Ovarian metastases in early-stage cervical cancer (IA2-IIA): a multicenter retrospective study of 1965 patients (a Cooperative Task Force study).

This is a retrospective study of patients treated for early-stage cervical cancer to identify pathologic risk factors associated with ovarian metastases and, therefore, to establish when ovarian preservation can be performed without increasing the risk of relapse in order to improve the quality of life in premenopausal patients. Between 1982 and 2004, 1965 patients with FIGO stage IA2-IB-IIA cervical squamous cell carcinoma and nonsquamous histology types were surgically treated; 1695 (86%) patients underwent primary radical hysterectomy, bilateral salpingo-oophorectomy, and pelvic node dissection, the remaining 270 patients (14%) had their ovaries preserved. The clinical records were reviewed for all patients and clinical features at presentation, the histopathology and follow-up data were recorded. Overall, ovarian metastases were diagnosed in 16 of 1695 patients, for an incidence rate of 0.9%. Univariate analysis shows age (45 years: P = 0.0079), FIGO stage (IB1-IIA 4 cm: P = 0.0133), histology (squamous vs nonsquamous, P = 0.0014), noninvolved peripheral stromal thickness (<3 vs >3 mm: P = 0.0001), lymphvascular space involvement (present vs absent, P = 0.0007), lymph node status (positive vs negative, P = 0.00009) to be statistically associated with the presence of ovarian metastases. Multivariate analysis shows only age (P = 0.0119), FIGO stage (P = 0.011), histology (P = 0.001), and unaffected peripheral stromal thickness (<3 mm: P = 0.037) to be independent risk factors for ovarian metastases. Based on the present data and on the data available in the literature, ovarian preservation could be safely performed in young patients with early-stage squamous cell carcinoma (histology as the most significant risk factor), with macroscopically normal ovaries, and with preserved peripheral unaffected cervical stroma.

[Diabetic cardiomyopathy in preclinical phase. Polycardiographic and echocardiographic study (author's transl)]. / Miocardiopatia diabetica in fase preclinica. Studio policardiografico ed ecocardiografico.

Eighteen selected diabetic patients, without symptoms or signs of cardiac diseases and a control group of 15 normal subjects, age and sex matched, underwent polycardiographic and echocardiographic study, with the aim to evaluate their systolic and diastolic function of the left ventricle. PEP, LVET and PEP/LVET ratio were determined on the polycardiographic tracings. In eleven diabetic patients these data were also determined after amyl nitrite inhalation. Left ventricular diastolic dimension (DD), LV systolic dimension (DS), ejection fraction (EF), VCF, fractional shortening (FS), mitral opening delay (MOD) and the relaxation speed of the left ventricular posterior wall were determined on the echocardiographic tracings. All these data underwent statistical analysis by Student test, and some significant differences were found between diabetic patients and normal subjects. The mean value of PEP was augmented (diabetic patients: 100 +/- 18 msec; normal subjects: 88 +/- 9 msec; p 0,05), while the mean value of LVET was diminished (diabetic patients: 275 +/- 22 msec; normal subjects: 300 +/- 23 msec; p less than 0,005); the PEP/LVET ratio was, therefore, increased in diabetic patients (diabetic patients: 0,37 +/- 0,08; normal subjects: 0,29 +/- 0,04; p less than 0,005). Of all echocardiographic data only MOD (diabetic patients: 54 +/- 31 msec; normal subjects: 14 +/- 21 msec; p less than 0,001) was significantly increased in diabetic patients. The feasibility and reliability of polycardiographic and echocardiographic techniques in detecting early myocardial disfunction is discussed and the accurate selection of patients in order to exclude other myocardiopathies in pointed out. It is then concluded that diabetic patients, in comparison with normal subjects, show an impairment of both systolic and diastolic function of the left ventricle, exclusively depending on diabetes.