ABSTRACT
Prognosis of ovarian carcinoma in complete histologic remission (CHR) at second-look surgery is still controversial. In a series of 83 patients in CHR we studied retrospectively several prognostic factors (age, stage, histologic grade, histologic type, initial residual disease after surgery, CA 125 normalization period) to determine which patients present a high risk of relapsing after CHR and could be included in therapeutic protocols for consolidation treatment. Univariate analysis showed that the combination of CA 125 normalization < 8 weeks with absence of macroscopic tumoral residue after initial surgery permits the definition of a group with a very good prognosis, while for patients with CA 125 normalization period > 8 weeks and an initial macroscopic residual tumor, the prognosis is relatively poor (progression-free survival 100% vs. 47%, at 2 years P < 0.05). Using the Cox multivariate analysis, only the initial tumoral residue is of prognostic significance for progression-free survival; there is no prognostic significance for overall survival. The therapeutic strategy for ovarian cancer may be improved for patients in CHR after second-look surgery by determining those at high risk, making it possible to confine consolidation treatment trials to such a group.
ABSTRACT
Three hundred eleven intravenous glucose tolerance tests were performed in normal pregnant women between the 8th and the 40th week, and compared with similar tests performed in two groups of non-pregnant women, one group on oral contraceptives, the other not. There was a relative improvement in glucose tolerance at the beginning of pregnancy followed by marked loss of tolerance after the 24th week. This evolution is due to the physiologic adaptation of the maternal pancreas to fetal and placental metabolism. The range of normality for the glucose disappearance rate differs before and after the 24th week of pregnancy, and this must be recognised in setting diagnostic criteria for gestational diabetes. Consideration of simultaneous studies of glucose tolerance and insulin secretion at various periods of pregnancy suggests that changes in K value are more closely correlated with variations in peripheral insulin effects than with changes in insulin secretory function of the maternal pancreas.
Subject(s)
Glucose Tolerance Test , Pregnancy , Female , Glucose/administration & dosage , Humans , Injections, Intravenous , Pregnancy Trimester, First , Pregnancy Trimester, Second , Pregnancy Trimester, ThirdABSTRACT
The glucose tolerance has been studied in 140 non diabetic pregnant women by successively oral and intravenous glucose tolerance test, as described respectively by O'Sullivan and Conard. The results of both tests are grossly similiar, and are affected on the same way by the evolution of the pregnancy. The intravenous glucose tolerance test is the easiest and the most reproducible; however some extra diabetic factors can interfere and mainly this test is not sensitive enough to discriminate between the pathologic and borderline situations. For all these reasons the intravenous glucose tolerance test can be used as a screening test for diabetes mellitus during pregnancy. The oral glucose tolerance test is necessary only when the K value is abnormal or subnormal.
Subject(s)
Glucose/administration & dosage , Pregnancy in Diabetics/diagnosis , Administration, Oral , Adult , Female , Glucose Tolerance Test/methods , Humans , Injections, Intravenous , PregnancyABSTRACT
Physiological changes in carbohydrate tolerance were studied between the beginning and end of pregnancy. Amongst 145 oral glucose tolerance tests performed between the 9th and 40th weeks, results indicated that carbohydrate tolerance evolved throughout pregnancy. The first 24 weeks were characterised by a change in the shape of the glucose tolerance curve, in the form of horizontalisation of the terminal part, but with no increase in early blood glucose figures. It was only after the 24th week that mean blood glucose levels were seen to be increased. The interpretation of glucose tolerance tests during pregnancy should take these physiological changes into account. Critical values, above which diabetes must be suspected, are different at the beginning and end of pregnancy. The critical point would appear to be around the 24th week.