No abstract

The evident advantage of high-field MR (magnetic resonance) scanners is their higher signal-to-noise ratio, which results in improved imaging. While no reliable efficacy studies exist that compare the diagnostic capabilities of low- versus high-field scanners, the adoption and acceptance of low-field MRI (magnetic resonance imaging) is subject to biases. On the other hand, the cost savings associated with low-field MRI hardware are obvious. The running costs of a non-superconductive low-field scanner show even greater differences in favor of low-field scanners. Patient anxiety and safety issues also reflect the advantages of low-field scanners. Recent technological developments in the realm of low-field MR scanners will lead to higher image quality, shorter scan times, and refined imaging protocols. Interventional and intraoperative use also supports the installation of low-field MR scanners. Utilization of low-field systems has the potential to enhance overall cost reductions with little or no loss of diagnostic performance.

No abstract

The clinical value of transvaginal ultrasonography in the evaluation of the uterine cervix of pregnant women was studied. Comparison with conventional transabdominal ultrasound in 24 pregnant subjects revealed that transvaginal ultrasound was superior, because the transabdominal technique usually requires a full bladder, which causes deformation and elongation of the cervix. Digital examination showed dilatation of the internal os in only ten (38.5%) of 26 patients in whom it had previously been shown by transvaginal sonography. Transvaginal ultrasonography has the advantage of providing natural and objective information on the cervix. The values of three sonographic signs found transvaginally for predicting preterm delivery were evaluated in a total of 130 at-risk patients and 129 control subjects. Shortening of the cervical length by -1.5 SD or more was associated with an increased risk of preterm delivery (11.3% vs. 2.8%, p < 0.01). A dilated internal os of more than 5 mm before 30 weeks of gestation was associated with preterm delivery more often than an undilated internal os (33.3% vs. 3.5%, p < 0.01). Dynamic changes in the degree of dilatation of the cervical canal which were found in nine women were significantly related with preterm delivery (p < 0.05). But, in the at-risk group, only dilatation of the internal os had a predictive value for preterm birth. From these data, dilatation of the internal os on transvaginal ultrasonography was proved to be an early and important predictor of preterm delivery.

Nucleophilic substitution reactions of 2-methoxy- and 2-acyloxypiperidines were investigated. First, new and efficient methods for the preparation of the starting piperidine derivatives were developed. N-Benzyloxycarbonyl-2-methoxypiperidine (3) and 3-substituted-2-acyloxy-N-benzyloxycarbonylpiperidines (4a-d), which are recognized as the simplest imino-sugars, were prepared and were examined as substrates for nucleophilic substitution reactions with silyl enolates under the influence of catalytic amounts of metal triflates (Sc(OTf)3, Sn(OTf)2, Cu(OTf)2, Hf(OTf)4, etc). Among the triflates tested, Sc(OTf)3 gave the best results. It was found that 2-acetoxy-3-benzyloxy-N-benzyloxycarbonylpiperidine (4a) reacted with silyl enolates to afford the 2-alkylated adducts in high cis-selectivity, while 2,3-diacyloxy-N-benzyloxycarbonylpiperidines (4b-d) showed transselectivity. The stereochemical assignments were carefully performed using NMR analysis, X-ray crystallography, and synthetic transformations. Febrifugine (1), a potent antimalarial alkaloid, was successfully synthesized from 2,3-diacetoxy-N-benzyloxycarbonylpiperidine (4b) on the basis of these diastereoselective nucleophilic substitution reactions.

No abstract

No abstract

This study has demonstrated that the systematic lymphadenectomy had benefit only in patients with ovarian cancer macroscopically confined to the pelvis. In patients with clear cell adenocarcinoma, systematic lymphadenectomy was beneficial. To the contrary, systematic lymphadenectomy had no benefit on OS or PFS in patients with advanced ovarian cancer if optimally debulked.