Apolipoprotein E gene polymorphism in the Mongolian population.

Apolipoprotein E plays a key role in the regulation of lipid metabolism. ApoE function is determined by the presence of three common alleles (epsilon2, epsilon3, epsilon4). The apo epsilon3 allele is the most prevalent, apo epsilon2 is associated with dysbetalipoproteinaemia, and apo epsilon4 is frequently associated with an increased risk for cardiovascular and Alzheimer's diseases. Mongolian population has a high rate of cardiovascular mortality and morbidity and there might be genetic susceptibility of the population to cardiovascular disease. The aim of our study was to establish the frequency of apoE genotypes in 744 Mongolian subjects and to compare the results with findings from other Asian populations. The apo E sequence was amplified using polymerase chain reaction and apo E genotyping was performed by restriction enzyme cleavage with CfoI. The relative apoE allele frequencies were epsilon2 = 3.7%, epsilon3 = 80.8%, and epsilon4 = 15.5%, the genotype frequencies were epsilon2/epsilon2 = 0% (N = 0), epsilon2/epsilon3 = 5.7% (N = 42), epsilon2/epsilon4 = 1.7% (N = 13), epsilon3/epsilon3 = 65.3% (N = 486), epsilon3/epsilon4 = 25.4% (N = 189), epsilon4/epsilon4 = 1.9% (N = 14); the occurrence of the risk epsilon4 allele in Mongolia is among the highest in Asia. The high frequency of the apo epsilon4 allele may increase the susceptibility of Mongolian population to cardiovascular diseases.

[Granulosa cell tumor of the ovary; evaluation of therapeutic results]. / Granulózo-celulární tumory ovaria, zhodnocení lécebných výsledku.

In 1956-1985 in the Oncological Research Institute in Brno a total of 70 patients was treated on account of granulosa-cell tumours of the ovary. This accounts for 10% of all ovarian malignities treated in the Institute during this period. The initial treatment of all patients was surgery, i.e. abdominal hysterectomy with bilateral adnexectomy, performed in 54.5% of the patients, uni- or bilateral adnexectomy in 35.7%, supravaginal amputation of the uterus with adnexectomy in 7.1% and in 2.7% (two patients) exploratory laparotomy only. All patients had irradiation of the pelvic area, in recent years the area of external irradiation was extended with regard to the lymphographic finding. This examination has become an integral part of the pre-treatment routine examination of every single patient. Comprehensive treatment of the tumour comprised chemotherapy involving in a major number of patients an adjuvant chemotherapeutical regime of CVF (Cyclophosphamide, Vinblastin, Ftorouracil), later a MAFC regime (Methotrexate, Actinomycin D, Cyclohosphamide, Ftorouracil). In more advanced tumours or mixed tumours according to histopathological analysis, in recent years a chemotherapeutic regime of CAP is used (Cyclophosphamide, platinum, Adriblastina) or VAB (Vinblastin, Adriblastina, Bleomycin), or a combination of platinum, Vinblastin and Bleomycin. In the submitted group a recovery extending over five years has been recorded in 63.6%, 60.5% of the patients survive 10 years and 54.1% of the women 15 years. In stage I 5-year survival is 82.5%, in stage Ia 85.3%.

Adenocarcinoma cervicis uteri. An appraisal of treatment results for a period of 40 years.

A retrospective study was done in 316 patients with primary cervical adenocarcinoma treated at the Research Institute for Clinical and Experimental Oncology in Brno over a period of 40 years (1939-1978). The treatment results were compared to those in 2571 patients with epidermoid carcinomas of the uterine cervix treated at the Institute over the same period. The 5-year survival rate was significantly lower in adenocarcinoma patients (in Stage I patients, 77.8% vs. 84.5%, and, in the whole group, 60.8% vs. 70.3%). The assessment of the treatment results of this study has clearly showed that in cervical adenocarcinomas, surgery combined with radiotherapy was much more effective than radical radiotherapy alone (77.4% vs. 64.7%). In contrast to this, in epidermoid carcinomas the treatment results were better after radical radiotherapy (86.5% vs. 81.3%). Thus, in the prognosis of cervical adenocarcinomas the mass of the tumor, the size of the uterus, as well as the grading play a role. That means that primary cervical adenocarcinomas at early stages can be successfully treated by a combination of radical surgery and radiotherapy, while radiotherapy of advanced stages of this tumor is less successful.

Stage IIb, IIIb, and IVa carcinoma of the uterine cervix--results of treatment by radiotherapy in 649 patients.

During the period of January 1969 to December 1980, 649 patients have been treated by radical radiotherapy for Stage IIb, IIIb, and IVa carcinoma of the cervix uteri. This retrospective study was performed to assess therapeutical results in two groups of patients. Clinical staging and the methods of treatment were standard in both groups. Group I was treated by external irradiation of the pelvis minor with 60Co in combination with intracavitary radium administration. Group II patients were irradiated with a 42 MeV betatron according to the findings of lymphography, again in combination with radium brachytherapy. In Group I the 5-year survival rate was 59.2%, that in Group II was 66.7%. There was a statistically significant difference in the 5-year survival rate in Stage IIb patients of Group II (85.5%) against that in Group I (75.6%). The incidence of serious complications elicited by radiotherapy increased from 4.8% in Group I patients to 7.5% in Group II. Clinical stage, age at the time of diagnosis, findings of lymphography and tolerance to irradiation are prognostically important factors that influence the cure of the patients. On the basis of these findings, the possibilities of further therapeutic improvements are discussed.

Multiple tumors in gynecology.

Two large groups of patients, i.e. 1893 patients treated at the Institute for carcinoma cervicis uteri and 1184 patients with Ca corporis uteri were selected and evaluated for a follow-up study and statistical processing of tumor duplicity of gynecological origin. Double tumor in the group with Ca cervicis uteri was found in 88 women, i.e. 4.6%, and in that treated for Ca corporis uteri in 85, i.e. 7.2% of the patients. The most frequent combination in the two groups of carcinoma is breast cancer amounting to 28.4% in Ca cervicis uteri and to 35.3% in Ca corporis uteri. The second most frequent primary carcinoma in Ca cervicis uteri is dermal carcinoma--23.9%, and in Ca corporis uteri that of the digestive tract--21.1%. A statistical follow-up over 40 years indicates a rise in tumor duplicity in both groups of gynecological carcinoma--cervical and endometrial, with the number in the former having increased more than twofold.

Carcinoma cervicis uteri. Long-term follow-up therapeutic results.

The principle of the therapy of carcinoma cervicis uteri in the Research Institute of Clinical and Experimental Oncology in Brno is the combination of betatron megavoltage irradiation and cobalt 60 irradiation with intracavital radium irradiation. On the basis of many years' study concerning the therapy and therapeutic results of this tumor accurate directions of total therapy were elaborated. Carcinoma is diagnosed and classified precisely according to valid international directions. In addition to basic examination, limb lymphography was introduced giving the strategy of irradiation when lymphatic system is involved and in early stages of the disease. By preliminary evaluation of the obtained data a certain improvement of therapeutic results is proven. About 15% more patients are alive till 5 years without any signs of the disease than in precedent years. In spite of a high dose summation given by the extent of megavoltage irradiation the number of postirradiation reaction, nor early late, is increased to much. Complex therapy of this tumor is performed by a team of physicians composed of gynecologist, radiologist, rentgendiagnosticist, pathologist, and radiation physicist. By increasing the number of cured patients and their return and enclosure into further working process the savings in state budget are achieved. The effectiveness of the carcinoma cervicis uteri therapy is therefore dependent not only on earlier diagnosis and modern irradiation technique, but also on the cooperation of a team of physicians who plan, perform and follow the therapy.

Use of 42 MeV betatron bremsstrahlung irradiation in the therapy combined with radium in carcinoma of the cervix.

The article deals with the therapy of cancer of the cervix with external 42 MeV betatron bremsstrahlung irradiation in combination with intracavitary applicated radium. The described irradiation technique using special shielding blocks extends the dose distribution till to the region of paraaortic nodes in an extended field. The extended irradiation field is used on the basis of lymphographic examination. In the region of pelvis minor, sufficiently uniform dose distribution is attained with lethal tumor effect. The dose variability with betatron or cobalt external irradiation was also studied.