The impact of cesarean birth on subsequent fertility

Purpose of review Recently, the rate of cesarean delivery has increased to 25-30% of all births, the highest rate ever reported in the USA. Primary cesarean deliveries, especially elective procedures, mainly contribute to this increase. Currently, controversy concerning elective cesarean delivery is an area of growing debate. Women should be well informed about the benefits and risks of on-demand cesarean delivery. This may be problematic, however, due to the limited current scientific data on the benefits and risks. One of the issues causing debate is the association between cesarean section and subsequent infertility. In the present review, we aim to analyze the evidence for the impact of cesarean delivery on subsequent fertility

Choice of Pd-103 seed activity to minimize adverse effects due to seed misplacement associated with prostate implants

We have found that depending on the seed activity used for the implant, Pd-103 treatment plans have different robustness to seed misplacement, This may be related to the average inter-seed distance, in part determined by the use of a fixed, 5-mm template for planning

Induction and concurrent chemotherapy with concomitant boost radiotherapy in non-small cell lung cancer

This study was designed to evaluate the tolerability and therapeutic activity of paclitaxel and carboplatin combination therapy followed by radical thoracic radiotherapy with a concomitant boost technique with concurrent weekly paclitaxel in good performance status of patients with stage IIIA and IIIB non-small cell lung cancer. Patients with newly diagnosed inoperable non-small cell lung cancer received paclitaxel (100 mg/m(2)) as a 1-h infusion on d 1,8,15,28,35, and 42. Carboplatin (area under the curve of 6) was given as a 30-min infusion on d 1 and 28. Radiotherapy commenced on d 49 and was delivered with accelerated fractionation with concomitant boost at 1.8 Gy/fraction/d, 5 d/week and 1.5 Gy/fraction/d to a boost field as a second daily treatment for the last 10 treatment days to 60 Gy/35 fractions/5 wk. During radiation treatment, paclitaxel (60 mg/m2) was given as a 1-h infusion once weekly for 5 wk. Twenty-four patients were enrolled in the study. Hematologic toxicities and alopecia were the major acute toxicities during induction chemotherapy; 8.7% of the patients experienced grade 3-4 neutropenia and alopecia. The main acute toxicity of concurrent chemoradiotherapy was esophagitis; grade 3 esophagitis was documented in 23.5% of the patients. No major late toxicity was seen. Overall response rate to the treatment was 65.2%. The median and 1-yr overall-survival rates were 24.9 mo and 63.8%, respectively. The median and 1-yr progression-free survival rates were 9.0 mo and 27.8%, respectively. The main acute toxicities were hematologic toxicity, esophagitis, and alopecia. The response rate and the survival rates achieved with this treatment regimen are particularly noteworthy, especially considering the advanced stage of the patients treated

Utility of CEA in the diagnosis of patients with cancer

Serum CEA levels in patients with malignant tumors (n = 536) were investigated by using two cut-off values (> 2.5 ng/ml and >10 ng/ml). In the control group and cancer patients the mean values for serum CEA were 1.67 +/- 0.99 ng/ml and 160.43 +/- 1317.86 ng/ml, respectively. Although the specificity was high, the sensitivity of the test was poor for both cut-off values. The sensitivity was 42 % for breast cancer, 33.3 % for lung cancer and 16.7 % for gastrointestinal malignancies. Increasing the cut-off value from 2.5 ng/ml to 10 ng/ml resulted in a lower sensitivity. Our data shows that CEA should not be used as a diagnostic test in cancer patients independently. However, recording the percentage rise in a series of multiple measurements may predict disease recurrence

The diagnostic value of macrophage migration inhibitory factor (MIF) in gastric cancer

The present study was conducted to investigate the sensitivity, specificity, predictive values and accuracy of serum MIF, CEA, CA 19-9 levels and their various combinations in patients with gastric cancer. Study group consists of pathologically verified, gastric cancer (n=63) and apparently healthy controls (n=50). Serum MIF concentrations were determined by enzyme-linked immunosorbent assay (ELISA). Serum values of patients were significantly higher than the controls (p=0.011). Diagnostic sensitivity and specificity, predictive values and accuracies were calculated for each marker and their various combinations. The best results were achieved with the marker combination of MIF-CEA-CA 19-9 and MIF-CEA combination. In our opinion, the combination of the markers MIF-CEA is a valuable diagnostic tool for gastric cancer

Lack of Diagnostic Potential of Dickkopf-1 in Colon and Rectum Cancers

The Wnt/b-catenin signalling pathway plays crucial roles in development and its aberrant activation is an initial and crucial event in the majority of colon cancers. The Dickkopf-1 (Dkk-1) gene encodes an extracellular Wnt inhibitor that blocks the formation of signalling receptor complexes at the plasma membrane. Here, we report the serum levels of Dkk1 in colorectal cancer patients without any therapy. The levels were determined by enzyme-linked immunosorbent assay (ELISA) in 135 colon and 160 rectum cancer patients, as well as 90 healthy subjects. Data analyses were performed using SPSS software (SPSS 16, Chicago, IL). There were no significant differences among the groups for Dkk-1 (p=0.363). In conclusion, the present study did not confirm that serum Dkk-1 levels could have any diagnostic potential in colon and rectum cancers

Perinatal and maternal outcomes of fetal macrosomia

Objective: To determine the perinatal and maternal outcome of the macrosomic infants. Study Design: A case-control, retrospective study is performed in the Department of Gynecology and Obstetrics, Istanbul University Cerrahpasa Medical Faculty, between 1988-1992. The maternal and neonatal records of infants with birthweight of at least 4000 g (n = 1000) were reviewed. Another 1000 cases amongst the newborns delivered in the same period between 2500 and 3999 g formed the control group. The obstetrical outcome variables of the groups including mode of delivery and the incidence of maternal and perinatal complications were compared. Results: A total of 16,112 deliveries occurred during the study period. The rate of macrosomic deliveries was 6.21% and the rate of the deliveries (4500 g or heavier) was 1.04%. The mean birthweight of the study group was 4272 +/- 239 and 3277 +/- 316 g of the control group (P < 0.001). While the cesarean section rate was 28.8% for the study group and it was 16.6% for the control group (P < 0.001). In the study group, 17 cases of brachial plexus palsy (2.4%), 16 cases of clavicular fracture (2.3%) and one case of humeral fracture were observed (P < 0.001). The rate of perinatal mortality was 0.8%, in the study group. No perinatal mortality was recorded in the control group. There were 14 cases (1.4%)of asphyxia related to delivery in the study group(P < 0.01). The rate of maternal complications, were significantly higher in the study group (P < 0.01). Conclusion: The macrosomic infants are in increased risk for birth trauma and asphyxia. The risk of birth trauma for the infants weighing 4500 g or more is even greater. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved

The robustness of dose distributions to displacement and migration of I-125 permanent seed implants over a wide range of seed number, activity, and designs

Purpose: To investigate the robustness of permanent prostate implant dosimetry for various 1251 seed activities and various seed models. The dosimetric impact of seed misplacement and seed migration (seed loss) is also taken into account using various standard dose indices