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Curved crystals are a simple but powerful approach to bridge the gap between single crystal surfaces and nanoparticle catalysts, by allowing a rational assessment of the role of active step sites in gas-surface reactions. Using a curved Rh(111) crystal, here, we investigate the effect of A-type (square geometry) and B-type (triangular geometry) atomic packing of steps on the catalytic CO oxidation on Rh at millibar pressures. Imaging the crystal during reaction ignition with laser-induced CO2fluorescence demonstrates a two-step process, where B-steps ignite at lower temperature than A-steps. Such fundamental dissimilarity is explained in ambient pressure X-ray photoemission (AP-XPS) experiments, which reveal partial CO desorption and oxygen buildup only at B-steps. AP-XPS also proves that A-B step asymmetries extend to the active stage: at A-steps, low-active O–Rh–O trilayers buildup immediately after ignition, while highly active chemisorbed O is the dominant species on B-type steps. We conclude that B-steps are more efficient than A-steps for the CO oxidation.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2006.07.006 Byline: Wesley S. Hilger (a), Andrew Walter (b), Mark E. Zobitz (c), Kevin O. Leslie (d), Paul Magtibay (a), Jeffrey Cornella (a) Abstract: The objective of the study was to describe the histologic and biomechanical changes of implanted dermal collagen graft materials. Author Affiliation: (a) Division of Gynecologic Surgery, Mayo Clinic Arizona, Scottsdale, AZ (b) Division of Urogynecology, Kaiser Sacramento, Sacramento, CA (c) Orthopedic Biomechanics Laboratory, Mayo Clinic Rochester, Rochester, MN (d) Division of Pathology, Mayo Clinic Arizona, Scottsdale, AZ Article History: Received 16 January 2006; Revised 30 June 2006; Accepted 11 July 2006 Article Note: (footnote) Supported by Mayo Foundation for Education and Research. Presented at the 32nd Annual Meeting of the Society of Gynecologic Surgeons, April 3-5, 2006, Tucson, Arizona.

Surgeons who remove the uterus of a woman who has had a tubal sterilization should consider removing the fallopian tubes as well. In a study of 83 women with a fallopian tube abnormality called a hydrosalpinx, those who had a tubal sterilization were seven times more likely to have hydrosalpinx than women who had not. This is because the removal of the uterus after a tubal sterilization blocks both ends of the fallopian tubes.

Women whose blood levels of creatinine are greater than 0.2 milligrams per deciliter (mg/dL) after gynecologic surgery may have an injured ureter, according to a study of 187 women. The ureters carry urine from the kidneys to the bladder. They can sometimes be injured during gynecological surgery.

Laparoscopic surgery does not appear to be better than traditional surgery when performing a Burch retropubic urethropexy to treat urinary incontinence. This was the conclusion of a study of 76 women who had laparoscopic Burch retropubic urethropexy and 143 women who had traditional Burch retropubic urethropexy.

Taking tissues from the leg to use as a graft for treating pelvic disorders appears to be beneficial with few complications in most women. In a study of 71 women, only 13% expressed dissatisfaction with the procedure.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1067/mob.2001.115747 Byline: Andrew J. Walter, Joseph G. Hentz, Paul M. Magtibay, Jeffrey L. Cornella, Javier F. Magrina Keywords: Endometriosis; histology; laparoscopy Abstract: Objective: The purpose of this study was to correlate the diagnosis of endometriosis on the basis of visualization at laparoscopy with the pathologic diagnosis. Study Design: A prospective study of 44 patients undergoing laparoscopy for the evaluation of chronic pelvic pain was carried out. All areas suggestive of endometriosis were excised and examined pathologically. Peritoneal biopsy specimens were obtained from areas of normal-appearing peritoneum to rule out microscopic endometriosis. All lesions were identified by anatomic site. Visual and histologic American Fertility Society scores were compared. The positive predictive value, sensitivity, negative predictive value, and specificity were determined for visually identified endometriosis versus the histologic correlate. Results: The mean prevalence of abnormalities visually consistent with endometriosis was 36%, with 18% confirmed histologically. The positive predictive value was 45%; sensitivity, 97%; negative predictive value, 99%; and specificity, 77%; for visual versus histologic diagnosis of endometriosis. Thirty-six percent of the diagnoses were downstaged on the basis of histologic findings. Conclusion: A diagnosis of endometriosis should be established only after histologic confirmation. (Am J Obstet Gynecol 2001;184:1407-13.) Author Affiliation: Scottsdale, Arizona From the Department of Obstetrics and Gynecology.sup.a and the Section of Biostatistics,.sup.b Mayo Clinic Scottsdale Article Note: (footnote) [star] The opinions and conclusions in this article are those of the authors and are not intended to represent the official position of the Department of Defense, United States Air Force, or any other government agency. , [star][star] Reprint requests: Andrew J. Walter, MD, 60 MDG/SGCG 101 Bodin Circle, Travis AFB, CA 94535.

Embryonal tumours with multi-layered rosettes (ETMRs) are a newly recognised, rare paediatric brain tumour with alterations of the C19MCmicroRNA locus. Due to varied diagnostic practices and scarce clinical data, disease features and determinants of outcomes for these tumours are poorly defined. We did an integrated clinicopathological and molecular analysis of primary ETMRs to define clinical phenotypes, and to identify prognostic factors of survival and key treatment modalities for this orphan disease.

One of the great honors of my professional career was being nominated to the presidency of the Society of Gynecologic Surgeons and being given the opportunity to deliver the presidential [...]

Since the original description of pathogenic germline DICER1variation underlying pleuropulmonary blastoma (PPB), the spectrum of extrapulmonary neoplasms known to be associated with DICER1has continued to expand and now includes tumors of the ovary, thyroid, kidney, eye, and brain among other sites. This report documents our experience with another manifestation: a primitive sarcoma that resembles PPB and DICER1-associated sarcoma of the kidney. These tumors are distinguished by their unusual location in the peritoneal cavity, associated with visceral and/or parietal mesothelium. A total of seven cases were identified through pathology review in children presenting at a median age of 13 years (range 3–14 years). Primary sites of origin included the fallopian tube (four cases), serosal surface of the colon (one case), and pelvic sidewall (two cases). One case had pathologic features of type I PPB, another type Ir (regressed) PPB, and the remaining five had features of type II or III PPB with a mixed primitive sarcomatous pattern with or without cystic elements. All had a pathogenic DICER1variation identified in germline and/or tumor DNA. PPB-like peritoneal tumors represent a newly described manifestation of DICER1pathogenic variation whose pathologic features are also recapitulated in DICER1-related renal sarcoma, cervical embryonal rhabdomyosarcoma, and some Sertoli–Leydig cell tumors with heterologous elements. Tumors arising from the fallopian tube or elsewhere in the abdomen/pelvis, especially those with heterogeneous rhabdomyosarcomatous and/or cartilaginous differentiation, should prompt consideration of germline and tumor DICER1testing.

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(Abstracted from Obstet Gynecol2022;139:277–286)Because the US Food and Drug administration gave approval for mesh midurethral slings for surgical treatment of female stress incontinence (SUI) in 1996, these synthetic midurethral slings have become procedure of choice for this diagnosis. A systematic review of evidence-based practice guidelines for partial and total removal of these slings after complications was performed by the Society of Gynecologic Surgeons Systematic Review Group.

Vicinal surfaces may undergo structural transformations as a function of temperature or in the presence of adsorbates. Step-doubling in which monatomic steps pair up forming double-atom high staircases is the simplest example. Here we investigate the case of Ni(111) using a curved crystal surface, which allows us to explore the occurrence of step-doubling as a function of temperature and vicinal plane (miscut α and step type). We find a striking A-type ({100}-like microfacets) versus B-type ({111}-like) asymmetry toward step-doubling. The terrace-width distribution analysis performed from scanning tunneling microscopy data points to elastic step interactions overcoming entropic effects at very small miscut α in A-type vicinals, as compared to B-type steps. For A-type vicinals, we elaborate the temperature/miscut phase diagram, on which we establish a critical miscut αc= 9.3° for step-doubling to take place.

The development of targeted anti-cancer therapies through the study of cancer genomes is intended to increase survival rates and decrease treatment-related toxicity. We treated a transposon–driven, functional genomic mouse model of medulloblastoma with ‘humanized’ in vivo therapy (microneurosurgical tumour resection followed by multi-fractionated, image-guided radiotherapy). Genetic events in recurrent murine medulloblastoma exhibit a very poor overlap with those in matched murine diagnostic samples (<5%). Whole-genome sequencing of 33 pairs of human diagnostic and post-therapy medulloblastomas demonstrated substantial genetic divergence of the dominant clone after therapy (<12% diagnostic events were retained at recurrence). In both mice and humans, the dominant clone at recurrence arose through clonal selection of a pre-existing minor clone present at diagnosis. Targeted therapy is unlikely to be effective in the absence of the target, therefore our results offer a simple, proximal, and remediable explanation for the failure of prior clinical trials of targeted therapy.

Posterior reversible encephalopathy syndrome (PRES) and cerebral sinus thrombosis are 2 known complications of acute lymphoblastic leukemia and its treatment. We describe a patient with acute lymphoblastic leukemia whose course was complicated by both of these conditions. This case is novel both for the fact that PRES developed before the initiation of therapy and that PRES was followed shortly by the development of cerebral sinus thrombosis. Our patient’s story raises questions about our current understanding of the pathophysiology of PRES, and it suggests that PRES may actually be a predisposing risk factor for cerebral sinus thrombosis.

Single-sided fluorination has been predicted to open an electronic band gap in graphene and to exhibit unique electronic and magnetic properties; however, this has not been substantiated by experimental reports. Our comprehensive experimental and theoretical study of this material on a SiC(0001) substrate shows that single-sided fluorographene exhibits two phases, a stable one with a band gap of ∼6 eV and a metastable one, induced by UV irradiation, with a band gap of ∼2.5 eV. The metastable structure, which reverts to the stable “ground-state” phase upon annealing under emission of blue light, in our view is induced by defect states, based on the observation of a nondispersive electronic state at the top of the valence band, not unlike that found in organic molecular layers. Our structural data show that the stable C2F ground state has a “boat” structure, in agreement with our X-ray magnetic circular dichroism data, which show the absence of an ordered magnetic phase. A high flux of UV or X-ray photons removes the fluorine atoms, demonstrating the possibility of lithographically patterning conducting regions into an otherwise semiconducting 2D material.

We elucidate how graphene bilayers form on Ir(111). Low-energy electron diffraction (LEED) reveals that the two graphene layers are not always rotationally aligned. Monitoring this misalignment during growth shows that second-layer islands nucleate between the existing layer and the substrate. This mechanism occurs both when C segregates from the Ir and when elemental C is deposited from above. Low-energy electron microscopy (LEEM) and angle-resolved photoemission spectroscopy (ARPES) show that second-layer nucleation occurs preferentially under the first-layer rotational variants that are more weakly bound to the substrate. New-layer nucleation tends to occur inhomogeneously at substrate defects. Thus new-layer nucleation should be rapid on substrates that weakly bind graphene, making growth unstable toward mound formation initiated at substrate defects. In contrast, stronger binding permits layer-by-layer growth, as for Ru(0001). ARPES shows that bilayer graphene has two slightly p-doped π-bands. The work function of bilayer graphene is dominated by the orientation of the bottom layer.

Sturge-Weber syndrome (SWS) is a neurocutaneous disorder characterized by vascular malformations involving brain, skin, and occasionally eyes. There is no recognized tumor predisposition in patients with SWS as there is with some other phakomatoses. We present a patient with SWS who developed a low-grade glioma (LGG). We hypothesize that there could be an association between SWS and LGG formation, noting that GNAQmutations have been implicated in the underlying biology of both SWS and a subset of pediatric LGG. It is suggested that SWS may be a cancer predisposition syndrome.

The article discusses the increasing demand for organic essential oils in the flavor and fragrance industry in the U.S. The rising demand for organic foods has led to the steady increase in the demand for organic essential oils. The growth rate of the organic essential oil sector in the U.S. is about 20% per year.

The purpose of this study was to evaluate the histologic response of human cadaveric fascia lata after vaginal implantation. Freeze-dried, gamma-irradiated cadaveric fascia lata from three lots was implanted between the rectovaginal membrane and vaginal epithelium in New Zealand white rabbits. Rabbits were killed at 2, 4, 8, and 12 weeks after implantation. At necropsy, gross findings were described and specimens for routine cultures were taken. Histologic evaluation determined graft integrity, neovascularization, inflammatory response, and host tissue incorporation. Nine rabbits were available for histologic analysis and 14 for gross and microbiologic analysis. Vaginal erosions occurred with three grafts. The remainder were adherent to the surrounding tissues. Erosion was associated with bacterial colonization of the graft. Autolysis of one graft occurred at 4 weeks. Over time, the inflammatory response decreased and neovascularization increased; by 12 weeks, the graft collagen was replaced by host collagen. Cadaveric fascia lata serves as scaffolding for host tissue incorporation with replacement by host collagen.

Traditionally, surgery has been taught by an apprentice model, where the learner imitates the actions of a skilled mentor. Although effective, this model is inefficient because it requires learners to be exposed to a large number of surgeries performed by a limited number of dedicated teaching faculty. In addition, competence is proved with subjective evaluations. Because of changes in modern medical practice, specifically reimbursement issues, resident work hour restrictions, and need for reliable and valid credentials, the critical components of the apprentice model are eroding. A paradigm shift is needed in modern surgical education.

Abstract The aim of this study is to determine if the diagnostic accuracy of the supine empty stress test (SEST) differs depending on the volume of residual urine. We performed a review of all patients who were diagnosed with stress urinary incontinence (SUI) via multi-channel urodynamics including valsalva leak point determinations (VLPP). A SEST was performed and the residual urine recorded via catheterization. The test-specific indices of the SEST for the prediction of low VLPP (defined as <60 cm H20) were determined for varying residual volumes. Ninety-nine patients were included. Regardless of residual volume, low sensitivities, specificities and positive predictive values were demonstrated. Sensitivity and positive predictive values were further reduced and negative predictive values were improved slightly with higher residual volume. The highest negative predictive value was 89% at a residual volume of greater than 10 mL. Residual urine volume has minimal impact on the utility of the SEST.

The electrooxidation of quaternary ammonium binaphthyl salts is shown to proceed by a quasi-reversible one-electron process. The oxidation of an aza-crown ether substituted binaphthyl salt is affected by the presence of lithium and sodium ions in solution and there is shown to be a linear relationship between the limiting current for the process and the concentration of Li+ and Na+. The electrochemistry of the binaphthyl salt is also shown to be affected by the addition of organic cations to the solution, showing that these receptors could form the basis of analytical devices which could be made specific to a range of analytes.

We determined changes in tensile properties after vaginal implantation of human cadaveric fascia lata.

The effects of ionic analytes on the electrochemical properties of quaternary ammonium binaphthyl salts are described in this work. The stability of the binaphthyl radicals and hence the reversibility of the electrochemical response are discussed in terms of molecular structure. The ability of azacrown derivatised binaphthyl salts to act as amperometric receptors is ascribed to the strain imparted in the cyclic ammonium ring when Li+ ions complex with them. It is also shown that the redox properties of quaternary ammonium binaphthyl salts are pH dependent in aqueous solutions, but that reversible redox properties can be observed in extremely basic solutions. The effect of anions binding to the quaternary ammonium cation can be seen in the redox properties of the binaphthyl moiety and the use of a chiral binding site for enantiomeric recognition is also demonstrated.

The risk factors responsible for an increased prevalence of obesity or overweight in survivors of acute lymphoblastic leukemia (ALL) remain controversial. We evaluated changes in body mass index (BMI) in a cohort of ALL survivors, all of whom have been followed until completion of linear growth. BMI (weight/height²) was used as an index of adiposity and was calculated at diagnosis, at the end of treatment, and at attainment of final height in a cohort of 126 (59 males) survivors of ALL. BMI was adjusted for age and sex by computing a BMI standard deviation score (SDS) or z score. The spectrum of therapies used included intrathecal chemotherapy given alone (n = 38) or combined with cranial irradiation (CRT; 18 Gy, n = 35; 24 Gy, n = 53) and exposure to prednisone at a low dose (&lt;3.5 gm, n = 49), medium dose (3.5–9.4 gm, n = 46), or high dose (>9.4 gm, n = 30). Overall, mean ± SEM BMI-SDS increased significantly between diagnosis (−0.18 ± 0.08) and the end of therapy (0.41 ± 0.09, P &lt; 0.01), with no significant change thereafter. For patients without CRT, mean BMI-SDS remained unchanged, whereas, for those so treated, mean BMI-SDS increased significantly between diagnosis and the completion of therapy (P &lt; 0.001). The change in mean BMI-SDS was greater in the 24 Gy group vs. the 18 Gy CRT sample (P &lt; 0.005). In a multivariate logistic regression model, CRT was an independent predictor of being overweight (BMI ≥85 percentile) at attainment of final height [odds ratio = 1.6 (95% confidence interval 1.0–23.1)]. The percentage of subjects who were overweight at attainment of final height was 10.5%, 40%, and 38% for subjects treated with no CRT, 18 Gy CRT, or 24 Gy CRT, respectively (P &lt; 0.01). Children with ALL given CRT develop increases in their BMI-SDS early on and during treatment and remain at significant risk for becoming overweight as young adults, a development that may increase their already heightened risk for various adverse health outcomes. Med. Pediatr. Oncol. 35:91–95, 2000. © 2000 Wiley-Liss, Inc.

The authors conducted a single-arm, prospective study using tamoxifen and carboplatin for the treatment of children with progressive or symptomatic low-grade gliomas.

Results of a phase II trial of cyclophosphamide (CPM) for children with progressive low-grade astrocytoma are reported.

A retrospective study evaluated the clinical characteristics, prognostic factors, and outcome of patients with newly diagnosed supratentorial malignant gliomas treated with preirradiation chemotherapy. Of 41 patients with supratentorial malignant gliomas accrued between 1984-1994, all had neuroimaging documentation of the extent of resection and 37 had complete neuraxis staging prior to treatment; 80% were treated with one of a variety of neoadjuvant chemotherapy regimens. Thirteen patients had anaplastic astrocytoma (AA), 25 had glioblastoma multiforme (GBM), and 3 had anaplastic oligodendroglioma. Gross total resection (GTR) was performed in 10 patients, subtotal resection (STR) in 22 patients, and biopsy (Bx) alone in 9 patients. For the entire group the 3-year overall and progression free survivals were 35 ± 8% and 18 ± 6%, respectively. Tumor recurrence was dominantly local. However, 9 patients with initially local disease failed at a distant neuraxis site, giving a 26 ± 7% actuarial risk of dissemination at 3 years. The only significant prognostic factor was extent of tumor resection: patients who underwent GTR survived longer than those who underwent STR or Bx (P = 0.004). Histology (GBM vs. AA), age, and the use of enhanced local dose radiation therapy (brachytherapy or stereotactic irradiation) did not affect survival. Neoadjuvant chemotherapy was not associated with a survival rate significantly different from that observed in adjuvant chemotherapy studies. Systematic neuraxis staging at diagnosis and recurrence revealed a rate of neuraxis dissemination as a component of recurrence that was higher than previously reported; the utility of craniospinal irradiation in preventing isolated dissemination remains uncertain. Cancer 1997; 80:497-504. © 1997 American Cancer Society.

Standard therapy for pediatric nonrhabdomyosarcoma soft tissue sarcomas (PNRSTS) consists of surgical resection with or without radiotherapy. The role of chemotherapy in the treatment of these tumors has not yet been defined. We investigated the efficacy and toxicity of an ifosfamide-based regimen in controlling disease in children with high-risk PNRSTS. Between January 1992 and June 1994 at St. Jude Children's Research Hospital, we treated 11 children and young adults with PNRSTS who were at high risk for treatment failure by using a combined modality regimen that comprised aggressive surgery, radiotherapy, and chemotherapy including vincristine, ifosfamide, and doxorubicin (VID). Nine of these patients had grade 3 disease and one had grade 2 tumor; due to insufficient tissue, the disease grade of the remaining patient could not be established. Metastases were present at diagnosis in 2 children. Therapy was generally well tolerated, with minimal morbidity and no mortality. The most common toxicity was grade 4 neutropenia, which occurred in 51% of evaluable courses. Among 4 patients evaluable for response to chemotherapy alone, 1 child attained a partial response and 3 had stable disease. One child had a response to chemotherapy and concurrent irradiation. At a median follow-up of 30 months, 10 of 11 patients are alive; 8 of 11 patients are alive without evidence of disease. Aggressive multimodality therapy for PNRSTS is well tolerated, despite frequent and profound neutropenia. Although adjuvant chemotherapy for this group of cancers remains unproved, the rate of tumor control achieved in this pilot study encourages further investigation in a multi-institutional setting. Med. Pediatr. Oncol. 30:210–216, 1998. © 1998 Wiley-Liss,Inc.

Diffuse pontine gliomas remain one of the most lethal of pediatric malignancies despite the use of increasingly intensive therapies. We delivered intensive chemotherapy during and following 70.2 Gy of hyperfractionated radiation therapy in an attempt to improve survival. Nine consecutive children with diffuse pontine gliomas were treated on this single arm study. Carboplatin, given in combination with fixed dose etoposide, was escalated in successive cohorts to determine its maximum tolerated systemic exposure (AUC). Outcome was coded based on imaging characteristics and clinical status. Eight of the nine children on thisstudy died of their disease at a median of 44 weeks, essentially the same survival as those treated on a previous Pediatric Oncology Group study using hyperfractionated radiation therapy alone. Toxicity was almost exclusively hematologic and not associated with significant morbidity. The use of concurrent carboplatin and etoposide with hyperfractionated radiation therapy did not appear to improve the survival in this group of children with diffuse pontine gliomas. The toxicity of this chemotherapy during radiation therapy was primarily hematologic and well tolerated. New approaches to the treatment of these tumors need to be investigated. Med. Pediatr. Oncol. 30:28–33, 1998. © 1998 Wiley-Liss, Inc.

ABSTRACTThis study will evaluate the safety and efficacy of in vivogene transfer of the herpes simplex thymidine kinase (HSV-Tk1) gene using PA317/G1Tk1SvNa.7 vector producer cells (VPC) in pediatric patients with progressive or recurrent primary supratentorial malignant brain tumors. Insertion of the HSV-Tk1 gene confers a sensitivity to the anti-herpes drug ganciclovir. It has been demonstrated that the direct injection of HSV-Tk vector producer cells into growing tumors in animals can result in their complete destruction with ganciclovir therapy. This selective destruction of growing tumors in situis thought to result from the transfer of the HSV-Tk gene into the tumor cells and the production of toxic ganciclovir metabolites which result from the interaction of HSV-Tk and ganciclovir. This procedure can result in the cure of some experimental animals with limited systemic toxicity due to selective gene transfer into tumors.This clinical trial will focus on maximizing the relative number of vector producer cells to the tumor mass by stereotactically injecting VPCs into the tumor mass. Children with progressive or recurrent primary supratentorial malignant brain tumor which is accessible to stereotactic injection will be evaluated for the extent and location(s) of their disease before being entered into the study. Fifteen days after stereotactic injection of the tumor mass, ganciclovir will be administered at 5 mg/kg IV b.i.d. for 14 days. Upon completion of the treatment with HSV-Tk1 vector producer cells and ganciclovir, the patient will be followed monthly for the first three months, then every two months for the next twenty-one months, and annually for life thereafter.

Purpose: We report that patients with nevoid basal cell carcinoma syndrome (Gorlin syndrome) are at risk for developing neoplasms, especially basal cell carcinomas and rarely medul-loblastoma.

During chemotherapy for bilineal leukemia, a 6-month-old infant presented with a necrotizing skin and soft-tissue infection of the chest wall due to Rhizopussp. Successful outcome was achieved by systemically administered liposomal amphotericin B and local wound control with the novel administration of topical deoxycholate amphotericin B and surgical resection.

A 6-week-old boy presented with fever, pallor, and hepatomegaly. Ultrasound showed a huge midline abdominal mass. -human chorionic gonadotropin was markedly elevated, suggesting a diagnosis of infantile choriocarcinoma of the liver. A biopsy confirmed the diagnosis. The patient received 6 cycles of bleomycin, cisplatin, and etoposide with significant decrease in tumor size. However, the tumor remained unresectable. A donor liver became available, and the infant underwent successful liver transplantation. He received 2 posttransplant cycles of moderate dose of methotrexate. This case shows the use of liver transplantation in cases of infantile choriocarcinoma of the liver where the tumor remains unresectable despite chemotherapy.

Pancytopenia in hospitalized children is not a common occurrence. The causes may vary in different patients and in diverse areas of the world. There are no reports in the literature describing these etiologies in a developed country. Our review focused on children presenting with pancytopenia at a children's hospital in the United States with the purpose to allow us to better evaluate and care for children.

Objective.The objective of this study was to examine the feasibility of laparoscopic radical parametrectomy after previous hysterectomy.

Bilateral pelvic and aortic node lymphadenectomy is recommended for clinically localized unilateral epithelial ovarian adenocarcinoma (International Federation of Gynecologists and Obstetricians stage IA). The laterality of nodal metastasis in clinical stage I disease is rarely documented in the literature. Some authors have reported that ipsilateral node dissection is adequate for staging. A patient with contralateral pelvic and aortic lymph node metastasis and clinical stage I epithelial ovarian adenocarcinoma is presented. Pathologic findings were consistent with contralateral-only lymph node metastasis. This case illustrates the importance of bilateral lymph node sampling for appropriate staging of clinically localized epithelial ovarian cancer.