Impact of hospital type and treatment on long-term survival among patients with FIGO Stage IIIC epithelial ovarian cancer: follow-up through two recurrences and three treatment lines in search for predictors for survival.

The purpose of this study was to investigate the impact of hospital type determined at primary treatment and find possible predictors of survival in a cohort of patients with advanced epithelial ovarian cancer (EOC) who recurred twice and received three lines of treatment during eight-year follow-up. Using the Norwegian Cancer Registry, the authors identified 174 women with FIGO Stage IIIC EOC diagnosed in 2002. First-line treatment consisted of up-front debulking surgery and chemotherapy, received in either a teaching hospital (TH, n = 84) or a non-teaching hospital (NTH, n = 90). After recurrence all patients in Norway are equally consulted at TH. Survival determined for three time intervals (TI): TI-1, from end date of first-line treatment to first recurrence or death, TI-2, from beginning of second-line treatment until second recurrence or death, and TI-3, from beginning of third-line treatment to death or end of follow-up. Extensive surgery carried out in TH followed by at least six cycles of platinol-taxan chemotherapy resulted in longer survival in the TH group during TI-1. Altogether, the majority of those who receive treatment for recurrences were primary better debulked with following platinol-taxane chemotherapy. Survival in TI-2 was influenced by platinol-sensitivity. During TI-3 the majority (96%) had good performance status and their mean age at primary diagnosis at either hospital type was 57 years. Extensive primary surgery at TH, platinol sensitivity, age, and performance status were predictors of survival in this cohort.

Effect of the 5-HTTLPR polymorphism on affective temperament, depression and body mass index in obesity.

BACKGROUND AND AIM: Many studies show high prevalence of affective disorders in obese patients. Affective temperament is a subclinical manifestation of such conditions. The 5-HTT gene encoding the serotonin transporter may be involved in both mood and eating dysregulation. The aim of this study was to investigate the influence of a polymorphism in the 5-HTT gene on affective temperament types, depressive symptoms and Body Mass Index (BMI) in obese patients. METHODS: This study involved 390 patients (237 females, and 153 males) with obesity. The TEMPS-A questionnaire, Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HDRS) were used to evaluate affective temperaments and prevalence of depression. DNA was obtained for serotonin transporter gene-linked polymorphism (5-HTTLPR) genotyping. RESULTS: In obese patients S/S genotype was associated with depressive and L/L with cyclothymic temperament. Subjects with L/L genotype presented significantly higher BMI and greater intensity of depressive symptoms in BDI and HDRS. Females scored higher in anxious and depressive, while males in hyperthymic, cyclothymic and irritable temperaments. Females scored higher in BDI (subjective depression) while males in HDRS (objective depression). LIMITATIONS: TEMPS-A, BDI and HDRS are frequently used in studies on affective disorders. However, these methods do not examine all dimensions of mood and personality. CONCLUSIONS: In obese patients S allele of 5-HTTLPR was associated with development of depressive temperament while L allele corresponded with greater obesity and prevalence of depression. Different mechanisms may be involved in manifestation of depression in males and females with obesity.

Etiology of inguinal hernia: ultrastructure of rectus sheath revisited.

In the last decade, in the search for abdominal-wall hernia etiology, attention has been brought to alterations in the connective tissue ultrastructure as the probable etiological factor. These may cause weakening of connective tissue, which in turn may form ground for hernia formation. To investigate this hypothesis in depth, we compared the ultrastructure of the connective tissue in hernia patients and the control group. The study group consisted of five patients with primary inguinal hernia (Nyhus II = 4, Nyhus IIIa = 1). Another five patients posted for emergency appendectomy created the control group. Tissue specimens, harvested intraoperatively from the rectus muscle sheath (RAMS) and fixed in 4% glutaraldehyde, underwent staining by the Masson, H-E and methylene blue techniques and were assessed by microscopy (light and scanning electron). The examinations showed significant differences in the rectus sheath ultrastructure. They included altered architecture, placement and quantity of collagen and elastic fibers, differences in the caliber of individual fibers and disrupted ground matter-to-fiber ratio. In patients with hernias, chaotic arrangement of collagen fibers was seen, as well as their thinning and a decrease in the general amount of elastic fibers, replaced by ground matter. Our research has shown significant differences in the structure of the RAMS between patients with hernias and healthy individuals. This supports the theory linking connective tissue alterations with the etiology of hernia, and stating that these alterations include connective tissue at locations distant from the hernia site as well, as the rectus sheath itself does not form a hernial defect.

Vascular access for chronic dialysis using the superficial femoral vein.

PURPOSE: We report our experience in using the superficial femoral vein to create hemodialysis (HD) arteriovenous (AV) fistulas. Surgery was performed on six patients (four female, two male). Indications for surgery included previous fistula loss, graft infection and exhaustion of typical shunt sites. METHODS: The femoral vein was evaluated preoperatively, by Doppler ultrasound, harvested by one long incision on the anteromedial surface of the thigh, followed by suction drainage. In four patients, harvested veins were transplanted in the arm between the brachial artery and axillar vein, followed by an end-to-side anastomosis. In two patients, the venous graft remained on the anterior surface of the thigh. In those patients, they were extended with either a piece of polytetrafluoroethylene (PTFE) graft or the saphenous vein. RESULTS: Follow-up ranged between 14 months and 2 yrs, ensuring proper dialysis. Two patients presented with complications, including lower leg swelling and axillary lymphorrhea, which subsided spontaneously. CONCLUSIONS: We recommend this type of AV fistula, especially in difficult cases, where all other classical vascular approaches have been used. However, the procedure is time consuming and requires experience in vascular surgery.

The 'sleeve' anastomosis method for hemodialysis shunts: an eleven-year follow-up study.

PURPOSE: The problem of long form fistula for hemodialysis is well known among vascular surgeons because of frequent thromboses in anastomotic place. One of the pro-thrombotic factors is suture in the vessel's lumen. Since the 'sleeve' method prevents this, the patency rate should improve. METHODS: One hundred and eighty-two (182) patients were operated using the "sleeve" method. The operation was done under local anaesthesia and the first step was the dissection of the cephalic vein and the radial artery. Using Prolene 7-0 the artery and the vein were connected as follows: the first suture was placed intramuraly about 5 mm from the artery edge to the vein edge. The second suture (placed in the same way) was on the opposite side. The end of the radial artery was placed into the lumen of the cephalic vein and the sutures were tied. Two additional sutures were placed between them. Finally, four sutures were added to keep the artery in the vein. RESULTS: In our hands the patency rate of 'sleeve' arterio-venous fistulas was high: 95% after one month, 86% after one year, 64% after 5 years and 57% after 10 and 11 years. Every 'sleeve' fistula provided adequate blood flow, which increased during the follow-up period. CONCLUSIONS: The authors consider the "sleeve" fistula method as the primary choice because of its simplicity and excellent long-term patency.

[Some blood flow parameters of forearm arteries in patients with "sleeve" arteriovenous shunts]. / Niektóre parametry przeplywu krwi w tetnicach przedramienia u chorych z przetoka tetniczo-zylna teleskopowa.

UNLABELLED: The aim of the study was estimation of some blood flow parameters in arteries of both forearms in patients with "sleeve" arterio-venous fistula (AVF) created for hemodialysis. From 1988 to 1996 145 radio-cephalic AVF's with "sleeve" anastomoses were created in our Department. Duplex-Scan examinations were performed in 30 patients aged from 22 to 68 years. There are 15 women and 15 men with primary AVF lasting over 12 months. The B&K Medical System 3535 with 7.5 MHz transducer was used for all measurements. Diameter of radial artery (TP) in forearms with AVF fistula was on average 4.7 mm, and in ulnar artery (TL) 2.6 mm. In forearms without AVF diameters were, respectively 2.4 mm and 2.3 mm. Volume flow in forearms with AVF was in TP 1056, and in TL 169 ml/min. In forearms without AVF these flows were 59 and 63 ml/mm, respectively. Resistance index in forearms with AVF was 0.29 in TR and 0.47 in TL, however in forearms without AVF 0.76 in both arteries. Pulsatility index on the side of AVF was 0.8 in TR and 1.8 in TL, however on the side without AVF 4.1 in both arteries. These differences were statistically significant. CONCLUSIONS: 1. In arteries of forearm with AVF diameter and volume blood flow increases, however resistance and pulsatility indices decreases. 2. Volume flow in ulnar artery in forearms with AVF is similar to flow in both arteries in forearm without AVF.

Insulin and the parasympathetic dependence of pancreatic juice secretion in healthy and alloxan diabetic sheep.

Pancreatic function was measured in four ewes following vagal stimulation under control conditions and after the induction of alloxan diabetes. The volume and protein content of the pancreatic juice was measured along with simultaneous measurement of blood glucose and plasma insulin. The volume of pancreatic juice and its protein content decreased markedly in the diabetic state and returned to the initial value after insulin treatment. In normal animals, vagal stimulation markedly increased; the volume of pancreatic secretion and its protein content as well as the plasma insulin concentration. In the diabetic animals vagal stimulation caused only a slight increase in the protein content of pancreatic juice and plasma insulin concentration. It is suggested that insulin is probably one of the more important factors directly regulating the secretion of pancreatic juice.