Neoadjuvant chemotherapy with cisplatin, ifosfamide and 5-fluorouracil in the treatment of locally advanced cervical cancer.

The objective of this study was to evaluate clinical and histological response, resectability, and survival in patients with cervical epidermoid carcinoma stage IB2 to IIIB with the use of neoadjuvant chemotherapy followed by radical surgery and/or radiation therapy. Between September 1989 and February 1996, 53 patients were admitted to this study. They were given three cycles of cisplatin 30 mg/m2/day, 5-fluorouracil 500 mg/m2/day, ifosfamide 2000 mg/m2/day i.v., and mesna 400 mg/m2/day i.v. at hour 0 and 400 mg/m2 at hours 4 and 8 during three days every 21-28 days. We evaluated 47 patients. Global clinical response obtained was 85% {95% (CI), 75-97%, CR in 14 patients (30%) and PR in 26 patients (55%)}. Twenty-three patients underwent surgery. Six patients (13%) had a complete histological response. Median follow-up was 42 months (5-96). In resected patients, with a median follow-up of 57 months (5-96), the estimated five-year disease-free survival was 78%. Global survival estimated to 60 months was 83% for stage IB2, 70% for IIB, and 20% for IIIB. This mode of therapy offers a new option to improve survival in locally advanced cervical cancer. Randomized trials are required in order to establish a definitive role for this therapeutic strategy.

Schwannoma maligno de localización pleuropulmonar en un caso de enfermedad de Von Recklinghausen / Malignant Schwannoma with pleuropulmonary localization in a case of Von Recklinghausen`s disease

Se presenta un caso de neurofibromatosis tipo I que desarrolló un schwannoma maligno pleuropulmonar. Se puntualiza el potencial maligno de la enfermedad, que suele ser diagnosticada por el dermatólogo, debido al compromiso cutáneo temprano(AU)

Schwannoma maligno de localización pleuropulmonar en un caso de enfermedad de Von Recklinghausen / Malignant Schwannoma with pleuropulmonary localization in a case of Von Recklinghausen`s disease

Se presenta un caso de neurofibromatosis tipo I que desarrolló un schwannoma maligno pleuropulmonar. Se puntualiza el potencial maligno de la enfermedad, que suele ser diagnosticada por el dermatólogo, debido al compromiso cutáneo temprano

Disección aórtica aguda asociada con inhalación de cocaína / Acute aortic dissection associated with cocaine abuse

Se presenta el caso de un paciente de sexo masculino de 21 años de edad, con disección aórtica aguda, del tipo A de la clasificación de Daily, complicada con taponamiento cardíaco por hemopericardio, seguida de muerte. Adicto a la cocaína, había inhalado la misma hasta la internación. No presentaba hipertensión arterial y la necropsia no mostró necrosis quísticade la media aórtica. Se compara con otros casos similares hallados en la literatura (AU)

Disección aórtica aguda asociada con inhalación de cocaína / Acute aortic dissection associated with cocaine abuse

Se presenta el caso de un paciente de sexo masculino de 21 años de edad, con disección aórtica aguda, del tipo A de la clasificación de Daily, complicada con taponamiento cardíaco por hemopericardio, seguida de muerte. Adicto a la cocaína, había inhalado la misma hasta la internación. No presentaba hipertensión arterial y la necropsia no mostró necrosis quísticade la media aórtica. Se compara con otros casos similares hallados en la literatura

High-performance liquid chromatographic determination of some of the hydrolytic decomposition products of poly(alpha-hydroxyacid)s.

An HPLC procedure is described for the separation and identification of some hydrosoluble by-products resulting from the hydrolytic degradation of poly(alpha-hydroxyacid)s having biomedical interest: poly(L-lactide), poly(DL-lactide), poly-(glycolide) and poly(lactide-co-glycolide). Peak identification was performed by comparing the respective retention times with those of pure standards. It was observed that optimum shape and separation of peaks are considerably affected by the composition of the mobile phase, consisting of acetonitrile (A) and a 0.006 M K2HPO4 buffer (B), and, in particular, its pH and A:B ratio, which had to be adjusted to around 5.8 and 75:25 (v/v), respectively. Under the investigated experimental conditions (aqueous suspension, 100 degrees C for 12 h under stirring), poly(L-lactide) is quite stable, poly(glycolide) degrades easily to glycolic acid, whereas poly(DL-lactide) and poly(DL-lactide-co-glycolide) exhibit intermediate behaviour. Upon hydrolytic decomposition, these poly(alpha-hydroxyacid)s yield not only the corresponding acids, but also their linear dimers and, possibly, trimers, tetramers and higher oligomers.

Carcinoma de próstata con metástasis en ganglios linfáticos no regionales / Carcinoma of the prostate with non regional lymphatic nodes metastases

Presentamos un caso de cáncer de próstata cuyo primer y único signo fue una adenopatía axilar derecha. Destacamos la ausencia de sintomatología urinaria y la mínima alteración de la exploración prostática por tacto rectal. Analizamos las diferentes teorías sobre las rutas de diseminación hacia la axila, siendo en este caso la vía linfática la de mayor asidero. La revisión de la literatura efectuada sugiere que el tratamiento debe enfocarse con idénticos protocolos en aquellos pacientes que presentan inicialmente metástasis óseas, vicerales o en ganglios linfáticos no regionales,ya que la respuesta y su duración han sido similares en ambos grupos(AU)

Carcinoma de próstata con metástasis en ganglios linfáticos no regionales / Carcinoma of the prostate with non regional lymphatic nodes metastases

Presentamos un caso de cáncer de próstata cuyo primer y único signo fue una adenopatía axilar derecha. Destacamos la ausencia de sintomatología urinaria y la mínima alteración de la exploración prostática por tacto rectal. Analizamos las diferentes teorías sobre las rutas de diseminación hacia la axila, siendo en este caso la vía linfática la de mayor asidero. La revisión de la literatura efectuada sugiere que el tratamiento debe enfocarse con idénticos protocolos en aquellos pacientes que presentan inicialmente metástasis óseas, vicerales o en ganglios linfáticos no regionales,ya que la respuesta y su duración han sido similares en ambos grupos

[Malignant mesothelioma of the pericardium]. / Mesotelioma maligno del pericardio.

Malignant mesothelioma is a tumor which occurs in one out of every 4,000 patients autopsied for malignant neoplasia. Pericardial location is the least frequently encountered, accounting for less than 2% of the total cardiac tumors. We are presenting here a patient in whom the tumor resulted in a syndrome of cardiac tamponade. It could not be diagnosed in the living patient in spite of having performed a subxiphoideal pericardic biopsy. The patient died suddenly, and the tumor was found during autopsy, infiltrating the right atrium and protruding into the cavity, involving the right coronary artery. This latter situation could have been responsible for the patient's death. Clinical and pathological findings are compared with those of 30 cases found in recent literature.

Mesotelioma maligno del pericardio. / [Malignant mesothelioma of the pericardium]

Malignant mesothelioma is a tumor which occurs in one out of every 4,000 patients autopsied for malignant neoplasia. Pericardial location is the least frequently encountered, accounting for less than 2

of the total cardiac tumors. We are presenting here a patient in whom the tumor resulted in a syndrome of cardiac tamponade. It could not be diagnosed in the living patient in spite of having performed a subxiphoideal pericardic biopsy. The patient died suddenly, and the tumor was found during autopsy, infiltrating the right atrium and protruding into the cavity, involving the right coronary artery. This latter situation could have been responsible for the patients death. Clinical and pathological findings are compared with those of 30 cases found in recent literature.

[Percutaneous mitral commissurotomy: immediate and short-term results]. / Commissurolisi mitralica percutanea: risultati immediati e a breve termine.

31 symptomatic patients with mitral stenosis were selected for percutaneous transvenous mitral commissurotomy using Inoue catheter. The patients were selected using the echocardiographic score for: leaflets mobility, leaflets thickening, subvalvular thickening, degree of calcifications. All patients had a score less than or equal to 8 and represented 17.5% of the patients studied in our echocardiographic laboratory for mitral stenosis. We were able to perform the commissurotomy in 30 of them. Mean left atrial pressure decreased from 26 +/- 5.2 mmHg to 14.6 +/- 6 mmHg (p less than 0.001). The mean mitral diastolic pressure gradient decreased from 8.9 +/- 3.1 mmHg to 3.9 +/- 1.3 mmHg (p less than 0.001). The mitral valve area, using the echocardiographic Pressure Half Time (PHT), increased from 0.94 +/- 0.17 cmq to 1.96 +/- 0.33 cmq (p less than 0.001). Mitral regurgitation, angiographically evaluated in 29 patients, increased in 11 (38%), being of degree + + + in 3 patients. There were 2 heart tamponades and 5 cases (16.6%) of left-to-right shunt with Qp / Qs less than 2. After 3 months, the follow-up showed improvement of one or more functional classes in 96.6% of all patients. The mitral valve area, determined after 6 months in 24 patients by PHT, was stable (1.98 +/- 0.31 vs 1.93 +/- 0.25) (p = 0.5); we did not find mitral stenosis recurrence in any instance. In the first 10 patients, after 1 year, the results are stable (1.85 +/- 0.28 cmq vs 1.93 +/- 0.21 cmq) (p = 0.5) without mitral stenosis recurrence. These data suggest that in selected tight mitral stenosis the percutaneous transvenous commissurotomy may be alternative to the open surgical solution. Using an Inoue catheter, the percutaneous transvenous mitral commissurotomy is easier and the complications are few. The major procedural hazards derive from the transseptal technique.

Hypothesizing, circularity, and neutrality revisited: an invitation to curiosity.

This essay examines the systemic guiding principles of neutrality, hypothesizing, and circularity, historically developed by the Milan Team of Selvini-Palazzoli, Boscolo, Cecchin, and Prata (12, 13). With the reorganization of these team members (see 11 for a summary of the distinctions between the work of the Selvini-Palazzoli and Prata research team and the Cecchin and Boscolo training team), different reconstructions of the original systemic principles have evolved. New understanding of the concepts of circularity, hypothesizing, and neutrality are now possible, given the systemic epistemology on which the early Milan model was based. It should be emphasized, however, that the ideas presented in this essay are most associated with the systemic work of the Cecchin and Boscolo team.

Hypothesizing--circularity--neutrality: three guidelines for the conductor of the session.

This paper presents the results of our research focused on individuating and elaborating principles and methods that we have found highly productive in interviewing the family. We have synthesized these principles under the headings Hypothesizing, Circularity, and Neutrality, giving conceptual definitions, descriptions, and practical examples of their application. Our purpose is to aid the therapist in stimulating the family to produce meaningful information, which is indispensable to the therapist in making a therapeutic choice.

Family rituals a powerful tool in family therapy.

The use of systemic models in family therapy obliged our team to devise therapeutic tasks involving the entire family. Among these, one was found to be extremely effective: the prescribing of a family ritual. This article gives details of on such example aimed at the destruction of a myth that had been created by three generations of a family. In order that the reader may have a adequate understanding of this ritual, were shall fully describe the story of the family and of the transgenerational evolution of this myth. In the description of the treatment of the family, certain errors were made by the therapists that will come to light-errors that, as usual, were far more instructive than the actual successes. Eventually, it was the very understanding of these errors and their repercussions that led us to the successful prescription of the ritual. Finally, detailed analysis of the substance and aim of the ritual will illustrate and explain exactly what we mean by the term ritual.