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The division of endometrial sarcoma into lowand high-grade categories based on mitotic count has fallen out of favor The current WHO grouping is based on tumor cytology rather than mitotic count In ltrative tumors with cytology resembling normal proliferative-phase stromal cells are classi ed as low-grade endometrial stromal sarcomas In ltrative tumors with marked cytologic atypia, dissimilar to normal endometrial stromal cells, are classi ed as undifferentiated endometrial sarcomas once leiomyosarcoma and carcinosarcoma have been excluded by the pathologist The very rare tumors that show mixed features of conventional endometrial stromal sarcoma and undifferentiated sarcoma should still probably be classi ed as high-grade endometrial stromal sarcomas a slow-growing tumor and the third most common form of uterine sarcoma The use of the term high-grade ESS is not part of the current standard nomenclature for these tumors.

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The primary goal of preventing or treating osteoporosis in eating-disordered patients should focus on achieving a normal body weight through a calcium-enriched, balanced diet.

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Tumors with high-grade cytologic atypia, not resembling normal proliferative-phase endometrial stromal cells, should be classi ed as undifferentiated stromal sarcomas15, 18 The average patient is in her 40s and typically presents with abnormal uterine bleeding and an enlarged uterus It is often challenging to make a de nitive diagnosis based on endometrial curettings alone, and thus careful pathologic evaluation is required of the entire uterus Low-grade ESS is a clinically indolent tumor and commonly presents with abnormal uterine bleeding Women with this disease are usually either perimenopausal or have completed child-bearing, making hysterectomy the de nitive treatment Microscopically they have cells resembling proliferative-phase endometrial stromal cells that in ltrate myometrial vessels and lymphatics These tumors rarely metastasize or recur, and when they do, they are usually limited to the pelvis However, pulmonary metastases are recognized in 10% of those with metastatic disease.

although in practice the authors performed the computation in the spatial domain. When the boundary is represented instead by the radius function, a roughness coef cient can be de ned as 1 2

Provision for compulsory treatment of psychiatric disorders, including anorexia nervosa, varies from country to country. Due to the nature of anorexia nervosa, many patients have impaired insight despite an apparent understanding of the nature and consequences of the illness. This compromises their capacity to make an informed choice about treatment. Until relatively recently, there was uncertainty about the legality of compulsory treatment for anorexia nervosa in the UK but the position has recently been clari ed by guidance from the Mental Health Act Commission:

the report automatically moves up the reporting chain for approvals and then to accounting An Alternative Tight information technology budgets are making providers of EMA software more willing to negotiate, but the cost to license this software still averages about $150,000 for 1,000 users (100 concurrent users) As a result, smaller companies that want these systems are turning to application service providers (ASPs) that provide so-called hosted solutions Then, companies lease such software and avoid the capital investment that they would otherwise have to make when they license Case Study of Hosted EMA One company that has implemented a variation of a hosted solution is Paul Davis Restoration Following insured losses, employees of this franchisor work with insurance adjusters, businesses, and homeowners to restore damaged property Currently, the company has 215 franchisees in 45 states, but the franchisor itself has only 50 employees.

The 5-year survival rate is excellent (80 100%), particularly for early-stage disease1 Undifferentiated stromal sarcoma is a clinically more aggressive endometrial sarcoma characterized by relatively high rates of metastases and recurrence It has marked cellular atypia with high mitotic index and commonly presents in an advanced stage The most signi cant prognostic factor for these tumors is stage19.

an assessment, which includes standardised questionnaires, the athletes are presented with the possible treatment options This may be nutrition counselling only, such counselling in combination with short-term psychotherapy (10 20 sessions) and to a limited extent there is a possibility for long-term psychotherapy Time limited group therapy may also be an alternative Different types of treatment strategies have been described in detail elsewhere (Thompson & Trattner Sherman, 1993) For a number of athletes with eating disorders we have to rede ne their ambitions and clarify the therapist s involvement in training and competition programmes The coaches play an important role in such dialogues and negotiations But it is important to stress that the treatment of athletes with eating disorders should be undertaken by health care professionals.

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