British Gynaecological Cancer Society Recommendations for Evidence Based, Population Data Derived Quality Performance Indicators for Ovarian Cancer.

Ovarian cancer survival in the UK lags behind comparable countries. Results from the ongoing National Ovarian Cancer Audit feasibility pilot (OCAFP) show that approximately 1 in 4 women with advanced ovarian cancer (Stage 2, 3, 4 and unstaged cancer) do not receive any anticancer treatment and only 51% in England receive international standard of care treatment, i.e., the combination of surgery and chemotherapy. The audit has also demonstrated wide variation in the percentage of women receiving anticancer treatment for advanced ovarian cancer, be it surgery or chemotherapy across the 19 geographical regions for organisation of cancer delivery (Cancer Alliances). Receipt of treatment also correlates with survival: 5 year Cancer survival varies from 28.6% to 49.6% across England. Here, we take a systems wide approach encompassing both diagnostic pathways and cancer treatment, derived from the whole cohort of women with ovarian cancer to set out recommendations and quality performance indicators (QPI). A multidisciplinary panel established by the British Gynaecological Cancer Society carefully identified QPI against criteria: metrics selected were those easily evaluable nationally using routinely available data and where there was a clear evidence base to support interventions. These QPI will be valuable to other taxpayer funded systems with national data collection mechanisms and are to our knowledge the only population level data derived standards in ovarian cancer. We also identify interventions for Best practice and Research recommendations.

The use of MRI for selecting patients with endometrial cancer and significant co-morbidities for vaginal hysterectomy.

OBJECTIVE: The objective of this study is to ascertain the presence of extrauterine spread in radiologically early stage and grade endometrial cancer. This could be the basis for offering vaginal hysterectomy without salpingo-oophorectomy as an alternative option to primary radical radiotherapy in women with significant medical co-morbidities in whom laparotomy will be contraindicated. MATERIALS AND METHODS: A retrospective cohort study assessing patients with clinically early stage endometrioid adenocarcinoma of the endometrium, treated at the Gynaecological Oncology Centre, Norfolk and Norwich University Hospital and James Paget University Hospital between January 2003 and July 2008. The cancer registry was reviewed, and 542 endometrial cancer cases were identified during the study period, of these 439 were endometrioid type. MR is the standard staging investigation unless there are contraindications. Demographic, clinic-pathologic and surveillance data were collected from hospital records, operative notes and histopathology reports. The histology included tumour type, stage and grade. Post-operative histopathological findings served as a reference standard. Sensitivity and specificity of pre-operative MRI scan were assessed. RESULTS: Of the 439 cases treated during the study periods, 415 patients had an MRI pre-operatively imaging and 14% of these cases showed signs of extrauterine spread. MRI staging was then compared with the histopathology staging; the latter was taken as the gold standard. In 8% of the cases where no spread was seen on MRI, the disease was actually spread outside uterine corpus mainly to the cervix and pelvic lymph nodes. The sensitivity, specificity, positive predictive value and negative predictive value for MRI were 56, 93, 60, and 92, respectively, while predicting early stage disease. There were three cases of adnexal metastases, where the tumour had already spread to uterine serosa. Two cases had poorly differentiated and one had moderately differentiated tumour. CONCLUSIONS: The risk of adnexal metastasis is less than 1% in clinically early stage disease and highly unlikely if MRI suggests that the disease is confined to the inner half of the myometrium and low-grade disease. MRI has a high specificity and negative predictive value in endometrial cancer staging with reduced sensitivity of detecting cervical, adnexal and lymphatic spread. We suggest that vaginal hysterectomy might be a safe alternative to laparotomy in the treatment of radiological early stage disease in medically compromised elderly patients. The possibility of converting a vaginal approach to an abdominal route should be always taken into consideration.

Neurobiología del síndrome de Tourette / The neurobiology of tourette syndrome

Introducción. El síndrome de Tourette es un trastorno neuropsiquiátrico, hereditario, que se manifiesta por tics motores crónicos múltiples y tics verbales. Las alteraciones neurobiológicas que al parecer explican la sintomatología que genera los tics en estos pacientes abarcan afecciones a tres niveles. Desarrollo. Estos niveles serían: alteración en el circuito corticoestriado talamocortical, disfunción dopaminérgica que ocasiona una hiperactividad de este neurotransmisor que genera tics, y probablemente una alteración inmunológica desencadenada por infección del estreptococo betahemolítico del grupo A que origina autoanticuerpos frente a sistemas neuronales específicos, que, sin embargo, precisa más estudios. Conclusión. El objetivo de este artículo será revisar los mecanismos fisiopatogénicos de la neurobiología del síndrome de Tourette (AU)

Introduction. Tourette syndrome is a hereditary neuropsychiatric disorder that manifests as multiple chronic motor tics and verbal tics. The neurobiological disorders that seem to account for the symptoms that generate tics in these patients include alterations at three levels. Development. These levels are as follows: alterations in the thalamocortical corticostriatal pathway; dopaminergic dysfunction that leads to hyperactivity of this neurotransmitter, which generates tics; and probably an immunological alteration triggered by infection by group A beta-haemolytic streptococcus that creates autoantibodies to combat specific neuronal systems; nevertheless, further study is required in this area. Conclusions. The aim of this paper was to review the pathophysiological mechanisms underlying the neurobiology of Tourette síndrome (AU)