Concordancia entre histología pre, intra y postoperatoria en cáncer de endometrio / Concordance between pre and intraoperatory biopsy in endometrial cancer

Antecedentes: En pacientes con cáncer de endometrio se discute la concordancia entre biopsia pre e intraoperatoria versus la definitiva, en grado de diferenciación, tipo histológico y profundidad de mioinvasión. Método: Se determinó sensibilidad (S), especificidad (E), valor predictivo positivo (VPP) y valor predictivo negativo (VPN) de: grado de diferenciación bien diferenciado y tipo histológico sólo endometrioide en biopsia preoperatoria; y grado de diferenciación bien diferenciado, tipo histológico sólo endometrioide y profundidad de mioinvasión menor o igual a la mitad interna del miometrio, en biopsia intraoperatoria, para resultados similares en biopsia definitiva en serie clínica de pacientes con cáncer de endometrio clínicamente limitado al útero sometidas a tratamiento quirúrgico primario. Resultados: Biopsia preoperatoria: grado de diferenciación bien diferenciado S: 100 por ciento, E: 77,8 por ciento, VPP: 78,9 por ciento y VPN: 100 por ciento. Tipo histológico sólo endometrioide S: 86,4 por ciento, E: 33,3 por ciento, VPP: 86,4 por ciento y VPN: 33,3 por ciento, para resultado similar en biopsia definitiva. Biopsia intrao-peratoria: grado de diferenciación bien diferenciado S: 91,7 por ciento, E: 94,4 por ciento, VPP: 91,7 por ciento y VPN: 100 por ciento. Tipo histológico sólo endometrioide S: 95,7 por ciento, E: 77,8 por ciento, VPP: 95,7 por ciento y VPN: 70 por ciento. Profundidad de mioinvasión menor o igual a mitad interna del miometrio S: 95,2 por ciento, E: 30 por ciento, VPP: 74,1 por ciento y VPN: 75 por ciento, para resultado similar en la biopsia definitiva. Conclusión: No hubo concordancia absoluta de grado de diferenciación bien diferenciado entre biopsia preoperatoria y biopsia definitiva, ni de grado de diferenciación bien diferenciado ni tipo histológico sólo endometrioide entre biopsia intraoperatoria y biopsia definitiva, por lo que se recomienda etapificación quirúgica independiente de los resultados de las biopsias pre e...

Background: Among patients with endometrial cancer there is discussion about concordance between pre and intraoperatory biopsy and the definitive one, for diferentiation grade, histologyc type and depth of myoinvasion. Method: To determinate sensibility (S), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of: good diferenciated diferentiation grade and only endometrioid histologyc type on preoperatory biopsy, and good diferenciated diferentiation grade, only endometrioid histologyc type and inner half of the miometryum or less myoinvasion depth on intraoperatory biopsy, for similar result on definitive biopsy in a clinical cohort of patients with endometrial cancer clinically limited to uterus treated with primary surgery. Results: Preoperatory biopsy: good diferentiated diferentiation grade S: 100 percent, Sp: 77.8 percent, PPV: 78.9 percent and NPV: 100 percent. Only endometrioid histologyc type S: 86.4 percent, Sp: 33.3 percent, PPV 86.4 percent and NPV 33.3 percent, for similar result on definitive biopsy. Intraoperatory biopsy: Good diferentiated diferentiation grade S: 91.7 percent, Sp: 94.4 percent, PPV: 91.7 percent and NPV 100 percent. Only endometrioid histologyc type S: 95.7 percent, Sp 77.8 percent, PPV 95.7 percent and NPV 70 percent. Inner half of the myometrium or less myoinvasion depth S: 95.2 percent, Sp 30 percent, PPV 74.1 percent and NPV 75 percent, for similar result on definitive biopsy. Conclusion: There wasn't absolute concordance of good diferentiated diferentiation grade between preoperatory and definitive biopsy. Also there weren't absolute concordance of neither good diferentiated diferentiation grade, nor only endometrioid histologyc type, between intraoperatory and definitive biopsy, for that it is recommended surgical staging, independent of results of pre and intraoperatory biopsies.

Development and characterization of recombinant chromosome substitution lines (RCSLs) using Hordeum vulgare subsp. spontaneum as a source of donor alleles in a Hordeum vulgare subsp. vulgare background.

The ancestor of barley (Hordeum vulgare subsp. spontaneum) may be a source of novel alleles for crop improvement. We developed a set of recombinant chromosome substitution lines (RCSLs) using an accession of H. vulgare subsp. spontaneum (Caesarea 26-24, from Israel) as the donor and Hordeum vulgare subsp. vulgare 'Harrington' (the North American malting quality standard) as the recurrent parent via two backcrosses to the recurrent parent, followed by six generations of selfing. Here we report (i) the genomic architecture of the RCSLs, as inferred by simple sequence repeat (SSR) markers, and (ii) the effects of H. vulgare subsp. spontaneum genome segment introgressions in terms of three classes of phenotypes: inflorescence yield components, malting quality traits, and domestication traits. Significant differences among the RCSLs were detected for all phenotypes measured. The phenotypic effects of the introgressions were assessed using association analysis, and these were referenced to quantitative trait loci (QTL) reported in the literature. Hordeum vulgare subsp. spontaneum, despite its overall inferior phenotype, contributed some favorable alleles for agronomic and malting quality traits. In most cases, the introgression of the ancestral genome resulted in a loss of desirable phenotypes in the cultivated parent. Although disappointing from a plant breeding perspective, this finding may prove to be a useful tool for gene discovery.

Genetic diversity in three groups of barley germplasm assessed by simple sequence repeats.

Genetic diversity can be measured by several criteria, including phenotype, pedigree, allelic diversity at marker loci, and allelic diversity at loci controlling phenotypes of interest. Abundance, high level of polymorphism, and ease of genotyping make simple sequence repeats (SSRs) an excellent molecular marker system for genetics diversity analyses. In this study, we used a set of mapped SSRs to survey three representative groups of barley germplasm: a sample of crop progenitor (Hordeum vulgare subsp. spontaneum) accessions, a group of mapping population parents, and a group of varieties and elite breeding lines. The objectives were to determine (i) how informative SSRs are in these three sets of barley germplasm resources and (ii) the utility of SSRs in classifying barley germplasm. A total of 687 alleles were identified at 42 SSR loci in 147 genotypes. The number of alleles per locus ranged from 4 to 31, with an average of 16.3. Crop progenitors averaged 10.3 alleles per SSR locus, mapping population parents 8.3 alleles per SSR locus, and elite breeding lines 5.8 alleles per SSR locus. There were many exclusive (unique) alleles. The polymorphism information content values for the SSRs ranged from 0.08 to 0.94. The cluster analysis indicates a high level of diversity within the crop progenitors accessions and within the mapping population parents. It also shows a lower level of diversity within the elite breeding germplasm. Our results demonstrate that this set of SSRs was highly informative and was useful in generating a meaningful classification of the germplasm that we sampled. Our long-term goal is to determine the utility of molecular marker diversity as a tool for gene discovery and efficient use of germplasm.

Importancia de aa linfadenectomia pelvica y lumoaortica en la etapificacion quuirurgica del cancer de endometrio

Se reportan 40 pacientes con cáncer de endometrio sin evidencia clínica de diseminación extrauterina, tratadas en la Unidad de Oncología Ginecológica del Hospital de Carabineros entre enero de 1992 y enero de 2001, que fueron sometidas a etapificación quirúrgica como tratamiento primario. En 16 pacientes (40%) se efectuó linfadenectomía pélvica y lumboaórtica más histerectomía total, anexectomía bilateral, omentectomía y citología peritoneal. Este grupo se catalogó como con etapificación quirúrgica completa (EQC). En 24 pacientes (60%) sólo se efectuó disección parcial de los ganglios retroperitoneales, o no se efectuó, catalogándose este grupo como con etapificación quirúrgica incompleta (EQI). Recibieron radioterapia postoperatoria en el grupo con EQC 3 pacientes (18,75%) y en el grupo con EQI 13 pacientes (54,17%) (p < 0,05). El grupo total tuvo una sobrevida global de 75% y una sobrevida libre de enfermedad de 72,5%, con una mediana de seguimiento de 38,5 meses. La sobrevida global fue 87,5% y 66,7% para el grupo con EQC y EQI respectivamente (p NS). La sobrevida sin evidencia de enfermedad fue 87,5% y EQI 62,5% para el grupo con EQC y EQI respectivamente (p < 0,05). La sobrevida sin evidencia de enfermedad fue 77,8% y 30% para los subgrupos con factores quirúrgico-patológicos de alto riesgo sometidos a EQC y EQI respectivamente (p < 0,05). La sobrevida sin evidencia de enfermedad fue 60% y 0 para los subgrupos con enfermedad extrauterina sometidos a EQC y EQI respectivamente (p < 0,025). La sobrevida sin evidencia de enfermedad fue 33% y 0 para los subgrupos con metástasis linfonodales sometidos a EQC y EQI respectivamente (p < 0,025). Conclusión: La linfadenectomía pelviana y lumboaórtica como componente esencial de la etapificación quirúrgica primaria en cáncer de endometrio, sería beneficiosa para la paciente al asociarse con menor necesidad de radioterapia postoperatoria y mejor sobrevida.

We report 40 patients with endometrial cancer without clinical evidence of extrauterine disemination, treated in the Gynecologic Oncology Unit of the Carabineros Hospital between January 1992 and january 2001, managed with surgical staging as primary treatment. In 16 patients (40%) it consisted of pelvic and lumboaortic lymphadenectomy with total hysterectomy, bilateral adnexectomy, omentectomy and peritoneal citology. This group was classified as complete surgical staging (CSS). In 24 patients (60%) retroperitoneal lymphonodes disection was only partial, or not at all being classified as incomplete surgical staging (ISS). In the CSS group 3 patients received postoperatory radiotherapy (18.75%) and in the ISS group 13 patients did (54.17%) (p < 0.05). The global survival of the total group was 75% and the free of disease survival was 72.5%, with a median follow up of 38.5 months. The global survival was 87.5% and 66.7% for the CSS and ISS groups respectively (p NS). The free of disease survival was 87.5% and 62.5% for the CSS and ISS groups respectively (p < 0.05). The free of disease survival was 77.8% and 30% for the subgroups with high risk surgical-pathological factors with. CSS and ISS respectively (p < 0.05). The free of disease survival was 60% and 0 for the subgroups with extrauterine disease with CSS and ISS respectively (p < 0.025). The free of disease survival was 33% and 0 for the subgroups with lymphonodal metastases with CSS and ISS respectively (p < 0.025). Conclusion: The pelvic and lumboaortic lymphadenectomy as esential component of primary surgical staging of endometrial cancer, could be beneficious for the patient through its association with less need of postoperatory radiotherapy and better.

Avoidance of Phycomyces in a controlled environment.

The sporangiophore of the fungus Phycomyces bends away from nearby objects without ever touching them. It has been thought that these objects act as aerodynamic obstacles that damp random winds, thereby generating asymmetric distributions of a growth-promoting gas emitted by the growth zone. In the interest of testing this hypothesis, we studied avoidance in an environmental chamber in which convection was suppressed by a shallow thermal gradient. We also controlled pressure, temperature, and relative humidity of the air, electrostatic charge, and ambient light. A protocol was established that yielded avoidance rates constant from sporangiophore to sporangiophore to within +/- 10%. We found that avoidance occurred at normal rates in the complete absence of random winds. The rates were smaller at 100% than at lower values of relative humidity, but not by much. Remarkably, at a distance as great as 0.5 mm, avoidance from a 30-micron diam glass fiber (aligned parallel to the sporangiophore) was about the same as that from a planar glass sheet. However, the rate for the fiber fell more rapidly with distance. The rate for the sheet remained nearly constant out to approximately 4 mm. We conclude that avoidance depends either on adsorption by the barrier of a growth-inhibiting substance or emission by the barrier of a growth-promoting substance; it cannot occur by passive reflection. Models that can explain these effects are analyzed in the Appendix.

Oral folic acid versus placebo in the treatment of males with the fragile X syndrome.

A double-blind, crossover study of a 10 mg folic acid per day (vs. placebo) treatment was carried out in 25 fra(X) males (ages 1-31 years). Each treatment period lasted 6 months. Before, during and after the study, the patients were assessed blindly with psychological, language and behavioral evaluations, and parent or caretaker reports were collected. Standardized testing did not show statistically significant changes in the group as a whole; psychological testing demonstrated a statistically significant improvement on folic acid in the prepubertal males. After uncoding, caretaker or parent reports also demonstrated behavioral improvements in the prepubertal males while being treated with folic acid.

Autism and the fragile X syndrome.

Ten patients with the fragile X syndrome were diagnosed at the Child Development Unit in 1982. Six of these patients are autistic and demonstrate similar profiles on three evaluations designed to measure the severity of autism. The similarities of these six autistic patients are described in depth.

Relaxation and subjective estimates of muscle tension: implications for a central efferent theory of muscle control.

The relationship of "awareness of muscle tension" to depth of relaxation was explored. In one experiment, accuracy of forearm flexor control was assessed using the psychophysical method of magnitude production, and depth of flexor relaxation was measured using the integrated EMG before and after EMG biofeedback training. No consistent relationship between motor-control accuracy and depth of relaxation was found. A second, similar experiment with frontalis showed increased accuracy of frontalis control with deeper relaxation. Accuracy of passive, verbal judgments of spontaneous frontalis tension fluctuation exhibited no clear relationship with depth of relaxation. It was concluded that forearm flexor and frontalis may be under the control of distinct mechanisms, and that afferent information probably contributes to the control of neither muscle. Three structural theories of the control mechanisms were considered, and one depending on the central monitoring of efferent outflow (rather than afferent inflow) seemed most compatible with the frontalis data. Both flexor and frontalis data could be accounted for by a two-phase scheme combining central outflow monitoring with the monitoring of mental contents for arousal value at very low muscle tension levels.

Asthma attack frequency in a pediatric population.

The joint occurrence of asthmatic symptomatology and psychological maladjustment does not necessarily imply a functional relationship between these two sets of phenomena. To test the contribution of psychological adjustment to the prediction of asthma symptomatology, a stepwise multiple regression was applied. Pulmonary and psychological adjustment variables were included in the regression analysis. The single best predictor of attack frequency was the pulmonary factor MMEF. Predictability was significantly increased with the family adjustment rating, the pulmonary factor FEV1, and the Child Adjustment Rating entered into the equation. The results were interpreted to be consistent with psychosomatic theory.

Patient variables supporting chronic illness. A scale for measuring attitudes toward respiratory illness and hospitalization.

To enable the study of attitudes as one basis for the maintenance of chronic illness, a scale of patient attitudes toward chronic respiratory illness and hospitalization was developed. Key cluster analysis was performed on a large set of statements which had been rated by patients hospitalized for chronic asthma in a residential treatment setting. The analyses identified six attitudinal clusters: Optimism, Negative Staff Regard, Specific Internal Awareness, External Control, Psychological Stigma, and Authoritarian Attitudes toward Illness and Hospitalization. The clusters showed good internal consistency, reliability, and generality. The low to moderate inter-relationships among clusters suggest the existence of identifiable patterns of attitudes which may be related to differences in coping styles to chronic illness.