Diverse definitions of the early course of schizophrenia - a targeted literature review

Schizophrenia is a debilitating psychiatric disorder and patients experience significant comorbidity, especially cognitive and psychosocial deficits, already at the onset of disease. Previous research suggests that treatment during the earlier stages of disease reduces disease burden, and that a longer time of untreated psychosis has a negative impact on treatment outcomes. A targeted literature review was conducted to gain insight into the definitions currently used to describe patients with a recent diagnosis of schizophrenia in the early course of disease ('early' schizophrenia). A total of 483 relevant English-language publications of clinical guidelines and studies were identified for inclusion after searches of MEDLINE, MEDLINE In-Process, relevant clinical trial databases and Google for records published between January 2005 and October 2015. The extracted data revealed a wide variety of terminology and definitions used to describe patients with 'early' or 'recent-onset' schizophrenia, with no apparent consensus. The most commonly used criteria to define patients with early schizophrenia included experience of their first episode of schizophrenia or disease duration of less than 1, 2 or 5 years. These varied definitions likely result in substantial disparities of patient populations between studies and variable population heterogeneity. Better agreement on the definition of early schizophrenia could aid interpretation and comparison of studies in this patient population and consensus on definitions should allow for better identification and management of schizophrenia patients in the early course of their disease

Hot-knife conization of the cervix: clinical and pathologic findings from a study introducing a new technique.

OBJECTIVE: To introduce an alternative method for conization of the cervix using a Teflon-coated hot knife and to evaluate thermal distortion, adequacy of excision, operating time, blood loss, and short- and long-term effects of this method. METHODS: Between 1987-1993, 88 patients underwent cervical conization using a Teflon-coated hot knife at temperatures ranging from 110-130C. Histopathologic slides were reviewed simultaneously by two pathologists, who assessed thermal distortion, adequacy of excision, and interpretability of the surgical margins. Clinical information was obtained prospectively, including operating time, blood loss, and depth and volume of the excised cone. In addition, data were accumulated retrospectively from 40 randomly selected patients who underwent cold-knife conization between 1985-1990. Short- and long-term data were assessed for healing and scarring and the adequacy of postoperative Papanicolaou smears in the hot-knife patients. RESULTS: Thermal injury was minimal, with 300 mu or less in 83 patients (92%) and 350-600 mu in four patients. One patient had thermal distortion of 1500 mu. All slides were interpreted adequately. Blood loss was mild to moderate in 84 of 88 patients (95%) in the hot-knife group and in 34 of 40 patients (85%) in the cold-knife group. No patient in the hot-knife group needed blood transfusion or hospitalization. Operating time was reduced by as much as 67% when the hot knife was used. Thirteen percent of the hot-knife patients developed stenosis of the external os. No patient in the hot-knife group developed recurrence within 2 years of surgery. CONCLUSION: Using a Teflon-coated hot knife for conization of the cervix produces adequate surgical margins and reduces blood loss and operating time over that with cold-knife conization. Long-term follow-up reveals no increase in cervical stenosis and demonstrates adequate cytologic smears in the hot-knife patients

Assessment of current International Federation of Gynecology and Obstetrics staging of vulvar carcinoma relative to prognostic factors for survival (a Gynecologic Oncology Group study).

Analysis of 588 patients with vulvar carcinoma delineated four risk groups by the proportional hazards model. Groin node status (laterality and number positive) and lesion diameter were the only two important independent prognostic factors. The 5-year relative survival rates were 98%, 87%, 75%, and 29% for the risk group categories of minimal (negative groin nodes and lesion diameter less than or equal to 2 cm), low (one positive groin node and lesion diameter less than or equal to 2 cm or negative groin nodes and fewer than two lesions less than or equal to 8 cm diameter), intermediate (negative groin nodes and lesion diameter greater than 8 cm diameter, one positive groin node and lesion diameter greater than 2 cm, or two unilaterally positive groin nodes and lesion diameter less than or equal to 8 cm), and high (three or more positive groin nodes or two bilaterally positive groin nodes), respectively. Applying the International Federation of Gynecology and Obstetrics staging (1988) to these data discriminated risk of death (caused by recurrent vulvar cancer); the 5-year rates were 98%, 85%, 74%, and 31% for stages I, II, III, and IV, respectively. However, within International Federation of Gynecology and Obstetrics stage III there were 47 low-, 95 intermediate-, and 28 high-risk patients with relative survivals of 95%, 74%, and 34%, respectively. Overall, this assessment validates current International Federation of Gynecology and Obstetrics vulvar carcinoma staging, but further refinements are warranted in stage III

Prognostic factors for groin node metastasis in squamous cell carcinoma of the vulva (a Gynecologic Oncology Group study).

From 1977 to 1984 the Gynecologic Oncology Group (GOG) conducted a prospective clinical and surgical staging protocol of squamous cell carcinoma of the vulva (n = 637). The patients with superficial (5 mm or less invasion) lesions were the subject of a previous report (n = 272). The subject of this report is on factors that predict groin node metastasis based on all 588 evaluable patients. Comparisons between the two reports are made. Almost half of this group (49.3%) had minimal tumor thickness (\u3c or = mm). Almost one-third of patients had small vulvar lesions (\u3c or = cm). Groin node metastasis was 18.9% for the \u3c or = 2-cm diameter tumors and 41.6% for the \u3e 2-cm diameter lesions. The inaccuracy of clinical palpation of the groin nodes (23.9% false negative) largely accounts for underestimation of extent of disease. Body weight was not related to the sensitivity of detecting positive groin nodes (P = 0.26). Using the logistic model, independent predictors of positive groin nodes were identified (in order of importance): less tumor differentiation by GOG criteria (P \u3c 0.0001), suspicious or fixed/-ulcerated nodes (P \u3c 0.0001), presence of capillary-lymphatic involvement (P \u3c 0.0001), older age (P = 0.0002), and greater tumor thickness (invasion) (P = 0.03). Lesion size and location were not independent predictors of positive groin nodes