Pelvic lymphadenectomy in vulvar cancer and its impact on prognosis and outcome.

BACKGROUND: The value of pelvic lymphadenectomy (LAE) has been subject of discussions since the 1980s. This is mainly due to the fact that the relation between lymph node involvement of the groin and pelvis is poorly understood and therewith the need for pelvic treatment in general. PATIENTS AND METHODS: N = 514 patients with primary vulvar squamous cell cancer (VSCC) FIGO stage ≥ IB were treated at the University Medical Center Hamburg-Eppendorf between 1996 and 2018. In this analysis, patients with pelvic LAE (n = 21) were analyzed with regard to prognosis and the relation of groin and pelvic lymph node involvement. RESULTS: The majority had T1b/T2 tumors (n = 15, 78.9%) with a median diameter of 40 mm (11-110 mm). 17/21 patients showed positive inguinal nodes. Pelvic nodal involvement without groin metastases was not observed. 6/17 node-positive patients with positive groin nodes also had pelvic nodal metastases (35.3%; median number of affected pelvic nodes 2.5 (1-8)). These 6 patients were highly node positive with median 4.5 (2-9) affected groin nodes. With regard to the metastatic spread between groins and pelvis, no contralateral spread was observed. Five recurrences were observed after a median follow-up of 33.5 months. No pelvic recurrences were observed in the pelvic nodal positive group. Patients with pelvic metastasis at first diagnosis had a median progression-free survival of only 9.9 months and overall-survival of 31.1 months. CONCLUSION: A relevant risk for pelvic nodal involvement only seems to be present in highly node-positive disease, therefore pelvic staging (and radiotherapy) is probably unnecessary in the majority of patients with node-positive VSCC.

[The influence of visualization of orthography on the recognition of written words]. / L'influence du voisinage orthographique lors de la reconnaissance des mots écrits.

This paper reviews the main research that has been conducted on the role of orthographic neighbourhood in visual word recognition. We focus here on the traditionally defined neighbourhood, that is corresponding to the set of words of the same length sharing all but one letter with the stimulus. Two major theoretical frameworks, namely the activation verification and the interactive activation models, assume that orthographic neighbours are activated when a written word is presented. Predictions formulated by both models for words and pseudowords on the effects of neighbourhood size (N), neighbourhood frequency (NF), and neighbourhood distribution (P), are examined in order to assess the plausibility of serial versus interactive processes. Findings from 27 empirical studies including more than 80 experiments suggest that neighbourhood effects depend on the neighbourhood indexes (N, NF, and P), on the particular tasks (lexical decision, naming, semantic categorization, perceptual identification, and reading), and on the languages (English, French, Spanish, and Dutch) that are used. The results for words can be summarized as follows: (1) In the lexical decision task, the N effect is facilitatory. The NF effect is rather inhibitory, particularly in French and Spanish experiments. The P effect is rather inhibitory in English studies, whereas the P effect for higher frequency neighbours is facilitatory in French. (2) In the perceptual identification task with a single identification response, N and NF effects are inhibitory whatever the language. (3) In the naming task, N and NF effects are facilitatory whatever the language. (4) In the semantic categorization task, an interaction effect between N and NF is found in both English and Spanish. (5) In eye movement studies, the NF effect is inhibitory in both English and French. The issue of lexical versus task-specific processes underlying neighbourhood effects in lexical identification tasks is also examined. On the whole, facilitatory N effects are usually attributed to nonlexical processes of the lexical decision task and of the naming task, whereas inhibitory neighbourhood frequency effects are usually attributed to lexical processes, at least in lexical-decision experiments and in eye-movement studies on normal reading. The distribution of higher frequency neighbours which is found to have a facilitatory effect on French words in lexical-decision experiments can be attributed to lexical processes in the interactive activation framework. The theoretical implications of the data are discussed in light of the original activation verification and interactive activation models and in recently extended versions of these models. We conclude that the lexical inhibition hypothesis which is central in the interactive activation framework is the most appropriate to account for the role of orthographic neighbourhoods in visual word recognition.

The neighborhood distribution effect in visual word recognition: words with single and twin neighbors.

Lexical-decision tasks were used to test the role of neighborhood distribution in visual word recognition. Predictions based on the interactive activation model were generated by running simulations. The data were compared for words with 2 higher frequency neighbors that differed in their neighborhood distribution. The neighbors were "single" when they did not share a neighborhood relationship (e.g., neighbors of flanc: flanc-blanc) or "twin" when they shared a neighborhood relationship (e.g., neighbors of firme: ferme-forme). Results show a facilitatory neighborhood distribution effect on words in Experiments 1 (easy pseudowords) and 3 (difficult pseudowords and easy pseudowords) and on pseudowords in Experiment 2. These data can be accounted for in terms of lexical inhibition in the interactive activation framework.

Ultrasonographic evaluation of the effects of exogenous gonadotropins on follicular recruitment and ovulation induction in the Atlantic bottlenose dolphin (Tursiops truncatus).

Transabdominal ultrasonography and serum steroid concentrations were used to evaluate the effects of exogenous gonadotropin administration on ovarian activity of two anestrous bottlenose dolphins (Tursiops truncatus). The gonadotropin used for follicular recruitment was PG600, which has 400 IU equine chorionic gonadotropin (eCG) and 200 IU human chorionic gonadotropin (hCG) activity per 5 ml. Ovulation induction was attempted with hCG. PG600 was administered in two doses of 20 ml (1,600 IU eCG and 800 IU hCG) and 12.5 ml (1,000 IU eCG and 500 IU hCG), respectively, 48 hr apart on days 0 and 2. On day 6, 1,500 IU of hCG was administered. Progesterone and total immunoreactive estrogens were determined before and after the gonadotropin administration. Bilateral ovarian ultrasonographic exams were performed daily on days 4-9 and on day 22. Serum immunoreactive estrogen concentrations were greater than the pretreatment concentrations after day 4 for both dolphins and remained elevated for the rest of the study. Serum progesterone concentrations rose above 1 ng/ml 2 days after hCG treatment and remained elevated for the rest of the study. Small antral follicles (< 0.5 cm) were initially observed bilaterally in both dolphins on day 4. In both animals on day 9, there were > 12 follicles/ovary, ranging from 0.5 to 1.5 cm. By day 22, the multiple follicles ranged from 0.5 to 4.5 cm in diameter. No ultrasonographic evidence of luteal formation was observed. The results indicate that 1) transabdominal ultrasonography can be used to detect and follow follicle growth in bottlenose dolphins; 2) bottlenose dolphins are sensitive to exogenous gonadotropins (multiple follicular recruitment of follicles occurred); and 3) until further ultrasonographic studies can be conducted to evaluate the effects of titrated doses of exogenous gonadotropins, these protocols should be considered unsuitable for ovulation induction.