 responses. Most respondents were Caucasian, female, and worked in hospital or outpatient settings. Half were staff nurses and 8% specialized in cancer genetics. Respondents with higher levels of nursing education or with continuing education in cancer genetics, who worked in positions other than staff nurses, and whose primary practice area was cancer genetics had significantly higher mean scores overall on questions measuring knowledge of cancer genetics and related areas. Higher perceived educational needs to improve knowledge or practice related to cancer genetics at basic, intermediate or advanced levels were associated with all or some of the following variables: lower education; hospital/ outpatient or managed care/private practice settings; lack of continuing education in cancer genetics, and positions other than advanced practice nurses. Although nearly half of the respondents had received patient inquiries regarding cancer genetics, only 35% were aware of referral resources and 26% had made such referrals. These findings may be used to develop targeted educational approaches that prepare oncology nurses to incorporate cancer genetics into any level of practice.

Analysis of Variance↗
PubMed2001

Surface keratopathy after penetrating keratoplasty.

PURPOSE: To determine the type and prevalence of epithelial abnormalities in the intermediate postoperative period after penetrating keratoplasty and to define the donor and recipient variables that influence the status of the graft epithelium. DESIGN: Prospective cohort study. METHODS: We prospectively followed the clinical course of 80 patients after penetrating keratoplasty. We monitored the status of the corneal epithelium for 3 months after surgery using slit-lamp biomicroscopy and fluorescein staining of the epithelium. Donor characteristics, recipient preoperative and postoperative variables, and postoperative medications were recorded. Epithelial abnormalities were analyzed against these variables by using univariate and combined statistical models to determine the impact of each variable on postoperative epithelial pathology. Main outcome measures included punctate keratopathy, macro-epithelial defects, hurricane keratopathy, rim defects, and filamentary keratopathy. RESULTS: Sixty-three percent of all patient visits demonstrated punctate epithelial keratopathy (PEK). Hurricane keratopathy (51%) and filamentary keratopathy (14%) constituted the next most commonly observed abnormalities. Older recipient age and the use of topical antibiotics were associated with a higher prevalence of punctate epithelial keratopathy. The odds ratio (OR) for a 1-year increase in age is 1.0276 (95% CI, 1.1013-1.0442), and the OR for using topical antibiotics is 6.9028 (95% CI, 3.1506-15.1239). Use of topical ofloxacin and increased time after surgery were associated with lower prevalence of punctate keratopathy; ORs were 0.9806 (95% CI, 0.9736-0.9876) and 0.3662 (95% CI, 0.1688-0.7943), respectively. Decreased corneal sensation and the presence of anterior blepharitis preoperatively were associated with an increase in hurricane keratopathy; ORs were 8.8265 (CI, 2.3837-32.6835) and 3.2815 (CI, 1.7388-6.1931), respectively. Total storage time for the donor material was also associated with an increased prevalence of hurricane keratopathy (OR, 1.0316; CI, 1.0052-1.0220). Patients with rim defects and macro-epithelial defects were more likely to have antibiotic and topical lubrication prescribed. No specific variable was found to have a significant association with filamentary keratopathy, except possibly for death-to-preservation time, which had a P value of .0587. CONCLUSIONS: Surface keratopathy is one of the most common complications of keratoplasty. Our study demonstrates that older age, preoperative lid disease, and decreased preoperative corneal sensation appear to increase the probability of clinically significant epithelial surface abnormalities after keratoplasty. Recognition of these risk factors in advance of surgery will alert the surgeon to the need for appropriate management.

Adolescent↗
PubMed2003

Nuclear morphometric features of epithelial cells lining keratocysts.

OBJECTIVE: To investigate the nuclear morphometric features of epithelial cells lining keratocysts and some other odontogenic cysts. STUDY DESIGN: All cases were selected from the archives of the Department of Pathology, Gülhane Military Medical Academy, as follows: 20 keratocysts and 10 dentigerous and 10 radicular cysts. Nuclear morphometric variables were measured on hematoxylin and eosin-stained histologic slides. Basal and intermediate cells of the epithelium were evaluated separately. Nuclei of the cells were outlined interactively and measured using a specially written macro program. Area, feret ratio (ratio of the longest nuclear axis to the shortest one) and circularity (F circle) of the nuclei were calculated. Additionally, nuclear densitometric analysis was performed on the keratocyst cases. RESULTS: The number of cells in the basal layer (cell density) was higher in keratocysts than in other cysts. The mean nuclear area of basal cells was smaller than of intermediate cells in both keratocysts and other cysts (P < .001). The feret ratio values revealed that basal cell nuclei of keratocysts were more ovoid as compared to those of other cysts (P < .001). Nuclear densitometric findings showed that the DNA indices of all keratocyst cases were close to 1.0, and the cells were considered diploid. CONCLUSION: Increased cell density, a more ovoid nuclear shape and more variation in the size of basal layer cell nuclei in keratocysts were helpful in differentiating these lesions from other odontogenic cysts.

Cell Nucleus↗
PubMed2006

[High-dose chemotherapy with autologous hematopoietic stem cell transplantation for non-Hodgkin's lymphoma in complete response as consolidation therapy, second report].

High-dose chemotherapy followed by autologous peripheral blood transplantation (HD-APBSCT) is a therapeutic option for patients with non-Hodgkin's lymphoma (NHL) after complete remission (CR) as consolidation therapy. In this report we describe a retrospective study of such treatment. A total of 38 patients with NHL were treated between November 19 9 1 and March 2005. At five years,the rate of disease-free survival (DFS) and overall survival (OS) was 64.3% and 66.5%, respectively. Patients who underwent transplantation in first CR had a 5-year probability of disease-free survival of 71.6% compared with 35.7% for those who were in second CR at the time of transplantation (p=0.10). In a monovariate analysis, second CR status at the time of transplantation was a relatively adverse predictor of DFS. None of those factors containing surface markers were significantly associated with clinical variables such as the CR status at the time of transplantation. Thirty high intermediate risk and high risk patients with aggressive B-cell lymphoma had a better outcome than patients treated with standard chemotherapy. In this study, 8 patients with T-cell lymphoma had a 3-year DFS and OS of 87.5% and 87.5%, respectively. HDT-APBSCT is a candidate for consolidation therapy for high-intermediate risk and high risk patients with aggressive B-cell and T-cell lymphoma.

Adolescent↗
PubMedDate not supplied

[Evaluation of the efficacy of premedication using omega potential measurement].

Spontaneous and evoked omega-potentials were registered, using high-ohm amplifier of the permanent current and non-polarized liquid minute chlorine-silver electrodes, in 40 surgical patients 40-60 min after premedication. It has been established that effective premedication in 77% of cases (29 patients) correlated with low stable (variability 1-2 mV) values of omega-potential ranging from 0 to 20 mV and an omegagram in the form of a conventionally straight line in response to the functional load. In 11 patients with ineffective premedication the functional load caused phase, smooth or uneven changes in omega-potential (variability from 5 to 27 mV), with both low (0-20 mV) and intermediate (21-40 mV) initial values. Hexenal consumption was twice lower in patients with effective than in patients with ineffective premedication. It is concluded that omegametry can be used as an effective criterion in the assessment of premedication efficacy.

Adult↗
PubMed1985

Hematopoietic factor production by a cell line (TC-1) derived from adherent murine marrow cells.

An adherent cell line, termed TC-1, has been isolated from long-term liquid culture of murine marrow cells by repeated exposure of the adherent cells to 0.1% trypsin. This is an alkaline phosphatase-positive cell line showing variable staining with acid phosphatase and alpha-naphthyl acetate esterase. On electron microscopy, the cells have moderate amounts of rough endoplasmic reticulum and variable numbers of polyribosomes. Some cells contain large clusters of laked glycogen particles. Intermediate junctions are present between some cells. Conditioned medium from this cell line produced from 384 to 638 units of CSF-1 per milliliter by radioimmunoassay and a CSF-1-dependent synergistic activity, which stimulates giant macrophage colony formation of marrow cells in soft agar. The conditioned medium also stimulates 3H-TdR incorporation by marrow cells in liquid culture and induces secondary adherent cell lines. The growth factor(s) produced by the TC-1 stromal cell line may be important in the regulation of early stages of hematopoietic differentiation. Two subclones, TC-1-C-11 and TC-1-C-3, have been isolated from passage 25 of the TC-1 cells by a penicylinder separation technique. The TC-1-C-11 is phenotypically like the parent TC-1 line and produces macrophage growth factors. The TC-1-C-3 grows as an epithelioid monolayer with visible junctions among adjacent cells under phase contrast microscopy. This subclone produces retrovirus and is capable of providing anchorage support for hematopoietic stem cells. The TC-1 cell line and its subclones may provide models for the control of early stem cell proliferation and differentiation.

Agar↗
PubMed1988

Design and implementation of a cost-accounting system in hospital pharmacy.

The design and implementation of a cost-accounting system in a hospital pharmacy department is described. Pharmacy resource use (labor, drugs, supplies, and overhead), or pharmacy's intermediate products, was clearly defined in terms of dosage forms (10 groupings representing variable labor and supplies) and drug products (more than 100 categories that incorporate cost and volume of use for 3000 line items). Costs were defined as variable or nonvariable (fixed), based on whether they were related to a specific medication order. Labor was divided into variable and fixed components. Time standards were developed using time and motion studies. Variable labor hours were determined as follows: specified hours (the volume of each dosage form multiplied by the standard time for each dosage form); nonspecified hours (time not directly associated with production); hours worked (specified plus nonspecified hours); and hours paid (hours worked plus sick leave and vacation). A standard cost for each drug product was based on the weighted average of volume and cost of the individual line items. The total drug budget was constructed by multiplying the standard cost for each drug product times the projected volume for each drug product. The pharmacy budget was developed by calculating the number and mix of pharmacy products used in association with the projected number and type of cases for the fiscal year. The monthly pharmacy budget reports were assembled with data from the payroll, billing, and cost-accounting systems.(ABSTRACT TRUNCATED AT 250 WORDS)

Accounting↗
PubMed1982

Lymphocytic infiltration of pleural mesothelioma and its significance for survival.

Pleural mesothelioma is an uncommon but usually highly malignant tumour. A study has been made of 110 cases from the Mesothelioma Register of the National Centre for Occupational Health. Adequate information regarding survival was documented in 63 cases. In 5 of the latter there was insufficient tissue for accurate classification. Thirty-five patients were dead within 9 months of first presentation, and in 33 of these there was an insignificant or absent lymphoid reaction. Fifteen patients survived 18 months or more, and 10 of these had a significant lymphocytic infiltration in the original biopsies. In an intermediate group of 8 patients, who survived between 9 and 18 months, a variable lymphoid reaction occurred. We conclude that the presence of significant lymphoid infiltration indicates a better prognosis for longer survival in patients with pleural mesothelioma.

Cell Aggregation↗
PubMed1993

Cytogenetic analysis has strong independent prognostic value in de novo myelodysplastic syndromes and can be incorporated in a new scoring system: a report on 408 cases.

Although the prognostic value of cytogenetic analysis has previously been demonstrated in myelodysplastic syndromes (MDS), karyotype had not been included in previously published scoring systems, such as Bournemouth and Sanz's scores. We studied karyotype at diagnosis in 408 cases of de novo MDS (after excluding therapy-related MDS). Karyotypes were classified in 10 groups: normal; isolated del 5q; del 5q and other rearrangements; isolated +8; isolated -7 or del 7q; del 20q; isolated -Y; miscellaneous single rearrangements; -7 or del 7q and other rearrangements; miscellaneous complex rearrangements. Karyotypes were considered complex when at least three chromosomes were rearranged. Complex karyotypes included all patients with del 5q and other rearrangements, -7 or del 7q and other rearrangements, and miscellaneous complex rearrangements (i.e. three of the 10 groups). Median actuarial survival of the 408 patients was 28 months, and 90 patients (22%) progressed to acute myeloid leukemia (AML). For survival, bone marrow (BM) blasts, circulating blasts, white blood cell (WBC), neutrophil count, platelet count, hemoglobin, age, sex, FAB classification, and Bournemouth and Sanz's scores had strong prognostic value. Cytogenetics also had strong prognostic value. An unfavorable cytogenetic group (patients with complex karyotypes) was identified. On the other hand, although patients with isolated del 20q and del 5q had a somewhat better prognosis than other patients with non-complex cytogenetic findings, they could not be statistically individualized as a favorable group, possibly owing to their relatively limited number. By multivariate regression analysis, a three-variable new scoring system could be designed based on karyotype (1 point for complex karyotype; 0 for other groups), platelets (0 for > 75 x 10(9)/l; 1 for < 75 x 10(9)/l), and BM blasts (0 for < 5%, 1 for 5-10%, 2 for > 10%). The total score (addition of points for the three variables) was able to separate patients in three groups with low (score 0) intermediate (score 1 or 2), and high risk (score 3 or 4) which included 34%, 47%, and 19% of the patients, and had a median survival of 55, 24, and 6 months, respectively (chi 2 = 110, p < 10(-4)). This new score (Lille score) was able to subdivide risk groups according to Bournemouth and Sanz's scores into further subgroups of different prognoses. For progression to AML, BM blasts, circulating blasts, WBC count, hemoglobin, FAB type, and karyotype had prognostic value by univariate analysis.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1981

Regression of area mortality rates on explanatory variables: what weighting is appropriate?

"One can often gain insight into the aetiology of a disease by relating mortality rates in different areas to explanatory variables. Multiple regression techniques are usually employed, but unweighted least squares may be inappropriate if the areas vary in population size. Also, a fully weighted regression, with weights inversely proportional to binomial sampling variances, is usually too extreme. This paper proposes an intermediate solution via maximum likelihood which takes account of three sources of variation in death rates: sampling error, explanatory variables and unexplained differences between areas. The method is also adapted for logit (death rates), standardized mortality ratios (SMRs) and log (SMRs). Two [United Kingdom] examples are presented."

Demography↗
PubMed1996

Optimal primer selection for clonality assessment by polymerase chain reaction analysis. III. Intermediate and high-grade B-cell neoplasms.

Previous studies have reported that low-grade B-cell lymphoproliferative disorders have variable B-cell monoclonality detection rates by polymerase chain reaction (PCR) analysis. For instance, monoclonal B-cell populations from chronic lymphocytic leukemia/small lymphocytic leukemia and mantle cell lymphoma are most often readily amplified with a single primer pair, whereas follicular lymphomas and plasma cell neoplasms require alternative strategies to approach these higher diagnostic sensitivity standards. Because most published reports have not focused on the variation in PCR B-cell monoclonality detection among subtypes of intermediate and high-grade B-cell neoplasms, additional information is necessary to determine primer selection strategies and identify problematic tumor subtypes within this group. The current investigation, the third part in a series, was aimed at documenting the efficiency of B-cell monoclonality detection by PCR in 71 aggressive B-cell neoplasms of various types using a comprehensive approach. A predetermined panel of primer sets was used in an algorithmic fashion. Specifically, all samples were analyzed with the standard VH-FRIII/JH assay previously shown to have the highest efficiency of monoclonality detection within low-grade B-cell lymphoproliferative disorders. Negative samples were further evaluated with primer sets in the following order until a positive result was observed, or all primer sets were used: (1) bcl-2/JH, (2) VH-FRI family specific/JH, and (3) VH-FRI consensus/JH. Forty-three (61%) of the 71 B-cell neoplasms evaluated with VH-FRIII/JH showed monoclonal B-cell populations. Sequential use of the three reserve primer sets in samples negative with this initial primer pair resulted in an overall improvement in PCR detection from 61% to 82% (58 of 71 specimens) (P < .001). The VH-FRI family specific assay identified B-cell monoclonality in 11 (73%) of these 15 specimens and was the most productive reserve primer set. Individual categories exhibited the following initial (I) and final (F) PCR detection rates: acute lymphoblastic leukemia/lymphoblastic lymphoma, 11 specimens (I = 91% to F = 91%); small noncleaved cell lymphoma, 14 specimens (I = 79% to F = 86% [P > .25]); diffuse large cell lymphoma, 33 specimens (I = 52% to F= 85% [P < .005]) and large cell, immunoblastic lymphoma, 13 specimens (I = 38% to F = 62% [P < .01]). The authors have shown that comprehensive PCR analysis is capable of detecting B-cell monoclonality in a significant proportion of samples from each subtype of intermediate and high-grade B-cell neoplasm. The VH-FRIII/JH assay was an adequate initial primer set, but required augmentation with the reserve PCR assays to attenuate the false negative rate and improve diagnostic sensitivity. The B-cell clonality PCR assay is optimally used as a screening tool and when used in this fashion, the more laborious and time-consuming restriction fragment-Southern blot hybridization (RF-SBH) method for IgH gene rearrangement detection may be limited to a relatively small proportion of PCR-negative aggressive B-cell neoplasms.

Algorithms↗
PubMed2006

High-dose irradiation for prostate cancer via a high-dose-rate brachytherapy boost: results of a phase I to II study.

OBJECTIVE: To evaluate outcomes of intermediate- and high-risk prostate cancer patients on a prospective dose-escalation study of pelvic external-beam radiation therapy (EBRT) combined with high-dose-rate (HDR) brachytherapy boost. METHODS: From November 1991 to April 2003, 197 patients were treated for intermediate- and high-risk disease features. All patients had prostate-specific antigen>10 ng/ml, Gleason score>or=7, or clinical stage>or=T2b, and all received pelvic EBRT (46 Gy) while receiving either two or three HDR boost treatments. HDR dose fractionation increased progressively and was divided into two dose levels. The mean prostate biologic equivalency dose was 88.2 Gy for the low-dose group and 116.8 Gy for the high-dose group (alpha/beta=1.2). Clinical failure was either local failure or distant metastasis; clinical event-free survival (cEFS) was defined as patients who lived free of clinical failure. RESULTS: Median follow-up was 4.9 years. The 5-year rates were as follows: biologic failure (BF), 18.6%, clinical failure (CF), 9.8%, cEFS 84.8%, cause-specific survival (CSS), 98.3%, and overall survival (OS), 92.9%. Five-year biochemical failure (68.7% vs. 86%, p<0.001), CF (6.1% vs. 15.6%, p=0.04), cEFS (75.5% vs. 91.7%, p=0.003), CSS (95.4% vs. 100%, p=0.02), and OS (86.2% vs. 97.8%, p=0.002) were significantly better for the high-dose group. Multivariate analysis showed that high-dose group (p=0.01, HR 0.35) and Gleason score (p=0.01, HR 1.84) were significant variables for cEFS. Multivariate analysis showed that high-dose group (p=0.01, HR 0.14) and age (p=0.03, HR 1.09 per year) were significant variables for overall survival. CONCLUSION: There is a strong dose-response relationship for intermediate- to high-risk prostate cancer patients. Improved locoregional control with higher radiation doses alone can significantly decrease biochemical and clinical failures.

Aged↗
PubMed2004

[Religion and drug use by adolescents].

INTRODUCTION: Many international studies show that religion is an important dimension modulating the use of alcohol and drugs by adolescents. OBJECTIVES: to determine which religious variables are associated to frequent or heavy use of alcohol, tobacco and drugs among adolescents in intermediate and high schools in Campinas, Brazil. METHODS: A cross-sectional study using a self-report anonymous questionnaire was administered to 2,287 students from a convenience sample of seven schools: five from central areas (two public and three private schools) and two public schools from the outskirts of the city, in 1998. The study analyzes data regarding the use of alcohol, tobacco, medicines, solvents, marijuana, cocaine and ecstasy. The religious variables included in the regression analysis were: religious affiliation, church attendance, self-assessed religiousness, and religious education in childhood. For the substances, nicotine, alcohol, marijuana, cocaine, ecstasy and "abuse of medicines" a logistic regression analysis for dicotomic answer was applied. RESULTS: The heavy use of at least one drug during the last month was more frequent among students that did not have a religious education during childhood. The use in the last month of cocaine, ecstasy and (abuse of) medicines was more frequent among those students that had no religion (cocaine and medicines) and that did not have a religious education during childhood (ecstasy and medicines). CONCLUSIONS: this study is consistent with previous investigations demonstrating a strong influence of religious variables over the use of drugs among adolescents. Interesting, it was found that no or weaker religious education during childhood was markedly associated with significant more use of drugs during adolescence.

Adolescent↗
PubMed1990

Clinical prognostic factors in patients with posterior uveal malignant melanoma.

The authors evaluated the prognostic value of clinically assessed variables for predicting length of survival until death from metastatic disease in 237 patient with a primary choroidal or ciliary body melanoma. Using multivariate Cox proportional hazards modeling, the authors identified the largest linear basal tumor diameter (mm), estimated by indirect ophthalmoscopy and fundus drawing, the location of the anterior margin of the tumor relative to the ocular equator and ora serrata, and the age of the patient at the time of treatment as the best combination of the clinically assessed variables for predicting survival. For each patient in this group, the authors computed a prognostic index based on the best multivariate Cox model. They showed that patients with low, intermediate, and high values of prognostic index had low, intermediate, and high melanoma-related mortality rates, respectively, during the first 5 to 8 posttreatment years. These results suggest that: (1) clinically assessed variables evaluated according to a standardized protocol are useful for predicting the survival of treated patients with posterior uveal melanoma and (2) ophthalmologists who assess potential clinical prognostic variables consistently may identify subgroups of patients with comparable mortality risk on the basis of noninvasive testing.

Analysis of Variance↗
PubMed1999

Intermediate expansions of a GAA repeat in the frataxin gene are not associated with type 2 diabetes or altered glucose-induced beta-cell function in Danish Caucasians.

A variable expansion of a GAA repeat is present in the first intron of the frataxin gene, also termed FRDA1 or X25. Long repeat lengths (>66 repeats) are present in patients with Friedreich's ataxia, while an intermediate expansion (10-66 repeats) has recently been reported to be highly associated with type 2 diabetes. Using a polymerase chain reaction-based assay, we found that 32.4% (95%CI 29.9-34.9) of 636 Danish Caucasian type 2 diabetic patients were carriers of an intermediate expansion, whereas the frequency was 30.4% (26.4-34.4) among 224 matched glucose-tolerant control subjects (P = 0.6). In the control subjects, the values of serum insulin and C-peptide responses during an oral glucose tolerance test were similar between the 69 carriers and 155 noncarriers. Furthermore, we investigated a possible relationship between expansions of the FRDA1 gene and glucose-induced beta-cell function in 338 young Caucasians (33.7% [30.1-37.3] carriers) and in 215 glucose-tolerant subjects (31.0% [26.6-35.4] carriers) with a type 2 diabetic parent. In neither population did the carriers differ from noncarriers according to values of fasting plasma glucose, serum insulin, or C-peptide, acute serum insulin, or C-peptide responses after intravenous glucose. In conclusion, intermediate expansion of the frataxin trinucleotide repeat is not associated with type 2 diabetes or altered glucose-induced insulin secretion in Danish Caucasians.

Adult↗
PubMed1985

A comparative analysis of glial and neuronal markers in the retina of fish: variable character of horizontal cells.

The immunohistochemical localizations of the enzymes glutamine synthetase, carbonic anhydrase-C, and the intermediate filament protein GFA were examined for potential neuroglial specificity in the retinas of several types of fish. Both glutamine synthetase and carbonic anhydrase-C appear to be characteristic markers for retinal Müller cells. However, the horizontal neurons of most fish examined also possess high levels of carbonic anhydrase. Furthermore, GFA, the characteristic marker for fibrous astroglia in higher vertebrates, was found specifically localized in the horizontal neurons of several teleost fish. The identity of the GFA antigens was qualified by immunochemical as well as cytological examinations. Furthermore, specific antisera to other intermediate filament proteins, including neurofilaments, validated and contrasted with the observations made with antisera to GFA. The presence of GFA in horizontal neurons of fish is widespread but not typical of all fish. These observations indicate an evolutionary constancy of retinal Müller glial cells. However, these results again focus attention on whether horizontal cells are truly neurons or rather represent an intermediate cell type that may prove useful in studying the evolution, ontogeny, and functional significance of the neuronal-glial phenotypic dichotomy.

Animals↗
PubMed1999

Percutaneous versus surgical tracheostomy: a double-blind randomized trial.

OBJECTIVE: To compare surgical (SgT) and percutaneous (PcT) tracheostomies. BACKGROUND: Percutaneous tracheostomy has been said to provide numerous advantages over classical SgT. METHODS: A prospective randomized trial with a double-blind evaluation was used to compare SgT and PcT. SgT and PcT were performed according to established techniques (n = 70). The procedure was performed at the bedside in the intensive care unit in 21 cases (30%). The outcome measures were divided into procedure-related variables, perioperative complications, and postoperative complications. The procedure-related variables (location, duration, and difficulty) were evaluated by the surgeon. The perioperative and postoperative complications were divided into serious, intermediate, and minor. Perioperative and early postoperative (14 days) complications were evaluated daily by an intensive care unit nurse blinded to the technique used. Long-term postoperative complications were evaluated 3 months after decannulation by a surgeon blinded to the surgical technique. RESULTS: There were no major complications in either group. Most variables studied were not statistically different between the PcT and SgT groups. The only variables to reach statistical significance were the size of the incision (smaller with PcT, p < 0.0001), minor perioperative complications (greater with PcT, p = 0.02), and difficult cannula changes (greater with PcT; p < 0.05). Among nonsignificant differences, difficult procedures and false passages were more frequent with PcT, whereas long-term unesthetic scars were more frequent with SgT. CONCLUSIONS: Both techniques are associated with a low rate of serious or intermediate complications when performed by experienced surgeons. There were more minor perioperative complications with PcT and more minor long term complications with SgT.

Double-Blind Method↗
PubMed1993

The uses and limitations of DNA flow cytometry in stage IB or II cervical carcinoma.

BACKGROUND: The role of flow cytometry in predicting prognosis for cervical carcinoma remains unclear. METHODS: Flow cytometric analysis was performed on tissues, fixed in formaldehyde solution and embedded in paraffin, from 411 patients with Stage IB or II cervical carcinoma who had been treated with radical abdominal hysterectomy and bilateral pelvic lymphadenectomy. RESULTS: DNA aneuploid-multiploid tumors were found in 37.5%, tetraploid in 4.6%, and diploid-peridiploid in 57.9%. Five-year recurrence-free survival rates of the three groups were 74.3%, 77.8%, and 76.4%, respectively (P > 0.05). DNA aneuploidy and DNA index (DI) of greater than 1.3 were highly correlated to parametria extension. In univariate analysis, pelvic lymph node metastases, stage, parametrial extension, depth of cervical stromal invasion, tumor size, and DI (1.3, 1.4, 1.5 as breakpoint) were significant prognostic factors. DNA ploidy, S-phase fraction, and S-G2M fraction were not significant. In multivariate analysis, DI of greater than 1.3, pelvic node metastases, clinical Stage II, and depth of stromal invasion greater than two-thirds of full cervical thickness were independent and significant variables. The prognostic index (PI), defined by the model, was able to categorize the patients into three distinct risk groups. The 5-year recurrence free survival rates of the low-, intermediate-, and high-risk groups were 89.5%, 73.0%, and 58.9%, respectively (P < 0.0001). CONCLUSIONS: The prognostic value of the DI as a single variable is promising and warrants additional investigation to establish its appropriate use.

Adult↗