Non-Metastatic Pelvic Ewing's Sarcoma : oncologic outcomes and evaluation of prognostic factors.

We are reporting our experience on patients with -pelvic Ewing's Sarcoma treated in our unit. We retrospectively reviewed a series of patients with non-metastatic pelvic Ewing's sarcoma treated between 1977 and 2009. Patients were classified into three groups according to the local treatment received : Group 1. radiotherapy-chemo ; Group 2. surgery-chemo and Group 3. radiotherapy-surgery-chemo. Recurrence free and overall survival rates were calculated using the Kaplan-Meier method. Influence of various factors (age at diagnosis, gender, tumour site and size, chemotherapy response, surgical margins and type of treatment) on survival was assessed with a logistic regression model. A total of 85 patients were treated with a mean follow-up of 65.8 months and mean -tumour volume of 435ml. The 5-year survival for all patients was 40.7% decreased to 36.2% at 10 years. A significant prognostic factor identified was chemotherapy response only. There was a trend for improved survival and local control rates for patients who had chemotherapy and surgery and the results were apparent for all tumours irrespective of size but not statistically significant. Currently, the optimal management of pelvic Ewing's sarcoma is contro-versial but our study shows a trend for improved -survival for patients treated with chemotherapy and surgery.

The effects of delayed hormone replacement therapy on estrogen receptors of the cynomolgus monkey bladder and vagina.

The aim of this study was to determine cytosolic estrogen receptor content of the cynomolgus monkey bladder and vagina after hormone replacement therapy. Animals maintained without hormone therapy for 2 years after surgical menopause were randomized to receive either no hormones (OVX), conjugated equine estrogens (CEE), or estrogen/medroxyprogesterone acetate (CEE + MPA) treatment for 30 months. Estrogen receptor content of bladder and vagina cytosolic extracts was determined using a commercial enzyme-linked immunosorbent assay. Estrogen receptors were uniformly present, although the vaginal concentration was 100-fold greater than in the bladder. Estrogen and combination therapy significantly decreased cytosolic receptor content in both sites compared with controls. The cynomolgus urogenital tract remains estrogen sensitive 2 years after surgical menopause. Prolonged exposure to estrogens decreases cytosolic estrogen receptor content in a manner similar to that described for short-term estrogen therapy. These results suggest that the effects of hormone replacement on the urinary tract can be identified even if initiated years after menopause.

Combining probabilistic and subjective assessments of error to provide realistic appraisals of demographic forecast uncertainty: Alho's approach.

"With increasing interest in forecast uncertainty, there is an evolving concern with assessing the degree of certainty we can attach to uncertainty itself. This concern is the subject of recent work by Juha Alho.... I examine [his] approach systematically and draw general conclusions about its efficacy. Suggestions for improvement are made."

Conducting a practice management review.

A practice management review can be used by a physician practice to identify problems within the practice, introduce operational improvements, and ensure that the practice is being run as profitably and efficiently as possible. Such a review involves scrutiny of nearly every aspect of a practice's operations--from reimbursement to personnel issues. Before deciding to have a practice review performed, the practice's management team must establish objectives for the review and must ensure that physicians and practice staff understand the review process. Once the review process is initiated, the steps that must be taken to identify and diagnose problems within a practice include conducting interviews, collecting data, analyzing data, and suggesting remedies.

Modeling and forecasting U.S. sex differentials in mortality.

"This paper examines differentials in observed and forecasted sex-specific life expectancies and longevity in the United States from 1900 to 2065. Mortality models are developed and used to generate long-run forecasts, with confidence intervals that extend recent work by Lee and Carter (1992). These results are compared for forecast accuracy with univariate naive forecasts of life expectancies and those prepared by the Actuary of the Social Security Administration."

Social inequality of stroke mortality among US black populations, 1968 to 1987.

Though the rate of stroke mortality in the United States has been declining for all race-sex-specific groups, rates for blacks are among the highest in the world. Studies of the geographic and social variation of stroke mortality between populations have focused solely on either trends or social determinants, but not on both. In addition, conclusions have concentrated on the comparison of whites to nonwhites. The purpose of this study was to investigate the variation in stroke mortality trends, from 1968 to 1987, between US black populations categorized by the socioeconomic structure of the state economic area. The educational achievement profile of the population (percentage of the state economic area that had not completed high school) was used as an indicator of socioeconomic development. This aggregate study assessed whether (1) an inverse relationship existed between stroke mortality and educational achievement category, and (2) levels and trends of stroke mortality by educational achievement category varied from 1968 to 1987, for each age-gender-specific group (35 to 64, 65 to 74, and 75 to 84 years). Results showed an inverse relationship between educational achievement level of communities and stroke mortality, as well as a rank-ordering in level of educational achievement for all age-gender-specific groups. The absolute difference in rates among educational achievement levels clearly converged over time, with greater convergence in the period 1968 to 1978 than 1979 to 1987. The percent declines were similar across education categories. Results suggest that geographic inequalities in stroke mortality, in relation to socioeconomic structure, have converged over time.(ABSTRACT TRUNCATED AT 250 WORDS)