Immunonutrition: does it have a role in improving recovery in patients receiving a stem cell transplant?

Numerous clinical trials have demonstrated that immunomodulating diets (IMDs) reduce treatment complications such as the risk of acquired infections, length of hospital stay, and wound complications in patients receiving planned surgery. These complications are possibly exacerbated by malnutrition at the time of surgery, resulting in decreased cell-mediated and humoral immune responses, which can be improved with the utilization of IMDs both prior to and following surgery. Although numerous randomized studies have investigated IMDs in the surgical setting, IMDs have not been well studied to evaluate whether their use improves outcomes for other patient groups with high incidence of malnutrition and acquired infections.

Risk for residual adenocarcinoma in situ or cervical adenocarcinoma in women undergoing loop electrosurgical excision procedure/conization for adenocarcinoma in situ.

Objective: To evaluate the risk for residual adenocarcinoma in situ (AIS) or cervical adenocarcinoma in women undergoing loop electrosurgical excision procedure (LEEP)/conization as the initial management for AIS.

Study Design: A retrospective chart study was conducted from 1990 to 2005. Patients with AIS were identified from a pathology database.

Effectiveness of a multivariate index assay in the preoperative assessment of ovarian tumors.

Objective: To compare the effectiveness of physician assessment with a new multivariate index assay in identifying high-risk ovarian tumors.

Methods: The multivariate index assay was evaluated in women scheduled for surgery for an ovarian tumor in a prospective, multi-institutional trial involving 27 primary- care and specialty sites throughout the United States. Preoperative serum was collected, and results for the multivariate index assay, physician assessment, and CA 125 were correlated with surgical pathology.

Performance of the American College of Obstetricians and Gynecologists' ovarian tumor referral guidelines with a multivariate index assay.

Objective: The American College of Obstetricians and Gynecologists (the College) published referral guidelines for women with a pelvic mass that incorporate CA 125. A new multivariate index assay assesses the malignant risk of ovarian tumors before surgery. Our objective was to estimate the performance of the College guidelines with this new multivariate index assay.

JAK2 V617F mutation testing in polycythemia vera: use and impact in an academic practice.

Background: The observation that a mutation in JAK2 (JAK2 V617F) is present in more than 90% of cases of polycythemia vera (PV) has altered the diagnostic approach to this disease. However, most studies of the utility of JAK2 V617F have been performed in large PV populations; most hematologists or hematologist-oncologists have relatively few PV patients in their individual practices.

Approach: To assess its impact in a practice of more typical size, the use of JAK2 V617F testing was reviewed in 5 individual clinics in an academic practice after a total of 16 patients carrying an established or presumed diagnosis of PV.

Gynecologic laparoscopy.

Gynecologic laparoscopy is an evolving discipline. Major advances in technology have facilitated the transition from traditional "open" surgery to minimally invasive procedures. This article reviews the basic tenets of gynecologic laparoscopy: pelvic anatomy, general procedures, laparoscopic instruments, complications, and common gynecologic surgeries.

Rate of pathology from atypical glandular cell Pap tests classified by the Bethesda 2001 nomenclature.

Objective: To estimate the risk of significant pathology from atypical glandular cell (AGC) Pap tests classified by the 2001 Bethesda system and to assess potential differences in AGC management practices between physician specialties.

Methods: A chart study was conducted to assess outcomes from AGC Pap tests diagnosed during 2001-2005.

Results: One hundred thirty-one AGC Pap tests were identified from 84,748 Pap tests.

Positron emission tomography in a premenopausal asymptomatic woman: a case report of increased ovarian uptake in a benign condition.

Positron emission tomography (PET) use is increasing; however, optimal utilization in gynecologic oncology remains unclear. PET is expensive, has limited anatomic detail, and it may be difficult to differentiate benign ovarian lesions from malignant lesions when PET is used. A 43-year-old female volunteer's PET scan revealed increased uptake in the left ovary.

Low-dose fractionated radiation as a chemopotentiator of neoadjuvant paclitaxel and carboplatin for locally advanced squamous cell carcinoma of the head and neck: results of a new treatment paradigm.

Purpose: Current therapies for locally advanced squamous cell carcinoma of the head and neck (SCCHN) result in 50% long-term remission. Low-dose radiotherapy (<100 cGy) induces enhanced cell killing in vitro via the hyper-radiation sensitivity phenomenon but has not been used in the clinical setting. On the basis of the demonstrated synergy between chemotherapy and low-dose fractionated RT, a novel neoadjuvant therapy was designed using low-dose fractionated RT as a chemopotentiator for locally advanced SCCHN.

Risk of malignancy in unilocular ovarian cystic tumors less than 10 centimeters in diameter.

Objective: To determine the natural history and to estimate the risk of malignancy of unilocular ovarian cystic tumors less than 10 cm in diameter followed conservatively by transvaginal ultrasound.

Methods: From 1987 to 2002, 15,106 asymptomatic women at least 50 years old entered the University of Kentucky's Ovarian Cancer Screening Program and underwent initial transvaginal ultrasonography. If the screen revealed nothing abnormal, women were asked to repeat transvaginal ultrasonography yearly.

Malignant struma ovarii: a case report and analysis of cases reported in the literature with focus on survival and I131 therapy.

Background: Malignant struma ovarii is a rare type of germ cell tumor that is most often diagnosed postoperatively. The natural history and optimal treatment regimen for the disease are essentially unknown due to the small numbers of published cases.

Case: A 32-year-old woman presented with pelvic pain and an ovarian mass that was ultimately treated by total abdominal hysterectomy/bilateral salpingo-oophorectomy.

Lymphocyte infusion for delayed extramedullary relapse of acute leukemia following bone marrow transplantation.

We report a case of extramedullary relapse of acute myelogenous leukemia twelve years after allogeneic bone marrow transplantation. Due to the localized nature of the relapse, we were able to eliminate a majority of the tumor burden, utilizing local irradiation. Destined with eventual systemic leukemia relapse, further therapy utilizing donor lymphocytes was given at a time of minimal disease burden.