Formation of a carbapenemase resistance detection algorithm for use in the routine laboratory.

The increasing prevalence of carbapenem non-susceptible Gram negative organisms demands prompt and accurate identification of resistance mechanisms to limit their transmission. The aim of this study is to evaluate the rapid CARB screen (Rosco Diagnostica, Denmark), the 'KPC/MBL in P. aeruginosa/Acinetobacter Confirm Kit' (Rosco Diagnostica), Check-MDR Carba and Check-Direct CPE kits (Check-Points, The Netherlands). The purpose of this study is the formation of a carbapenemase resistance detection algorithm that can be used in the routine laboratory. Results of the rapid CARB screen kit were improved when isolates were tested from Muller Hinton agar with a meropenem 10 µg disc instead of blood agar. The rapid CARB screen (performed in 2-3 h) demonstrated overall 98.7% sensitivity and 87.7% specificity (n = 133). The KPC/MBL in P. aeruginosa/Acinetobacter Confirm Kit (which requires overnight incubation) demonstrated a high number of false-positive results giving 38.6% specificity and 100% sensitivity (n = 44). The Check-MDR Carba (performed in 5 h), detecting carbapenemase presence, provides a cabapenemase-positive or -negative result demonstrated 96.7% specificity and 98.6% sensitivity (n = 132). The Check-Direct CPE (performed in 3 h), which identifies KPC, NDM/VIM or OXA-48 type carbapenemases, demonstrated 96.5% specificity and 97.1% sensitivity (n = 97). The Check-Direct CPE, however, failed to detect dual carbapenemase genes present in two out of four isolates. The principal conclusion is the recommendation of the rapid CARB screen and Check-MDR Carba for incorporation into a carbapenemase detection algorithm which, when used in combination, will yield results with 97.3% sensitivity and 99.6% specificity.

Undifferentiated uterine carcinoma: analysis of eighteen cases.

Analysis of the surgicopathological characteristics and clinical follow-up of patients with undifferentiated uterine carcinoma (UUC) was conducted. A total of 18 cases operated between January 1993 and December 2013 were included. Among 1,690 patients with endometrial cancer, 18 patients (1.1%) had UUC. Lymph node involvement was detected in 70.6%; depth of myometrial invasion was ≥ 0.5 in 55.6%; lymphovascular space invasion was detected in 99.3%; cervical stromal invasion was positive in 27.8%; omental and adnexal involvement were detected in 11.8% and 38.9%, respectively. The median follow-up time of the 12 patients evaluated in the survival analysis was 66 months. In the follow-up period, recurrence or progression during adjuvant therapy were observed in four patients (33.3%) and two patients (16.6%) died of the disease. UUC manifests as an aggressive tumour. In conclusion, a high rate of survival could be achieved with complete staging surgery, including an extensive lymphadenectomy with the contribution of adjuvant therapy.

Results with EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) chemotherapy in gestational trophoblastic neoplasia.

The aim of this study was to evaluate the efficacy and toxicity of EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) regimen for the treatment of high-risk gestational trophoblastic neoplasia (GTN). Thirty-three patients with high-risk GTN, scored according to World Health Organization, received 159 EMA/CO treatment cycles between 1994 and 2004. Twenty-three patients were treated primarily with EMA/CO, and 10 patients were treated secondarily after failure of single agent or MAC (methotrexate, actinomycin D, cyclophosphamide, or clorambucile) III chemotherapy. Adjuvant surgery and radiotherapy were used in selected patients. Survival, response, and toxicity were analyzed retrospectively. The overall survival rate was 90.9% (30/33). Survival rates were 91.3% (21/23) for primary treatment and 90% (9/10) for secondary treatment. Six (18.2%) of 33 patients had drug resistance. Four of them underwent surgery for adjuvant therapy. Three of these patients with drug resistance died. Survival and complete response to EMA/CO were influenced by liver metastasis, antecedent pregnancy, and histopathologic diagnosis of choriocarcinoma. Survival rate was also affected by blood group. The treatment was well tolerated. The most severe toxicity was grade 3-4 leukopenia that occurred in 24.3% (8/33) of patients and 6.9% (11/159) of treatment cycles. Febrile neutropenia occurred in one patient (3%). EMA/CO regimen is highly effective for treatment of high-risk GTN. Its toxicity is well tolerated.

Primary fallopian tube carcinoma: a retrospective multicenter study.

PURPOSE: This retrospective multicenter study aimed to assess the survival and prognostic factors of primary fallopian tube carcinoma. METHODS: The medical records of 29 patients with fallopian tube carcinoma from two centers were reviewed for age, stage, surgical intervention, relapse and survival. RESULTS: The mean age of the patients was 56 years (range, 37-76). Six patients were in Stage I (20.7%), eight cases in Stage II (27.6%), nine cases in Stage III (31%) and two cases in Stage IV (6.9%). Data on stage was not available in four cases (13.8). Fifteen patients underwent lymph node evaluation. The median follow-up was 29 months (range, 3-122). The median survival was 95 months with a 5-year survival rate of 69.7%. The median progression-free survival was 76 months with a 5-year survival rate of 51.8%. CONCLUSION: Age, stage and lymphadenectomy were found to be significant prognostic factors on overall survival.

Comparison of single-breath vital capacity rapid inhalation with sevoflurane 5% and propofol induction on QT interval and haemodynamics for laparoscopic surgery.

BACKGROUND AND OBJECTIVE: To compare two techniques to achieve induction of anaesthesia for laparoscopic surgery. A single-breath vital capacity rapid inhalation induction with sevoflurane was compared to intravenous propofol. Their effects on haemodynamics and the QT interval of the electrocardiogram were assessed. METHODS: Forty-four ASA I-II patients scheduled to undergo elective laparoscopic gynaecological surgery were divided into two groups. In the sevoflurane group (Group S, n = 22), general anaesthesia was induced with a single-breath vital capacity rapid inhalation of sevoflurane 5% with nitrous oxide (N2O) 65% in O2 and then anaesthesia was maintained with sevoflurane 1-1.5% with N2O 65% in O2. In the propofol group (Group P, n = 22), general anaesthesia was induced with propofol 2 mg kg(-1) intravenously and maintained with propofol 6 mg kg(-1) h(-1). Systolic, diastolic and mean arterial pressures, heart rate and end-tidal CO2 values were recorded before anaesthesia (basic value), during the induction period (time X), at 10 min (time Y) and at 30 min (time Z) of CO2 insufflation in all patients. QT intervals were calculated using Bazett's equation. RESULTS: Systolic, diastolic and mean arterial pressure values during the induction period (time X) were lower than the basic value in both groups (P < 0.05). In Group S, QTc intervals were significantly longer during the induction period (time X) and at the tenth min of CO2 insufflation (time Y) than Group P (P < 0.05). Five patients at time X and two patients at time Y developed ventricular dysrhythmias, which improved spontaneously in Group S. In Group P, there was no significant difference in QTc intervals and only one patient developed a ventricular dysrhythmia at time Y. CONCLUSIONS: Single-breath vital capacity rapid inhalation induction technique with sevoflurane can cause prolongation of the QT interval and dysrhythmias, compared with induction and maintenance of anaesthesia with propofol in laparoscopic surgery.

Primary choriocarcinoma of the uterine cervix in a postmenopausal patient: a case report.

BACKGROUND: Primary cervical choriocarcinoma seen in a postmenopausal patient is a very rare entity. CASE: Primary choriocarcinoma of the uterine cervix was diagnosed in a 54-year-old woman. She had admitted to our clinic with vaginal bleeding and had been postmenopausal for 1 year at the time of diagnosis. A cervical tumoral mass was seen in her pelvic examination and cervical biopsy revealed squamous cell carcinoma of the cervix. Pelvic examination under anesthesia was done and patient was accepted as FIGO Stage IIA. Type III hysterectomy with bilateral salphingoopherectomy and bilateral pelvic-paraaortic lymph node dissection was carried out. Postoperative pathological evaluation of the surgical specimen showed that case was a primary choriocarcinoma of the cervix. CONCLUSION: This is one of the few reported cases of cervical choriocarcinoma in a postmenopausal patient. The most appropriate theory for the development of this tumor is metaplastic differentiation of the tumor from another histologic type.

Inflammatory breast metastases of ovarian cancer: a case report.

BACKGROUND: Metastasis to the breast from extramammary malignancies is rare. CASE: A 35-year-old woman presented with bilaterally inflammatory breast involvement, 2 years after the diagnosis of stage IIIC epithelial ovarian cancer. Neoplastic tissue was immunohistochemically positive using antibodies against OC125 and negative for gross cystic disease fluid protein-15 (BRST-2) and estrogen receptor in biopsy material in the breast. Combination chemotherapy consisting of paclitaxel, cisplatin, and anthracycline was started. She died 18 months after the breast metastasis. CONCLUSION: Ovarian carcinoma usually presents with signs and symptoms related to the tumor burden within the abdominal cavity. The finding of isolated, distant metastases such as breast involvement without intraabdominal disease is extremely rare. Determining the origin of the primary tumor is important in directing the actual therapy.

Neoadjuvant chemotherapy or primary surgery in advanced epithelial ovarian carcinoma.

Neoadjuvant chemotherapy has been proposed as an alternative approach to conventional surgery as initial management of bulky ovarian cancer, with the goal of performing adequate debulking in the interval surgery. Two hundred five consecutive patients with advanced ovarian cancer were divided into two groups. Neoadjuvant chemotherapy followed by interval surgery was performed in 45 of 205 patients. The remaining 158 patients received primary surgery plus adjuvant chemotherapy. Optimal cytoreductive surgery rates were significantly higher in the neoadjuvant CT group (P<0.001). In multivariate analysis, only residual tumor diameter and appendix involvement were found to affect total survival significantly in both groups. Five-year survival and median survival were not statistically different when all patients treated conventionally were compared with all patients treated with neoadjuvant chemotherapy. Primary chemotherapy followed by interval debulking surgery in a selected group of patients does not appear to worsen prognosis, but it permits less aggressive surgery and improves patients' quality of life.

Significance of serum and peritoneal fluid lactate dehydrogenase levels in ovarian cancer.

We investigated prospectively whether the detection of serum lactate dehydrogenase (LDH) and/or peritoneal fluid LDH levels may serve as a reliable biochemical marker in discriminating ovarian carcinoma from benign ovarian tumors. In this series, postoperatively 20 of 50 patients had a diagnosis of ovarian cancer while the remaining 30 patients had benign ovarian tumor. No significant difference in peritoneal fluid LDH levels was observed between patients with ovarian cancer and benign ovarian tumor (p > 0.05). Serum LDH levels in ovarian cancer patients were significantly higher than those in patients with benign ovarian tumor (p < 0.05). Statistically significant differences were not observed in LDH levels of different histological types of ovarian cancer and different stages of the disease. Serum LDH levels presented diagnostic accuracy with high specificity and may have a potential use as a biochemical marker.

Benefit of adjuvant radiotherapy in surgically staged stage I-II endometrial carcinoma.

AIMS AND BACKGROUND: This study was performed to determine the treatment outcomes and patterns of failure following external beam therapy in patients with pathological stage I-II endometrial carcinoma. STUDY DESIGN: Eighty-three patients with stage I-II endometrial carcinoma surgically staged who were found to have high risk factors and who received postoperative radiation therapy are the subject of this report. High risk factors were: histologic grade II-III, depth of myometrial invasion (DMI) > or =1/2, stage II, poor prognostic histology (clear cell, papillary serous cell) and lymphovascular invasion. RESULTS: Recurrences were observed in six patients. The recurrences were located in the vagina (1), lung (2), liver (1), and paraaortic lymph nodes (1). Five of the six recurrences were stage IC and II. The overall survival (OS), cause-specific survival (CSS) and disease-free survival (DFS) at five years were 82.9%, 85.0% and 81.3%, respectively. DMI, grade, age and cervical stromal invasion had a significant impact on CSS. CONCLUSION: Adjuvant radiotherapy decreases the rate of relapse in pathologically staged high-risk stage I-II endometrial carcinoma patients. After reviewing the other studies on this subject we conclude that vaginal cuff brachytherapy alone could be used in stage IA grade III and stage IB grade I-II patients because the recurrence rate is low; pelvic radiotherapy + vaginal cuff brachytherapy should be used for stage IC-II disease. Distant metastases occurred in five of our patients and represent a significant type of failure.

Accuracy of frozen section diagnosis in borderline ovarian malignancy.

This study was conducted to determine the accuracy of frozen section diagnosis in borderline ovarian tumors. Thirty-three patients were evaluated on the basis of frozen sections between February 1992 and December 1997. Frozen section diagnosis and final diagnosis were divided into three categories: for frozen section diagnosis: 1 = benign, 2 = borderline, 3 = 'at least' borderline, and for final diagnosis: 1 = benign, 2 = borderline, 3 = cancer. Three patients with a benign diagnosis according to their frozen sections were reclassified as borderline in the final diagnosis and all of them were of the mucinous type. The frozen section diagnosis of tumors of borderline malignancy was inaccurate in 3 of 23 patients. Four of 7 patients with at least borderline according to their frozen section diagnosis had invasive cancer at the final diagnosis. The correlation between frozen section diagnosis and final pathological examination was 72.7% (24/33). We found 9% (2/22) inaccurate results in the serous type and 36.6% (4/11) in the mucinous type. The sensitivity and specificity of frozen section diagnosis were found to be 86.95 and 57.14%, respectively. We concluded that frozen section evaluation in identifying a borderline ovarian malignancy is accurate enough to exclude the presence of a benign pathology.

Treatment results and prognostic factors in inoperable carcinoma of the cervix treated with external plus high dose brachytherapy.

Patients with inoperable carcinoma of the cervix treated with external plus high dose rate brachytherapy (HDRB), between 1988 and 1995 were evaluated retrospectively. According to stage, 5 year survival rates were 67.3% in stage IIb and 52.6% in stage III (P = 0001) and disease free survival (DFS) rates were 54.0% in stage IIb and 43.9% in stage III (P = 0.01). The following parameters were studied: age; stage; external beam dose; brachytherapy dose; total dose to point A; tumor mass; tumor response rate; bilateral or unilateral invasion of parametria in stage IIb; and bilateral or unilateral invasion of pelvic wall in stage IIIb; and the existence of hydronephrosis. The only significant parameter of 5 year survival and local control was tumor mass (P = 0.003).

Biochemical investigation of leukocyte functions during lithium therapy.

1. The effect of lithium on phagocytic activity of polymorphonuclear leucocytes (PMNL) has been investigated by measurements of glucose-6-phosphate dehydrogenase (G6PD), NADPH oxidase and myeloperoxidase (MPO) both in lithium treated rats and lithium treated infected rats. 2. The results have been compared with two control groups, one of which was without lithium treatment and the other was only infected. 3. In the first experimental group increased activities of these enzymes have been observed, while in lithium-treated infected rats there was a decrease in the activities of the same three enzymes. 4. It is proposed that defense mechanisms against infection fail during the lithium treatment.