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Traditionally radical hysterectomy has formed the mainstay of treatment for early stage cervical carcinoma. More recently radical trachelectomy and laparoscopic lymphadenectomy have been introduced to allow preservation of fertility. We present a new approach to fertility-sparing surgery, namely abdominal radical trachelectomy. The technique is similar to a standard radical hysterectomy and lymphadenectomy. In our technique the ovarian vessels are not ligated and, following lymphadenectomy and skeletonisation of the uterine arteries, the cervix, parametrium and vaginal cuff are excised. The residuum of the cervix is then sutured to the vagina and the uterine ateries reanastomosed.Traditionally the treatment for invasive cervical carcinoma which has progressed beyond microinvasion has been radical hysterectomy. Long term experience of radical surgery for Stage l b carcinoma has shown that it produces excellent results in terms of survival but that morbidity may be significant, and there is always loss of potential for future childbearing. Increasingly, large numbers of young women (24-35 years) are being diagnosed with cervical cancer1. Clearly, the loss of fertility in these women can be devastating.In recent years there has been a move towards more conservative approaches for the treatment of cervical carcinoma. Conisation of the cervix has become acceptable practice for the management of FIG0 classification Stage la(i) tumours. In an attempt to develop a more conservative operation for early invasive carcinoma of the cervix, Dargent et al.* described a new technique suitable for exophytic tumours of Stages l a to 2a which allowed preservation of the uterus but removed the cervix, parametrium and upper one third of the vagina.He called this procedure 'radical trachelectomy '. His patients also underwent laparoscopic pelvic lymphadenectomy, with negative histology results. The

Srdjan Saso clinical research fellow 1 , Jayanta Chatterjee clinical research fellow 1 , Ektoras Georgiou clinical research fellow 2 , Anthony M Ditri general practitioner 3 , J Richard Smith gynaecological surgeon 4 , Sadaf Ghaem-Maghami senior lecturer and honorary consultant in gynaecological oncology 5The International Agency for Research on Cancer recently estimated that endometrial carcinoma is the commonest gynaecological cancer in the developed world, 1 with a rising incidence in postmenopausal women. In 2007, 7536 new endometrial cancers were diagnosed in the UK, making it the fourth most common cancer in women after breast, lung, and colorectal cancers. 2 Cancer of the endometrium is the commonest cancer of the uterine corpus (about 92%, the remainder being uterine carcinosarcomas and sarcomas), according to the Surveillance, Epidemiology and End Results programme of the US National Cancer Institute, which has collected data on cancer from various locations and sources since 1973. 3 Cure is possible and the overall five year survival rate for all stages is currently around 80%. Most women present early in the course of the disease when cure is more likely, so primary care practitioners need to be vigilant for potential indicators. We discuss the epidemiology, diagnosis, and treatment of endometrial cancer on the basis of a review of observational research, randomised trials, reviews, and meta-analyses. Summary pointsEndometrial cancer is the most common gynaecological cancer in more developed countries and its incidence is increasing in postmenopausal women Postmenopausal bleeding is the hallmark symptomThe main risk factors for the development of endometrioid endometrial carcinoma are obesity and chronic unopposed oestrogen stimulation of the endometrium All women with suspected endometrial cancer require transvaginal ultrasonography and most will undergo endometrial biopsy; more sophisticated radiological examinations are required for accurate preoperative staging.Treatment is usually surgical, comprising total hysterectomy and bilateral salpingo-oophorectomy.Adjuvant therapy with radiotherapy, chemotherapy, or hormonal therapy is considered in more advanced or high risk disease Sources and selection criteriaWe searched PubMed to identify peer reviewed original research articles, meta-analyses, and reviews. Search terms were endometrial cancer, cancer of the endometrium, endometrial adenocarcinoma, neoplasm and endometrium, and endometrial neoplasm. Only papers written in English were considered.

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Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing this collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Department of Defense, Washington Headquarters Services, Directorate for Information The fluoride reactivation process was evaluated for measuring the level of sarin or soman nerve agents reactivated from substrates in plasma and tissue from in vivo exposed guinea pigs (Cava porcellus), in blood from in vivo exposed rhesus monkeys (Macaca mulatta), and in spiked human plasma and purified human albumin. Guinea pig exposures ranged from 0.05 to 44 LD5 0 , and reactivated nerve agent levels ranged from 1.0 ng/mL in plasma obtained from 0.05 LD 50 sarinexposed guinea pigs to an average of 147 ng/g in kidney tissue obtained from two 2.0 LD 50 soman-exposed guinea pigs. Positive dose-response relationships were observed in all low-level, 0.05 to 0.4 LD 50 , exposure studies. An average value of 2.4 ng/mL for reactivated soman was determined in plasma obtained from two rhesus monkeys three days after a 2 LD 50 exposure. Of the five types of guinea pig

The major metabolites and breakdown products of some toxic organophosphonates are their respective alkymethylphosphonic acids. These acids ionize at physiological pH and are not amenable to gas chromatographic analysis in their underivatized forms. Their detection in biological samples has been difficult because of their presence at only trace levels. Existing analytical methods were developed mainly for measuring these phosphonic acids in environmental samples and at higher concentrations. In this study, we devised a gas chromatographic/mass spectrometric method to provide confirmation and quantification of the organophosphonic acids of soman (GD), sarin (GB) and GF in blood and urine. This report describes the various derivatization conditions that we have studied and demonstrates the characteristic mass spectra by different ionization techniques.

Following an accidental human exposure to a vesicating agent, plasma samples were analyzed for specific biomarkers of sulfur mustard. One individual suffered chemical burns over 6.5% of the body surface area and required hospitalization; the second individual developed a single, small blister. Plasma specimens from both individuals were examined using two different assays. The first assay targeted sulfur mustard adducts to cysteine-34 of albumin using affinity chromatography, enzyme digestion, and analysis of the alkylated peptide fragment using liquid chromatography-tandem mass spectrometry. The second assay targeted alkylation sites of glutamic and aspartic acids of plasma proteins. Following precipitation of plasma proteins, the sulfur mustard adducts were cleaved from the protein using base, derivatized, and analyzed using gas chromatography-mass spectrometry. Samples obtained over a 42-day period from the individual requiring hospitalization produced positive results for sulfur mustard adducts using both assays. Observed levels of the sulfur mustard biomarker decreased by approximately 75% between days 2 and 42 for both assays. Samples obtained over a six-day period from the individual with a single, small blister produced positive results for the albumin adduct assay. Observed levels were much lower than levels from the hospitalized patient. Blood samples from suspected human exposures to sulfur mustard have only rarely been made available for analysis by sensitive and specific laboratory assays. The data presented here add significantly to the small database of information that currently exists on human biomarkers of sulfur mustard exposure, linking a well-documented exposure event with levels of plasma protein adducts.