The Emergence of New Psychoactive Substance (NPS) Benzodiazepines. A Survey of their Prevalence in Opioid Substitution Patients using LC-MS

Benzodiazepines have a wide range of clinical uses being among the most commonly prescribed medicines globally. The EU Early Warning System on new psychoactive substances (NPS) has over recent years detected new illicit benzodiazepines in Europe's drug market1. Additional reference standards were obtained and a multi-residue LCMS method was developed to test for 31 benzodiazepines or metabolites in urine including some new benzodiazepines which have been classified as New Psychoactive Substances (NPS) which comprise a range of substances, including synthetic cannabinoids, opioids, cathinones and benzodiazepines not covered by international drug controls. 200 urine samples from patients attending the HSE National Drug Treatment Centre (NDTC) who are monitored on a regular basis for drug and alcohol use and which tested positive for benzodiazepine class drugs by immunoassay screening were subjected to confirmatory analysis to determine what Benzodiazepine drugs were present and to see if etizolam or other new benzodiazepines are being used in the addiction population currently. Benzodiazepine prescription and use is common in the addiction population. Of significance we found evidence of consumption of an illicit new psychoactive benzodiazepine, Etizolam.

Pregabalin Abuse amongst Opioid Substitution Treatment Patients.

Pregabalin (Lyrica®) is used in treating epilepsy, nerve pain and anxiety. Pregabalin was initially thought to have a low misuse potential however there are emerging reports of Pregabalin being abused. A study was commenced at the National Drug Treatment Centre's (NDTC) Drug Analysis Laboratory to determine the level of usage of Pregabalin within the addiction services population in Ireland. A total of 498 urine samples representing samples from 440 individual opioid substitution patients, initially screened by immunoassay for drugs of abuse, were subjected to further analysis for Pregabalin by Liquid Chromatography/Mass Spectrometry (LC/MS). Of 440 patients tested, 39 tested positive for Pregabalin (9.2%). Only 10 patients from this group were prescribed this drug to our knowledge thus giving an estimated rate of misuse of 7.0%. Other drugs detected in the Pregabalin positive patients were Opiates (31.8%), Cocaine (11.4%), Benzodiazepines (79.5%) and Cannabis (77.8%). Our study confirms that Pregabalin abuse is taking place amongst the addiction services population. We believe that misuse of this prescription drug is a serious emerging issue which should be monitored carefully.

Modified transseptal approach in endoscopic transsphenoidal pituitary surgery.

OBJECTIVE: Transsphenoidal pituitary surgery is commonly performed via a direct transostial approach with a posterior septectomy. However, a technique via an endoscopic transseptal route has been described that avoids a posterior septectomy, but it comes with its own disadvantages. METHODS: This paper describes a modification, and discusses its pros and cons. RESULTS: The initial incision in the mucosa is placed level with the anterior middle turbinate. The mucoperichondrial flap is raised ipsilaterally until the sphenoid sinus ostium. An incision is made at the osseocartilaginous junction, and the contralateral mucoperichondrial flap is raised. The bony septum and posterior aspect of this flap is excised. The size and position of this window can be adapted. At the end of the operation, the lateralised intact mucoperichondrial flap is moved back to the midline. CONCLUSION: Excision or deflection of the cartilaginous septum is not required. It maintains an intact septal mucosa on one side and avoids a septal perforation.

Prevalence of Sexual Victimization Among Female and Male College Students: A Methodological Note With Data.

This study provides insight on how sample recruitment methods may affect reported rates of sexual victimization on college campuses. The study compares sexual victimization rates among students who complete surveys after initial requests with those who complete them only after multiple reminders. Using probability sampling methods, undergraduate students from 12 universities were invited to complete a survey on campus violence; initial invitations were followed with up to five reminders. Women (n = 1,008) and men (n = 344) who completed surveys were categorized as early, middle, or late responders based on the number of reminders required to convert them from non-responders to responders. About 24.2% of women and 15.6% of men reported sexual victimization in the previous two months. In initial analyses, female early and late responders did not differ on sexual victimization, but males did. Male late responders reported higher rates of sexual victimization than early responders. In sensitivity analyses that re-defined early and late responders, women who were early responders reported more sexual victimization than women who were late responders, while men who were early responders reported less sexual victimization than men who were late responders. These findings suggest that researchers may underestimate sexual victimization rates for male college students unless multiple attempts are made to solicit their participation. Researchers are encouraged to utilize multiple reminders to increase research participation.

Ultrasound in the selective screening of developmental dysplasia of the hip.

INTRODUCTION: Developmental dysplasia of the hip (DDH) can result in chronic pain, gait abnormalities and degenerative arthritis. Infants with a family history, Breech delivery or unstable/"clicking" of the hip on examination are at higher risk. The goal is to detect cases early enough for normal hip development and function by the end of adolescence, but clinical examination alone is ineffective. MATERIALS AND METHODS: All infants born at the West Middlesex University Hospital, Isle-worth, U.K., between 3/3/2005 and 21/10/2006 underwent prospective clinical screening to reveal risk factors of unstable hip on examination, family history of DDH and Breech delivery. Infants with risk factors underwent static and dynamic ultrasound of the hips (Harke's method with Terjesen measurements), performed by a consultant radiologist or sonographer. The infant was then examined by an Orthopaedic Surgeon who was blinded to the ultrasound findings until after creating a management plan. RESULTS: 5772 infants were born during the study period. 200 (3.5%) at-risk infants were identified, resulting in 400 hip ultrasounds. Following review of ultrasound findings, the majority of cases (163/200, 81.5%) lead to no change in management. Change in timing or type of clinical follow up occurred in 31 cases with normal ultrasounds and 20 cases with abnormal (immature hip) ultrasounds. Dysplasia was demonstrated in 6 infants (3%) on ultrasound, who were treated with Parvlik Harness. Of these, only 5 were detected on examination. Therefore, the ultrasound findings lead to 1 intervention with Parvlik Harness which would have otherwise gone undiagnosed from clinical examination. CONCLUSION: Whereas type and timing of follow up was adjusted in 18.5% of the at-risk infants, targeted screening of at-risk with ultrasound lead to only one intervention. This encourages discussion on the resource implication and viability of ultrasound screening, as only one from two hundred lead to an intervention.

A day in the life of a doctor working at the Himalayan Rescue Association.

The Himalayan Rescue Association's (HRA) clinic in Pheriche, Nepal (4243m) is one of a number of high altitude medical posts where demands for services are increasing. Every year international doctors see over 1000 patients, assisting local people with basic health needs and providing emergency care for trekkers with both altitude-related and general illnesses and injuries. This article describes the work of the voluntary clinic and some of the challenges it faces.

Students in a Course-Based Undergraduate Research Experience Course Discovered Dramatic Changes in the Bacterial Community Composition Between Summer and Winter Lake Samples.

Course-based undergraduate research experience (CURE) courses incorporate high-impact pedagogies that have been shown to increase undergraduate retention among underrepresented minorities and women. As part of the Building Infrastructure Leading to Diversity program at the University of Detroit Mercy, a CURE metagenomics course was established in the winter of 2019. Students investigated the bacterial community composition in a eutrophic cove in Lake Saint Clair (Harrison Township, MI, United States) from water samples taken in the summer and winter. The students created 16S rRNA libraries that were sequenced using next-generation sequencing technology. They used a public web-based supercomputing resource to process their raw sequencing data and web-based tools to perform advanced statistical analysis. The students discovered that the most common operational taxonomic unit, representing 31% of the prokaryotic sequences in both summer and winter samples, corresponded to an organism that belongs to a previously unidentified phylum. This result showed the students the power of metagenomics because the approach was able to detect unclassified organisms. Principal Coordinates Analysis of Bray-Curtis dissimilarity index data showed that the winter community was distinct from the summer community [Analysis of Similarities (ANOSIM) r = 0.59829, n = 18, and p < 0.001]. Dendrograms based on hierarchically clustered Pearson correlation coefficients of phyla were divided into a winter clade and a summer clade. The conclusion is that the winter bacterial population was fundamentally different from the summer population, even though the samples were taken from the same locations in a protected cove. Because of the small class sizes, qualitative as well as statistical methods were used to evaluate the course's impact on student attitudes. Results from the Laboratory Course Assessment Survey showed that most of the respondents felt they were contributing to scientific knowledge and the course fostered student collaboration. The majority of respondents agreed or strongly agreed that the course incorporated iteration aspects of scientific investigations, such as repeating procedures to fix problems. In summary, the metagenomics CURE course was able to add to scientific knowledge and allowed students to participate in authentic research.

Perpendicular spin torque in magnetic tunnel junctions.

A steady-state electrical current flowing in a magnetic heterostructure can exert a torque on the magnetization, and provides a means to control magnetization states and dynamics in spintronics structures. However, some components of the torque are difficult to measure and to calculate. We have determined the perpendicular spin torque in MgO magnetic tunnel junctions by measuring their lowest ferromagnetic resonance frequency and find that it decreases linearly with increasing bias voltage. Micromagnetic modeling shows that this decrease is caused by the perpendicular component of spin torque. We obtain a quantitative value for the perpendicular spin torque effective field as a function of bias voltage, and show that this effective field is a linear function in bias voltage and approximately equal in magnitude to the in-plane spin torque effective field.

Head shop compound abuse amongst attendees of the Drug Treatment Centre Board.

The use of "Head Shop" compounds has received much media attention lately. There is very little research in the current literature with regard to the extent of the usage of these substances amongst the drug using population in Ireland. We conducted a study to examine the extent of the usage of Mephedrone, Methylone and BZP amongst attendees of Methadone maintenance programs at the DTCB. Two hundred and nine samples in total were tested. The results showed significant usage of these compounds amongst this cohort of drug users, with 29 (13.9%) of samples tested being positive for Mephedrone, 7 (3.3%) positive for Methylone and 1 (0.5%) positive for BZP.

Al13H-: hydrogen atom site selectivity and the shell model.

Using a combination of anion photoelectron spectroscopy and density functional theory calculations, we explored the influence of the shell model on H atom site selectivity in Al(13)H(-). Photoelectron spectra revealed that Al(13)H(-) has two anionic isomers and for both of them provided vertical detachment energies (VDEs). Theoretical calculations found that the structures of these anionic isomers differ by the position of the hydrogen atom. In one, the hydrogen atom is radially bonded, while in the other, hydrogen caps a triangular face. VDEs for both anionic isomers as well as other energetic relationships were also calculated. Comparison of the measured versus calculated VDE values permitted the structure of each isomer to be confirmed and correlated with its observed photoelectron spectrum. Shell model, electron-counting considerations correctly predicted the relative stabilities of the anionic isomers and identified the stable structure of neutral Al(13)H.

First Report of a New Postharvest Disease of Pear Fruit Caused by Sphaeropsis pyriputrescens in Canada.

A survey of stored d'Anjou pears was conducted in British Columbia (BC), Canada in January 2006 to determine if Sphaeropsis rot was present in BC as had been reported previously for apples and pears in Washington (1,2). Sphaeropsis pyriputrescens Xiao & J.D. Rogers produces decay similar to Botrytis cinerea that originates from the stem or calyx end. Of 3,614 pears sampled, 55 (1.5%) had symptoms similar to those described for Sphaeropsis rot. Isolations were made from each infected pear onto acidified potato dextrose agar (APDA) dishes and incubated at 20°C for 5 to 7 days. Twenty-seven cultures resembling S. pyriputrescens were induced to produce pycnidia by exposing them to 12-h cycles of alternating light and dark periods at 20°C (1). Conidia extracted from pycnidia were then streaked onto PDA dishes and incubated at 20°C for 12 to 24 h from which single-spore cultures were made. These isolates developed a dense, white-to-cream mycelium that turned yellow over time; black pycnidia were formed on the culture dishes after 4 weeks. Conidia were brown, clavate to subglobose to irregular, and similar in size (16 × 10 µm) to previous descriptions (1). Identification of S. pyriputrescens was confirmed by using DNA sequence data from the ß-tubulin and ribosomal genes. Sequences from S. pyriputrescens from Washington (1) were compared with those from BC, Canada. Isolates from Canada shared 99 to 100% sequence homology with those from Washington. Two of the BC isolates (DAOM 238917 and 238918) were deposited in the Canadian Culture Collection, Ottawa, ON and their corresponding sequences were placed in the GenBank database (NCBI, Bethesda, MD) with accession nos. EU156037 and EU156040 (ribosomal gene) and EU156048 and EU 156050 (ß-tubulin gene), respectively. Five isolates from different locations in BC and two isolates from Washington were tested for pathogenicity on d'Anjou pears and four apple cultivars (Ambrosia, Fuji, Gala, and Granny Smith). Plugs (3 mm in diameter) removed from 2-week-old cultures were placed into two corresponding wounds on each of five fruit per cultivar. The fruit were then placed at 1 or 20°C for 22 or 7 days, respectively, when the diameters of the decay areas were recorded. All isolates were pathogenic on pears (P = <0.05). Decay lesion diameter was greater at 1°C, ranging from 46.8 to 57.9 mm, than at 20°C, ranging from 32.6 to 44.2 mm. All BC isolates were also pathogenic on the fruit of each apple cultivar (P = <0.05), although at 20°C, decay areas were smaller than on pears, and at 1°C, very little rot developed. Koch's postulates were completed by reisolating S. pyriputrescens from the inoculated pears and apples and identifying the isolates as above. Although S. pyriputrescens was only observed on pears in BC, research in Washington indicates that it is a more serious problem on apples (2). To our knowledge, this is the first documented report of the occurrence of S. pyriputrescens in Canada. References: (1) C. L. Xiao and J. D. Rogers. Plant Dis. 88:114, 2004. (2) C. L. Xiao et al. Plant Dis. 88:223, 2004.

Continuous digital hypothermia prevents lamellar failure in the euglycaemic hyperinsulinaemic clamp model of equine laminitis.

BACKGROUND: Continuous digital hypothermia can prevent the development and progression of laminitis associated with sepsis but its effects on laminitis due to hyperinsulinaemia are unknown. OBJECTIVES: To determine the effects of continuous digital hypothermia on laminitis development in the euglycaemic hyperinsulinaemic clamp model. STUDY DESIGN: Randomised, controlled (within subject), blinded, experiment. METHODS: Eight clinically normal Standardbred horses underwent laminitis induction using the euglycaemic hyperinsulinaemic clamp model (EHC). At initiation of the EHC, one forelimb was continuously cooled (ICE), with the other maintained at ambient temperature (AMB). Dorsal lamellar sections (proximal, middle, distal) were harvested 48 h after initiation of the EHC and were analysed using histological scoring (0-3) and histomorphometry. Cellular proliferation was quantified by counting epidermal cell nuclei staining positive with an immunohistochemical proliferation marker (TPX2). RESULTS: Severe elongation and disruption of SEL with dermo-epidermal separation (score of 3) was observed in all AMB feet at one or more section locations, but was not observed in any ICE sections. Overall 92% of the AMB sections received the most severe histological score (grade 3) and 8% were grade 2, whereas ICE sections were classified as either grade 1 (50%) or grade 2 (50%). Relative to AMB feet, ICE sections were 98% less likely to exhibit grades 2 or 3 (OR: 0.02, 95% CI 0.001, 0.365; P<0.01). Histomorphometry measurements of total and nonkeratinised primary epidermal lamellar length were significantly increased (P<0.01) in AMB limbs compared with ICE. TPX2 positive cell counts were significantly increased (P<0.01) in AMB limbs compared with ICE. MAIN LIMITATIONS: Continuous digital hypothermia was initiated before recognition of laminitis and therefore the clinical applicability requires further investigation. CONCLUSIONS: Continuous digital hypothermia reduced the severity of laminitis in the EHC model and prevented histological lesions compatible with lamellar structural failure.

Negative ions of nitroethane and its clusters.

Valence and dipole-bound negative ions of the nitroethane (NE) molecule and its clusters are studied using photoelectron spectroscopy (PES), Rydberg electron transfer (RET) techniques, and ab initio methods. Valence adiabatic electron affinities (EA(a)s) of NE, C(2)H(5)NO(2), and its clusters, (C(2)H(5)NO(2))(n), n=2-5, are estimated using vibrationally unresolved PES to be 0.3+/-0.2 eV (n=1), 0.9+/-0.2 eV (n=2), 1.5+/-0.2 eV (n=3), 1.9+/-0.2 eV (n=4), and 2.1+/-0.2 eV (n=5). These energies were then used to determine stepwise anion-neutral solvation energies and compared with previous literature values. Vertical detachment energies for (C(2)H(5)NO(2))(n)(-) were also measured to be 0.92+/-0.10 eV (n=1), 1.63+/-0.10 eV (n=2), 2.04+/-0.10 eV (n=3), and 2.3+/-0.1 eV (n=4). RET experiments show that Rydberg electrons can be attached to NE both as dipole-bound and valence bound anion states. The results are similar to those found for nitromethane (NM), where it was argued that the diffuse dipole state act as a "doorway state" to the more tightly bound valence anion. Using previous models for relating the maximum in the RET dependence of the Rydberg effective principle number n(max)(*), the dipole-bound electron affinity is predicted to be approximately 25 meV. However, a close examination of the RET cross section data for NE and a re-examination of such data for NM finds a much broader dependence on n(*) than is seen for RET in conventional dipole bound states and, more importantly, a pronounced [l] dependence is found in n(max)(*) (n(max)(*) increases with [l]). Ab initio calculations agree well with the experimental results apart from the vertical electron affinity value associated with the dipole bound state which is predicted to be 8 meV. Moreover, the calculations help to visualize the dramatic difference in the distributions of the excess electron for dipole-bound and valence states, and suggest that NE clusters form only anions where the excess electron localizes on a single monomer.

Comparison of biochemical disease-free survival of patients with localized carcinoma of the prostate undergoing radical prostatectomy, transperineal ultrasound-guided radioactive seed implantation, or definitive external beam irradiation.

PURPOSE: This retrospective study compares the long-term biochemical disease-free survival for patients undergoing radical prostatectomy, transperineal ultrasound-guided (125)Iodine implantation, or external beam irradiation alone in a tertiary referral community-based hospital. METHODS AND MATERIALS: Five hundred forty patients were available for evaluation, which included: external beam, 132; (125)I, 186; and radical prostatectomy, 222. For the 318 patients referred to the Department of Radiation Oncology, those with T3 disease underwent external beam irradiation while patients with T1 or T2 underwent (125) 0.2 ng/mL or if they had three consecutive increases in their PSA or an increase in their postoperative PSA warranting intervention with androgen ablation or external beam irradiation to the pelvis. RESULTS: Patients were stratified by pretreatment risk groups predicting for post-treatment PSA recurrence. Patients were considered to be at a low or intermediate risk for recurrence if their clinical stage was T1c, T2a, T2b, pretreatment PSA level was 20, or Gleason score was >/= 7. For 132 patients undergoing external beam irradiation, 28 of 37 low or intermediate risk obtained a 1 year nadir PSA of < 1 (76%) while 40% of high risk patients obtained nadir < 1. Of 186 patients undergoing (125)I, 112 of 147 low or intermediate risk (76%) obtained a nadir PSA < 1. Twenty of 39 (51%) high risk obtained a nadir PSA < 1. Of the 222 patients undergoing prostatectomy, 83 of 88 (94%) low or intermediate risk had undetectable levels of PSA at 1 year. One hundred seventeen of 134 (86%) were high risk and had undetectable levels of PSA at 1 year. The biochemical disease-free survival for patients with low or intermediate risk at 5 years is approximately 70% with no significant difference between those patients treated with radical prostatectomy, external beam, or (125)I. For those patients with high risk factors for recurrence, there is no significant difference between ultrasound-guided implant or external beam, but there is a significant improvement in biochemical disease-free survival with radical prostatectomy. CONCLUSION: For patients with low or intermediate risk disease, external beam, ultrasound-guided (125)I, or a radical prostatectomy give comparable long-term biochemical disease-free survival. For patients with high risk disease, a radical prostatectomy provides a significantly improved biochemical disease-free survival. Our current protocols utilize androgen ablation in combination with conformal three-dimensional external beam irradiation or androgen ablation in conjunction with external beam irradiation and (103)Pd seed implantation for patients at high risk for extra capsular disease. It is too early to determine if this combination therapy will give results comparable to radical prostatectomy. For patients who obtain a 1 year nadir PSA of < 1, the biochemical disease-free survival is durable with little risk of subsequent recurrence.

Pathologic fracture after radiation therapy for primary non-Hodgkin's malignant lymphoma of bone.

Between 1963 and 1981, 32 patients with biopsy proven non-Hodgkin's lymphoma involving bone were treated at the Mallinckrodt Institute of Radiology either with radiation alone or in conjunction with chemotherapy. An unexpectedly high rate of fracture at the site of the tumor was observed. Six patients were excluded because they survived less than six months after the completion of radiotherapy or were lost to follow-up within six months. There were 15 appendicular and 17 axial sites treated. Local control was achieved in 30 of 32. There were 10 patients with appendicular lesions of which seven suffered a fracture. Of the seven patients with lesions in a weight bearing bone, six suffered fractures. Twenty-six sites of involvement received less than 5000 rad. Five sites of involvement with diffuse histiocytic lymphoma (DHL) involving the appendicular skeleton received 5000 to 6000 rad. One site with DHL involving the axial skeleton received 5000 rad. Of the six patients receiving high dose, two presented with pathologic fractures of the femur requiring surgical stabilization and the remaining four patients suffered subsequent fractures 7 to 30 months after completion of therapy. Two of these six had local recurrence of disease. It appears that involvement of the appendicular skeleton by lymphoma frequently results in fracture. Doses of 5000 rad or greater do not increase the probability of local control but may contribute to the risk of fracture following radiotherapy.

Prognostic factors and results of radiotherapy alone in the management of pituitary adenomas.

Prognostic factors and results of therapy were analyzed in a retrospective review of 70 patients with pituitary adenomas treated with radiotherapy alone from January 1954 through December 1982 at the Radiation Oncology Center, Mallinckrodt Institute of Radiology. The 10-year overall and disease-free survival was 77.8 and 76.0%. The expected survival for an age-, sex-, and race-matched population was not significantly greater at 87.2%. The 10-year disease-free survival for the distinct tumor types was 100% for Cushing's disease, 82.3% for patients with amenorrhea/galactorrhea, 79.6% for non-functioning adenomas, 69.0% for acromegaly, and 66.7% for Nelson's syndrome. Prognostic variables analyzed were age, race, sex, tumor type, tumor extent, visual field defects at diagnosis, and volume irradiated. Only the presence of visual field defects at diagnosis conferred a poor prognosis (p less than 0.001). There was a tendency toward superior tumor control with radiation doses greater than 4500 cGy (p = 0.15). The median time to progression of disease was 4.2 years, with the last failure occurring at 12 years following the completion of radiotherapy. Severe complications were apparent in 5 patients (7.1%), including one death from central nervous system radionecrosis.

Transperineal ultrasound-guided radioactive seed implantation for organ-confined carcinoma of the prostate.

PURPOSE: This retrospective study was undertaken to: (a) determine the prognostic significance of pretreatment and 1-year nadir serum prostate specific antigen (PSA) levels in organ-confined carcinoma of the prostate treated with ultrasound-guided radioactive 125I seed implantation; (b) determine the factors associated with postimplant morbidity and whether modification of the technique would reduce morbidity; (c) evaluate the local control rate and disease-free survival of patients undergoing seed implantation. METHODS AND MATERIALS: From October 1988 through December 1992, 142 patients with organ-confined adenocarcinoma of the prostate and a Gleason score < or = 7 underwent ultrasound-guided radioactive 125I seed implantation as an alternative to radical prostatectomy. Patients were considered to have persistent or progressive disease if there was evidence of local progression on digital exam, or if there were two consecutive increases in the PSA level. Patients suspected of persistent or progressive disease underwent restaging to include CT scan of the pelvis, bone scan, and ultrasound-guided prostate biopsy. Patients with increasing PSA levels in which active disease could not be confirmed were considered biochemical failures with occult systemic disease and were offered hormone ablation. RESULTS: With 1-6-year follow-up, median 30 months, the relapse patterns were prostate 4 (2.8%), bone 4 (2.8%), rising PSA 16 (11%). Pretreatment PSA level correlated with subsequent recurrence; pretreatment PSA < or = 4 (0), 4.1 to 10 (14%), 10.1 to 20 (21%), 20.1 to 50 (58%). Disease free survival at 2 years was 90% and at 5 years 76%. Nadir PSA (nPSA) at 1 year also correlated with recurrence: nPSA < or = 1 (3%), nPSA 1 < or = 4 (50%), and nPSA > or = 4 (100%). Seed implantation was well tolerated with 31% of patients experiencing RTOG morbidity > or = Grade 2, which typically consisted of transient radiation urethritis, which resolved with conservative measures. Eleven (8%) experienced RTOG morbidity > or = Grade 3. There was no correlation between number of seeds or total millicuries implanted and subsequent morbidity. However, reduction in the periurethral seed intensity reduced > or = Grade 3 morbidity from 11 to 4%. CONCLUSION: Ultrasound-guided radioactive seed implantation provides excellent local control of 97%, with a median 30 month follow-up. Morbidity is comparable to other curative modalities and by modifying Blasko's technique to reduce radioactive seed strength in the periurethral area, significant morbidity is rare. Pretreatment PSA and the nadir PSA at 1 year are important predictors of subsequent disease outcome. With a liberal definition of systemic recurrence as two consecutive increases in PSA levels, the 5-year disease-free survival is 76%.

Hysterectomy and adjuvant irradiation for pathologic stage III adenocarcinoma of the endometrium.

Three hundred and four evaluable patients with FIGO clinical Stage I adenocarcinoma of the endometrium were treated with hysterectomy and adjuvant irradiation. At surgery, 15 patients (5%) were found to have disease outside the uterus, but within the pelvis Pathologic Stage III (PSIII). A higher grade of tumor was not associated with an increase in the frequency of PSIII, being 7/158 (4%), 5/89 (6%), and 3/57 (5%) for Grades 1, 2, and 3 respectively. Depth of myometrial invasion correlated with PSIII disease in 5/69 (7%) for less than 1/3 myometrial invasion versus 7/33 (21%) for greater than 1/3 invasion (p = .05). One patient died of intercurrent disease at 4 months with 6/14 (43%) of the remaining patients developing recurrent disease. The site of initial failure was pelvis 1/15 (7%), pelvis and distant metastasis 3/15 (20%), and distant metastasis alone 2/15 (13%). Of seven patients who received external pelvic irradiation, there was one local failure (14%), which is not statistically significant from the 3/8 (38%) local failure rate among patients not receiving external pelvic irradiation (p = .569). None of the seven patients experienced a treatment related complication as a result of adjuvant irradiation.