Expression of CD44, E-cadherin, and antimetastatic protein nm23-H1 in complete hydatidiform moles.

INTRODUCTION: There is scant information about the expression of CD44 and E-cadherin, two cell adhesion molecules, and the antimetastatic protein nm23-H1, in complete hydatidiform moles. We measured the expression of these markers to determine their usefulness in predicting the development of invasive disease. MATERIALS AND METHODS: We performed a retrospective study of 27 patients with complete hydatidiform moles, collecting clinical information including the patient's age, pre-evacuation hCG level, pathology, hCG monitoring, and the development of gestational trophoblastic neoplasia. Immunohistochemical staining for CD44, E-cadherin, and nm23-H1 was performed. CD44 expression was classified as positive or negative. For E-cadherin and nm23-H1, the intensity of expression was graded on a 0 to 3 scale. Chi-square or Fisher's exact testing was used to evaluate the relationship between these markers and the development of invasive disease. RESULTS: CD44 was expressed in 26% of cases. E-cadherin expression was 1+, 2+, and 3+in 8%, 33%, and 59% of cases, respectively. Nm23-H1 expression was 1+, 2+, and 3+in 4%, 11%, and 85% of cases. The risk of developing invasive disease did not correlate with the expression of CD44, E-cadherin, or nm23-H1. CONCLUSION: In this preliminary study, there is no relationship between CD44, E-cadherin, and nm23-H1 expression in complete hydatidiform moles and the risk of invasive disease. Other molecular markers predictive of invasive disease should be sought to limit hCG surveillance to those at risk.

Abnormal cervical cytology: a risk factor for endometrial cancer recurrence.

The objective of this study was to evaluate the relationship between cervical cytology, histologic type, and risk of endometrial cancer recurrence. We performed a retrospective study of patients undergoing surgery for endometrial carcinoma. Risk factors for recurrence including histology, tumor grade, nodal status, myometrial invasion, peritoneal washings, stage, and cervical cytology were assessed. Abnormal cervical cytology was defined as the presence of any endometrial cells on Pap smear. Papillary serous and clear cell carcinomas were considered high-risk histologies. Univariate and multivariate analyses of risk factors for recurrence were performed. Thirty-nine (9%) patients developed recurrent endometrial cancer. More patients with abnormal Pap smears recurred (12% versus 4%, P < 0.05). For endometrioid adenocarcinoma, abnormal cervical cytology occurred in 61% and 7% recurred, while with high-risk histologies, 84% had abnormal cervical cytology and 19% recurred (P < 0.05). Other significant predictors of recurrence on univariate analysis were myometrial invasion, nodal status, washings, stage, and histology. On multivariate analysis, only nodal status remained a significant predictor of recurrence. Abnormal cervical cytology is associated with increased risk of endometrial cancer recurrence. Abnormal cervical cytology occurs more frequently in high-risk histologies, which are known to have a higher risk of recurrence. On multivariate analysis, only nodal spread remains a significant predictor of recurrence.

Lack of relationship between variable decelerations during reactive nonstress tests and oligohydramnios.

We sought to prospectively determine the value of variable and lambda decelerations noted during nonstress tests in predicting oligohydramnios and perinatal outcome. On the same day as having had reactive nonstress tests, 651 women underwent obstetrical ultrasound examinations for amniotic fluid index (AFI). Lambda and variable fetal heart rate decelerations were identified on sets of otherwise-reactive nonstress tests. Those with variable decelerations composed group 1; those without variable decelerations composed group 2. Demographic, perinatal outcome, and AFI data were compared, and group 1 inclusion criteria were varied. There were 200 nonstress tests in group 1 and 490 in group 2. There was a small difference between groups in maternal age (1.2 years, p = 0.02) and gestational age (0.8 weeks, p = 0.01), but no differences in gravidity, parity, race, or indications for testing (p >0.05). Oligohydramnios was present in 14.5% in group 1 and in 13.3% of group 2 (p = 0.68). In the cases of amniotic fluid index <8 cm, depth and duration of the variable decelerations did not correlate with AFI (R2 = 0.11, p = 0.09). Variable decelerations were associated with intrapartum "fetal distress," but lambda decelerations did not correlate with any outcome. Variable decelerations on an otherwise-reactive nonstress test did not correlate with amniotic fluid volume and were not cause for intervention in this study.

OTR-COTA collaboration in home health: roles and supervisory issues.

This article describes the registered occupational therapist (OTR)-certified occupational therapy assistant (COTA) team within the home health setting. It reviews regulations and guidelines for supervision, team interactions, and collaboration with other health care professionals and paraprofessionals. With the complexities of providing treatment in a client's home, the team members must combine their resources to successfully achieve desired outcomes. The article addresses various areas in which quality OTR-COTA collaboration enhances therapy effectiveness in reaching established treatment goals in a realistic and creative manner.