Evaluation of the intraoperative human papillomavirus test as a marker of early cure at 12 months after electrosurgical excision procedure in women with cervical high-grade squamous intraepithelial lesion: a prospective cohort study.

OBJECTIVE: To evaluate if the intraoperative human papillomavirus (IOP-HPV) test has the same prognostic value as the HPV test performed at 6 months after treatment of high-grade squamous intraepithelial lesion (HSIL) to predict treatment failure. DESIGN: Prospective cohort study. SETTING: Barcelona, Spain. POPULATION: A cohort of 216 women diagnosed with HSIL and treated with loop electrosurgical excision procedure (LEEP). METHODS: After LEEP, an HPV test was performed using the Hybrid Capture 2 system. If this was positive, genotyping was performed with the CLART HPV2 technique. The IOP-HPV test was compared with HPV test at 6 months and with surgical margins. MAIN OUTCOME MEASURE: Treatment failure. RESULTS: Recurrence rate of HSIL was 6%. There was a strong association between a positive IOP-HPV test, a positive 6-month HPV test, positive HPV 16 genotype, positive surgical margins and HSIL recurrence. Sensitivity, specificity, and positive and negative predictive values of the IOP-HPV test were 85.7, 80.8,24.0 and 98.8% and of the HPV test at 6 months were 76.9, 75.8, 17.2 and 98.0%. CONCLUSION: Intraoperative HPV test accurately predicts treatment failure in women with cervical intraepithelial neoplasia grade 2/3. This new approach may allow early identification of patients with recurrent disease, which will not delay the treatment. Genotyping could be useful in detecting high-risk patients. TWEETABLE ABSTRACT: IOP-HPV test accurately predicts treatment failure in women with CIN 2/3.

Pharmacodynamic studies of gefitinib in tumor biopsy specimens from patients with advanced gastric carcinoma.

PURPOSE: Epidermal growth factor receptor (EGFR) is highly expressed in some gastric cancers and is implicated in cancer cell growth and proliferation. The objective of this study was to assess the in situ biologic activity of the EGFR tyrosine kinase inhibitor gefitinib in gastric tumor samples in a phase II study. METHODS: Patients with previously treated stage IV adenocarcinoma of the stomach or gastroesophageal junction were randomly assigned to receive gefitinib (250 or 500 mg/d). Tumor biopsies, obtained at screening and on day 28 of treatment, were assessed for biomarker expression using immunohistochemistry and analysis of apoptosis. RESULTS: One hundred sixteen tumor samples from 70 patients were available, 70 were baseline and 46 were on-therapy biopsies. At baseline, levels of EGFR expression significantly correlated with levels of phosphorylated EGFR (pEGFR; P < .001) and Ki67 expression (P = .011), but not with phosphorylated mitogen-activated protein kinase (pMAPK). After gefitinib treatment, levels of pEGFR in tumor cells were significantly reduced (P = .001); this was not the case for pMAPK and phosphorylated Akt (pAkt). However, in some cases gefitinib inhibited pAkt and these tumors had enhanced apoptosis. Likewise, there was a significant correlation between increased exposure to geftinib and enhanced apoptosis. CONCLUSION: Gefitinib reached the tumors at concentrations sufficient to inhibit EGFR activation in advanced gastric carcinoma patients, although this did not translate into clinical benefit. Overall, intratumoral phosphorylation of MAPK and Akt was not significantly inhibited by gefitinib. However, the finding that decreases in pAkt correlated with enhanced apoptosis deserves further exploration.

[Pharmacoresistant temporal-lobe epilepsy. Exploration with foramen ovale electrodes and surgical outcomes]. / Epilepsia farmacorresistente del lóbulo temporal. Exploración con electrodos del foramen oval y resultados quirúrgicos.

AIM: To report our experience in the surgical treatment of temporal-lobe epilepsy. PATIENTS AND METHODS: An analysis was performed of the outcomes of 137 patients submitted to surgery between 1990 and 2001, with a follow-up of more than two years. A study was conducted of the percentages of successful detection by the different complementary tests--MRI, EEG, interictal SPECT, video-EEG with foramen ovale electrodes (FOE), neuropsychological study (NPS)--and the precision with which they reported the epileptogenic focus. RESULTS AND CONCLUSIONS: Successful surgical outcomes (Engel grades I-II): 73.4%. No surgical mortality occurred, although some mild, reversible morbidity was observed. Surgical outcomes were not affected by sex, age, age of onset and the length of time the patient had had the disease, or the frequency of the seizures. No association was found between seizures in the immediate post-operative period and a poorer long term control of the epilepsy. MR images were normal in 25% of patients; in these cases the surgical outcomes (Engel grades I-II at two years: 62%) were significantly poorer than in cases of tumours/cavernomas (86%); RMI studies of other types of lesions gave intermediate results (72%). With respect to the capacity of the different tests to lateralise/locate the epileptogenic focus, video-EEG-FOE proved to be the best, followed by MRI, SPECT, EEG and NPS.

Epilepsia farmacorresistente del lóbulo temporal. Exploración con electrodos del foramen oval y resultados quirúrgicos / Pharmacoresistant temporal-lobe epilepsy. Exploration with foramen ovale electrodes and surgical outcomes

Objetivo. Presentar nuestra experiencia en el tratamiento quirúrgico de la epilepsia del lóbulo temporal. Pacientes y métodos. Se analizan resultados en 137 pacientes, intervenidos quirúrgicamente entre 1990 y 2001, con seguimiento mayor de dos años. Se estudia el porcentaje de aciertos de las pruebas complementarias-RM, EEG, SPECT interictal, vídeo-EEG con electrodos del foramen oval (EFO), estudio neuropsicológico (NPS)- y la precisión con que informaron del foco epileptógeno. Resultados y conclusiones. Éxitos quirúrgicos (grados I-II de Engel): 73,4%. No hubo mortalidad quirúrgica, aunque sí escasa morbilidad, leve yreversible. No modificaron los resultados quirúrgicos ni el sexo, edad, edad de comienzo y tiempo de desarrollo de la enfermedad, ni la frecuencia de las crisis. No encontramos asociación entre crisis en el postoperatorio inmediato y peor control de la epilepsia alargo plazo. La RM fue normal en el 25% de los pacientes; en ellos, los resultados quirúrgicos (grados I-II de Engel a los dos años: 62%) fueron significativamente peores que en los casos detumor/cavernoma (86%); ante otras lesiones en la RM, el resultado fue intermedio (72%). En relación a la capacidad lateralizadora/localizadora del foco epileptógeno de las diferentes pruebas, destaca el vídeo-EEG-EFO, seguido de la RM, SPECT, EEG y NPS

Aim. To report our experience in the surgical treatment of temporal-lobe epilepsy. Patients and methods. Ananalysis was performed of the outcomes of 137 patients submitted to surgery between 1990 and 2001, with a follow-up of more than two years. A study was conducted of the percentages of successful detection by the different complementary tests - MRI,EEG, interictal SPECT, video-EEG with foramen ovale electrodes (FOE), neuropsychological study (NPS) - and the precision with which they reported the epileptogenic focus. Results and conclusions. Successful surgical outcomes (Engel grades I-II):73.4%. No surgical mortality occurred, although some mild, reversible morbidity was observed. Surgical outcomes were not affected by sex, age, age of onset and the length of time the patient had had the disease, or the frequency of the seizures. No association was found between seizures in the immediate post-operative period and a poorer long term control of the epilepsy.MR images were normal in 25% of patients; in these cases the surgical outcomes (Engel grades I-II at two years: 62%) were significantly poorer than in cases of tumours/cavernomas (86%); RMI studies of other types of lesions gave intermediate results (72%). With respect to the capacity of the different tests to lateralise/locate the epileptogenic focus, video-EEG-FOE proved to be the best, followed by MRI, SPECT, EEG and NPS

[Peripheral neuropathy and mixed cryoglobulinemia: clinical, neuro- physiological and pathological signs in a group of 12 patients]. / Neuropatía periférica y crioglobulinemia mixta: aspectos clínicos, neurofisiológicos y patológicos en una serie de 12 pacientes.

This retrospective study involved a series of 12 patients with peripheral neuropathy and mixed type III cryoglobulinemia. The predominating symptoms were sensory. In patients with essential cryoglobulinemia, neuropathy most often presented as multiple mononeuropathy, while polyneuropathic forms were most common among those with secondary cryoglobulinemia. The absence of cryosensitivity was evident in secondary forms. Both neurophysiological and morphological examination revealed a predominance of axonal neuropathy. Two cases of demyelinating neuropathy were found among those with secondary cryoglobulinemia associated with monoclonal gammopathy. Although the vascular lesion was clearly demonstrable in muscle and skin tissue, this was not so in the nervous system.