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The expression of vimentin intermediate filament has been examined in 62 cases of stage IB/IIA uterine cervical carcinoma as it has been demonstrated that some vimentin-positive epithelial neoplasms arising in the breast, stomach and kidney have an aggressive clinical behavior. No correlation was found between vimentin staining in cervical carcinomas and tumor differentiation, lymph node status or clinical outcome although vimentin-positive adenocarcinomas had a non-statistically significant tendency to lack metastases.Despite being over-expressed in each of the three main tumor subtypes, it appears unlikely that vimentin analysis will prove to be useful as a prognostic indicator in uterine cervical carcinoma. [ABSTRACT FROM AUTHOR]

Over-expression of epidermal growth factor receptor (EGFR) and c-erbB-2, in uterine cervical carcinomas, is associated with a worsened prognosis. A third member of this proto-oncogene family, c-erbB-3, has now been identified and its over-expression has been described in a variety of carcinomas. In this immunohistochemical study we have shown that c-erbB-3 is widely expressed in cervical carcinomas, but we have found no association between its over-expression and lymph node status or clinical outcome. In a similar study examining the expression of EGFR and c-erbB-2 it was possible to demonstrate an association between over-expression and a worse prognosis. We conclude, therefore, that it is unlikely that demonstration of c-erbB-3 over-expression will be of any value as a prognostic indicator in carcinoma of the uterine cervix. [ABSTRACT FROM AUTHOR]

Sixty-two serous and mucinous ovarian tumors, an admixture of benign, borderline and malignant neoplasms, were immunostained for proliferating cell nuclear antigen (PCNA), with the monoclonal antibody PC10. The PC10 index, the proportion of cells showing nuclear positive staining, was calculated in each case. All the tumors showed positive immunoreactivity for PCNA. There was no overlap of PC10 counts between benign, borderline and malignant serous tumors but within the mucinous group of neoplasms there was considerable overlap between the counts for borderline and malignant tumors. There was no relationship between the PC10 index and the surgical stage of the malignant neoplasms and the index could not be correlated with patient death. Staining for PCNA does not, therefore, appear to be of any prognostic value in ovarian adenocarcinomas. [ABSTRACT FROM AUTHOR]

A clinicopathologic analysis of 70 patients treated by radiotherapy and/or chemotherapy following primary radical surgery has been undertaken. Clinical stage at presentation was IB (58 patients) and IIA (12 patients). Thirty-five patients (50%) had squamous carcinoma, 23 (33%) had adenosquamous carcinoma, 9 (13%) had adenocarcinoma and 3 (4%) had an undifferentiated neoplasm. The reasons for further treatment were: (i) pelvic lymph node metastases (PLNM), 35 (50%); (ii) inadequate central clearance (ICC), 13 (18%); (iii) recurrent disease (RD), 17 (24%); (iv) others, 5 (8%) cases. Sixty-seven patients had radiotherapy, one of whom also received adjuvant chemotherapy, three patients had chemotherapy alone, and 12 patients received chemotherapy for recurrence following radiotherapy. The 5-year survival in the above referral groups were: (i) 66%; (ii) 62%; (iii) 12%. The site of relapse following treatment was primarily pelvic in groups 2 (ICC) and 3 (RD) and extrapelvic in group 1 (PLNM). Of the histologic parameters studied the only factor of statistical significance in predicting outcome in this group who are recognized to have a generally poor prognosis was the presence of parametrial extension (P = 0.0066). Six cases (9%) developed complications following therapy, lymphoedema being the most common (66%). [ABSTRACT FROM AUTHOR]

The 235 patients with stage IB/IIA cervical carcinoma treated by Wertheim's hysterectomy, as a primary procedure, at St Mary's Hospital, Manchester between 1975 and 1989 inclusive, form the basis of this study. Using Cox's regression model, four variables were shown to have independent prognostic significance. These were: (1) lymphatic permeation (adjacent to the tumor); (2) tumor volume; (3) being pregnant at diagnosis and (4) lymph node metastases. A heuristic model was formulated which was based upon these four factors and by using this information it was possible to separate the patients into four distinct prognostic groups. It is suggested that this model may prove useful in identifying those patients at a higher risk of dying of disease and who would benefit from early adjuvant systemic therapy. [ABSTRACT FROM AUTHOR]

Hale RJ, Buckley CH, Fox H, Wilcox FL, Tindall VR, Logue JP. The morphology and distribution of lymph node metastases in stage IB/IIA cervical carcinoma: relationship to prognosis. Int J Gynecol Cancer 1991; 1: 233-237.In this study 49 cases of stage IB/IIA cervical carcinoma with nodal metastases treated by Wertheim's hysterectomy have been examined. Note was made of the number of nodal metastases found, the site of the highest involved node and the pattern and extent of nodal infiltration. None of these parameters showed any significant effect on prognosis.These results suggest that in patients treated surgically for cervical carcinoma every lymph node should be thoroughly examined for the presence of metastatic tumor and where this is found, no matter how minimal, adjuvant therapy should be considered. [ABSTRACT FROM AUTHOR]

A clinicopathological analysis of 235 patients with stage IB/IIA cervical carcinoma was performed. These patients represent all those treated between 1975 and 1989 inclusive by primary Wertheim's hysterectomy at St Mary's Hospital, Manchester. We found that a significantly higher proportion of tumors from patients under 40 years of age contained mucin and that overall the adenosquamous carcinomas had a significantly greater incidence of lymph node metastases (P= 0.00049). Pelvic lymph node metastases had no effect on prognosis in these adenosquamous carcinomas but did in squamous carcinomas (P= 0.0004) and adenocarcinomas (P= 0.0001). Univariate log-rank analysis showed that variables associated with survival were: pregnancy at diagnosis (P= 0.0238), lymphatic permeation (P < 0.0001), vascular permeation (P < 0.0001), lymph node metastases (P < 0.0001), tumor volume (P < 0.0001), canal length of tumor (P= 0.0009), cervical stromal tumor-free rim (P= 0.0027), parametrial extension (P= 0.0008) and adequacy of excision (P= 0.0389). In a multivariate regression analysis (Cox's regression model) lymphatic permeation, tumor volume, pregnancy at diagnosis and lymph node metastases were independent prognostic variables. [ABSTRACT FROM AUTHOR]

AIM: To assess overexpression of the proposed tumour suppressor gene product p53 using the mouse monoclonal antibody DO-7 in the three main subtypes of carcinoma of the uterine cervix and to evaluate its value as a prognostic indicator. METHODS: Eighty two cases of FIGO Stage IB/IIA uterine cervical carcinoma were studied retrospectively. The tumours had been previously typed into adenocarcinomas, squamous carcinomas and adenosquamous carcinomas after the tissue had been fixed in formalin and embedded in paraffin wax. p53 protein expression was assessed using a standard immunohistochemical technique and the findings were correlated with tumour type, lymph node status and clinical outcome. RESULTS: In total, the p53 gene product was overexpressed in 17.1% (14/82) of all carcinomas and also in areas of cervical intraepithelial neoplasia grade III adjacent to invasive squamous carcinoma. Where present, the normal epithelium was uniformly negative. No association was found between p53 overexpression and tumour subtype, lymph node status or clinical outcome. CONCLUSIONS: It seems unlikely that p53 analysis will be of value in determining prognosis in carcinoma of the uterine cervix. [ABSTRACT FROM PUBLISHER]

AIMS: To investigate the pattern of epidermal growth factor receptor expression and its prognostic value in the three main types of cervical carcinoma. METHODS: 62 cases of stage IB/IIA cervical carcinoma, all with a minimum of five years of follow up, were studied. Representative sections were stained for mucin to permit accurate tumour typing and a standard avidin-biotin immunoperoxidase technique using the polyclonal antibody 12E was used to demonstrate the presence of epidermal growth factor receptor. RESULTS: A proportion of all three tumour types expressed epidermal growth factor receptor, it being most common in squamous cell carcinomas (50%). Overall, there was a correlation between epidermal growth factor expression and mortality. This was particularly obvious in the absence of lymph node metastases. When the individual tumour types were considered this association with prognosis was not demonstrable for squamous cell carcinomas or adenocarcinomas but was a very prominent feature of adenosquamous carcinomas. CONCLUSIONS: Immunohistochemical demonstration of epidermal growth factor receptor expression may be useful in identifying those patients with a poor prognosis, particularly those with adenosquamous carcinomas which have not metastasised to the regional lymph nodes. [ABSTRACT FROM PUBLISHER]

Focuses on medical sciences in Great Britain. State of the prisons; Identification of thyroxine tablets; Rational treatment of asthma.

AIMS: To examine neuroendocrine differentiation, as shown by chromogranin A (CGA) expression, in cervical carcinomas. METHODS: Sixty seven cervical carcinomas were studied and were classified as adenocarcinomas, adenosquamous carcinomas or squamous cell carcinomas based on the assessment of haematoxylin and eosin staining and stains for mucin. Where features of glandular differentiation were identified, sections were also stained for evidence of intestinal type mucin. CGA immunostaining was done and the results were graded on a three point scale: 0, + (1-5% of cells positive) and ++ (> 5% of cells positive). These findings were then analysed with respect to lymph node status, tumour differentiation and clinical outcome. RESULTS: There were 32 adenocarcinomas, 18 adenosquamous carcinomas and 17 squamous cell carcinomas. Positive staining was seen in 14 (20.9%) cases, of which four were strongly positive. All but one case were either adenocarcinomas or adenosquamous carcinomas. There was a trend for CGA positivity to be related to intestinal differentiation but this failed to reach statistical significance. No correlation could be demonstrated between CGA staining and lymph node status, tumour differentiation and clinical outcome. CONCLUSIONS: Neuroendocrine differentiation is common in cervical carcinomas where there is evidence of glandular differentiation. Whilst the numbers in this study are relatively small, the presence of neuroendocrine cells in otherwise typical carcinomas does not seem to have any association with clinical behaviour. [ABSTRACT FROM PUBLISHER]

AIMS: To determine whether the expression of proliferating cell nuclear antigen (PCNA) in villous cytotrophoblast could distinguish between placental tissue from a hydropic abortion and that from a partial hydatidiform mole. METHODS: Tissue from 18 partial hydatidiform moles, 15 hydropic abortions, five normal first trimester placentas and five normal full term placentas were immunostained for expression of PCNA, using the monoclonal antibody PC10. RESULTS: PCNA immunoreactivity was very much higher in the cytotrophoblast of normal first trimester placentas than in normal term placentas. Villous tissue from partial hydatidiform moles showed, on average, less immunoreactivity for PCNA than did villous tissue from hydropic abortions. CONCLUSIONS: Immunostaining for PCNA is of no value for differentiating between partial hydatidiform moles and hydropic abortions. The findings indicate that trophoblastic proliferation or hyperplasia is not a feature of partial hydatidiform moles. [ABSTRACT FROM PUBLISHER]

AIMS: To study the pattern of expression and prognostic importance of c-erbB-2 protein in cervical carcinoma. METHODS: Sixty two cases of stage IB/IIA cervical carcinoma, representing the three main tumour types, were investigated immunohistochemically for the presence of c-erbB-2 protein expression, using a monoclonal antibody (CB11) to its internal domain. Follow up of at least five years' duration was available in all cases. RESULTS: Definite membrane staining was seen in 38.7% of cases. There was a strong correlation with poor survival (p less than 0.0001) particularly. For those with adenocarcinomas, this was the case when nodal metastases were present. In contrast, for squamous carcinomas and adenosquamous carcinomas, the association with a poor prognosis was most apparent in those patients without lymph node metastases. CONCLUSIONS: These findings raise the possibility that immunostaining for c-erbB-2 protein could be used as a prognostic marker and may help identify those patients for whom early adjuvant treatment might be beneficial. [ABSTRACT FROM PUBLISHER]

Two cases of progressive hearing loss due to middle ear tumours are described. The histological characteristics numbered intraluminal mucin production and neuroendocrine features, as shown by argyrophilia and ultrastructural demonstration of dense core granules. These tumours have been known by many different names, reflecting the controversies relating to their presumed histogenesis and differentiation. The currently preferred designation is middle ear adenoma, and these two cases provide further evidence for dual lines of differentiation. [ABSTRACT FROM PUBLISHER]

Objectives: To identify levels of psychological distress in accident and emergency (A&E) senior house officers (SHOs).Methods: Questionnaire survey given to SHOs at training sessions.Measures: General Health Questionnaire (GHQ) and the Brief COPE.Results: Over half of the 37 respondents (51%; 95% CI: 36% to 67%) scored over the threshold for psychological distress on the GHQ. This is considerably higher than for other groups of doctors and for other professional groups. Correlational analysis revealed that the coping style Venting was significantly related to greater anxiety (r=0.34; p<0.05) and depression (r=0.33; p<0.05), while the coping style Active was significantly related to lower anxiety (r=-0.38; p<0.05), somatic complaints (r=-0.46; p<0.001) and years since qualification (r=0.40; p<0.05).Conclusions: Replicating findings from a study of stress in A&E consultants, this study shows higher levels of overt psychological distress among A&E SHOs than among other groups of doctors. An intervention to improve coping strategies may be useful for this group of doctors. [ABSTRACT FROM AUTHOR]

A quiz concerning the diagnosis of a 46-year-old woman who experiences intermenstrual bleeding is presented.

A case of amyloid tumour of the colon and the first in association with a carcinoma is reported. A previously healthy 65 year old man presented with non-specific symptoms of lower abdominal pain and flatulence without rectal bleeding. A clinical diagnosis of diverticular disease was made and colonoscopy performed. Two lesions (one at 15 cm and the other at 30 cm from the anal margin) were found on endoscopy and removed. On histology, the lesion at 15 cm was a moderately differentiated adenocarcinoma and that at 30 cm contained amyloid. Further tests (standard tinctorial methods and immunohistochemistry) revealed the 30 cm lesion to be an amyloid tumour of the colon of AL (lambda) type. When biopsy of an atypical, large, solitary colorectal lesion reveals amyloid deposition, the possibility of an amyloid tumour should be considered and the lesion resected. [ABSTRACT FROM PUBLISHER]

Background: The delivery of end-of-life care in nursing homes is challenging. This situation is of concern as 20% of the population die in this setting. Commonly reported reasons include limited access to medical care, inadequate clinical leadership and poor communication between nursing home and medical staff. Education for nursing home staff is suggested as the most important way of overcoming these obstacles., Objectives: To identify educational interventions to enhance end-of-life care for nursing home staff and to identify types of study designs and outcomes to indicate success and benchmark interventions against recent international guidelines for education for palliative and end-of-life care., Design: Thirteen databases and reference lists of key journals were searched from the inception of each up to September 2014. Included studies were appraised for quality and data were synthesised thematically., Results: Twenty-one studies were reviewed. Methodological quality was poor. Education was not of a standard that could be expected to alter clinical behaviour and was evaluated mainly from the perspectives of staff: self-reported increase in knowledge, skills and confidence delivering care rather than direct evidence of impact on clinical practice and patient outcomes. Follow-up was often short term, and despite sound economic arguments for delivering effective end-of-life care to reduce burden on the health service, no economic analyses were reported., Conclusions: There is a clear and urgent need to design educational interventions that have the potential to improve end-of-life care in nursing homes. Robust evaluation of these interventions should include impact on residents, families and staff and include economic analysis., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)