Perception and use of complementary and alternative medicine among gynecologic oncology care providers.

OBJECTIVE: To determine general attitudes and approaches to complementary and alternative medicine (CAM) among physicians who care for gynecologic oncology patients. METHODS: Surveys were mailed to members of the Society of Gynecologic Oncologists and the Michigan Oncology Group. Physicians were asked to rate their general attitude toward CAM. RESULTS: Surveys were obtained from 462 physicians. Gynecologic oncologists and female physicians were more likely to have positive attitudes toward CAM, and to believe that clinical care should integrate conventional and CAM practices, compared with other oncologists and male physicians. CONCLUSION: Discrepancies exist among oncologists regarding attitude and use of CAM in their practice. Education of physicians regarding the safety and efficacy of CAM modalities may ultimately improve patient care.

Outcomes of surgical management of stage III vulvar hidradenitis suppurativa.

OBJECTIVE: To review prior experiences and outcomes of patients treated for stage III vulvar hidradenitis suppurativa (HS) and determine postoperative patient satisfaction. STUDY DESIGN: Patients managed surgically for stage III vulvar HS at University of Michigan Health Systems (January 2000 to December 2005) were identified. Retrospective record review was undertaken and data collected. Five met study criteria. All underwent radical vulvectomy to excise the HS. Most required extensive excision of the vulva, including mons, perianal area and buttock. One surgical defect was allowed to heal by secondary intention; all others underwent interval closure with split-thickness skin grafting (STSG). After debridement, all wounds were dressed with a vacuum assisted closure device. RESULTS: Of the 5 patients, 4 were satisfied with their outcome. The patient managed without STSG developed an introital stricture and was the only patient regretting undergoing surgical excision of the hidradenitis suppurativa. Some amount of depression was present in all patients postoperatively. Four were happy with the surgery; 3 said they would undergo surgery again. CONCLUSION: Patients with severe HS often require radical excision. Data conflict regarding optimal surgical management. Our experience supports good outcome in patients managed with radical excision and STSG.

Plastic responses to temporal variation in moisture availability: consequences for water use efficiency and plant performance.

The ability to appropriately modify physiological and morphological traits in response to temporal variation should increase fitness. We used recombinant hybrid plants generated by crossing taxa in the Piriqueta caroliniana complex to assess the effects of individual leaf traits and trait plasticities on growth in a temporally variable environment. Recombinant hybrids were used to provide a wide range of trait expression and to allow an assessment of the independent effects of individual traits across a range of genetic backgrounds. Hybrid genotypes were replicated through vegetative propagation and planted in common gardens at Archbold Biological Station in Venus, Florida, where they were monitored for growth, leaf morphological characters, and integrated water use efficiency (WUE) (C isotope ratio; delta(13)C) for two successive seasons. Under wet conditions only leaf area had significant effects on plant growth, but as conditions became drier, growth rates were greatest in plants with narrow leaves and higher trichome densities. Plants with higher WUE exhibited increased growth during the dry season but not during the wet season. WUE during the dry season was increased for plants with smaller, narrower leaves that had higher trichome densities and increased reflectance. Examination of alternative path models revealed that during the dry season leaf traits had significant effects on plant growth only through their direct effects on WUE, as estimated from delta(13)C. Over the entire growing season, plants with a greater ability to produce smaller and narrower leaves with higher trichome densities in response to reduced water availability had the greatest growth rate. These findings suggest that plants making appropriate changes to leaf morphology as conditions became dry had increased WUE, and that the ability to adjust leaf phenotypes in response to environmental variation is a mechanism by which plants increase fitness.

Aerenchyma development and elevated alcohol dehydrogenase activity as alternative responses to hypoxic soils in the Piriqueta caroliniana complex.

The ability of plants to make morphological or physiological adjustments in response to environmental cues allows them to survive and reproduce under a wide range of conditions. One stress that plants are often exposed to is soil oxygen depletion due to flooding. Plants can respond to hypoxic soils by producing oxygen-conducting aerenchymous tissue or through induction of enzymes in the ethanolic fermentation pathway. Here we use greenhouse experiments to examine flood responses in plants of the Piriqueta caroliniana (Turneraceae) complex, which occupy a range of moisture regimes. Morphotypes and hybrids in this complex exhibited contrasting responses to hypoxic conditions. Genotypes from flooded habitats developed aerenchyma and did not substantially elevate levels of alcohol dehydrogenase (ADH) activity, an enzyme associated with anaerobic respiration. Plants from drier sites, on the other hand, did not develop aerenchyma but had much higher levels of ADH activity. Plants with aerenchymous tissue had substantially higher rates of growth under sustained flooding. Results are consistent with the hypothesis that aerenchyma development is an effective strategy in habitats subject to persistent flooding, while elevating activity of enzymes for ethanolic fermentation is effective only under ephemeral flooding. The range of phenotypic responses observed illustrates contrasting adaptive strategies that can lead to habitat isolation and evolutionary divergence.

Home study course: fall 2006.

OBJECTIVE: The Home Study Course is intended for the practicing colposcopist or practitioner who is seeking to develop or enhance his/her colposcopic skills. The goal of the course is to present colposcopic cases that are unusual or instructive in terms of appearance, presentation, or management, or that demonstrate new and important knowledge in the area of colposcopy or pathology. Participants may benefit from reading and studying the material or from testing their knowledge by answering the questions. ACCME ACCREDITATION: The American Society for Colposcopy and Cervical Pathology (ASCCP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The ASCCP designates this education activity for a maximum of 1 American Medical Association Physician's Recognition Award Category I Credit. Physicians should only claim credit commensurate with the extent of their participation in the activity. The ASCCP also designates their educational activity for 1 Category 1 credit hour of the ASCCP's Program for Continuing Professional Development. Credit is available for those who choose to apply. The Home Study Course is planned and produced in accordance with the ACCME's Essential Areas and Elements. DISCLOSURES: The clinical history and images in the Home Study Course may represent an actual case, but not always. To improve educational quality, some gross, cytological, or histological images may come from photographic libraries. Good teaching cases are often difficult to obtain, and we encourage our readers to submit cases with high-quality images to the Home Study Course editor or executive editor to consider for publication.

A minimally invasive technique for management of the large adnexal mass.

STUDY OBJECTIVE: To describe our experience managing large pelvic masses through a minilaparotomy incision using a flexible, self-retaining wound retractor and exteriorized drainage by application of 2-octyl cyanoacrylate and a thin polyurethane membrane. DESIGN: Prospective nonrandomized trial (Canadian Task Force classification II-1). SETTING: Academic university hospital. PATIENTS: Ten women undergoing minilaparotomy for adnexal masses. INTERVENTIONS: After obtaining institutional review board approval, we identified 10 patients who underwent minilaparotomy for treatment of adnexal masses not thought to be amenable to laparoscopic surgical management and with clinical, radiographic, and laboratory evaluation consistent with a low probability of malignancy. Charts were reviewed and data collected. MEASUREMENTS AND MAIN RESULTS: The median mass size was 17.5 cm (range 9-30 cm), median incision length was 4.0 cm (range 3-5.5 cm), median patient age was 29.5 years (range 19-41 years), median body mass index was 24.7 (range 19.4-30.7), median duration of surgery was 85 minutes (range 53-141 minutes). Blood loss was minimal in all cases and all patients were discharged on the day of surgery. There were no diagnoses of ovarian malignancy. Pathologic diagnoses included mature cystic teratomas, cystadenomas, and cystadenofibromas. There were no instances of intraabdominal leakage of cyst fluid. One patient required readmission for a postoperative ileus. CONCLUSION: Minimally invasive management is a reasonable alternative to traditional laparotomy in the setting of a large adnexal mass with low probability of malignancy. This technique allows adequate access and exposure while minimizing the risk of intraabdominal contamination, speeding patient recovery, and optimizing cosmetic results. Further, this approach can be converted to a laparoscopic staging procedure if a patient is found to have ovarian cancer.

Contributions of heterosis and epistasis to hybrid fitness.

Early-generation hybrid fitness is difficult to interpret because heterosis can obscure the effects of hybrid breakdown. We used controlled reciprocal crosses and common garden experiments to distinguish between effects of heterosis and nuclear and cytonuclear epistasis among morphotypes and advanced-generation hybrid derivative populations in the Piriqueta caroliniana (Turneraceae) plant complex. Seed germination, growth, and sexual reproduction of first-generation hybrids, inbred parental lines, and outbred parental lines were compared under field conditions. Average vegetative performance was greater for hybrids than for inbred lines, and first-season growth was similar for hybrids and outbred parental lines. Hybrid survival surpassed that of inbred lines and was equal to or greater than outbred lines' survival, and more F(1) than parental plants reproduced. Reductions in hybrid fitness due to Dobzhansky-Muller incompatibilities (epistasis among divergent genetic elements) were expressed as differences in vegetative growth, survival, and reproduction between plants from reciprocal crosses for both F(1) and backcross hybrid generations. Comparing performance of hybrids against parental genotypes from intra- and interpopulation crosses allowed a more robust prediction of F(1) hybrids' success and more accurate interpretations of the genetic architecture of F(1) hybrid vigor.

Seed production from the mixed mating system of Chesapeake Bay (USA) eelgrass (Zostera marina; Zosteraceae).

In monoecious plants, gametes can be exchanged in three ways: among unrelated genets (outbreeding), with close relatives (inbreeding), or within individuals (geitonogamous selfing). These different mating systems may have consequences for population demography and fitness. The experiment presented herein used artificial crosses to examine the mating system of Chesapeake Bay, Virginia, USA eelgrass (Zostera marina L; Zosteraceae), a bisexual submerged aquatic plant that can outbreed, inbreed, and self. Genetic data indicate severe heterozygosity deficiencies and patchy genotype distribution in these beds, suggesting that plants therein reproduce primarily by vegetative propagation, autogamy, or geitonogamy. To clarify eelgrass reproductive strategies, flowers from three genetically and geographically distinct beds were hand-pollinated in outbred, inbred, and selfed matings. Fertilization success and seed production, life history stages which contribute greatly to the numeric maintenance of populations, were monitored. We found no evidence that inbreeding had negative consequences for seed production. On the contrary, selfed matings produced seeds significantly more frequently than outcrossed matings and produced significantly larger numbers of seeds than either inbred or outbred matings. These results contrast with patterns for eelgrass in other regions but might be expected for similar populations in which pollen limitation or a short reproductive season renders selfing advantageous.