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The most distinctive characteristics of a network organization are (1) continually changing internal and external affiliations and (2) shifting organizational boundaries because of flexible in- and outsourcing in reaction to the opportunities that arise IT is no longer purely an internal affair To a great extent, IT determines the effectiveness of collaborating within a partnership ( from IT to exT ) In all this, we recognize an increasing importance of IT and a corresponding increase in the tension between agility and coherence Both are essential conditions for an efficient and effective IT use, but both conditions must be held in balance..

4.4.3; 4.4.5; 4.4.6 4.4.1; 4.4.3

The most commonly found ovarian cysts in adolescent populations are functional cysts. However, the most commonly found solid ovarian tumors in the juvenile population are germ cell tumors and sex cord stromal tumors.15 Many germ cell tumor types are associated with elevations in a variety of serum tumor markers.

pressure from life s iniquitous burdens are unlikely to change the comforting habits of a lifetime because of glossy advice delivered by a pair of reasonably well-off, middle-class health education of cers. Barbara explains her worries and ndings to Kim, who listens and understands Barbara s point of view, but nonetheless insists on doing her duty as a health education of cer working for the health service. She can, she says, hardly do anything other than defer to the opinion of a quali ed medic.

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Linthicum, D.S. Enterprise Application Integration. Reading, MA: AddisonWesley, 1999. Mastenbroek, W.F.G. Verandermanagement. [Change Management]. Heemstede, NL: Holland Business Publications, 1997. META Group. EAS Process Model: Evolution 2000. META Group, April 2000. Nathans, H. Adviseren als tweede beroep [Consultancy as a Second Profession], 2nd ed. Deventer, NL: Kluwer, 1995. Parker, M.M., and R. J. Benson. Information Economics. Englewood Cliffs, NJ: Prentice Hall, 1988. Rosser, B. IT Architecture by Time: Today, Tomorrow or Next Minute. Gartner Research Note, December 1999. Sanden, W. van der, and B. Sturm. Informatie-architectuur: De infrastructurele benadering [Information Architecture: The Infrastructural Approach]. Rosmalen, NL: Panfox, 1997. Schadler, T., S.D. Woodring, C.S. Overby, and J. Walker. Getting Apps to Work Together. Forrester Research, June 1998. Siegel, D. Futurize your Enterprise: Business Strategy in the Age of the e-Customer. New York: John Wiley & Sons, 1999. Simons, J.L., and G.M.A. Verheijen. Informatiestrategie als Managementopgave; Planning, Ontwikkeling en Beheer van Informatieverzorging op Basis van Information Engineering [Information Strategy as Management issue: Planning, Development and Maintenance of Information Services on the Basis of Information Engineering]. Deventer, NL: Stenfert Kroese/Kluwer, 1991. Stapleton, J. DSDM : De Methode in de Praktijk [The Method in Practice]. Schoonhoven, NL: Academic Service, 1999. Stroes, H.J., and M.E. Egberts. Veranderen met Resultaat [Changing with Results]. Deventer, NL: Kluwer, 1996. Swede, V. Van. Information Architecture: Relevance and Use as a Business IT Alignment Tool. Cap Gemini Institute, 1999.

Gestational Trophoblastic Disease such patients. It occurs in 1 of 22,000 to 100,00 pregnancies; both complete and partial moles with coexisting fetuses have been reported.23, 24 Most of these are diagnosed by ultrasound examination during the antepartum period as a complex cystic placental component distinct from the feto-placental unit, but in a few cases the diagnosis was at the time of placental examination after delivery. A detailed antepartum sonographic examination is necessary to rule out other possible causes of placental pathology such as retroplacental hematoma, broids, or other placental abnormalities in addition to a detailed fetal ultrasound examination to exclude any anomalies. If molar pregnancy is still suspected and the pregnancy desired, fetal karyotyping to document normal fetal karyotype, chest x-ray to exclude metastases, and serial hCG levels may be of value in counseling the patient. There is a higher rate of medical complications of pregnancy in addition to more frequent development of postmolar GTNs with a higher rate of metastatic lesions or requirement for multiagent chemotherapy when such pregnancies are compared to singleton hydatidiform moles.13, 25 Matsui et al13, 25 concluded from their national collaborative study that because the risk of malignancy is unchanged with advancement of gestational age, continued pregnancy may be allowed in patients with hydatidiform mole with twin fetus provided that severe maternal complications are controlled, and fetal karyotype and development are normal. Such patients should be counseled extensively prior to any treatment plan. Viable infants delivered of such pregnancies have not been found to have any congenital malformations4, 10 ; on the other hand, there have been cases of documented choriocarcinoma of infants delivered to these mothers.26 30 Because the disease can manifest up to 6 months after delivery, monitoring of hCG levels following delivery is recommended in these infants.1

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