Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in pediatric ovarian tumors: a novel treatment approach.

PURPOSE: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been used in adults with ovarian carcinoma proving overall survival benefit in randomized trials, but measured in months. Diffuse peritoneal disease from pediatric type ovarian tumors is rare. We applied CRS and HIPEC to pediatric girls with diffuse peritoneal disease as part of a clinical trial. METHODS: In all patients complete cytoreduction was followed by HIPEC using 100 mg/m2 of cisplatin for 90 min in a closed technique. All received neoadjuvant chemotherapy. Patients with disease outside of the abdominal cavity were excluded. RESULTS: Of 101 pediatric CRS and HIPEC operations, 8 had ovarian primary tumors and multifocal peritoneal disease. There were three yolk sac tumors (germ cell, mixed teratoma), one Sertoli­Leydig, one PNET of the ovary, one choriocarcinoma, one juvenile granulosa cell tumor and one adenocarcinoma. Age ranged 4­18 years. Three of the 8 (37 %) recurred and died. The remaining 63 % are disease free 2­6 years post HIPEC. Overall survival and relapse-free survival in this cohort was 64 and 62 %, respectively [CI 0.64 (0.34, 1); 0.62 (0.37, 1)]. CONCLUSIONS: This is the first report of CRS and HIPEC in pediatric ovarian tumors. HIPEC may be effective in pediatric-type ovarian tumors. More study is needed in a larger cohort.

Cloned transgenic offspring resulting from somatic cell nuclear transfer in the goat: oocytes derived from both follicle-stimulating hormone-stimulated and nonstimulated abattoir-derived ovaries.

The use of nuclear transfer (NT) techniques to create transgenic offspring capable of producing valuable proteins may have a major impact on the pharmaceutical market. Our objective was to compare the in vivo developmental potential of NT embryos produced from the fusion of transgenic donor cells with cytoplasts prepared from either FSH-stimulated ovaries or nonstimulated abattoir-derived ovaries. Donor cells were prepared from a transgenic fetus carrying the gene for human antithrombin III as a marker and used within four to eight subpassages. Cells were serum deprived for 4 days prior to cytoplast transfer. Oocytes were enucleated by removing the metaphase plate using a DNA stain and epifluorescent illumination. Donor cells were fused to enucleated oocytes by electric pulse and then chemically activated. There was no difference in the number of transferable embryos produced from cytoplasts of FSH-stimulated ovaries or from the fusion of cytoplasts from abattoir ovaries, nor was there a difference in the number of pregnancies established per recipient with either treatment. All pregnancies from both groups culminated in the births of healthy female kids (five total). To our knowledge, this is the first report of cloned goats produced from NT using cytoplasts derived from abattoir ovaries.

Induction and maintenance of ethanol self-administration in cynomolgus monkeys (Macaca fascicularis): long-term characterization of sex and individual differences.

BACKGROUND: Investigations of oral ethanol self-administration in nonhuman primates have revealed important parallels with human alcohol use and abuse, yet many fundamental questions concerning the individual risk to, and the biological basis of, excessive ethanol consumption remain unanswered. Moreover, many conditions of access to ethanol in nonhuman primate research are largely unexplored. This set of experiments extends within- and across-session exposure to ethanol to more fully characterize individual differences in oral ethanol self-administration. METHODS: Eight male and eight female adult cynomolgus monkeys (Macaca fascicularis) were exposed to daily oral ethanol self-administration sessions for approximately 9 months. During the first 3 months, a fixed-time (FT) schedule of food delivery was used to induce the consumption of an allotted dose of ethanol in 16-hr sessions. Subsequently, the FT schedule was suspended, and ethanol was available ad libitum for 6 months in 16- or 22-hr sessions. RESULTS: Cynomolgus monkeys varied greatly in their propensity to self-administer ethanol, with sex and individual differences apparent within 10 days of ethanol exposure. Over the last 3 months of ethanol access, individual average ethanol intakes ranged from 0.6 to 4.0 g/kg/day, resulting in blood ethanol concentrations from 5 to 235 mg/dl. Males drank approximately 1.5-fold more than females. In addition, heavy-, moderate-, and light-drinking phenotypes were identified by using daily ethanol intake and the percentage of daily calories obtained from ethanol as criteria. CONCLUSIONS: Cynomolgus monkeys displayed a wide intersubject range of oral ethanol self-administration with a procedure that used a uniform and prolonged induction that restricted early exposure to ethanol and subsequently allowed unlimited access to ethanol. There were sex and stable individual differences in the propensity of monkeys to consume ethanol, indicating that this species will be important in characterizing risk factors associated with heavy-drinking phenotypes.

Narrow QRS ventricular tachycardia.

OBJECTIVE: To determine the frequency and clinical characteristics of narrow QRS ventricular tachycardia (QRS duration less than or equal to 0.11 seconds). DESIGN: Consecutive survey of patients with ventricular tachycardia. SETTING: Tertiary, referral-based arrhythmia service at a university medical center. PATIENTS: Sequential sample of patients with inducible ventricular tachycardia who had a 12-lead electrocardiogram of the tachycardia available for review. MEASUREMENTS AND MAIN RESULTS: Of 106 patients with ventricular tachycardia, 5 (4.7%; 95% CI, 2.1% to 10.6%) had ventricular tachycardia with a QRS duration less than or equal to 0.11 seconds. Three of the five patients were previously incorrectly diagnosed as having supraventricular tachycardia. All five patients had at least two electrocardiographic findings other than QRS duration to suggest ventricular tachycardia. CONCLUSIONS: Narrow QRS ventricular tachycardia should be considered in the differential diagnosis of narrow QRS tachycardias. Electrocardiographic findings other than QRS duration are usually present to suggest the diagnosis.

Levels of short (1-15 ms) electrical shocks from a 50 Hz supply inducing ventricular fibrillation in hyperbaric helium and oxygen.

An investigation was undertaken to determine the ventricular fibrillation (VF) threshold of anaesthetised dogs subjected to external application of electric shocks between a foreleg and a hindleg. The shocks were 2-15 ms sections of 50 Hz sine waveform starting at peak current and were applied at a known time in the heart cycle. The object of the experiment was to determine if there was an increase in cardiac susceptibility to electrically induced VF at 31 atmospheres absolute (atm abs) in a helium and oxygen environment. The duration and position of that part of the cardiac cycle most vulnerable to induction of VF by electrocution was found (seven animals) using 4 ms shocks and then the minimum fibrillating current for shocks of 2-15 ms (min FC2-15) delivered at the most vulnerable point of the cycle (five animals). Body resistance was calculated from the data so gathered. Fibrillation thresholds were not changed by compression and there were no significant changes in the vulnerable period of the cardiac cycle. Min FC2 was significantly higher than for other durations under both control (3.21 A, SD 1.08) and test conditions (3.26 A, SD 0.39), p = 0.001. There was no difference in body resistance at 31 atm abs (395.5, SD 12.9) from control values at 1 atm abs (396.7, SD 10.9). From these data it was concluded that the heart is no more susceptible to the induction of VF at 31 atm abs in a helium oxygen environment and additional safety factors are unnecessary from this point of view.

Fetal electroencephalography using a new, flexible electrode.

A single flexible active electrode for monitoring the fetal electroencephalogram (FEEG), has been designed specifically for use in routine obstetrics. It does not require penetration of or adherence to the fetal scalp, and it is reusable. The equipment's performance has been tested in 20 normal labours. The recordings obtained were not contaminated by the fetal electrocardiogram and were relatively free from artefact so that minimal filtering of the signal was required. No FEEG signal was obtained if the electrode was applied to breech presentations. The trace obtained from a healthy fetus was comparable with that recorded after delivery.

Ambulatory ST segment monitoring. Problems, pitfalls, solutions, and clinical application.

The introduction of frequency modulated recording systems for ambulatory electrocardiographic monitoring (Oxford Medilog mark 2 and Cardiodyne cassette recorders) prompted comparison with a conventional direct recording type of recorder (Oxford Medilog mark 1). The recordings obtained by the frequency modulated recorders were very much superior to those obtained by the direct recording type of recorder. The direct recording suffered from poor low frequency response, phase shift, and cable motions artefacts. Correction of these problems with careful attention to electrode application enabled stable graphs to be obtained over 24 hours. The clinical applications were explored by comparing the results of exercie tests with a computer assisted system with frequency modulated ambulatory monitoring in 30 patients. A range of ST deviations from pure ST depressions throughout 24 hours, pure ST elevation, and a combination of ST elevation and depression were seen, suggesting a spectrum of changes hitherto unsuspected in these patients. Painless ST changes were approximately twice as common as those associated with pain. These findings indicate a valuable role for ST segment monitoring in ischaemic heart disease, particularly with the availability of high fidelity modulated tracings which do not distort ST segments.