New System Of Classification Research Articles

Sinonasal sarcoidosis: A new system of classification acting as a guide to diagnosis and treatment.

The signs and symptoms of sinonasal sarcoidosis are diverse and nonspecific. It easily mimics more common sinonasal disorders such as allergic rhinitis, bacterial sinusitis, and atrophic rhinitis. The purpose of this study was to develop a classification system of sinonasal sarcoidosis that will help serve as a guide for both diagnosis and treatment. A retrospective chart review was performed of all patients diagnosed with sinonasal sarcoidosis from 1974 to 2013. A PubMed literature review of all published case series of sinonasal sarcoidosis was also reviewed. The charts of 14 patients with biopsy-proven sinonasal sarcoidosis were reviewed. Follow-up time ranged from 6 months to 28 years. Presenting signs included hypertrophic mucosa, nasal polyps, crusting, nasal enlargement, and destructive processes. Eight patients underwent medical management alone and six patients underwent endoscopic sinus surgery. Five of the six patients were successfully treated with surgery. On review of the literature, 256 cases of sinonasal sarcoidosis were found, of which 43 patients underwent surgery. Clinical outcomes of the patients who underwent surgery were not consistently reported. Based on critical analysis of the clinical presentation of sinonasal sarcoidosis in our case series and on review of the literature, sinonasal sarcoidosis can be classified into four subgroups: atrophic, hypertrophic, destructive, and nasal enlargement. Each subgroup responds differently to treatment and has its own differential diagnosis. Surgery is only indicated for a select group of patients and the vast majority of patients benefit from medical management alone.

Tree species composition in areas of Atlantic Forest in southeastern Brazil is consistent with a new system for classifying the vegetation of South America

Rigorous and well-defined criteria for the classification of vegetation constitute a prerequisite for effective biodiversity conservation strategies. In 2009, a new classification system was proposed for vegetation types in extra-Andean tropical and subtropical South America. The new system expanded upon the criteria established in the existing Brazilian Institute of Geography and Statistics classification system. Here, we attempted to determine whether the tree species composition of the formations within the Atlantic Forest Biome of Brazil is consistent with this new classification system. We compiled floristic surveys of 394 sites in southeastern Brazil (between 15o and 25oS; and between the Atlantic coast and 55oW). To assess the floristic consistency of the vegetation types, we performed non-metric multidimensional scaling (NMDS) ordination analysis, followed by multifactorial ANOVA. The vegetation types, especially in terms of their thermal regimes, elevational belts and top-tier vegetation categories, were consistently discriminated in the first NMDS axis, and all assessed attributes showed at least one significant difference in the second axis. As was expected on the basis of the theoretical background, we found that tree species composition, in the areas of Atlantic Forest studied, was highly consistent with the new system of classification. Our findings not only help solidify the position of this new classification system but also contribute to expanding the knowledge of the patterns and underlying driving forces of the distribution of vegetation in the region.

Cerebral dysfunction in children: should this be the central tenet for a new system of classification?

This commentary is on the original article by Creavin et al. on pages 164–170 of this issue.

Character Traits Depicted in Newbery Medal Books from the 1920s Through the 2000s

Readers readily identify with characters in literature; therefore, educators must be acutely aware of the overt and underlying messages conveyed in Newbery Medal books. In this quantitative content analysis with a qualitative component, the researchers employed nonparametric measurements to examine Newbery Medal books from the 1920s to the 2000s to quantify the frequency of positive Biblical and negative opposite character traits exhibited through the thoughts and actions of characters in Newbery Medal books as well as the emergent moral themes of each book. A new system of classification for Newbery Medal books has been proposed to provide the American Library Association with an alternative method by which Newbery Medal books categorized.

Study on the Method of Planetary Gear Trains Based on Topological Theory

The method research of planetary gear trains (PGTs) by applying topological theory is very significance in searching for innovative planetary trains. A new graph representation and stratification standard are introduced firstly. Then three topological graphs of basic structure of PGTs are established as the basis of synthesis theory. Next several kinds of planetary trains with small teeth difference and method of isomorphic determination are presented, thus built up the procedure of PGTs by graphs and example. Finally a new system of classification and synthesis for PGTs is put forward according to the feature of loops in topological theory.

Systematic Studies on Cucurbitaceae Family at Rajshahi Division, Bangladesh

Systematic investigation on the family Cucurbitaceae growing throughout the Rajshahi Division situated in the northern parts of Bangladesh was carried out. A total of 24 species under 13 genera of the family Cucurbitaceae were collected and identified. A complete taxonomic account of each species has been given along with their current name, local name, brief description, phenology, basic chromosome number and voucher number. A new system of classification of the family Cucurbitaceae has been proposed on the basis of morphological, cytological and floral characters.

Systematic Studies on Asteraceae in the Northern Region of Bangladesh

Systematic investigation on the family Asteraceae (Compositae) growing throughout in the northern region of Bangladesh was carried out. A total of 36 species under 29 genera of the family Asteraceae were collected and identified. A complete taxonomic account of each species has been given along with their current name, local name, brief description, phenology, basic chromosome number, anatomy and voucher number. Among the recorded species, both anomocytic and anisocytic stomata were found in 21 species; anomocytic stomata in 10 species; anisocytic stomata in 3 species; anomocytic and paracytic stomata were found in 1 species; anomocytic, anisocytic and paracytic stomata were found in 1 species. Out of the 36 species, stomata were found to be present both on the upper and lower surface in 33 species and only on lower surface in 3 species. Three types of trichomes, i.e. non-glandular multicellular, non-glandular unicellular and glandular multicellular trichomes were recorded. Non-glandular multicellular trichome was found in 25 species, non-glandular unicellular in 1 species and glandular multicellular trichome was found in 1 species. Trichomes were absent in rest of the species. Finally, a new system of classification of the family Asteraceae has been proposed on the basis of morphological, anatomical, cytological and floral characters.

Naturalia : the history of natural history and medicine in the seventeenth century

In 1712 the poet Elkanah Settle (1648–1724) published a funeral poem, Threnodia Apollinaris , dedicated to the memory of Dr Martin Lister.[1][1] Settle had a good deal of material to draw upon, because Lister had been Vice-President of the Royal Society, a physician to Queen Anne, and the first

Erratum to: Anterior instrumentation (dual screws single rod system) for the surgical treatment of idiopathic scoliosis in the lumbar area: a prospective study on 33 adolescents and young adults, based on a new system of classification

Erratum to: Anterior instrumentation (dual screws single rod system) for the surgical treatment of idiopathic scoliosis in the lumbar area: a prospective study on 33 adolescents and young adults, based on a new system of classification

History of German language dermatology

History of German language dermatology

Anterior instrumentation (dual screws single rod system) for the surgical treatment of idiopathic scoliosis in the lumbar area: a prospective study on 33 adolescents and young adults, based on a new system of classification

The choice of anterior instrumentation in the treatment of lumbar scoliosis in adolescents and young adults is not a new topic for the authors. The first results achieved using the Dwyer surgical modality were reported by one of the authors followed by the results achieved using Zielke (VDS) instrumentation. Today, new techniques and new instrumentations have been developed that challenge the instrumentation choices. Here we describe how the new system of classification of scoliotic curves we developed has been used as a basis for treating idiopathic scoliosis in lumbar area in adolescents and young adults using an anterior approach. A prospective study was carried out between 1998 and 2010 at two hospital centers on 33 adolescents and young adult with idiopathic lumbar scoliosis involving curves of three kinds, on whom surgical treatment was performed using a single solid rod. Topography of curves: our system of classification includes curves corresponding to the following three type of scoliosis: Type K I: double thoracic and lumbar curves (lumbar predominant) scoliosis (17 cases) mean age 16 years all female patients. Mean Cobb angle of lumbar curve 41°. Mean Cobb angle of thoracic curve 28°. The lumbar curve was left hand convex in 15 cases and right hand convex in 2 cases. Horizontal tilting of L4 mean value 22°. C7 offset mean value 3 cm. Type K IV A: unbalanced thoracolumbar scoliosis (13 cases) mean age 17 years, ten female patients and three male patients. Mean Cobb angle of thoracolumbar curve 39°. The thoracolumbar curve was left hand convex 4 times and right hand convex 9 times. Horizontal tilting of L4 mean value 18°. C 7 offset mean value 2.5 cm. Type K VI A: real lumbar (three cases). Age: 17, 15 and 13 years; all female patients. Cobb angle of the lumbar curve 66°, 29° and 70° (all LH convex). Horizontal tilting of L4: 40°, 20° and 46°. C 7 offset: 7 cm, 1 cm and 4 cm. Surgical instrumentation: We used the EUROS AZUR anterior instrumentation for all the procedures. Cages have been used on five patients at the lower stages. Number of vertebrae instrumented: mean five vertebrae. The patients did not wear postoperative orthosis. Mean duration of procedure: 3 h 50 min. Mean blood loss: 350 cm(3). Type K I scoliosis (17 cases): Mean follow-up: 6 years. Correction of the lumbar curve Cobb angle: the mean angle has been corrected from 41° to 21°. Number of vertebrae instrumented: 4:6 times and 5:11 times. Correction of the upper thoracic curve Cobb angle: mean angle corrected from 28° to 19°. Correction of L4 horizontal tilting: mean residual was 7°. Correction of C 7 offset: mean 0.7 cm. Type K IV A scoliosis (13 cases): mean follow-up: 4 years. Correction of the lumbar curve Cobb angle: the mean angle has been corrected from 39° to 16°. Mean number of instrumented vertebrae: 5 (4:4 times, 5:6 times and 6:3 times.) Correction of L4 horizontal tilting: mean residual 5°. Correction of C 7 offset: mean 0.7 cm. Type K VI A scoliosis (three cases): mean follow-up: 7, 2 and 4 years; Correction of the lumbar curve Cobb angle: the angles have been corrected from 66° to 15°, from 29° to 11° and from 70° to 28°. Number of instrumented vertebrae: 5, 4 and 6. Correction of L4 horizontal tilting: residual tilting of 8°, 7° and 17°. Correction of C 7 offset: 1 cm, 0 cm and 1 cm. There has been no report early or late septic or vascular or neurological complications. Instrumentation failure: there were three cases of screw breakage, all occurred on the lowest implant. Revision surgery was undertaken in both cases, only the last plate needed to be replaced and the rod could be kept without any other modification of the construct. In both cases, fusion has been achieved without any loss of correction. The mean loss of correction of the main curve was 2.5° for the three series. Anterior instrumentation of lumbar idiopathic scoliosis gives highly satisfactory morphological and functional results, since the lumbar musculature is spared and the instrumentation placed at the apex of the curvature has selective effects. Despite our preference and that of other surgeons throughout the world for anterior instrumentation, we are still a minority in comparison with the users of posterior instrumentation. There are several reasons for this reticence, including surgeons' training and ideas about pedicular screw fixation, but the main reason has been the lack of a sufficiently exact system of classification. Previous comparative studies between the anterior and posterior approaches have been biased by the use of an excessively restrictive mode of classification (lumbar/thoracolumbar) of the curves. Real lumbar scoliosis, unbalanced thoracolumbar scoliosis and thoracic and lumbar double curve (lumbar predominant) scoliosis should be properly defined before being compared.

2257 ANALYSIS OF JAPANESE PATIENTS WITH CYSTINURIA: THE NEED FOR A NEW CLASSIFICATION SYSTEM

You have accessJournal of UrologyStone Disease: Evaluation & Medical Management II1 Apr 20122257 ANALYSIS OF JAPANESE PATIENTS WITH CYSTINURIA: THE NEED FOR A NEW CLASSIFICATION SYSTEM Shinichi Sakamoto, Yukio Naya, Yasuhiro Shigeta, Masaaki Fujimura, Takeshi Ueda, Kazuo Mikami, Koichiro Akakura, Motoyuki Masai, Kuniyoshi Nozumi, and Tomohiko Ichikawa Shinichi SakamotoShinichi Sakamoto Chiba , Japan More articles by this author , Yukio NayaYukio Naya Chiba , Japan More articles by this author , Yasuhiro ShigetaYasuhiro Shigeta Chiba , Japan More articles by this author , Masaaki FujimuraMasaaki Fujimura Chiba , Japan More articles by this author , Takeshi UedaTakeshi Ueda Chiba , Japan More articles by this author , Kazuo MikamiKazuo Mikami Chiba , Japan More articles by this author , Koichiro AkakuraKoichiro Akakura Chiba , Japan More articles by this author , Motoyuki MasaiMotoyuki Masai Chiba , Japan More articles by this author , Kuniyoshi NozumiKuniyoshi Nozumi Chiba , Japan More articles by this author , and Tomohiko IchikawaTomohiko Ichikawa Chiba , Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2434AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Cystinuria is caused by a defect in the cystine transporter rBAT/BAT1. We have previously identified a novel Japanese specific mutation, P482L in BAT1, which is found in nearly 80% of Japanese patients with cystinuria. Although cystinuria is known to be an autosomal recessive disorder, a heterozygous P482L mutation causes cystinuria in a number of Japanese patients. Based on those unique characteristics, we have analyzed correlation of genotype and phenotype in 92 Japanese cystinuria patients. METHODS Patient blood samples were obtained, under informed consents, from Chiba University Hospital and a collaborative hospital in Japan. Mutations in rBAT/BAT1 were studied by direct sequencing. Cystine concentrations in urine were assessed by 24-h acidic urine collection. RESULTS Twenty-two mutations were found in rBAT and 76 mutations were found in BAT1. Seven novel mutations in rBAT (W443stop, Y236S, T371X etc) and 8 novel mutations in BAT1 (A331V, A354D etc) were identified. The P482L mutation was found in 66 of 92 patients (71%). Among those patients, 33 possessed a homozygous P482L mutation and 33 possessed a heterozygous P482L mutation. When these patients were grouped based on a genotype classification proposed by Dello et al., 2 patients were Type A (rBAT homo), 41 patients were Type B (BAT1 homo), and 5 patients were Type AB (rBAT/BAT1 hetero). However, 44 patients were unclassified in these categories. Under a new classification system, Type a (rBAT hetero) and Type b (BAT1 hetero) are added, and among the 44 previously unclassified patients, 5 patients were classified as Type a and 39 patients were classified as Type b. As a phenotype, the 3 highest average cystine concentration groups were Type B (1998.7 nmol/mg Cre), Type AB (1678.5 nmol/mg Cre), and Type b (1335.0 nmol/mg Cre). When compared on the basis of genotype, the highest cystine concentration was observed in the P482L homozygous mutation (2074.6 nmol/mgCre). CONCLUSIONS Cystinuria has been recognized as an autosomal recessive disorder; however, in cases with a P482L mutation, half of the patients were heterozygous. Because their genotype is quite different from that of patients in western countries, a new classification may be needed for Japanese patients with cystinuria. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e910-e911 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shinichi Sakamoto Chiba , Japan More articles by this author Yukio Naya Chiba , Japan More articles by this author Yasuhiro Shigeta Chiba , Japan More articles by this author Masaaki Fujimura Chiba , Japan More articles by this author Takeshi Ueda Chiba , Japan More articles by this author Kazuo Mikami Chiba , Japan More articles by this author Koichiro Akakura Chiba , Japan More articles by this author Motoyuki Masai Chiba , Japan More articles by this author Kuniyoshi Nozumi Chiba , Japan More articles by this author Tomohiko Ichikawa Chiba , Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Multiloculated hydrocephalus: a review of current problems in classification and treatment

Loculated hydrocephalus is a condition in which discrete fluid-filled compartments form in or in relation to the ventricular system of the brain. Both uni- and multiloculated variants exist, with marked differences in outcome. However, several competing and seemingly interchangeable nomenclatures exist, and none address the pathophysiological basis of the condition. To clarify current treatment options, we carried out a review of the literature. A protocol describing search strategy and inclusion criteria was prepared in advance, and a search of MEDLINE, the Cochrane Database of Systematic Reviews, and the U.S. NIH ClinicalTrials.gov database was carried out with the search terms: "multicystic," "multiloculated," "multicompartment," "uniloculated," and "loculated." All were used in conjunction with the search term "hydrocephalus." A single study with a control group was found. Remaining reports are purely case series. Research efforts are hampered by unclear and seemingly interchangeable nomenclatures, which makes comparison between studies difficult. There is a paucity of studies of high methodological quality concerning choice of treatment. At the case series level, evidence is in favor of the neuroendoscopic approach. In order to ensure a consistent nomenclature as well as to guide future research, we propose a new system of classification for loculated hydrocephalus. It acknowledges the differences between uniloculated and multiloculated hydrocephalus, and goes beyond a pure anatomical model. For future research, it enables us to clearly characterize subgroups, which is essential if we are to advance our understanding and level of care for this challenging group of patients.

James Watson Kernohan (1896–1981): Frontiers in neuropathology

James Watson Kernohan (1896–1981): Frontiers in neuropathology

Data-driven sciences: From wonder cabinets to electronic databases

Even by the journal’s own standards, this was a wild claim. In July 2008, Wired magazine announced on its cover nothing less than ‘‘The End of Science’’. It explained that ‘‘The quest for knowledge used to begin with grand theories. Now it begins with massive amounts of data’’. Such claims about the emergence of a new ‘‘data-driven’’ science in response to a ‘‘data deluge’’ have now become common, from the pages of The Economist to those of Nature. Proponents of ‘‘data-driven’’ and ‘‘hypothesis-driven’’ science argue over the best methods to turn massive amounts of data into knowledge. Instead of jumping into the fray, I would like to historicize some of the questions and problems raised by data-driven science, taking as a point of departure the three rich papers by Isabelle Charmantier and Staffan Muller-Wille on Linnaeus’ information processing strategies, Sabina Leonelli and Rachel Ankeny on model organisms databases, and Peter Keating and Alberto Cambrosio on microarray data in clinical research. That a historical approach is warranted is made clear by the remark of the great book historian Robert Darnton that ‘‘every age was an age of information, each in its own way’’ (Darnton, 2000, p. 1). In particular, perceptions of an ‘‘information overload’’ (or a ‘‘data deluge’’) have emerged repeatedly from the Renaissance though the early modern and modern periods and each time specific technologies were invented to deal with the perceived overload (Ogilvie, 2003; Rosenberg, 2003). This commentary will explore the similarities and differences between past and present data-driven life sciences, from early modern natural history to current post-genomics. Renaissance naturalists were no less inundated with new information than our contemporaries. The expansion of travel, epitomized by the discovery of the New World, exposed European naturalists to new facts that did not fit into the systems of knowledge inherited from the Greeks and Romans. This prompted those interested in understanding the natural world to devise newmethods for managing this data, such as note-taking strategies, and new systems of classification (Blair, 2010; Ogilvie, 2006). Ironically, as Charmantier and Muller-Wille point out, these methods and systems, which were meant to tame the information overload, made it possible to accumulate even more data. But accumulation was usually only a mean to an end. These early naturalists established collections, which included specimens, drawings, and texts, so that they could compare these items systematically and draw from the comparisons conclusions about the natural world. In general, they were not testing specific hypotheses, but trying to bring order to the bewildering diversity of natural forms by examining large amounts of collected ‘‘data’’. This tradition continues to be central in natural history to the present day. As George Gaylord Simpson, the leading American paleontologist of the twentieth century,made clear in 1961, natural history, and taxonomy in particular, was the ‘‘science that is most explicitly and exclusively devoted to the ordering of complex data’’ (Simpson, 1961, p. 5). What is striking about Simpson’s definition is not only that he chose the ‘‘ordering of complex data’’ as the most essential element of natural history, but also how similar his definition is to current characterizations of the supposedly unprecedented data-driven sciences. This should come as no surprise since, for several centuries, the natural historical sciences have fundamentally been data-driven sciences. But was natural history driven by data alone? Most likely not, because natural history has never been free of ontological assumptions. For example most naturalists assume the existence of natural groups. As Charmantier and Muller-Wille show, Linnaeus who struggled with a data deluge of his own creation and devised numerous note-taking methods to deal with it, could only do so because he began with a hypothesis about the genus categories he used to organize his data. In other words, Linnaeus may have been driven by his data, but his approach was not exclusively datadriven. This conclusion, however, is insufficient to distinguish early modern approaches to data with contemporary ones. Indeed, as Keating and Cambrosio show in their paper, modern day biostatisticians analyzing cancer microarray data were equally driven by various hypotheses. For example, the determination of the sample size needed to produce statistically significant results required researchers to make an hypothesis about the number of classes that the data might reveal. In other words, they too were guided by

Carl Linnaeus and the Visual Representation of Nature

The Swedish naturalist Carl Linnaeus (1707-1778) is reputed to have transformed botanical practice by shunning the process of illustrating plants and relying on the primacy of literary descriptions of plant specimens. Botanists and historians have long debated Linnaeus's capacities as a draftsman. While some of his detailed sketches of plants and insects reveal a sure hand, his more general drawings of landscapes and people seem ill-executed. The overwhelming consensus, based mostly on his Lapland diary (1732), is that Linnaeus could not draw. Little has been said, however, on the role of drawing and other visual representations in Linnaeus's daily work as seen in his other numerous manuscripts. These manuscripts, held mostly at the Linnean Society of London, are peppered with sketches, maps, tables, and diagrams. Reassessing these manuscripts, along with the printed works that also contain illustrations of plant species, shows that Linnaeus's thinking was profoundly visual and that he routinely used visual representational devices in his various publications. This paper aims to explore the full range of visual representations Linnaeus used through his working life, and to reevaluate the epistemological value of visualization in the making of natural knowledge. By analyzing Linnaeus's use of drawings, maps, tables, and diagrams, I will show that he did not, as has been asserted, reduce the discipline of botany to text, and that his visual thinking played a fundamental role in his construction of new systems of classification.

Land cover mapping within fixed segmented parcels and grown regions based on metadata attributes

Geographic object-based image analysis (GEOBIA) has become an area of increasing research interest in the field of remote sensing. Land Cover Map 2000 (LCM2000) of the United Kingdom represents an early use of such techniques to create a national mapping product. The work described here makes use of the object-level metadata created in the production process of LCM2000 to assess uncertainty within the database. Many mapping applications using GEOBIA techniques use segmentation algorithms to generate parcels from imagery that have a similar spectral response. These parcels are then classified to create the final map product. Here we show that by recording detailed metadata at the object level the final map can still be analysed further to assess the uncertainty in the classification of the parcel, or to re-evaluate parcels or groups of parcels for a new system of classification, by developing criteria for classification. This can be done not only using the parcels own metadata but also that from the immediate locality. Breaking down the spatial unit of the parcel, using a region-growing technique, prevents the user from being constrained by the parcels once they have been generated and potentially increases the power of any uncertainty analysis using the available metadata in a potentially more informative way. The example presented here uses these techniques to assess the potential extent of woodland within the area of the National Forest. The technique shows considerable promise in analysing greater complexity in land cover than is possible from a standard land cover map. Object-level metadata can be used to provide an analysis of uncertainty in classification and re-evaluate one parcel in the light of the properties of its neighbours. This can identify the areas where classification uncertainty may be problematic to a user and also the areas that could be more accurately described using mixed classes to represent the heterogeneity at the location.

Classification of diabetic foot ulcers: Improving communication

The complications of foot ulcerations are the leading cause of hospitalization and amputation among diabetic patients. Yet despite the high associated morbidity and mortality, there is no universally accepted classification system for diabetic foot ulcers. Although a handful of classification systems have been developed, they are used infrequently, even by wound specialists. Only by improving communication between care providers will the healthcare strategies we use be improved, because management of the diabetic foot involves a multidisciplinary approach. This review is meant to provide an overview of four existing classification systems and offer a new system of classification that is simple to conduct, easy to remember, and serves as a guide for treatment. It is our hope that this effort will encourage discussion and debate in the process.

Feasibility of a new system of classification of submucous myomas: a multicenter study

To evaluate the performance of the STEPW (size, topography, extension, penetration, wall) classification system in predicting partial or complete fibroid removal on hysteroscopic myomectomy. Multicenter, prospective study (Canadian Task Force classification II-2). Four hysteroscopy centers in Brazil, China, Italy, and the United States. Four hundred forty-nine women who underwent hysteroscopic resection of 465 submucous fibroids. Resection of the submucous fibroids (hysteroscopic myomectomy). Fibroids were scored according to the European Society for Gynaecological Endoscopy (ESGE) and STEPW classifications. The validation of the two classifications was assessed using sensitivity and specificity of each classification, with their best cutoff point. A test of equality of the two areas under the receiver operating characteristic curves was performed for correlated samples. Correlation of ESGE and STEPW classifications with complete or incomplete removal of submucous fibroid. Removal of the myoma was complete in 432 (92.9%) of 465 myomectomies and incomplete in 33 (7.1%). All 320 fibroids (100%) with a score≤4 in the STEPW classification were completely removed, and 112 of 145 fibroids (77.2%) with a score>4 were removed. All 33 cases of incomplete hysteroscopic myomectomy (100%) had a STEPW score>4. Using the ESGE classification, 85 of 86 cases (98.9%) of type 0 fibroids, 278 of 298 (93.3%) of type 1, and 69 of 81 (85.2%) of type 2 were completely resected. Classifying submucous fibroids using the STEPW classification permits greater correlation with complete or incomplete removal of the myoma by hysteroscopic myomectomy.

The Development of an International Registry

The International Registry of Lung Metastases was launched in 1990 to gather a large set of data to perform a meta-analysis of the experience accumulated by the major European and American centers of thoracic surgery over a period of 50 years. We sought to evaluate the survival after metastasectomy according to the primary tumor, to define the prognostic factors by multivariate analysis, and to propose a new system of classification based on long-term survival. A comprehensive database was designed to provide a simple and flexible instrument for the registry. This included a single record form for each patient, which is divided into four different sections: patient’s identification, features of the primary neoplasm, description of every metastasectomy performed, and updated follow-up. We made an important distinction between planned sequential surgery and repeat metastasectomy for further recurrence. Patients who underwent planned sequential or staged thoracotomies were considered as one single metastasectomy and not as redo surgery. Between 1991 and 1995, a total of 5290 patients were enrolled, from 18 centers and 9 countries, including the consecutive series of all cases operated by each center within a given period of time. Memorial Sloan Kettering provided the largest series, with 1075 patients treated from 1945 to 1995. Adequate information was available for most of these patients. Only 84 cases (1.6%) were excluded because of an incomplete dataset, thus leaving 5206 patients fully evaluable. The analysis was conducted by an independent agency, the Institute of Drug Development in Brussels. The article published as a result of this work is still widely cited,1 and a number of other analyses have been performed on subsets of patients. The experience is illustrated in the Figure 1 We have applied our classification to the different cancer types. In all cancer types, it brings about a separation of survival trajectories, more widely dispersed in some than in others. It should be noted that the classification incorporates elements identifiable before surgery (interval since the primary resection and the metastasis count) and resectability, which is typically an operative finding. The “disease-free interval” (DFI), defined from the data as the interval between the primary cancer resection and the metastasectomy, is of course an indicator of tumor doubling time while the number of metastases is some measure of aggressiveness of the cancer. It is noteworthy that for most cancer types, those who have unfavorable characteristics have poor survival rates as early as 1 to 2 years. In a recent Memorial Sloan Kettering Cancer Center publication on colorectal metastasectomy, the authors point out that, as a group, patients with multiple metastases and short-time intervals are unlikely to survive for a long period and that we are beginning to define patients who should not be offered metastasectomy.2 Perhaps, we are beginning to be more confident of the limits on which patients should be offered metastasectomy. Conversely, that patients with all three characteristics favorable survive longer, leaves the question of whether it is the selection for surgery, rather than the effect of surgery that is important in survival, a possibility mooted by Aberg.3 It is also notable that the dispersion of survival by our classification is least with breast and melanoma. Breast cancer regarded as being a systemic disease from when first detected. The survival curve may support that the features related to lung metastases are less indicative of survival than in other diseases. Finally, having done the difficult work on data collection for the registry, we would support the plea for better reporting of clinical data.4