Randomized Phase II trial assessing estramustine and vinblastine combination chemotherapy vs estramustine alone in patients with progressive hormone-escaped metastatic prostate cancer

Abstract Based on the results of combined data from three North American Phase II studies, a randomised Phase II study in the same patient population was performed, using combination chemotherapy with estramustine phosphate (EMP) and vinblastine (VBL) in hormone refractory prostate cancer patients. In all, 92 patients were randomised into a Phase II study of oral EMP (10 mg kg day continuously) or oral EMP in combination with intravenous VBL (4 mg m(2) week for 6 weeks, followed by 2 weeks rest). The end points were toxicity and PSA response in both groups, with the option to continue the trial as a Phase III study with time to progression and survival as end points, if sufficient responses were observed. Toxicity was unexpectedly high in both treatment arms and led to treatment withdrawal or refusal in 49% of all patients, predominantly already during the first treatment cycle. The mean treatment duration was 10 and 14 weeks, median time to PSA progression was 27.2 and 30.8 weeks, median survival time was 44 and 50.9 weeks, and PSA response rate was only 24.6 and 28.9% in the EMP/VBL and EMP arms, respectively. There was no correlation between PSA response and survival. While the PSA response in the patients tested was less than half that recorded in the North American studies, the toxicity of EMP monotherapy or in combination with VBL was much higher than expected. Further research on more effective and less toxic treatment strategies for hormone refractory prostate cancer is mandatory

Symphysiotomy in Zimbabwe; Postoperative Outcome, Width of the Symphysis Joint, and Knowledge, Attitudes and Practice among Doctors and Midwives

BACKGROUND: Obstructed labour remains one of the leading causes of maternal and foetal death and morbidity in poorly resourced areas of the world, where the 24 hours availability of a caesarean section (CS) cannot be guaranteed, and the CS related mortality rate is still high. In these settings, reinstatement of symphysiotomy has been advocated. The objectives were, in1994; to study perioperative and long-term complications of symphysiotomy and compare them to those related to CS for similar indications, in 1996; to measure the symphyseal width after symphysiotomy and compare it to that after normal vaginal delivery, and, in 1998; to assess knowledge, attitudes and practice related to symphysiotomy among doctors and midwives in Zimbabwe. METHODS AND FINDINGS: Thirty-four women who had undergone symphysiotomy and 29 women who had undergone a CS for obstructed labour were interviewed. The symphyseal widths of 19 women with a previous symphysiotomy were compared to that of 92 women with previous normal vaginal deliveries, using ultrasound technique. Forty-one doctors and 39 midwives, in three central hospitals and seven district hospitals in Zimbabwe, were interviewed about symphysiotomy. None of the 34 women reported serious soft tissue injuries or infections post symphysiotomy. Long-term complications after symphysiotomy do not differ notably from those after CS for similar indications. The intra-articular width of the symphysis pubis is increased after a symphysiotomy. Seventy-nine of the 80 interviewed health care workers knew about symphysiotomy. One obstetrician had performed symphysiotomies. Two-thirds of the participants considered symphysiotomy an obsolete and second-class operation, but lifesaving and appropriate in remote areas of Zimbabwe. Ten of 13 midwives in remote areas wanted to carry out symphysiotomies themselves. CONCLUSIONS: No severe complications due to symphysiotomy were revealed in this study. The results suggest that a modest permanent enlargement of the pelvis post symphysiotomy (together with the absence of a scarred uterus) may facilitate subsequent vaginal delivery. Doctors and midwives working in district hospitals have a more positive attitude to symphysiotomies than the colleagues in central hospitals. Obstetricians (who would have to do the teaching), working in the large urban hospitals almost exclude symphysiotomy as an alternative management in Zimbabwe

Jardín infantil, en Beniarjó, Valencia

This children's nursery has been provided so that the children of the town can be looked after during the periods when their mothers are busy collecting oranges. The building has, in addition to the director's quarters, eight school rooms, wash rooms, covered playing ground, indoor garden, living quarters for the nuns and a cloister. The various functional parts of the building are well differentiated, both spatially and in style. The lighting and ventilation has been the object of special study, and all the rooms have plenty of light, and are extremely diaphanous. The style aims at giving the children a sense of liberty, and integrating the beauty of the outdoor scenery with the indoor design. The structure is metallic, and the walls are made of light cream coloured brick in the schoolrooms, whilst the small convent walls have a rustic tyrolean surface.<br><br>Este jardín infantil ha sido construido con el fin de que los niños de Beniarjó puedan ser atendidos, durante la ausencia de sus madres, en la época de la recolección de la naranja. El edificio consta de las siguientes zonas: dirección, ocho aulas, laboratorios, aseos, juegos cubiertos, jardín interior, residencia de religiosas y claustro. Cada una constituye un elemento bien diferenciado dentro del conjunto, por su individualidad volumétrica y por su carácter. Han sido cuidadosamente estudiadas la iluminación y ventilación de las diversas dependencias, y se ha conseguido, felizmente, que el conjunto ofrezca una gran diafanidad, crear un ambiente de gran libertad en los niños, e incorporar la belleza del paisaje a todos los rincones del edificio. La estructura es metálica y predomina el ladrillo visto, de color hueso, en las aulas y la tirolesa rústica en el pequeño convento

Dos edificios de viviendas - Valencia (España)

This article describes two blocks which have been built as housing communities, where there is a concentration of facilities and services, as well as the possibility of the flexible distribution of space, according to the needs of each family. The «Plaza de América» building is in one of the most interesting parts, with some of the best views of the city. It has a curved facade with continual openings, which favours the above-mentioned flexibility. The «Ciudadela» building is in the old Ciudadela sector, overlooking the Paseo de la Alameda and the Turia River. It consists of basement, ground floor and mezzanine floor for commercial purposes, and thirteen storeys for housing, it is a metal structure, built on piles, with D.C. flooring and concrete screens for bracing against the wind.Se describen dos edificios construidos para viviendas en régimen de comunidad, con los imperativos que esta circunstancia entraña en cuanta a concentración de servicios y posibilidad de una distribución flexible, según las necesidades de cada familia. El edificio «Plaza de América» está situado en uno de los puntos más singulares y de mejores vistas de la ciudad, con fachada curva y huecos continuos, lo que favorece la flexibilidad antes citada

Edificio «Vicoman Rex» - Valencia (España)

This apartment building is pyramid shaped, to meet the local town planning requirements. This has necessitated the adoption of terraces, to reduce progressively the floor area of the successive storeys. This has greatly improved the living facilities of the flats, though it has meant that the distribution of each flat has been separately worked out.Este edificio de viviendas presenta una forma piramidal, en función de las exigencias de las ordenanzas municipales, lo que ha impuesto el uso de las terrazas como elemento regulador de los sucesivos retranqueos. Como consecuencia, se han conseguido mejores perspectivas y más favorables condiciones de habitabilidad de las viviendas, las cuales, en cambio, responden a las más variadas distribuciones, ya que cada planta ha sido objeto de proyecto singular

The axillary study with ultrasound and cytological puncture with fine needle in invasive breast cancer.

El objeto del presente Proyecto Final de Carrera es el Estudio de Viabilidad de una promoción inmobiliaria en la población de Puigcerdà capital de la Cerdanya en la provincia de Girona. A partir de la máxima información que podamos disponer, se sacarán las conclusiones para determinar si la propuesta de la promoción inmobiliaria (que definiremos posteriormente) es factible y si será rentable o no