Impact of treatment on quality of life for oral and oropharyngeal carcinoma.

This study evaluates the changes in quality of life (QoL) from pre-treatment to 3 years after commencement of treatment and its relation to therapeutic variables in patients with oral and oropharyngeal carcinoma. QoL was assessed using the EORTC QLQ-C30 questionnaires and the EORTC head and neck cancer specific module QLQ-H&N35. QoL data were obtained prior to treatment and 1 and 3 years after treatment began. Of 128 patients, 69 completed all the questionnaires over the course of 3 years. Variable deterioration of QoL scores was detected before treatment. Most of the parameters worsened significantly after treatment and during the first year, and improved by the third year. Patients who underwent surgical treatment combined with adjuvant radiotherapy and chemotherapy generally showed worse scores and needed a long time to recover from the disease and the treatment adverse effects. This long-term prospective study performed using the EORCT questionnaires in a homogeneous group of patients with oral and oropharyngeal carcinoma may allow better understanding of the impact of treatment and the changes in QoL that occur.

Ovarian follicular dynamics: from basic science to clinical practice.

The management of low responders (LR) to ovarian stimulation in cycles of assisted reproduction (AR) is a difficult challenge. Aging of the ovary and LR are coincidental in many situations, but LR is also present in young patients undergoing AR. In fact, today it is a recognized cause of infertility. When the aged ovary is considered, there is evidence that the functioning of the granulosa cells as well as the quality of the oocytes and resulting embryos are affected. Similarly, in young LR, the production of inhibin is affected. However, there is no evidence that the quality of the oocyte and/or the resulting embryo is affected. In this study, we have retrospectively analyzed our files and observed that the quality of the oocytes and embryos was similar between younger and older LR and normal responders (NR). Studies using color Doppler vaginal ultrasound have shown that the pulsatility index (PI) and the resistance index (RI) were increased in LR as compared with NR, suggesting that there was some degree of vascular resistance to flow. Treatment of LR is also a difficult challenge. Ovum donation is a successful treatment for LR, since cumulative birth rates are > 85% with four attempts of embryo transfer. The future may be promising for LR once new technologies are introduced into clinical practice. The use of recombinant gonadotropins and genetically engineered human gonadotropin derivatives may be of considerable help for LR. Similarly, non-gonadotropin hormones, such as cytokines or growth factors, may be shown to play a role in the stimulation of the ovary in the near future, and may therefore open new frontiers for treatment of LR.

Endometrial thickness and serum oestradiol concentrations as predictors of outcome in oocyte donation.

Adequate endometrial preparation with exogenous steroids is mandatory for successful ovum donation. This study was undertaken to assess the value of endometrial thickness by ultrasound and serum oestradiol as predictors of ovum donation outcome and to analyse the correlation between serum oestradiol concentrations and the endometrial thickness. Endometrial thickness and serum oestradiol concentrations on the day of oocyte donation were recorded and compared to several in-vitro fertilization parameters. The cycles (n = 465) were classified according to serum oestradiol values and endometrial thickness. Comparison of the groups showed that endometrial thickness was significantly (P = 0.002) higher when serum oestradiol was >400 pg/ml as compared to <100 pg/ml. Pregnancy and implantation rates did not differ among the groups, women with serum oestradiol <50 pg/ml having similar outcome to the remaining cases. Endometrial thickness showed a similar picture in terms of pregnancy and implantation. Also, women with an endometrium <4 mm in size had normal pregnancy and implantation rates. There was a positive correlation (P = 0.0044) between endometrial thickness and implantation, as well as between endometrial thickness and serum oestradiol (P = 0.0184). None of the parameters examined was able to predict ovum donation outcome. It is concluded that endometrial thickness is preferred to serum oestradiol for the monitoring of endometrial development, although neither is able to predict success in oocyte donation.

The impact of endometriosis in couples undergoing intracytoplasmic sperm injection because of male infertility.

To assess the impact of endometriosis on intracytoplasmic sperm injection (ICSI) outcome, we have retrospectively evaluated 980 ICSI cycles, comparing the results of women with and without endometriosis. A total of 101 cycles was identified in which various degrees of endometriosis were involved, and in the remaining 879 cycles, male infertility was the only cause of infertility. Ejaculated spermatozoa were microinjected in all cycles. There was a significant reduction (P = 0.004) in the number of oocytes retrieved from women with endometriosis as compared to those without endometriosis. However, there were no significant differences in either fertilization or pregnancy and implantation rates between women with or without endometriosis. We conclude that the presence of endometriosis in patients undergoing ICSI because of severe male infertility does not affect fertilization, pregnancy and implantation rates, although significantly fewer oocytes are retrieved from patients with endometriosis.

[Cervicobrachial fibromatosis presenting in the mother and the child simultaneously]. / Fibromatosis cervicobraquial de aparición simultánea en madre e hijo.

Fibromatosis is the proliferation of connective tissue with local infiltrative growth and a tendency to relapse in contrast with fibrosarcoma which never produces metastases. Two patients, a mother and son diagnosed with fibromatosis of initial cervical location in whom surgical extirpation and complementary radiotherapy were performed. The mother underwent polychemotherapy (adriamicine plus dacarbazine) because of extensive relapse. Definitive resolution was achieved in both cases.

[Polychemotherapy treatment with cisplatin, adriamycin, 5-fluorouracil (FAP) and cisplatin, adriamycin and cyclophosphamide (CISCA) in advanced transitional carcinoma of the bladder]. / Tratamiento poliquimioterápico con cisplatino, adriamicina, 5-fluoracilo (PAF) y cisplatino, adriamicina y ciclofosfamida (CISCA) en el carcinoma transicional avanzado de vejiga.

We study 50 patients with advanced bladder carcinoma, divided into two protocols of 25 patients, treated with polychemotherapy. Protocol I (PAF) formed by DDP at 20 mgrs/m2 day 1 to 5, ADM at 50 mgrs./m2 day 1 and 5-FU at 500 mgrs./m2 day 1, and Protocol II (CISCA) made up of the combination of DDP at 75 mgrs./m2 day 1, ADM at 50 mgrs./2 day 1 and CPM at 600 mgrs./m2 I.V. day 1. In Protocol I the overall response was 60% (RC = 28%, RP = 32%), with amean response duration of 12.24 months, after receiving an average of 4.8 cycles. In Protocol II the results were 60% (RC = 16%, RP = 44%), 7.04 months and 5 cycles per patient, respectively. Both protocols were tolerated well, although Protcol I proved more toxic. Nauseas, vomiting and alopecia were the most common symptoms. There was no significant difference between the survival of responders and non-responders with Protocol I, but there was with Protocol II with (p less than 0.01).

Right pulmonary artery--left atrial communication. A case report and literature review.

A 22-month-old girl with Down's syndrome with a direct communication between the right pulmonary artery and left atrium leading to systemic desaturation is presented. She also had an atrial septal defect of the secondum type, which spontaneously closed. She underwent successful ligation of the abnormal communication. The literature is reviewed and, considering the high incidence of cerebral and systemic emboli, early surgical intervention is recommended.