Cropland intensification mediates the radiative balance of greenhouse gas emissions and soil carbon sequestration in maize systems of sub-Saharan Africa.

Sub-Saharan Africa (SSA) must undertake proper cropland intensification for higher crop yields while minimizing climate impacts. Unfortunately, no studies have simultaneously quantified greenhouse gas (GHG; CO2 , CH4 , and N2 O) emissions and soil organic carbon (SOC) change in SSA croplands, leaving it a blind spot in the accounting of global warming potential (GWP). Here, based on 2-year field monitoring of soil emissions of CO2 , CH4 , and N2 O, as well as SOC changes in two contrasting soil types (sandy vs. clayey), we provided the first, full accounting of GWP for maize systems in response to cropland intensifications (increasing nitrogen rates and in combination with crop residue return) in SSA. To corroborate our field observations on SOC change (i.e., 2-year, a short duration), we implemented a process-oriented model parameterized with field data to simulate SOC dynamic over time. We further tested the generality of our findings by including a literature synthesis of SOC change across maize-based systems in SSA. We found that nitrogen application reduced SOC loss, likely through increased biomass yield and consequently belowground carbon allocation. Residue return switched the direction of SOC change from loss to gain; such a benefit (SOC sequestration) was not compromised by CH4 emissions (negligible) nor outweighed by the amplified N2 O emissions, and contributed to negative net GWP. Overall, we show encouraging results that, combining residue and fertilizer-nitrogen input allowed for sequestering 82-284 kg of CO2 -eq per Mg of maize grain produced across two soils. All analyses pointed to an advantage of sandy over clayey soils in achieving higher SOC sequestration targets, and thus call for a re-evaluation on the potential of sandy soils in SOC sequestration across SSA croplands. Our findings carry important implications for developing viable intensification practices for SSA croplands in mitigating climate change while securing food production.

The role of p27 in endometrial carcinoma.

OBJECTIVE: The cyclin-dependent kinase inhibitor p27 has been shown to mediate cell growth arrest in response to various environmental stimuli. p27 protein levels have shown prognostic value in several different types of cancer. We examined the prognostic value of p27 protein expression in endometrial cancer, the most common gynecologic malignancy. METHODS: A total of 95 paraffin-embedded tumor blocks were obtained and stained via immunohistochemical techniques with a monoclonal antibody against p27. Ten high-power fields were evaluated per slide with at least 1000 cells per slide and two slides per specimen evaluated by two reviewers for nuclear and cytoplasmic staining. The specimens were evaluated for associations with age, stage, grade, and histology. Statistical analysis was performed using the Student t test, chi(2) Kaplan-Meier, and likelihood ratios to assess the data and to generate P values. RESULTS: A total of 91 patients met inclusion criteria for statistical analysis. Fifty-three patients were stage I, 13 stage II, 14 stage III and 11 stage IV with a positive stain (>50% of cells) for p27 obtained in 32.1, 23.1, 35.7, and 36.4%, respectively (Student t test P = 0.77). Survival data were available on 24 advanced stage patients. p27 protein immunostaining showed no association with patient survival. We also found no association of p27 staining with age or histology. Notably, we found a trend in increasing staining with increase in grade, particularly with stage I patients. Also, there was an association of the nuclear and cytoplasmic staining and stage (P = 0.05), but it had no correlation with patient survival. CONCLUSION: Our study showed decreased p27 protein staining in endometrial cancers compared to normal endometrial cells. We found that p27 protein staining shows no association with stage, age, or histology and is not prognostic for survival in advanced endometrial cancers. However, there may be a trend associated with increased p27 protein staining with advanced grades of tumors.

Management of cervical cancer in pregnancy.

Carcinoma of the cervix is the most common gynecologic cancer found during pregnancy. Management and treatment of this condition depend on cancer stage, estimated gestational age, and ethical, religious, and personal desires. Review of the medical literature in English from 1965 to 1998 is presented with recommendations for management.

Hydropic degenerating leiomyoma presenting as pseudo-Meigs syndrome with elevated CA 125.

BACKGROUND: Leiomyomas rarely cause pseudo-Meigs syndrome. Increased levels of CA 125 often are associated with some types of malignancy. No reported case of pseudo-Meigs syndrome presenting with hydropic degeneration of uterine leiomyoma and an elevated CA 125 level could be found on a MEDLINE search. CASE: A 46-year-old woman presented with a pleural effusion and a pelvic mass measuring 30 x 18 cm. Preoperative evaluation was remarkable for a CA 125 level of 254 U/mL. At laparotomy, the diagnosis was a benign leiomyoma with focal hyaline and extensive hydropic degeneration. Her pleural effusion resolved completely by 4 months postoperatively. CONCLUSION: Pseudo-Meigs syndrome can present with an elevated CA 125 level.

Angiographic-guided embolization of metastatic invasive mole.

BACKGROUND: The friable and hypervascular nature of a metastatic invasive mole places the patient at risk for significant hemorrhage. Bleeding is the chief cause of morbidity and mortality in patients with a histopathological diagnosis of invasive mole. Bleeding from vaginal metastatic lesions can be controlled by packing the vagina and local excision if necessary. Often the results are less than satisfactory. CASE: This case describes a 43-year-old Hispanic female with metastatic invasive mole to the vagina. Following chemotherapy, she underwent life-threatening hemorrhage requiring hospitalization and multiple transfusions. The metastatic lesions were successfully embolized with gelfoam by selective angiography. The patient required minimal additional chemotherapy and is currently without evidence of disease. CONCLUSIONS: The technique of angiographic embolization is emerging as a successful and minimally invasive procedure as illustrated in this presentation. Prophylactic embolization with or prior to the administration of chemotherapy in the management of metastatic invasive mole is discussed and may play a role in the primary therapy of this condition.

The role of radioimmunoscintigraphy and computed tomography scan prior to reassessment laparotomy of patients with ovarian carcinoma. A preliminary report.

BACKGROUND: Accurate evaluation of patients with ovarian carcinoma who have completed primary therapy often requires surgical exploration. Radioimmunoscintigraphy (RIS) represents an evolving technique that may allow noninvasive detection and localization of persistent or recurrent disease in these patients. METHODS: Our prospective, blinded study enrolled patients with normal CA 125 levels and no clinical evidence of disease after primary cytoreductive surgery and cytotoxic chemotherapy for ovarian carcinoma. Each patient underwent RIS using Indium-satumomab pendetide (labeled antibody B72.3 to the tumor-associated antigen TAG-72) and abdominal/pelvic computed tomography (CT) prior to reassessment laparotomy. RESULTS: Twenty patients were enrolled from January 1994 to January 1995. Two patients with negative RIS scans refused reassessment laparotomy and were without evidence of disease > 15 months from the study. Twelve of the remaining 18 patients (66.7%) had histologically proven disease at reassessment laparotomy. RIS images indicated the presence of disease in all 12 patients, whereas CT scans detected disease in only 2 patients. In three of five patients, biopsy-proven microscopic disease (no gross disease at the time of laparotomy) was found only in specimens obtained by RIS-directed biopsies. RIS was superior to CT in sensitivity (100% vs. 16.7%), accuracy (72% vs. 33%), and negative predictive value (100% vs. 28.6%) (P < 0.005). CONCLUSIONS: Routine use of CT is of limited value in the assessment of ovarian carcinoma patients with negative physical examinations and normal CA 125 levels. With its high level of sensitivity and negative predictive value, RIS may play a role in the detection of persistent disease in this population and aid in the classification of patients into three distinct groups: those with gross residual disease, small volume or microscopic disease, and no disease. Separation of this heterogenous group without surgery may help guide subsequent consolidation therapy. However, attaining a high level accuracy with RIS, depends on optimizing the method of image acquisition, the timing of scans, and the reconstruction of data.

Efficacy of radical hysterectomy as treatment for patients with small cell carcinoma of the cervix.

BACKGROUND: This study was performed to identify pathologic and clinical features that best predict disease free survival of patients with early stage small cell carcinoma of the cervix treated by radical hysterectomy. METHODS: Three hundreds and seventy patients with cervical carcinoma were analyzed retrospectively to define those variable that best predict disease free survival (DFS). Variables included age, weight, race, marital status, economic status, tumor size, depth of invasion (DI), lymph-vascular space involvement (LVSI), cell type, tumor grade, lymph node metastasis (LNM), and total number of lymph nodes removed. Patients with lymph node metastasis, parametrial involvement, and positive or close surgical margins were offered postoperative radiation. RESULTS: Twelve patients were found to have small cell carcinoma (3.2%). One patient had microinvasive carcinoma of the cervix (MIC) as defined by the Society of Gynecologic Oncologists with a depth of invasion of 3 mm or less and no lymph-vascular space invasion, and has been reported previously. A detailed analysis of the other patients with nonsmall cell carcinoma is presented separately. Five patients achieved a DFS of at least 5 years, whereas 7 patients died with disease. Excluding the patient with MIC, the 5-year DFS rate was 36.4%. CONCLUSIONS: Relative to other cell types, small cell carcinomas of the cervix is an aggressive neoplasm with a higher rate of LVSI and LNM despite smaller DI and tumor size. These data suggest that multimodality therapy, combining radical surgery and radiation with cytotoxic chemotherapy, may provide these patients with the best chance for cure.

Traumatic vulvar hematomas. Assessing and treating nonobstetric patients.

Management of the vast majority of vulvar hematomas is conservative. Most resolve spontaneously when simple measures are taken. Serial examinations are necessary to distinguish uncomplicated hematomas from those requiring surgery. The clinician must also be vigilant for the possibility of sexual abuse and respond with appropriate workup and referral if this situation is suspected.

The Northwestern University Twin Study. VIII: On the causes and care of multiple pregnancy.

Recent clinical literature on the causes of twin pregnancy and specific areas of antenatal care are reviewed. Controversial aspects of clinical management are discussed.

The Northwestern University Twin Study. V: Twin deliveries at Prentice Women's Hospital and Maternity Center, 1978-83.

Two hundred fifty-one twin deliveries between January 1, 1978 and June 30, 1983 at Prentice Women's Hospital and Maternity Center were reviewed. Cases were excluded if birth weight was less than 500 g, if gestational age was less than 26 weeks or if an antenatal fetal demise had occurred. Maternal demographic characteristics, delivery data and infant characteristics are described. The effect of providing care to a high-risk population of mothers in whom approximately 60% either deliver their infants preterm or with a birth weight of less than 2,500 g is discussed in terms of costs of care.

Economic considerations in the use of laparoscopy for diagnosing pelvic inflammatory disease.

The clinical diagnosis of pelvic inflammatory disease (PID) is associated with an average accuracy rate of 65% when preoperative impressions are confirmed or rejected with laparoscopy. The cost of this error rate should be evaluated when considering the cost and risks of immediate laparoscopy in patients suspected of having PID. This study reviewed selected patient admissions for PID from Northwestern Memorial Hospital for the years 1981-1985. The costs of hospitalization and treatment and the inherent diagnostic error rate were considered concurrently. No significant additional expense would have been incurred if all the women admitted with a clinical diagnosis of PID had had laparoscopic verification of their clinical diagnoses as compared to the cost of treatment with intravenous antibiotics for three to five days. We recommend the early use of laparoscopy in establishing the diagnosis of PID because it ensures a more accurate and definitive diagnosis and does not add significantly to costs.

Generic drugs in reproductive medicine: is the value anticipated the value obtained?

PIP: Potential risks of prescribing generic drugs for oral contraception, ovulation induction and menopausal estrogen substitution are reviewed. In the U.S. all 50 states permit or require generic substitution, unless the prescription states otherwise. F.D.A. guidelines allow the bioavailability to range within 25%, i.e., the circulating level of drug in male test subjects after a single dose must be within + or - 25% of the range reported with the pioneer drug. Thus if a patient renews her prescription monthly she may receive a 50% range in dose level if different generics with both extremes in bioavailability are provided. Potential ranges for women, ill or elderly may vary even more. The potential risks for oral contraceptives are unwanted pregnancy, breakthrough bleeding, blood lipid elevation and less serious consequences such as minor side effects or confusion over package design. Risks for generic estrogen replacement include lack of protection from cardiovascular disease or osteoporosis and lack of therapeutic effect on menopausal symptoms; those from progestins are atherogenesis and failure to stop dysfunctional bleeding, ending in an unnecessary D & C. Possible sequelae of generics for ovulation induction are multiple pregnancy and ovarian hyperstimulation resulting in hospitalization for acute massive ovarian enlargement or rupture, as well as extra months of expense for treatment and monitoring. The most pressing concern is liability for the physician or pharmacist related to provision of generics. In most cases even 1 additional office visit for drug dose adjustment will obviate all savings accrued from taking generics.^ieng

SEM observations of an IUD from a patient with Actinomyces-like organisms on papanicolaou smear.

PIP: Scanning electron microscopy (SEM) was used to study an IUD from an asymptomatic patient with Actinomyces-like organisms on Papanicolaou smear and in whom Actinomyces israelii was determined to be present in cervical smears. The objective was to determine if there were any variations in surface morphology that might be correlated with the Actinomyces-like organisms. SEM revealed numerous areas of thick surface encrustation. The surface morphology of the IUD fragments showed basic similarities to the morphologies observed in other cases. Encrustations were attached to the arms and stem of the device. A unique finding was apparently biological material adherent to a fragment of encrusted material. Filamentous structures radiated perpendicularly from a central core. These filaments resembled Actinomyces-like organisms in the patient's Pap smear. Also of interest was a delicate network of hair-like structures at the bottom of a naturally occurring space in the surface encrustation.^ieng

The Ljubljana IUDs: further observations on surface morphology.

Twelve IUDs that had been worn from 8 years 10 months to 24 years were examined by SEM. Photomicrographs of selected samples are shown, and a discussion of the nature of the surface encrustations is provided. The authors are of the opinion that surface encrustations are generic to different types of IUDs and that their clinical significance is presently unknown.

Surface changes in intrauterine contraceptive devices after variable use.

Four used intrauterine contraceptive devices and two new control devices were studied by scanning electron microscopy. All intrauterine contraceptive devices were found to have surface deposits that differed not only from site to site on a given device but between devices. A finding of this study not previously described in the literature was the observation of a euhedral crystal rosette of an apatite mineral group [Ca5(PO4)3(F,Cl,OH)] on the Lippes Loop that had been in situ for 15 years.

PIP: Scanning electron microscopy was used to study 4 used contraceptive devices and 2 new control devices. A Lippes Loop No. 1 (in situ 15 years), a Saf-T-Coil No. 1 (in situ 8 years), a Cu-7 No. 2 (in situ 4 years), and a Cu-T No. 1 (in situ 6-1/2 years) were placed in 2.5% glutaraldehyde in Millonig's buffer immediately after their removal. Unused IUDs -- the Cu-7 No. 1 and the Lippes Loop No. 2 -- also were placed in glutaraldehyde immediately after removal from their sterile envelopes. After suitable fixation, all specimens were prepared for scanning electron microscopy according to standard techniques. Samples were mounted on aluminum studs and vacuum evaporated with gold-palladium in a ratio of 60:40. A MEOL JSM 50A scanning electron microscope was used. Photographs were taken with Polaroid P/N 55 film. The intrauterine portion of 1 of the 2 strings of the Lippes Loop No. 1 demonstrated an irregular distribution of plaquelike encrustation with a smooth string surface visible underneath the plaque. In contrast, part of the intravaginal portion of the 2nd string was so heavily encrusted that the underlying surface was not visiable at any point. The body of the Lippes Loop showed 2 different encrustation morphologic characteristicss. These were seen on both sides of the clearly visible molding mark that bisects the IUD. 1 pattern had the appearance of a continuous mud-cracked encrustation. On a more superior portion of the IUD body several rounded masses appeared to project from the surface. The dissimilarity of the Saf-T-Coil to the Lippes Loop No. 1 centered around the absence of euhedral crystalline forms and the presence of "bulbous nodules" surrounded by plaquelike encrustation that appeared fibrous at times and granular at others. In some areas a netlike matrix was visible, suggesting that the nodules represented filled-in areas of a fibrous network. On other areas of the IUD the superficial encrustations had broken off revealing an underlying and more regular granular base of plaque on the IUD surface. An observation not seen on any other device examined was the presence of spaghetti-like structures projecting from a coherent base of the plaquelike encrustation on the intrauterine portion of string of this device. The observations of the Cu-7 No. 1 were characterized by thick and dense encrustation; "bulbous nodules" were absent. The surface of the IUD body and its string had plaque-like encrustations with a more textured appearance. There were 2 notable features to the encrustation of the Cu-T, No. 1: the thick and contiguous nature of the encrustation; and a series of symmetrical cracks in an underlying base coating seen at a higher magnification.