Strong coupling of a single electron in silicon to a microwave photon.

Silicon is vital to the computing industry because of the high quality of its native oxide and well-established doping technologies. Isotopic purification has enabled quantum coherence times on the order of seconds, thereby placing silicon at the forefront of efforts to create a solid-state quantum processor. We demonstrate strong coupling of a single electron in a silicon double quantum dot to the photonic field of a microwave cavity, as shown by the observation of vacuum Rabi splitting. Strong coupling of a quantum dot electron to a cavity photon would allow for long-range qubit coupling and the long-range entanglement of electrons in semiconductor quantum dots.

Intravenous chemotherapy, early debulking surgery, and consolidation intraperitoneal chemotherapy in advanced ovarian carcinoma.

OBJECTIVE: The efficacy of a cisplatin-anthracycline combination, early debulking surgery, and intraperitoneal chemotherapy has been demonstrated through separate studies. We evaluated a multimodal treatment strategy integrating these therapeutic options. METHODS: Women with stage III or IV ovarian carcinoma received six cycles of cisplatin/epirubicin alternating with leucovorin and 5-fluorouracil. Patients with a residual disease (RD) measuring more than 2 cm after the initial laparotomy underwent an early debulking surgery after the first three cycles of chemotherapy. A second-look laparotomy (SLL) was performed after six cycles of intravenous chemotherapy. Intraperitoneal chemotherapy with cisplatin, VP16, and mitoxantrone was then administered in patients with no or RD < 2 cm after SLL. RESULTS: A total of 87 patients were included. After initial laparotomy, 11 patients (12%) had no macroscopic residual disease, 38 (44%) had a RD < or =2 cm, and 38 (44%) had a RD > 2 cm. After early debulking surgery, an additional 18 patients (21%) had a RD < 2 cm. Seventy-five patients were evaluable for response to intravenous chemotherapy: the overall response rate was 80%, and 30 patients achieved a pathological complete response (40%). Eight percent of the patients had stable disease and 12% had a progression. Sixty-eight patients received intraperitoneal chemotherapy after second-look laparotomy. With a 72-month median follow-up, median overall survival and progression-free survival were, respectively, 37 and 19 months. Five-year survival was 41%. CONCLUSION: The prognosis of patients with advanced ovarian carcinoma may be improved by a sequential treatment strategy including intravenous chemotherapy, early debulking surgery, and intraperitoneal chemotherapy.

Understanding opioid tolerance in cancer pain.

PURPOSE/OBJECTIVES: To review opioid tolerance in chronic cancer pain, define the phenomenon and its scope, review physiologic mechanisms, and discuss clinical strategies to identify and manage this complex issue. DATA SOURCES: Review articles, case studies, original research, and published guidelines. DATA SYNTHESIS: Novel therapies to prevent/reverse tolerance are being investigated with a possible future role for N-methyl-d-aspartate antagonists. CONCLUSIONS: Greater nursing research is needed to identify patient risk factors for tolerance development and clinical measurement of the phenomenon. Understanding cellular mechanisms for tolerance may contribute to better management. IMPLICATIONS FOR NURSING PRACTICE: Nursing knowledge of tolerance is important to provide the basis for accurate patient assessment, education, and pain management.

[Prosthetic replacement of the ureters]. / Le remplacement prothétique des uretères.

STUDY AIM: The aim of this study is to demonstrate the reliability of silicone prosthesis for the replacement of ureters. This prosthesis derives from the biliary prosthesis developed after a personal experimental study continued by Triboulet. PATIENTS AND METHODS: In 38 patients suffering from a malignant disease, a right silicone prosthesis was used for the replacement of an ureter during a 20-year period. There were 30 female and eight male patients. The mean age was 71 (range: 51-88 years). Forty one prostheses were used; one patient underwent two successive operations on the same side with a change of prosthesis, and two patients required a bilateral prosthesis. There were 12 gynaecological carcinomas (three with ureteral fistula), three prostatic carcinomas, 16 cancers of the rectum and recto-sigmoid junction, four cancers of the right colon with retroperitoneal carcinomatosis, and three ureteral fistulas after extended colonic resection. RESULTS: Early complications were limited to ureteral fistulas (n = 6, 16%) in patients who had already a preoperative fistula (n = 3) and in patients with peritoneal metastases on the superior wall of the bladder. The secondary destruction of the kidney (four secondary nephrectomies) occurred when the function of the kidney was already impaired at the time of the procedure. There were no secondary fistulas, no secondary obstruction of the prosthesis. The longest follow-up was 69 months. CONCLUSION: The silicone prostheses used for the replacement of ureters are reliable and still permeable beyond 5 years. The protection of the renal function in patients often submitted to chemotherapy improves the duration and quality of survival. These prostheses must be reserved to advanced malignant diseases with a rather long life expectancy.

Determination of serum creatinine prior to iodinated contrast media: is it necessary in all patients?

The risk of contrast-associated nephrotoxicity (CAN) is increased in the presence of preexisting renal disease. Although routine determination of serum creatinine (Cr) prior to imaging studies is the traditional method of assessing renal function, it is a costly and time-consuming practice. The purpose of this study was to investigate whether a patient survey could identify patients with a high likelihood of having normal Cr values and who, therefore, did not require serum testing. A survey was administered to 673 consecutive adult patients who were scheduled for contrast-enhanced computed tomography. Survey questions were designed to elicit a history of renal disorders as well as additional risk factors for CAN. Each patient had a Cr level determined within 48 hours prior to the injection of iodinated contrast media. Cr levels were assessed in the patients who gave negative responses to all survey questions. The degree to which positive responses to each survey question predicted elevated Cr levels was determined using the odds ratio (OR). Among the 673 respondents, 577 (85%) had normal Cr values (< or =1.3 mg/dL for women and < or =1.4 mg/dL for men). Completely negative responses to the questionnaire occurred in 191 (28%) of 673 of respondents, and 176 (92%) of these 191 had normal Cr values. A Cr cutoff value of 1.7 mg/dL is used in our department, i.e., patients with Cr values >1.7 mg/dL usually do not receive iodinated contrast media. Using this Cr cutoff value, 189 (99%) of 191 patients with negative responses had Cr values less than or equal to the cutoff value. The survey questions most strongly associated with elevated Cr values pertained to preexisting renal disease (OR 13.6), proteinuria (OR 8.7), prior kidney surgery (OR 8.1), hypertension (OR 5.4), gout (OR 4.6), and diabetes (OR 3.2). If the survey had been limited to these six questions, completely negative responses would have occurred in 450 (67%) of 673, 424 (94%) of these 450 would have normal Cr values, and 446 (99%) of 450 would have had Cr values at or below the 1.7 mg/dL cutoff for iodinated contrast. A completely negative response to a simple (six question) patient survey prior to iodinated contrast administration can identify a significant fraction of patients with normal Cr levels. Use of this survey could reduce by 67% the number of patients undergoing routine Cr determinations prior to imaging studies. This could reduce costs, decrease delays, and increase patient satisfaction associated with imaging studies.

Long-term follow-up after adjuvant chemotherapy in completely resected early stage ovarian carcinoma.

OBJECTIVE: To evaluate the impact of standardized staging, surgery and adjuvant chemotherapy on survival of patients with completely resected early ovarian carcinoma. STUDY DESIGN: We performed a multicentric retrospective analysis of 283 patients with early stage ovarian carcinoma consecutively treated between 1977 and 1993. Borderline tumours were excluded. A comprehensive staging was performed during initial laparotomy. Patients were treated by standardized surgical resection and all excepted stage IA received a 6-course adjuvant chemotherapy. RESULTS: Eighty patients were excluded because of incorrect substaging, inadequate surgery and adjuvant therapy. The analysis was performed on 203 patients with completely resected early stage ovarian cancer (139, stage I; 64, stage II). Relapse-free survival and overall survival rates for stage I were 66 and 69%, respectively. Relapse-free survival and overall survival rates for stage II were 57 and 61% respectively. Median time of relapse was 18 months (range, 1-107 months). Sites of relapse were peritoneum (45%), retroperitoneal lymph nodes (37%) and distant metastases (18%). Relapses occurring within 18 months had a median survival after relapse of 9 months while later relapses had a median survival of 22 months (P = 0.005). There was no significant difference in relapse-free and overall survival according to the age, performance status and pathology. Cisplatin-based chemotherapy improved the 10-year overall survival of patients with stage IIB and IIC as compared to chemotherapy without cisplatin (oral melphalan. CMF regimen); 91 vs. 33% (P = 0.012) and 75 vs. 42% (P = 0.05), respectively. Cisplatin-based regimens did not improve survival in stage IA, IB and IIA. CONCLUSIONS: Early ovarian cancers have a good prognosis after comprehensive staging, complete surgery and adjuvant chemotherapy. Cisplatin-based regimens compared to melphalan and CMF showed a significant increase of survival in stage IIB and IIC. Prognosis of relapse depends on the relapse-free interval duration.

Bimonthly high dose leucovorin and 5-fluorouracil 48-hour infusion with interferon-alpha-2a in patients with advanced colorectal carcinoma. Groupe d'Etude et de Recherche sur les Cancers de l'Ovaire et Digestifs (GERCOD).

UNLABELLED: BACKGROUND; The rationale for the modulation of 5-fluorouracil (5-FU) with interferon-alpha (IFN) is inhibition of 5-FU catabolism and 5-FU resistance. Clinical trials have shown debatable results when IFN is given in high doses with 5-FU used as a bolus alone or in combination with leucovorin (LV). A first-line Phase II study was performed in 50 patients with metastatic colorectal carcinoma who were given a bimonthly combination of high dose LV, a high dose 48-hour infusion of 5-FU, and a low dose of IFN. METHODS: The regimen was comprised of a 2-hour infusion of LV, 500 mg/m2, on each of 2 consecutive days, and a 48-hour infusion of 5-FU, 1.5 to 2 g/m2/24 hours, starting after Day 1 of LV treatment every 2 weeks until there was evidence of disease progression. IFN was administered subcutaneously three times weekly at a dose of 3 MU (body surface area [BSA] < 1.75 m2) or 4.5 MU (BSA > OR = 1.75 m2). RESULTS: World Health Organization toxicity Grade 3-4 occurred in 21 patients (42%): diarrhea in 6%, mucositis in 12%, neutropenia in 30%, and alopecia in 8%. The overall response rate was 44%; 1 patient had a complete response (2%), 21 had partial responses (42%), 23 had stable disease (46%), and 5 had disease progression (10%). The median progression free survival was 9 months, and median survival was 25 months. CONCLUSIONS: Bimonthly high dose LV, a high dose 48-hour infusion of 5-FU, and a low dose of IFN had good activity in patients with advanced colorectal carcinoma. However, as in other schedules of LV and 5-FU, IFN induces high grade toxicity.

[Laparoscopic surgery of recurrent hernias after prosthesis (35 cases)]. / Chirurgie laparoscopique des récidives herniaires après prothèse (35 cas).

We report 35 cases of laparoscopic repair after prosthesis surgery using the classic open technique (19 cases) or laparoscopic technique (16 cases). Most difficulties were observed after intraperitoneal laparoscopy. Hernia repair was preferentially intrapreperitoneal (31 cases). Post-operative morbidity was low with two cases of serohematic effusion treated by puncture. Mean hospital stay was 2.5 days. Patients returned to normal activity within 7 days but work stoppage in active patients depended more on patient motivation than the initial surgical procedure. There were no reiterative recurrences although follow-up is too short (mean 21.2 months) for definitive results.

[Early debulking surgery after chemotherapy in advanced cancer of the ovary]. / La cytoréduction chirurgicale précoce après chimiothérapie dans le cancer de l'ovaire avancé. GEROD. Groupe d'Etude et de Recherche sur les Cancers de l'Ovaire et Digestifs.

The main prognostic factor in advanced ovarian cancer is the volume of residual disease after the initial laparotomy. Early debulking surgery after several cycles of chemotherapy, before the emergence of resistant cell lines, could improve the prognosis of patients with bulky residual disease. This study concerns patients with advanced ovarian cancer entered into three prospective trials including IV cisplatin and anthracycline-based chemotherapy, early debulking surgery after three cycles of chemotherapy in case of initial residual disease superior 2 cm and intraperitoneal consolidation chemotherapy. Among 160 patients with stage III or IV, 80 (50%) had at least a residual tumor of more than 2 cm in diameter. Early debulking surgery was effectively performed in 54 patients (67.5%), leaving 39 patients with no residue over 2 cm. Twenty-one patients had no macroscopic residual disease. The median survival of all patients with initial residual disease over 2 cm was 23 months. Patients with no macroscopic residual disease at early debulking surgery had a median survival of 44 months. Early debulking surgery appears useful in advanced ovarian cancer with bulky residual disease. The objective of this operation is to achieve no macroscopic residual lesion.

[Laparoscopic resection-anastomosis in diverticular sigmoiditis and its complications apropos of 65 cases]. / La résection anastomose coeliochirurgicale dans la sigmoïdite diverticulaire et ses complications à propos de soixante-cinq cas.

From 1992 to 1995, 77 cases of diverticular sigmoiditis were treated laparoscopically. Conversion to open surgery was required in only 6 cases. There were 27 cases with perforated sigmoid including 5 with peritonitis. Leakages from the anastomosis occurred intraoperatively in 3 cases and were repaired laparoscopically. Early complications were fistulae (n = 2.3%), occlusion by loop agglutination (n = 1) and Richter's hernia (n = 1). A cerebral vascular event lead to death in one patient over 80. Late complications were limited to extensible anastomotic diaphragms (27%) as no true stenoses were observed. There was 1 occlusion on bride and 1 eventration through the extraction orifice. Both were treated laparoscopically. Our overall results after laparoscopic treatment of diverticular sigmoiditis show a 3-fold increase in operative time over classical surgery without any modification in operative risks, a 2-fold reduction in intensive care after surgery and preserved parietal wall (10-fold reduction in the number of eventrations and to a lesser extent fewer occlusions). Laparoscopic surgery does however have its limitations in major peritoneo-occlusive syndromes and in patients with a high risk for anesthesia.

[Laparoscopic surgery in the treatment of hiatal hernia and gastroesophageal reflux. Apropos of 172 cases]. / Traitement coelio-chirurgical des hernies hiatales et du reflux gastro-oesophagien. A propos de 172 cas.

Surgical cure of an anomaly of the oesocardial junction was performed 170 times in 172 patients (conversion rate 1.1%). Surgery was indication mainly due to complications of gastro-oesophageal reflux alone (32 cases) or associated with hiatal hernia. The Nissen Rosetti procedure was performed, usually with staple suture (excepting the pillars). A semi-Nissen was performed in 17 cases. There were two major postoperative complications (1.1%) due to necrotic perforation of the lower oesophagus or the greater curvature. Both cases required reoperation on the second and eighth day postoperatively. The postoperative period was uneventful in all the other cases and the mean hospital stay was 4 days. Follow-up examinations included a gastroduodenal contrast study the day after the operation, a fibroscopy at discharge and clinical examination at consultation 7 days later. Later follow-up examinations on day 30 and 90 were completed with a questionnaire or another consultation one year later. Radiography, fibroscopy or pH metry were ordered only for symptomatic patients. Poor functional outcome was observed in two cases with recurrent reflux and in five cases in which spiral procedures were used. Five second laparoscopic operations were successful. Almost all patients had dysphagia after the operation and in 17 cases balloon dilatation was required during the first month after surgery. Persistent dysphagia required the use of a candle twice in one patient. Dysphagia also persisted in one patient with impaired oesophageal motricity. Good and excellent results accounted for 84% of the patients at one year.(ABSTRACT TRUNCATED AT 250 WORDS)

Survival with intraperitoneal cisplatin in advanced ovarian cancer after second-look laparotomy.

We studied survival in 36 patients with Stage III/IV ovarian cancer who received intraperitoneal high-dose cisplatin (200 mg/m2) alone or in combination with cytarabine (2 g), after intravenous (i.v.) cisplatin-based chemotherapy followed by second-look laparotomy. Complete responders were scheduled for three courses of IP chemotherapy, and others for six. Eight patients (22%) did not complete treatment (6 catheter failures and 2 renal failures). Peritoneal cytology remained positive in 6 patients (17%). Median overall and progression-free survival after second-look laparotomy were 44 and 37 months, respectively, for 13 complete responders to i.v. chemotherapy; 24 months and 11 months for patients with residual tumors less than 2 cm (17 cases); 15 and 12 months with tumors greater than 2 cm (6 cases). There was a significant difference in overall (p = 0.05) and progression-free (p = 0.001) survival between complete responders to i.v. chemotherapy and patients whose tumor was less than 2 cm. We find no evidence that high-dose cisplatin-based intraperitoneal chemotherapy given after second-look laparotomy will enhance survival in advanced ovarian cancer with zero or minimal residual disease.

Teaching homosexual literature as a "subversive" act.

If taught in a way that exposes students extensively and closely to its texts, homosexual literature can "subvert" the long-standing cultural notion that homosexuality is and should remain "unspeakable" and "untouchable." The author's working methods and materials in his gay and lesbian literature courses at the New School for Social Research, where he has been teaching the subject since 1979, are organized according to those principles. His courses also have a secondary "subversiveness" in the present academic climate, in implicitly dissenting from the dominant "new-inventionist" trend in gay studies now.

Sequential cisplatin-doxorubicin, early debulking surgery and intraperitoneal chemotherapy in advanced ovarian cancer. Groupe d'Etude et de Recherche sur les Cancers de l'Ovaire et Digestifs (GERCOD).

40 patients with advanced ovarian cancer were treated with immediate debulking followed by sequential cisplatin and doxorubicin every 4 weeks, followed by second-look laparotomy (SLL). Six courses were given when residual disease (RD) was under 2 cm. When RD was over 2 cm, three courses were followed by early debulking and six more courses before SLL. Immediate debulking was optimal in 15 patients (38%) and early debulking in an additional 15 (38%). Pathological complete responses (34 evaluable cases) were observed in 14 cases (41%), partial response in 13 (38%), stable disease in 3 (9%) and progression in 5 (15%). Toxicity was mainly haematological. 11 patients with negative SLL and 15 with RD under 2 cm received intraperitoneal cisplatin 200 mg/m2 alone or with cytarabine. Median survival was 45 months: 58 months for RD under 2 cm at initial laparotomy and 31 months for RD over 2 cm. Median survival was 46 months when early debulking was successful. 5 year disease-free survival was only 16%. However, this multimodal treatment offers prolonged survival, especially in patients optimally debulked either at initial laparotomy or at early debulking surgery.