Direct visualization of coexisting channels of interaction in CeSb.

Our understanding of correlated electron systems is vexed by the complexity of their interactions. Heavy fermion compounds are archetypal examples of this physics, leading to exotic properties that weave magnetism, superconductivity and strange metal behavior together. The Kondo semimetal CeSb is an unusual example where different channels of interaction not only coexist, but have coincident physical signatures, leading to decades of debate about the microscopic picture describing the interactions between the f moments and the itinerant electron sea. Using angle-resolved photoemission spectroscopy, we resonantly enhance the response of the Ce f electrons across the magnetic transitions of CeSb and find there are two distinct modes of interaction that are simultaneously active, but on different kinds of carriers. This study reveals how correlated systems can reconcile the coexistence of different modes on interaction-by separating their action in momentum space, they allow their coexistence in real space.

Should advanced age alone be considered a contraindication to systemic lymphadenectomy in gynecologic oncologic patients? A university hospital experience in Turkey.

In this case-control study, we aimed at analyzing the effect of pelvic and paraaortic lymphadenectomy on intraoperative and postoperative morbidity and mortality rates in a series of elderly patients (age >/= 65 years) with gynecologic malignancies. We examined preexisting medical conditions, surgical data, intraoperative and postoperative morbidity and mortality in 37 patients aged 65 years or older with endometrial and ovarian carcinoma who underwent pelvic and paraaortic lymphadenectomy. Control group consisted of patients between 60 and 64 years with similar malignancies. The number of patients with hypertension (P = 0.03), minor (P = 0.01) and major cardiac problems (P = 0.03), chronic obstructive lung disease (P = 0.02), and history of cerebrovascular disease (P = 0.04) were significantly higher in the study group than that in control. The median operative time was significantly shorter (160 min) in the study group than that (191 min) in control (P = 0.004). There were no significant differences between the groups with regard to blood loss, intraoperative and postoperative blood transfusion, preoperative and postoperative hemoglobin levels, yielded lymph nodes, and postoperative stay. Minor and major intraoperative and postoperative complications were not different between the groups. In these elected elderly patients, we demonstrate that pelvic and paraaortic lymph node dissection can be performed with an acceptable morbidity and mortality. We should perform pelvic and paraaortic lymphadenectomy in the older aged patients and advanced aged should not be considered a contraindication.

The effect of ascites, mass volume, and peritoneal carcinomatosis on serum CA125 levels in patients with ovarian carcinoma.

The aim of this study is to investigate the effects of ascites, ovarian mass volume, and peritoneal carcinomatosis on serum CA125 levels in patients with nonmucinous epithelial ovarian carcinoma. Serum CA125 levels were determined by a commercial enzyme immunoassay kit in a series of 98 patients with stage I-IV nonmucinous epithelial ovarian carcinoma. Amounts of ascites were determined in each patient with ascites. Ovarian mass volumes were calculated in 22 patients with stage I disease without ascites. Peritoneal carcinomatosis was detected in 35 ovarian cancer patients. Serum CA125 levels were compared among the patients with different clinical conditions. Serum CA125 levels were significantly higher in cases of ovarian cancer with ascites when compared with those without ascites (P < 0.01). Abnormal levels of serum CA125 were found in 80% of all patients; these abnormal levels were detected in 92% and 97% of the patients with ascites and with peritoneal carcinomatosis, respectively. A positive correlation between serum CA125 levels and ascites amounts was found in patients with ascites (P < 0.01, r = 0.74). However, there was no correlation between ovarian mass volumes and levels of serum CA125 in patients having stage I disease but no ascites (P = 0.5, r = 0.15). Our results showed that serum CA125 levels might be affected by the amount of ascites and the presence of peritoneal carcinomatosis but not with ovarian mass volume. However, these findings need to be confirmed in more and larger studies. These results may be beneficial in the management of ovarian carcinoma patients with elevated CA125 levels.

May cathepsin D immunoreactivity be used as a prognostic factor in endometrial carcinomas? A comparative immunohistochemical study.

OBJECTIVE: To investigate the prognostic value of immunohistochemical detection of cathepsin D and the association between cathepsin D and established prognostic factors in endometrial carcinoma. METHODS: Cathepsin D immunoreactivity was determined by an immunohistochemical technique in a series of 79 patients with surgical stage I-III primary endometrial carcinoma. RESULTS: Of 79 tissue specimens, 48 (61%) showed a positive reaction for cathepsin D. A significant correlation between cathepsin D and histological grade was found (P < 0.05). The other established clinicopathological prognostic factors were not associated with cathepsin D. There was not any significant difference in prognosis between the positive cases and negative cases for cathepsin D (P > 0.05). In the univariate analysis cathepsin D immunoreactivity did not show significant prognostic value for overall survival (P > 0.05). The multivariate analysis also showed that cathepsin D was not related to patient outcome (P = 0.24, relative risk = 0.34, 95% confidence interval = 0.05-2.09). CONCLUSIONS: Our results suggest that cathepsin D immunoreactivity may not be of prognostic value but more studies are needed to evaluate the relationship between its immunoreactivity in tumor cells and in other cells.

Omentectomy, peritoneal biopsy and appendectomy in patients with clinical stage I endometrial carcinoma.

The aim of this study was to evaluate whether omentectomy, appendectomy, and peritoneal biopsy should be a routine part of staging surgery in endometrial carcinoma. Data of 97 patients who had been diagnosed with clinical stage I endometrial carcinoma were reviewed. Associations in the data obtained, pelvic and para-aortic lymph node status, depth of myometrial invasion, grade, and histology were investigated. The chi-square (chi2) test was used for statistical analysis. Of 97 patients, six (6%) had omental metastases, which was microscopic in four. There was a statistically significant relationship between omental metastasis and tumor grade (P < 0.01). Deep myometrial invasion was significantly more common in patients with omental metastases. Tumor was found in one of 55 appendectomy specimens (2%). Omentectomy may be included in surgical staging in patients with deeply invasive or grade 3 endometrial cancer because of the possibility of omental metastasis in spite of what appears to be stage I disease in laparotomy. In other cases, omentectomy and appendectomy and biopsies from peritoneal sites should be performed in the presence of grossly suspicious disease.

Accuracy of ovarian reserve tests.

Several tests predict ovarian reserve in women undergoing assisted reproductive technologies. However, the accuracy of these tests in assessing the number of the remaining follicles within the ovary (ovarian reserve) has not been previously validated. The aim of this study was to assess the accuracy of ovarian reserve tests, namely basal and clomiphene-stimulated follicle stimulating hormone (FSH) concentrations and gonadotrophin-releasing hormone (GnRH) agonist stimulation test in predicting the number of the follicles within the ovaries. The ovaries of 22 parous women over 35 years of age who underwent oophorectomy were examined histologically for follicle number. Early follicular phase serum FSH, clomiphene citrate challenge tests (CCCT) and GnRH agonist stimulation test (GAST) were performed in the menstrual cycle prior to the surgery. The predictive value of these tests was then assessed. A positive correlation was detected between basal serum oestradiol concentrations and follicles per unit tissue but no significant correlation was detected between basal and clomiphene-stimulated FSH and follicles per unit tissue. The receiver operator characteristic curves indicated that the clomiphene citrate challenge test was the most accurate of the three tests assessed. In conclusion, none of the tests in this study accurately reflects ovarian reserve.

Estrogen and progesterone receptor manipulations in castrated rat uterus models and the clinical adaptation.

To investigate the influence of tamoxifen, danazol and triptorelin (a GnRH agonist) on estrogen and progesterone receptors of rat endometrium, 44 castrated Sprague-Dawley rats were divided into four equal groups, and each group received either no treatment or one of the agents. After administration of the agents, estrogen and progesterone receptor levels, detected by immunohistochemical methods, were compared with the controls. Estrogen and progesterone receptors were significantly higher in the tamoxifen group than the controls (p<0.05), but this was not noticed in the triptorelin group (p>0.05). Receptor levels were higher in the danazol group than the controls, but it was significant only in the estrogen receptors. Among the 3 groups, receptor levels were higher than in the control group. There was not any correlation among the estrogen and progesterone receptor levels in all groups. Steroid receptor manipulations can be used in the treatment of gynecologic cancer, but further investigations are needed.

Borderline ovarian tumours: retrospective analysis of twenty-one cases.

Twenty-one borderline ovarian tumour cases, diagnosed and treated in our oncology section between 1986 and 1996, were retrospectively analysed. Thirty-three percent of the cases had serous tumours and the rest (66.6%) were mucinous, 57.1% of the mucinous tumours were the intestinal type and the remaining 42.9% were the endocervical type. When all the cases were analysed, the average age was 45.4+/-18.6 years, the average follow-up period was 5.5+/-2.6 years. The preoperative average CA125 level was 55.1+/-51.9 U/mL, and for CA19.9 it was 48.2+/-47.8 U/mL. Of the patients 85.7% were stage I and 14.3% state III. There were not any significant differences between the serous, intestinal-type mucinous and endometroid-type mucinous tumours regarding tumour volumes (p>0.05). When serous and mucinous tumours were compared according to the tumour markers, CA125 levels were significantly higher in the serous tumours (p=0.04) and CA19.9 levels were significantly higher in the mucinous tumours (p=0.02). All of the patients are under our follow-up and are in remission, except one, who died in the third year of the treatment because of chronic renal failure unrelated to the ovarian pathology.

PIP: Tumors of low malignant potential represent approximately 15% of epithelial ovarian tumors and tend to occur at a younger age than malignant neoplasia. This paper presents a retrospective analysis of the 21 borderline ovarian tumors diagnosed and treated at Dokuz Eylul University in Izmir, Turkey, in 1986-96. The average age at presentation was 45.4 +or- 18.6 years. The diagnosis was made by exploratory laparotomy and frozen section. 7 tumors (33.3%) were serous and 14 (66.6%) were mucinous. 8 borderline mucinous tumors (57.1%) were intestinal type and 6 (42.9%) were endocervical. The average preoperative cancer marker level was 55.1 +or- 51.9 U/ml for CA125 and 48.2 +or- 47.8 U/ml for CA19.9. CA125 levels were significantly higher in serous tumors (p = 0.04) while CA19.9 measurements were significantly higher in mucinous tumors (p = 0.02). 18 tumors (85.7%) were stage I and 3 (14.3%) were stage III. There were no significant differences in tumor volume between serous, intestinal-type mucinous, and endometroid-type mucinous tumors. Women with stage I tumors who wanted to preserve their fertility underwent unilateral salpingo-oophorectomy; total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed in the remaining cases. Women with stage III tumors received 6 rounds of first-line adjuvant chemotherapy followed by second-look laparotomy. 1 patient died in the third year of treatment as a result of chronic renal failure unrelated to the ovarian pathology; the remaining women, who have been followed an average of 5.5 +or- 2.6 years, are in remission.

Pelvic and periaortic pertioneal closure or non-closure at lymphadenectomy in ovarian cancer: effects on morbidity and adhesion formation.

The effects of pelvic and periaortic peritoneal closure or (non-closure) on morbidity and adhesion formation were prospectively compared in 102 patients with ovarian cancer who had undergone a pelvic and periaortic lymphadenectomy. Hysterectomy with bilateral salpingoophorectomy, bilateral pelvic and periaortic lymphadenectomy, omentectomy, appendectomy and lysis of pelvic adhesions for the standardization of initial adhesion scores was performed on all patients. The pelvic and periaortic peritoneum were re-approximated in group I (n = 50) patients, and left open in group II (n = 52) patients. The groups were similar for mean age, previous surgery, tumour histology and disease stage. Morbidity characteristics such as blood loss, transfusion rate, post-operative infectious and non-infectious complications, and total hospital stay were also similar. After six courses of PAC (cisplatin 50 mg/m(2), Adriamycin 50 mg/m(2), cyclophosphamide 500 Mg/M(2)) chemotherapy, all patients underwent a second-look laparotomy. Persistent cancer was detected in 49 of 102 (48.03%) patients. Adhesion scores were detected at the time of second-look laparotomy. Adhesion scores for group I (8.9 +/- 2.9) were significantly higher than the group II (peritoneum non-closure) (5.8 +/- 2.3) (P<0.01). Closing the pelvic and periaortic peritoneum did not effect morbidity, but leaving the pelvic and periaortic peritoneum open significantly decreased the adhesion formation.

Gentamicin excretion and uptake from breast milk by nursing infants.

OBJECTIVE: To investigate the excretion of gentamicin into human breast milk and resulting serum gentamicin levels in nursing newborn infants. METHODS: Women delivered by cesarean received gentamicin, 240 mg/day (80 mg intramuscularly three times a day) for 5 days postpartum. On day 4, maternal serum samples were collected 1 and 7 hours after gentamicin administration. Milk samples were collected 1, 3, 5, and 7 hours following administration. The infants were fed 1 hour after gentamicin administration, and serum samples were collected from the newborns 1 hour later. The concentrations of gentamicin were measured by a fluorescence polarization immunoassay. RESULTS: The mean (+/- standard deviation) maternal serum gentamicin levels at 1 and 7 hours were 3.94 +/- 1.12 and 1.02 +/- 0.78 microgram/mL, respectively. Milk gentamicin levels were: 0.42 +/- 0.26, 0.48 +/- 0.17, 0.49 +/- 0.17, and 0.41 +/- 0.25 microgram/mL at 1, 3, 5, and 7 hours, respectively. The mean milk:plasma gentamicin ratios were 0.11 and 0.44 at 1 and 7 hours, respectively. The correlation between maternal peak serum levels and milk levels was not statistically significant (P > .05). Detectable (above 0.27 microgram/mL) gentamicin levels were found in five of the ten newborn serum samples, with a mean level of 0.41 +/- 0.05 microgram/mL. CONCLUSION: Gentamicin is transferred into breast milk, and half of nursing newborn infants have detectable serum gentamicin levels.

Plasma copper, zinc and magnesium levels in patients with premenstrual tension syndrome.

We measured plasma Cu. Zn and Mg levels in 40 women suffering from premenstrual tension syndrome (PMTS) and in 20 control subjects by atomic absorption spectrophotometer. Mean plasma Cu, Zn and Mg levels, the Zn/Cu ratio were 80.2 +/- 6.00 micrograms/dl, 112.6 +/- 8.35 micrograms/dl, 0.70 +/- 0.18 mmol/l, and 1.40 +/- 0.10 in the PMTS group; and 77.0 +/- 4.50 micrograms/dl, 117.4 +/- 9.50 micrograms/dl, 0.87 +/- 0.10 mmol/l, and 1.51 +/- 0.05 in the control group respectively. The mean Mg level and the Zn/Cu ratio were significantly lower in PMTS patients than in the control group. Plasma Mg and Zn levels were diminished significantly during the luteal phase compared to the follicular phase in PMTS group. Mg deficiency may play a role in the etiology of PMTS.

Maternal, fetal and amniotic fluid prolactin levels in term and post-term pregnancies.

Prolactin (PRL) levels in maternal serum, amniotic fluid and mixed cord blood from 11 women with post-term pregnancies and 64 women with normal term pregnancies were measured by immunoenzymetric assay in order to investigate their possible role in the onset of labor. No differences were found between term and post-term pregnancies, and it is concluded that PRL probably has no function in triggering labor.

Diagnostic value of magnetic resonance imaging in gynaecology.

In this study 23 patients with various gynaecological pathologies were evaluated. Ultrasonography and magnetic resonance imaging were performed in all cases, but only 14 were evaluated with computed tomography. On the basis of ultrasonography, 4 patients were labelled as having malignant ovarian tumours, however, this diagnosis was confirmed by magnetic resonance imaging in only 1 of the 4. Magnetic resonance imaging also determined the correct diagnosis in a patient with endometrioma whereas computed tomography showed only a simple cyst, and ultrasonography diagnosed a subserous myoma. Tumour was demonstrated by magnetic resonance imaging in 2 patients with cervical carcinoma although computed tomography and ultrasonography had previously shown no tumour mass in these patients. It was concluded that magnetic resonance imaging is much superior to computed tomography and ultrasonography in gynaecological diagnosis. This advantage results from the correct detection of the contents of ovarian cysts, the number and localization of uterine leiomyomas in T2 scans, invasion of uterine malignancies and differential diagnosis of subserous uterine leiomyomas from ovarian tumours.

Prolactin and amniotic fluid electrolytes.

Prolactin (PRL) levels and Na+, K+, Cl-, Ca++ concentrations in maternal serum and amniotic fluid from 64 women in normal term pregnancy were measured by immunoenzymetric assay and flame photometry. The mean amniotic fluid PRL concentration was 597.7 (SE 31.5) ng/ml and the mean amniotic fluid Na+, K+, Cl- and Ca++ levels were 125.6 (SE 0.9) mmol/l, 4.5 (SE 0.1) mmol/l, 109.3 (SE 1.3) mmol/l and 2.0 (SE 7.5 E-02) mmol/l, respectively. There was no correlation between PRL levels in maternal serum and amniotic fluid, and the electrolyte concentrations in amniotic fluid. A close correlation was found between the concentrations of Na+ and Cl- in maternal serum and amniotic fluid. Thus, even though PRL may participate in the regulation of electrolytes in the amniotic fluid compartments, our findings provide indirect evidence for the existence of other regulatory mechanisms.

Reproductive failure and antisperm-antibody production among prostitutes.

Reproductive failure and anti-sperm antibody (ASA) production among prostitutes were investigated. A questionnaire including the subject's age, years of prostitution, date of most recent birth, number of children and contraceptive method used at the beginning of prostitution were asked of 109 prostitutes, but only 53 agreed to complete the questionnaire. ASA was detected by ELISA in the prostitutes (n = 109) and in the control group (n = 40) sera. The tests revealed a high ASA rate (43.1%) among the prostitutes. The difference in the incidence of ASA between controls (5%) and the prostitutes (43.1%) was highly significant (p less than 0.01). It was found that ASA positivity incidence in 27 prostitutes who had never use any contraception method and who became infertile within 9.3 years (average) was 61.3%. These results may be explained by repeatedly inoculations with multiple sperm antigens and/or microorganisms.

PIP: Health workers at the National Health Centre Laboratories in Izmir, Turkey took blood samples from 109 prostitutes to test for antisperm antibodies (ASA) and for Treponema pallidum (the causative agent for syphilis). Researchers analyzed the results to determine the role of ASA incidence in reproductive failure. 40 fertile women who were not prostitutes comprised the control group. Significantly more prostitutes (43.1%) tested positive for ASA than did the controls (5%) (p.01). 53 prostitutes tested positive for T. pallidum. T. pallidum positive women were slightly more likely to also be ASA positive women were slightly more likely to also be ASA positive than T. pallidum negative women (49.1% vs. 37.5%) (p.05). 27 (51%) prostitutes did not use any contraception. ASA incidence for these women stood at 61.31% compared to only 28.3% for the control group (p.01). 23 of these women had had children, but the last birth occurred on average 9.3 years prior to the study. It was significant that these 23 women had not used any contraception since the last birth. Mean length of prostitution stood at 9.6 years. Of the prostitutes who did use contraception, most (24.5% of all prostitutes) used oral contraceptives. The researchers could not determine if the prostitutes who used contraception would have also become infertile if they did not use contraception. In conclusion, repeated exposure to multiple sperm antigens and/or microorganisms may explain the high incidence of ASA and reproductive failure among prostitutes.