Ovarian conservation in placental site trophoblastic tumor.

While isolated reports on the management and natural biology of placental site trophoblastic tumor (PSTT) continue to accumulate, little attention has been given to ovarian conservation in the surgical management of this disease. Review of the literature reveals ovarian involvement by this tumor to be infrequent and, when present, grossly apparent at laparotomy. In the reported cases, grossly normal ovaries did not contain pathologic evidence of tumor. This study reports two additional cases in which at least one ovary was preserved. Until more reliable criteria are available for predicting which cases of PSTT will pursue a malignant course, the option of ovarian conservation should be available to young patients requiring abdominal surgery, if the disease remains confined to the uterus.

The feasibility of early administration of combination chemotherapy following cytoreductive surgery and second-look operation in patients with stage III ovarian carcinoma: a pilot study.

The purpose of this study is to evaluate the feasibility of early use of modified PAC-1 chemotherapy following debulking surgery and its efficacy by assessing disease status during a second-look operation. Twenty-six consecutive previously untreated patients with stage III ovarian carcinoma were evaluated in a prospective study over the 5-year period March 1981 to August 1986. Initial exploratory laparotomy was performed for staging and maximum cytoreduction. Within 24 hr postoperative modified PAC-1 (M-PAC-1) combination chemotherapy was administered and then repeated every 4 weeks for 11 months which was then followed by second-look operation. Patients were analyzed according to the following pretreatment characteristics: age, FIGO stage, histologic tumor type, extent of initial surgery, size of residual tumor, and findings during second-look. Nineteen patients were evaluable. No evidence of either microscopic or macroscopic disease was noted in 15 patients (79%), whereas the remaining 4 (21%) exhibited persistent disease. Of the remaining 7 patients not undergoing SLO, 4 completed 12 courses of chemotherapy but did not undergo surgery for medical reason (n = 2) or patient refusal (n = 2). Two more patients refused chemotherapy after 9 courses and the seventh patient expired with persistent disease after 8 courses. The early use of combination chemotherapy was well tolerated. Neurological, hematological, and renal toxicity was never severe enough to cause discontinuation of therapy.

Nail changes secondary to environmental influences.

Environmental medicine is a dynamic medical specialty that integrates medicine, mathematics, biology, and engineering. In this article an overview of how environmental agents affect the nail is presented. In addition, the three major routes of exposure (inhalation, dermal, and gastrointestinal) to environmental agents are discussed. Selected physical, chemical, and pharmaceutical agents and their effect on the nail structure are presented in the text.

Simultaneous colpo-recto-sacropexy.

The literature concerning coexisting massive genital and intussuscepting rectal prolapse is reviewed, two cases in point are presented, and the rationale for concurrent surgical management is offered. The technique of combined colporecto-sacropexy is described in detail.

Low-dose streptokinase in the treatment of celiac and superior mesenteric artery occlusion.

Selective delivery of low-dose streptokinase was effective in the treatment of embolic occlusion of the celiac and superior mesenteric arteries. The two-catheter technique resulted in complete lysis of clot in the celiac artery and improvement in patency of the superior mesenteric artery. The procedure restored effective mesenteric blood flow and provided an alternative to surgery in a very ill patient.