Habitat influences skeletal morphology and density in the snailfishes (family Liparidae).

We tested the hypothesis that deep-sea fishes have poorly mineralized bone relative to shallower-dwelling species using data from a single family that spans a large depth range. The family Liparidae (snailfishes, Cottiformes) has representatives across the entire habitable depth range for bony fishes (0 m-> 8000 m), making them an ideal model for studying depth-related trends in a confined phylogeny. We used micro-computed tomography (micro-CT) scanning to test three aspects of skeletal reduction in snailfishes (50 species) across a full range of habitat depths: 1) reduction of structural dimensions, 2) loss of skeletal elements, and 3) reduction in bone density. Using depth data from the literature, we found that with increasing depth, the length of the dentary, neurocranium, and suborbital bones decreases. The ventral suction disk decreases width with increasing maximum habitat depth and is lost entirely in some deeper-living taxa, though not all. Although visual declines in bone density in deeper-living taxa were evident across full skeletons, individual densities of the lower jaw, vertebra, suction disk, hypural plate, and otoliths did not significantly decline with any depth metric. However, pelagic and polar taxa tended to show lower density bones compared to other species in the family. We propose that skeletal reductions allow snailfishes to maintain neutral buoyancy at great depths in the water column, while supporting efficient feeding and locomotion strategies. These findings suggest that changes in skeletal structure are non-linear and are driven not only by hydrostatic pressure, but by other environmental factors and by evolutionary ancestry, calling the existing paradigm into question.

The evolutionary origins of Syngnathidae: pipefishes and seahorses.

Despite their importance as evolutionary and ecological model systems, the phylogenetic relationships among gasterosteiforms remain poorly understood, complicating efforts to understand the evolutionary origins of the exceptional morphological and behavioural diversity of this group. The present review summarizes current knowledge on the origin and evolution of syngnathids, a gasterosteiform family with a highly developed form of male parental care, combining inferences based on morphological and molecular data with paleontological evidence documenting the evolutionary history of the group. Molecular methods have provided new tools for the study of syngnathid relationships and have played an important role in recent conservation efforts. Despite recent insights into syngnathid evolution, however, a survey of the literature reveals a strong taxonomic bias towards studies on the species-rich genera Hippocampus and Syngnathus, with a lack of data for many morphologically unique members of the family. The study of the evolutionary pressures responsible for generating the high diversity of syngnathids would benefit from a wider perspective, providing a comparative framework in which to investigate the evolution of the genetic, morphological and behavioural traits of the group as a whole.

Ureteroarterial fistulas after radical pelvic surgery: pathogenesis, diagnosis, and therapeutic modalities.

Ureteroarterial fistulas (UAF) are a rare but potentially life-threatening complication of intra-abdominal malignancy, typically occurring after vascular or pelvic surgery. Patients with a history of radical pelvic surgery, chronic indwelling ureteral stents, and prior pelvic radiation appear to be at increased risk. The predisposing risk factors suggest that gynecological oncologists are the likely specialty to face this problem and should be familiar with the clinical presentation and etiology of UAF. We present two such cases to illustrate these salient points of clinical diagnosis and management.

Protein and Mg(2+)-induced conformational changes in the S15 binding site of 16 S ribosomal RNA.

The Bacillus stearothermophilus ribosomal protein S15 binds to the central domain of the 16 S rRNA inducing a conformational change in a three-way helical junction. To understand the nature of this conformational change, extended-helical junctions were prepared to examine the effects of S15 or Mg2+ binding on the relative helical orientation using native gel electrophoretic mobility and transient electric birefringence. The free junction is planar with approximately 120 degrees interhelical angles, whereas S15 and Mg2+ yield a junction conformation that remains planar in which two helices, 21 and 22, become colinear and the third, helix 20, forms a 60 degrees angle with respect to helix 22. This conformational change is thought to be important for directing the assembly of the central domain of the 30 S ribosomal subunit.

Effective palliative radiation therapy in advanced and recurrent ovarian carcinoma.

PURPOSE: To retrospectively review our experience using radiation therapy as a palliative treatment in ovarian carcinoma. METHODS AND MATERIALS: Eighty patients who received radiation therapy for ovarian carcinoma between 1983 and 1998 were reviewed. The indications for radiation therapy, radiation therapy techniques, details, tolerance, and response were recorded. A complete response required complete resolution of the patient's symptoms, radiographic findings, palpable mass, or CA-125 level. A partial response required at least 50% resolution of these parameters. The actuarial survival rates from initial diagnosis and from the completion of radiation therapy were calculated. RESULTS: The median age of the patients was 67 years (range 26 to 90 years). A median of one laparotomy was performed before irradiation. Zero to 20 cycles of a platinum-based chemotherapy regimen were delivered before irradiation (median = 6 cycles). The reasons for palliative treatment were: pain (n = 22), mass (n = 23), obstruction of ureter, rectum, esophagus, or stomach (n = 12), a positive second-look laparotomy (n = 9), ascites (n = 8), vaginal bleeding (n = 6), rectal bleeding (n = 1), lymphedema (n = 3), skin involvement (n = 1), or brain metastases with symptoms (n = 11). Some patients received treatment for more than one indication. Treatment was directed to the abdomen or pelvis in 64 patients, to the brain in 11, and to other sites in 5. The overall response rate was 73%. Twenty-eight percent of the patients experienced a complete response of their symptoms, palpable mass, and/or CA-125 level. Forty-five percent had a partial response. Only 11% suffered progressive disease during therapy that required discontinuation of the treatment. Sixteen percent had stable disease. The duration of the responses and stable disease lasted until death except in 10 patients who experienced recurrence of their symptoms between 1 and 21 months (median = 9 months). The 1-, 2-, 3-, and 5-year actuarial survival rates from diagnosis were 89%, 73%, 42%, and 33%, respectively. The survival rates calculated from the completion of radiotherapy were 39%, 27%, 13%, and 10%, respectively. Five percent of patients experienced Grade 3 diarrhea, vomiting, myelosuppression, or fatigue. Fourteen percent of patients experienced Grade 1 or 2 diarrhea, 19% experienced Grade 1 or 2 nausea and vomiting, and 11% had Grade 1 or 2 myelosuppression. CONCLUSIONS: In this series of radiation therapy for advanced ovarian carcinoma, the response, survival, and tolerance rates compare favorably to those reported for current second- and third-line chemotherapy regimens. Cooperative groups should consider evaluating prospectively the use of radiation therapy before nonplatinum and/or nonpaclitaxel chemotherapy in these patients.

Does preoperative serum squamous cell carcinoma antigen level predict occult extracervical disease in patients with stage Ib invasive squamous cell carcinoma of the cervix?

Preoperative serum squamous cell carcinoma antigen levels were obtained from 65 patients with International Federation of Gynecology and Obstetrics stage Ib invasive squamous cervical cancer before planned radical hysterectomy to determine whether elevated squamous cell carcinoma antigen levels (greater than 2.5 ng/mL) predicted occult extracervical extension of disease. Although the specificity of a normal level was good (0.91), the sensitivity of an elevated level was only 0.68. Not all patients with nodal metastases had elevated serum squamous cell carcinoma antigen levels; in particular, no patient with occult para-aortic nodal disease had elevated serum squamous cell carcinoma antigen.

The effect of a full bladder on labor.

The effect of a full bladder containing 300 ml or more of urine was studied during normal established labor in 20 patients and 10 controls. Uterine activity was measured in Montevideo units, and the progress of labor was assessed by partogram before and after catheterization. Although uterine activity increased after catheterization, there was no significant change in the slope of the partogram. It is concluded that a full bladder does not affect the course of normal established labor.

Squamous cell carcinoma metastatic to placenta and ovary.

A woman previously treated for squamous cell carcinoma of the neck underwent a cesarean section for fetal distress. Extensive metastases of the placenta and an ovary were histologically compatible with her prior malignancy. Diffuse infiltration of the placenta by this neoplastic process was associated with an infant who was small for gestational age and who had no evidence of metastatic disease.

Role of endocervical curettage in colposcopy.

Two-thousand three-hundred and four patients with abnormal cervical cytology were evaluated by colposcopy, cervical biopsy, and endocervical curettage. The endocervical curettage was more accurate than the cervical biopsy in 1.2% of patients with satisfactory colposcopic examinations, 15.7% of patients with unsatisfactory examinations, and 30.5% of patients with no lesions observed. The endocervical curettage contained neoplastic epithelium in all 15 of the patients with invasive cancer and in seven patients it was the only diagnostic parameter that indicated invasion. The information from the endocervical curettage, when correlated with the cervical cytology, colposcopic findings, and cervical biopsy, eliminated the need to do a diagnostic conization in 76% of patients with unsatisfactory examinations and 79% of patients with no lesion identified. It is recommended that the endocervical curettage be a part of every colposcopic examination.

Identification of histopathologic risk groups in stage IB squamous cell carcinoma of the cervix.

This study was undertaken to identify histopathologic risk factors in 100 women with stage IB squamous cell carcinoma of the cervix treated surgically. Histologic factors included maximum depth of stromal invasion, presence of lymph-vascular invasion, mitotic activity, nature of the tumor-stromal borders, plasma cell-lymphocyte stromal response, histologic grade, and metastases to regional lymph nodes. Using a multifactorial analysis, the maximum depth of stromal invasion was found to be the most important prognostic indicator (P less than .0001). The depth of invasion also correlated significantly with the presence of nodal metastases (P less than .0001), lymph-vascular space invasion (P = .0003), and "spreading" versus "pushing" borders (P = .0315). The number of mitoses, grade of tumor, or plasma cell-lymphocyte stromal response did not correlate significantly with depth of stromal invasion. Lymph-vascular involvement, although present in 59% of the patients, did not significantly affect survival. Depth of stromal invasion and lesion diameter were combined to constitute three risk groups: Patients with small size cervical tumors (less than 2 cm), regardless of depth of stromal invasion, as well as patients with intermediate size lesions (2.1 to 3 cm) with stromal invasion less than or equal to 1.5 cm, constituted a low-risk group; the intermediate-risk group was comprised of those patients with cervical lesions between 2.1 and 3 cm in size and deep stromal invasion (greater than 1.5 cm), as well as those patients with large cervical lesions (greater than 3.0 cm) and stromal invasion less than or equal to 1.5 cm.2+ (greater than 3 cm) and deep stromal invasion (greater than 1.5 cm).(ABSTRACT TRUNCATED AT 250 WORDS)

Association of extrauterine fetal death with failure of prostaglandin E2 suppositories.

The use of prostaglandin E2 vaginal suppositories is an effective method of uterine evacuation for patients with intrauterine fetal demise. Advanced extrauterine gestation, because of its rarity, is usually not a primary consideration for patients presenting with fetal death. This report presents 4 such cases and strongly suggests that, when this drug is used for the treatment of fetal death, failure to induce contractions and to effect uterine evacuation within a reasonable time should prompt the consideration of extrauterine pregnancy.

Effect of labor on the postpartum bladder.

Urodynamic investigations were performed on 20 patients at 48 hours and at four weeks after delivery to assess the effect of modern obstetric practice on the postpartum bladder. Although there were significant differences in some values over this period, the mean urodynamic measurements on both occasions were within normal limits. It is concluded that the current management of labor does not predispose women to bladder hypotonia, the chief factors responsible being avoidance of prolonged labor and early catheterization after delivery.

Study of superficially invasive carcinoma of the cervix.

A detailed histologic study has been completed on 125 patients with squamous cell carcinoma of the cervix invading to a depth no greater than 5 mm. Depth of invasion was 3 mm or less in 73% and 3.1 to 5 mm in 27%. The median width was 4.8 mm (range 0.08 to 20 mm). Most of the lesions were multifocal (82%); the number of invasive foci correlated well with increasing width and depth of invasion. Lymphvascular space invasion was found in seven patients, none of whom had lymph node metastases, although in one a single focus of carcinoma was present in the parametrium. Therapy consisted of radical hysterectomy and pelvic lymphadenectomy in 55% of the women, including 43 patients with lesions invading less than 3 mm. There was tumor metastatic to lymph nodes in only one of 69 patients with dissected nodes (1.4%). The mean follow-up time was 5.0 years; there was one recurrence (cervical intraepithelial neoplasia only). This study and a survey of the recent literature imply that tumor pattern, width, and confluence can be ignored in lesions invading to 5 mm, and that the most important factor to consider in therapy planning is depth of invasion. The following guidelines are proposed. In lesions without lymphvascular space invasion, those invading the stroma to no more than 3 mm may be treated with a total abdominal or vaginal hysterectomy. In lesions invading between 3 and 5 mm, a total abdominal hysterectomy and a pelvic lymphadenectomy seem adequate therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Surgical treatment of women found to have invasive cervix cancer at the time of total hysterectomy.

Twenty-three patients were referred after the unexpected finding of invasive cervix cancer at the time of total hysterectomy. Each was deemed a candidate for additional therapy and was treated surgically with a radical reoperation consisting of a lymphadenectomy, radical parametrectomy, and upper vaginectomy. When compared with patients undergoing radical hysterectomy at this institution, this reoperation was not technically more difficult as judged by the objective measures of operative time and blood loss. The risk of perioperative morbidity was not greater than radical hysterectomy. The surgical findings obviated the need for additional radiation therapy in more than 73% of patients. While therapy for all patients must be individualized, a radical reoperation should be considered a safe and efficacious alternative to pelvic radiation for patients who are deemed to require additional therapy in this clinical situation.

Cervical intraepithelial neoplasia associated with exposure to diethylstilbestrol in utero: a clinical and pathologic study.

The anatomic, colposcopic, cytologic, and histologic findings of the cervix in 300 women exposed to diethylstilbestrol (DES) in utero are reported. Structural cervical abnormalities were found in 51.7% of these patients and an abnormal colposcopic examination was present in 50.6%. The initial interpretation of the pathologic specimens revealed that 26.6% of patients had cytologic or histologic evidence of cervical dysplasia. A uniform pathologic review demonstrated that 10.8% of the cytologic specimens and 37.5% of the histologic specimens had been overread by the initial pathologist. A correlation of the review cytology and histology revealed that the Papanicolaou smear sensitivity for the prediction of abnormal histology was 83.9% and specificity was 86.3%. The probability of an atypical cytologic finding predicting an abnormal histologic pattern was highly significant (P less than .00001). Colposcopic and structural cervical abnormalities were not predictive of an abnormal histologic diagnosis. Of the 18 patients (6%) with histologic evidence of mild-moderate dysplasia, 12 have been followed with no treatment, and cytologic and colposcopic examination has been normal. Marked dysplasia-carcinoma in situ was found in 14 patients (4.7%). Their therapy is summarized. These data strongly suggest that women exposed to DES may be followed safely with Papanicolaou smears and colposcopic examinations provided that both cytopathologists and colposcopists are cognizant of the metaplastic changes in the DES progeny that distinguish them from patients with cervical intraepithelial neoplasia (CIN) who were not exposed to DES. Biopsy should be performed only if indicated by cytologic atypia, colposcopic evidence of advanced CIN, or the presence of an invasive lesion.

Correlation of perioperative morbidity and conization to radical hysterectomy interval.

Between October 1969 and December 1980, radical hysterectomies were performed on 311 patients at the University of Alabama Medical Center in Birmingham. The hospital records of these patients were reviewed for perioperative morbidity. One hundred twenty-two patients (39.2%) had had previous cold knife conization. The conization to radical hysterectomy interval varied between 48 hours and 8 weeks. An analysis of the perioperative morbidity was performed comparing patients with to those without prior conization. Previous cervical conization, regardless of the interval, was not associated with increased hospital stay, operative time, blood loss, or febrile morbidity in patients undergoing radical hysterectomy. These findings suggest that a radical hysterectomy may be safely performed after cervical conization, regardless of the intervening interval.

Metastatic tumors mimicking gynecologic cancer.

Review of the admissions to the Gynecologic Oncology Service at the University of Alabama Medical Center over a 12-year period reveals that 1% of all referrals had nongynecologic malignancies. Duration of symptoms was short; of 40 patients with adequate follow-up, 31 (77%) were dead from their cancer, with a median survival of eight months. The value of diagnostic radiologic procedures was assessed and, while these procedures proved helpful, most patients required a surgical procedure (often a reoperation) to establish the diagnosis.

Comparative effectiveness and safety of cefotetan and cefoxitin as prophylactic agents in patients undergoing abdominal or vaginal hysterectomy.

In a multicenter, randomized clinical trial, 282 women who underwent abdominal or vaginal hysterectomy were given a single preoperative 2 g dose of cefotetan (171 evaluable patients) or three perioperative 2 g doses of cefoxitin (84 evaluable patients) as antibiotic prophylaxis. A successful clinical response occurred in 92 percent of those receiving cefotetan and 90 percent of those receiving cefoxitin who underwent abdominal hysterectomy, and in 94 percent of those receiving cefotetan and 93 percent of those receiving cefoxitin who underwent vaginal hysterectomy. The incidence of vaginal cuff cellulitis was 3.4 percent and 5 percent for cefotetan and cefoxitin patients, respectively, who underwent abdominal hysterectomy, and 4.8 percent and 4.5 percent, respectively, for those who underwent vaginal hysterectomy. The incidence of major wound infection was 3.4 percent and 2.5 percent for cefotetan and cefoxitin, respectively, in the abdominal hysterectomy group. Postoperative changes in oral body temperature, duration of hospitalization, and postoperative grading of surgical wounds were similar. Both drugs were well tolerated. These results suggest that a single dose of cefotetan is equally effective and as safe as multiple-dose cefoxitin for prophylaxis in patients undergoing hysterectomy.

Surgical aspects of cervical cancer.

Surgery maintains an important role in the diagnosis and treatment of premalignant as well as early invasive and recurrent cervical cancer. Although the indications for and benefits of surgical staging remain to be determined, specific procedures frequently are necessary to manage treatment-related complications. The authors review the indications, morbidity, and outcome of these procedures.

Cervical cancer.

Despite the development of cervical cytology, cancer of the cervix continues to be a major health problem for women. The cause, diagnostic, and therapeutic management of women with preinvasive and invasive disease is discussed.