Is the current concept of recurrent ovarian carcinoma as a chronic disease also applicable in platinum resistant patients?

Purpose: The treatment of recurrent ovarian carcinoma (ROC) has become increasingly oriented according to the therapy principles of a chronic disease. We evaluated whether it is justifiable to also apply this concept to the treatment of platinum resistant patients with their known poor prognosis and short overall survival (OS). Methods: We analyzed the overall courses of 85 unselected ROC patients and defined the following groups: A, platinum resistant patients (n=39); subgroup A.1, those who received no or at maximum one line of palliative chemotherapy (n=15, 38.5%); subgroup A.2, those who received≥two therapy lines (n=24, 61.5%); B, platinum sensitive patients, n=46. Results: Group A had significantly lower OS than group B (median: 16 vs. 25months; p=0.019). Group A.1 had significantly worse outcome compared to group A.2 (median: 5 vs. 21.5months; p<0.001). The comparison between study group A.2 and group B showed comparable survival rates (p=0.738). Considering only the patients who had completed treatment courses, the median number of therapy lines administered was higher in group A.2 than in group B (4 vs. 3; p=0.008). Conclusions: There is not only the known dichotomy between platinum sensitive and resistant ROC patients, but rather also within the platinum resistant subgroup itself. There is a considerably large subgroup of platinum resistant patients who will subsequently enter a phase where multiple treatment programs will be considered and administered. These patients have similar survival rates compared to those from the platinum sensitive patient group and the therapy principles of a chronic disease are applicabl

Bilateral papillary cystadenoma of the mesosalpinx: a rare manifestation of Von Hippel-Lindau disease

We report a rare case of a woman with bilateral papillary cystadenomata of the broad ligament with von Hippel-Lindau disease (VHL) (other manifestations: capillary hemangioblastomas of the spinal cord). Patient surveillance is important, because in the course of VHL-associated tumors malignant lesions may arise that are relevant for the prognosi

Correlation of perineal ultrasound and lateral chain urethrocystography in the anatomical evaluation of the bladder neck

Although perineal ultrasound has been widely used, no standard values have been published. In 52 women with urinary stress incontinence the following parameters were measured during resting and straining: a) with ultrasound: distance (Dy) between bladder neck and central line of the symphysis, distance (Dx) between bladder neck and lower border of the symphysis, and retrovesical angle β; b) with urethrocystography (UCG): distance H between the bladder neck and the SCIPP line, inclination angle α and retrovesical angle β. Dy and H correlated during resting (r=0.608; p<0.001) and straining (r=0.575; p<0.001). The distance Dy of 11mm corresponded to a bladder neck position on the SQIPP line. A rotational descent was detectable when Dx increased from 13mm (± 6.5) during resting to 16mm (±7.8) during straining (p=0.009). It was concluded that perineal ultrasound is valuable for the anatomical evaluation of the bladder neck. This is the first report to better define the position of the bladder based on ultrasonographic measurement

Assessing impacts of hydroelectric dams in the Amazon Fluvial Basin

textThe amount of water the Amazon River delivers to the Atlantic Ocean every day is enough to supply New York City's fresh water needs for 9 years. This is soon to change with the race to choke the Amazon Basin with large hydrologic dams. Although studies investigating single dams can provide great analysis on a couple key issues, they often fail to consider these effects on the systems entirety. Without linking the physical and social components, one fails to fully understand the impacts of hydroelectric dams and therefore the vulnerability of the basin. The focus of this study is based on three forms of investigation: 1. a comprehensive literature review including scholarship on hydroelectric dams, basis characteristics, protected areas, and political characteristics within the respective countries; 2. data procurement of the physical geography of 20 sub-basins, 1,100 tributaries, and land use-land change (LULC) data; and together 3. the creation of a multivariable database integrated with GIS (geographic information systems) in order to better interpret human/nature complexities. Combined, this database will be a powerful tool to assess vulnerability and risks associated with individual dams sites within a larger system. In addition, this database can be adjusted in the future such that when impacts of planned dams are actualized they can be recorded, and based of shared attributes of other dams in the database, this information can be correlated to make better predictions of new environmental and social impacts.Latin American Studie

Major Powers and Militarized Conflict

This article attempts to answer the question of why major powers engage in more active foreign policy behaviors than minor powers. It does so by comparing two explanations for the increased conflict propensity of major powers. The first explanation focuses on major powers’ observable capabilities, while the second stresses their different behavior. We incorporate both into an ultimatum model of conflict in which a state’s cost of conflict consists of both observable and behavioral components. Using data from the period from 1870 to 2001, we empirically illustrate the observable and behavioral differences between major and minor powers. We then utilize a decomposition model to assess the relative significance of the two explanations. The results suggest that most of the difference in conflict propensity between major and minor powers can be attributed to observable differences

Systemic therapy developments and their effects regarding the current concept of recurrent ovarian carcinoma as a chronic disease

Purpose: To demonstrate how the current concept of recurrent ovarian carcinoma (ROC) as a chronic disease resulted in developments in the systemic treatment strategies and outcome over time. Methods: We compared therapy type and course of a population-based cohort whose recurrent disease was diagnosed from 1990 to 2006. We divided the patients into two subgroups depending on the year of diagnosis of ROC (group A 1990-1997, n=70; group B 1998-2006, n=63). Results: Both study groups showed similar results in survival (median recurrent disease-specific survival—A 18 months vs. B 19 months; P=0.549). In group B, the patients had significantly fewer combination therapies administered [12.0% vs. 24.1%; odds ratio (OR) 0.43; 95% confidence interval (CI) 0.23-0.81; P=0.0057], received more therapy lines (≥3 lines 56.1% vs. 31.1%; OR 3.10; 95% CI 1.37-7.17; P=0.005) and had significantly longer times of treatment (TT) in relation to the survival time (ST; mean TT/ST-ratio 57.5% vs. 47.5%; difference of the mean values B-A=−10.02; 95%CI −17.99 to −2.05; P=0.014). Conclusions: The finding that survival of ROC patients could not be improved over time should not necessarily be viewed with undue pessimism regarding the general therapy situation. In the more recent study period, a similar outcome could be achieved with less aggressive treatment regimens, i.e., with fewer combination therapies and with longer treatment periods using less toxic agents. When a disease which requires periodic chemotherapy to control progressive course is increasingly treated with a strategy that permits stabilization with limited cumulative toxicity, then the requirements of a chronic disease management have been fulfille

Elevated level of cell-free plasma DNA is associated with breast cancer

Background: We analysed cell-free DNA (cfDNA) in the plasma of patients with both malignant and benign breast lesions by real-time quantitative PCR to determine whether the finding may have diagnostic and prognostic implications. Methods: Plasma samples were obtained from 33 patients with breast cancer, 32 patients with benign breast lesions and 50 healthy women as normal controls. Circulatory cfDNA was extracted from the plasma samples and quantified by real-time quantitative PCR for the glyceraldehyde-3-phosphate dehydrogenase (GAPDH) gene. Results: The mean concentrations of cfDNA in the plasma samples from patients with breast cancer, patients with benign breast lesions and normal controls were 2,285, 1,368 and 1,489 genome equivalents (GE) per millilitre, respectively. The level of cfDNA in the breast cancer group was significantly higher than those in the benign lesion group and control group (P=0.007 and 0.013, respectively). These findings were associated with malignant tumour size. The levels of the cfDNA were high in patients with lymph node involvement and distant metastasis. Conclusions: Our results suggest that levels of cfDNA in the plasma are elevated in malignant breast cancer and correlated with tumour size. These findings could have diagnostic and prognostic value for malignant breast tumour

Impact of hormone replacement therapy on the histologic subtype of breast cancer

Objective: Postmenopausal hormone replacement therapy (HRT) is associated with an increase in breast cancer risk, which correlates to the duration of HRT use. We wanted to investigate a possible association between HRT use and the risk of a histologic subtype of breast cancer. Patients and methods: From 1995 until 2004, 497 cases of primary ductal, lobular or ductulolobular breast cancer in postmenopausal women were diagnosed at the Department of Gynecology and Obstetrics, University Hospital Basel, Switzerland. The data was derived from patient's records. HRT ever use was defined as HRT use for ≥6 months. Results: Of the 99 cases of lobular cancer 72.7% were invasive lobular cancers, 21.2% were invasive ductulolobular cancers and 6.1% were lobular cancers in situ. Of the 398 cases of ductal cancer, 90.5% were invasive ductal cancers and 9.5% were ductal cancers in situ. Totally 144 women were HRT ever users, and 341 women were HRT never users. HRT status could not be defined in 12 women. HRT ever use was associated with an increased risk for lobular cancer (OR 1.67; 95% CI 1.02-2.73). Also, menopause due to bilateral oophorectomy was associated with an increased risk for lobular cancer (OR 2.42; 95% CI 1.06-5.54). Conclusions: There is evidence that HRT as well as menopause due to bilateral oophorectomy may be associated with an increased risk for lobular cancer. This association is of major clinical relevance, since lobular breast cancer is more difficult to diagnose clinically and radiologically than ductal breast cance

Three-dimensional pathological size assessment in primary breast carcinoma

Maximal tumor diameter (MD) is traditionally an important prognostic factor in breast cancer. It must be questioned, however, how well a one-dimensional parameter alone can represent the actual morphologic condition of a three-dimensional body. Along with the pathologically assessed MD and two perpendicular diameters (PDs) of a lesion, eccentricity (EF) and the three-dimensional parameters tumor volume (TV) and surface area (TSA) of 395 ductal invasive breast carcinomas of limited size (10-40mm) were calculated. The dependent prognostic variable was axillary lymph node involvement (ALNI). MD, TV and TSA area were highly significant predictors of ALNI; these variables had similar levels of prediction accuracy (univariate analyses: MD: P=0.0003, TV: P=0.0009, TSA: P<0.0001; multivariate analyses: MD: P=0.0018, TV: P=0.0109, TSA: P=0.0009; pseudo R-squared values: MD: 0.42, TV: 0.39, TSA: 0.39). Despite certain variations in tumor shape, TV and TSA with similar MD, there is no evidence that three-dimensional pathologic measurements (TV/TSA) are more precise prognostic predictors of ALNI compared to the one-dimensional measurement alon