Clinical outcome and risk factors for recurrence in borderline ovarian tumours.

We investigated the long-term prognosis of borderline ovarian tumours and determined risk factors for recurrence. One hundred and twenty-one borderline ovarian tumours treated between 1994 and 2003 at the participating institutions in the Tohoku Gynecologic Cancer Unit were retrospectively investigated for clinical stage, histopathological subtype, surgical technique, postoperative chemotherapy, the presence or absence of recurrence, and prognosis. The median follow-up period was 57 months (1-126 months). One hundred and nine cases (90.6%) were at clinical stage I. The histopathological subtypes consisted of 91 cases of mucinous tumour (75.2%), 27 cases of serous tumour (22.3%), and three cases of endometrioid tumour. Conservative surgery was used in 53 cases (43.8%), radical surgery in 68 cases (56.2%), a staging laparotomy in 43 cases (35.5%), and postoperative adjuvant therapy in 30 cases (24.8%). Recurrence was found in eight cases, but no tumour-related deaths were reported. Although no significant difference in disease-free survival rate was seen between different clinical stages, the difference in disease-free survival rate between serous and non-serous (mucinous and endometrioid) types was significant (P<0.05). The 10-year disease-free survival rate was 89.1% for the radical surgery group and 57.4% for the conservative surgery group -- this difference was significant (P<0.05). In the conservative surgery group, cystectomy and serous tumour were independent risk factors for recurrence. Although recurrence was observed, the long-term prognosis of borderline ovarian tumour was favourable, without tumour-related deaths. Considering the favourable prognosis, conservative surgery can be chosen as far as the patient has a non-serous tumour and receive adnexectomy. However, in cases of serous type and/or receiving cystectomy special care should be given as relative risk rates of recurrence elevate by 2-4-folds.

Nutritional and mental health status of Afghan refugee children in Peshawar, Pakistan: a descriptive study.

The study sought to ascertain and describe the physical and mental health states of Afghan refugee children after the terrorist attack on September 11, 2001 in the US and the aerial bombing of Afghanistan that followed. A cross-sectional survey was carried out in four refugee camps in Peshawar, Pakistan from February to March 2002, and comparisons among camps were made. A total of 70 males (mean age SD = 9.81 +/- 1.98 years old) and 30 females (7.94 +/- 2.07) answered a self-developed questionnaire on demographic data, traumatic events experience, living environment in the camps, and physical and mental health, through interviews. Anthropometric measures were measured and physical symptoms including anaemia and edema were assessed. Severe malnutrition was not shown and there were no significant differences in most nutritional and physical states among the camps. Nevertheless, in the newer camps more children experienced war related traumatic events. Mental symptoms were prevalent in all camps, though the characteristics of the symptoms differed among the camps.

Sebaceous adenoma in the retromolar region: report of a case with a review of the English literature.

This paper reports a rare case of sebaceous adenoma on the right mandibular retromolar mucosa in a 73-year-old Japanese man, with a review of the English literature of sebaceous adenomas of salivary gland origin. A painless and yellowish polypoid lesion in the retromolar mucosa was histologically a relatively well-circumscribed neoplastic mass composed of well-differentiated sebaceous cells with cystic and duct-like structures, and was considered to be a true sebaceous gland neoplasm arising from the minor salivary gland tissue.

Telomerase activity and apoptosis as indicators of ageing in placenta with and without intrauterine growth retardation.

Telomerase activity (TA) and apoptosis were analysed in placenta with and without intrauterine growth retardation (IUGR). Thirty-one specimens were taken from chorionic villi in the first trimester (Group A), 32 placenta specimens were obtained from cases without IUGR in second and third trimester (Group B) and 12 specimens of placenta tissue were obtained from cases of asymmetric IUGR between 26 and 39 weeks of gestation (Group C). TA was analysed by the Telomeric Repeat Amplification Protocol (TRAP) and in situ TRAP assay. Apoptotic changes were assessed by immunohistochemical staining using Bcl-2 monoclonal antibody and by terminal transferase-mediated in situ end-labelling (TUNEL). TA was detected in 29 of the 31 (93.5 per cent) chorionic villi (Group A) and in 20 of the 32 (62.5 per cent) placenta without IUGR (Group B), whereas weak TA was observed in the placenta of all 12 asymmetric IUGR cases (Group C). Significantly higher Bcl-2 immunoreactivity was observed in trophoblastic cells of Group A (85.9+/-4.2 per cent) and Group B (72.8+/-7.2 per cent) than Group C (54.84+/-4.83 per cent), while TUNEL positive cells were identified at a significantly higher frequency in the trophoblastic cells of Group C (9.7+/-7.4 per cent) than Group A (1.1+/-1.9 per cent) or Group B (2.9+/-3.7 per cent).

Triple marker screening for trisomy 21, trisomy 18 and open neural tube defects in singleton pregnancies of native Japanese pregnant women.

OBJECTIVE: To report the results of prenatal triple marker screening on a population of Japanese pregnant women. METHODS: From April 1994 through March 1999, a total of 32,925 native Japanese women with singleton pregnancies requested a triple marker-screening test. Multiples of the median values for 3 markers and individual risks for each patient were calculated following adjustment for the Japanese weight correction factor. The risk cut-off values used for Down syndrome (T21), open spina bifida (OSB) and trisomy 18 (T18) were 1: 295, 1: 290, and 1: 100, respectively. Follow-up information was collected postpartum and statistically analyzed. RESULTS: Detection rates (DR) of T21 for women less than 35 years, over 35 years and overall were 58, 94, and 83%, respectively. DR of T18 for women less than 35 years, over 35 years and overall were 75, 79, and 79%, respectively. DR of open neural tube defects (ONTD) was 100%. CONCLUSIONS: The first cumulative data of an intervention program and prospective follow-up studies in Japan have proven to be similar to other published reports. Individual risk values were calculated for each pregnancy for T21, T18 and ONTD. This screening program is more effective than age-dependent screening for detecting T21, T18 and ONTD pregnancies.

Telomerase and proliferative activity in placenta from women with and without fetal growth restriction.

OBJECTIVE: To analyze telomerase and proliferative activity in placenta from women with and without fetal growth restriction (FGR). METHODS: Telomerase activity was analyzed in 30 first-trimester chorionic villi specimens (group A) and in 28 second- and third-trimester placenta specimens (group B) from women without FGR. Telomerase activity also was analyzed in 11 placenta specimens from women with asymmetric FGR (group C). The proliferative activity of these 69 specimens was assessed by immunohistochemical staining, using the MIB-1 monoclonal antibody. RESULTS: Telomerase activity was detected in 28 (93.3%) of 30 chorionic villi specimens and in 18 (64.3%) of 28 placenta specimens without FGR. In contrast, no telomerase activity was exhibited in the placenta specimens from any of the 11 women with asymmetric FGR by telomeric repeat amplification protocol assay. Telomerase activity also was detected by in situ telomeric repeat amplification protocol assay in trophoblastic cells from women without FGR but not in trophoblastic cells from women with asymmetric FGR. Thus, telomerase activity was detected significantly more often in groups A and B than in group C (P < .01). The rate of proliferative activity, evident as positive MIB-1 staining in trophoblastic cells, in groups A and B (28.1+/-1.7% and 7.0 +/-2.9%, respectively) was significantly higher than that in group C (1.9+/-0.6%; P < .01). CONCLUSION: Telomerase and proliferative activity were minimal in placenta from women with asymmetrical FGR, suggesting placental senescence with asymmetrical FGR.

Telomerase activity in human chorionic villi and placenta determined by TRAP and in situ TRAP assay.

Telomerase activity (TA) was analysed in human chorionic villi and placenta in normal and abnormal pregnancy using the telomeric repeat amplification protocol (TRAP) and in situ TRAP assay. Twenty chorionic villi specimens and 25 placenta specimens from normal pregnancies were examined as well as placenta specimens from 10 cases of intrauterine growth retardation (IUGR; nine asymmetric and one symmetric). TA was detected in 18 of the 20 (90 per cent) chorionic villi specimens and in 18 of the 25 (72 per cent) placenta specimens from normal pregnancy. However, no or only weak TA was exhibited in the placenta specimens of the nine asymmetric IUGR cases. In situ TRAP assay detected TA in trophoblastic cells from normal pregnancy, but not in trophoblastic cells from cases of asymmetric IUGR.

Effect of rolling bed on decubitus in bedridden nursing home patients.

Decubitus is one of the most difficult management problems encountered in bedridden elderly patients. Relief of pressure over decubitus is the most important principle of the management. We developed a rolling air cushion bed which turns the patient to a 15-degree inclined lateral position with an inflating ripple mattress, a longitudinally aligned air inflatable tube. The position of the patients was changed between right and left laterals and to supine every 15 minutes automatically. Nineteen bedridden patients with decubitus used the rolling air cushion bed for 3 months and 12 bedridden patients with decubitus used a conventional bed and had their position changes every 2 hours by care givers. Severity of decubitus was divided into 4 grades and the decubitus significantly improved from 2.8 (S.E. 0.2) to 2.0 (S.E. 0.3) after 3 months in patients using the rolling air cushion bed, while in patients with conventional beds it changed from 3.0 (S.E. 0.2) to 3.2 (S.E. 0.2) (not statistically significant). We suggest that the rolling air cushion bed would be beneficial to decubitus relief in bedridden elderly and may relieve labor by care givers.

Comparative cytogenetic studies of benign, borderline, and malignant epithelial ovarian tumors.

Comparative cytogenetic studies were performed in 40 cases of untreated epithelial ovarian tumors. Of these 40 tumors, 13 were classified as benign, 3 as borderline, and 24 as malignant, according to the WHO classification for ovarian tumors. Of 13 benign ovarian tumors, 4 (30.8%) showed chromosomal abnormalities. Of 4 ovarian tumors, 3 (75%) had single chromosomal abnormalities, and the remaining tumor (25%) retained multiple chromosomal abnormalities. Of 3 borderline-malignant ovarian tumors, 2 (66.7%) showed chromosomal abnormalities. Of 2 ovarian tumors, 1 (50%) indicated single chromosomal abnormalities, and the remaining tumor (50%) revealed multiple chromosomal abnormalities. Of 24 malignant ovarian tumors, 20 (83.3%) showed chromosomal abnormalities. Of these 20 ovarian tumors, 3 (15%) had single chromosomal abnormalities, and the other 17 (85%) exhibited multiple chromosomal abnormalities. These data indicate that the rate of chromosomal abnormalities, especially multiple abnormalities, increases following the progression of malignancy in epithelial ovarian tumors.

Numerical and structural chromosome abnormalities in an ovarian fibrothecoma.

Cytogenetic analysis of a fibrothecoma of ovary revealed numerical and structural chromosome abnormalities, i.e., 44,XX, dup(1)(p13p31),del(3)(p14) add (10p), -16, -22. This is the first report of numerical and structural abnormalities in a fibrothecoma of the ovary.

[A case of giant bronchogenic cyst complicated with postoperative esophageal perforation].

A 42-year-old man with giant bronchogenic cyst occupied from the middle and posterior mediastinum was treated surgically. The tumor was stoutly adhered to anterior aspect of the esophagus and membranous portion of the right bronchus. In dissecting the tumor, muscular coat of the esophagus was partly severed, which was repaired interruptedly with absorbable suture material. However, esophageal perforation was detected by barium swallow on the 3rd postoperative day. Conservative therapy included intrathoracic drainage and antibiotics was successfully undertaken. It is imperative to dissect the tumor very carefully if the giant bronchogenic cyst adheres to the esophagus or other surrounding organs.

Use of bromodeoxyuridine, proliferating cell nuclear antigen, and nucleolar organizer regions in the multiparametric assessment of proliferating potency in cervical intraepithelial neoplasia.

The authors analysed of the proliferative activity of intraepithelial neoplasia of the cervix utilizing the labeling index of monoclonal antibody to Bromodeoxyuridine (BrdU) or proliferating cell nuclear antigen (PCNA), and the number of Nucleolar organizer regions (Ag-NOR). The BrdU labeling index (B.L.I.) for normal squamous epithelium, mild dysplasia, and moderate dysplasia were significantly lower than for severe dysplasia or carcinoma in situ. The PCNA labeling index (P.L.I.) for normal squamous epithelium, mild dysplasia, and moderate dysplasia were significantly lower than for severe dysplasia or carcinoma in situ. The number of Ag-NOR dots of normal squamous epithelium and mild dysplasia were lower than those of severe dysplasia or carcinoma in situ. There are significantly positive correlations of the B.L.I., P.L.I., and the number of Ag-NORs in cervical intraepithelial neoplasia.

[Cell cycle analysis of endometrial cancer cells in vitro treated with growth factor and steroid hormone].

The aim of this study was to overtake the mechanism of the control system in endometrial cancer cell line in vitro. Ishikawa cell (IK cell) and HEC-1 cell (HEC cell) derived from endometrial cancers were cultured with serum free medium (SFM-101). IK cell possessed Estrogen receptor (ER), Progesterone receptor (PR), Epidermal growth factor (EGF) and its receptor (EGFR). HEC cell had PR, EGF, and EGFR, however HEC cell did not keep ER. EGF stimulated the growth of IK cell, but the growth of HEC cell was not stimulated by EGF. S phase cells were increased by EGF in IK cell, but were not increased by EGF in HEC cell. The growth of IK cell was stimulated significantly by EGF and Estradiol-17 beta (E2) +EGF than control. However, E2+EGF did not stimulate the growth of IK cell than EGF significantly. Danazol (D) and D+EGF inhibited the growth of IK cell significantly than control. S phase cells were decreased by the treatment of D and D+EGF. From our results, EGF stimulated the growth of ER positive endometrial cancer cell, but EGF did not stimulate ER negative endometrial cancer cell. E2+EGF and EGF stimulated the growth of IK cell as a same. However, D inhibited the growth of IK cell that was stimulated by EGF.

[Analysis of DNA synthetic cells in endometrial carcinoma cases treated with progestogen].

It is well known that the proliferation of endometrial adenocarcinoma is inhibited by progestogens. We often use medroxyprogesterone acetate (MPA) as endocrine therapy for advanced endometrial carcinoma. In the present study, we administered 400-600mg of MPA/day on 14 days as a progestogen challenge test (PCT) to 37 cases of endometrial carcinoma. We analysed the variation in the percentage of S phase cells by flow cytometry and also conducted an immunohistochemistry analysis with anti-BrdU monoclonal antibody before and after the administration of MPA. The percentage of S phase cells in endometrial carcinoma tended to decrease with much greater variation after PCT than before. The percentage of BrdU positive cells tended to decrease after PCT. The cases with a good histological effect such as 1) basal vacuolization 2) clear staining cytoplasm 3) homogenus finding of cells and nucleus by PCT had a better prognosis than the cases with no histological effect due to PCT.

Methods for volume assessment of an air filled compliance chamber.

The air-filled (120 ml) compliance chamber employs a Dacron covered Hexsyn-butyl bilaminar diaphragm to minimize gas diffusion. Finite permeability dictates the need for a means to detect the remaining air volume and a refill port for gas addition. X-ray studies were used to detect radiopaque chamber markers in cadavers. Tangential X-ray cinematography enabled detection of chamber volumes less than 100 ml and diaphragm center deflection predicted volume to within +/- 6 ml of the actual volume. An electrically driven left ventricular assist pump (90 cc) was used to evaluate motor current (MC) and intracompliance pressure (IP) as indicators of low compliance volume. Peak MC was a function of both hemodynamic output power and compliance volume. Thus, if the peak current for a given hemodynamic output is known, variances may be indicative of low compliance volumes. The cyclic minimum IP vs. volume was +1, -3, and -13 mmHg for compliance volumes of 120, 90, and 80 cc, respectively. Ejection velocity did not significantly affect IP. In conclusion, X-ray studies and MC are useful as noninvasive means of assessing the need for compliance refill. IP, though measured invasively, is the most sensitive volume-dependent parameter.

Diagnosis of benign and malignant cervical specimens by multifiberoptic microspectrophometry and by flow cytometry.

Two techniques for the automation of mass screening for cervical cancer were studied. Microspectrophotometry was tried first, using a novel multifiberoptic scanning system that measured the nuclear size and DNA content of cells in routine smears restained by the Feulgen technique. Specimen diagnoses were based on the percentages of cell types present, as determined by thresholds set for the two parameters. While this method gave good results in the automated detection of severe dysplasias and carcinomas, with only 3 of 72 cases misdiagnosed as negative (4.2%), it had a 22.9% false-positive rate (misdiagnosing 24 of 105 "benign" cases) and a 30.3% false-negative rate for adenocarcinomas (10 of 33 cases misclassified). The second approach involved flow cytometric measurements of specimens that were double stained for the assessment of both the DNA and RNA content, with the results analyzed by preset windows in a two-dimensional plane. This technique gave a 6.1% false-negative rate in 49 positive specimens and a 32.3% false-positive rate in 102 benign specimens, with an overall correct classification rate of 76.2%, including adenocarcinomas.

[Cell kinetic effects of cis-platinum on cancer cells in a culture system and in cases of cervical cancer using monoclonal antibody of BrdU].

Flow cytometric analyses were done in cervical squamous cell carcinoma cell line (SKG-IIIa) and in cancer cells of cervical cancer cases treated with CDDP using monoclonal antibody of BrdU. 1) In fundamental studies using culture system, accumulation of late S phase cells and of mid S phase cells was observed after 48 hours at the dose of 0.2 micrograms/ml and 0.5 micrograms/ml of CDDP, respectively. 2) Accumulation of early S phase cells was observed at the condition of 1 microgram/ml and 3 micrograms/ml of CDDP. All S phase cells decreased gradually thereafter 3) In clinical studies, accumulation of early S phase cells was observed in cancer cells of cervical cancer cases after intra-arterial infusion of CDDP. However, cell cycle recycling was observed in tumor cells which retained their low sensitivity to CDDP after 21-day treatment with intra-arterial infusion of CDDP.