Radical hysterectomy and pelvic lymphadenectomy for stage IB carcinoma of the cervix: 21 years experience.

From September 1971 through December 1982, 153 patients with Stage IB carcinoma of the cervix underwent radical hysterectomy and pelvic lymphadenectomy at two of the teaching hospitals of the Uniformed Services University of the Health Sciences. Records were retrospectively analyzed and independent pathologic review was performed. All surgical procedures were performed by fellows or senior residents under the direct supervision of the gynecologic oncology staff of the Walter Reed Army Medical Center or the Naval Hospital, Bethesda, Maryland. In this series, IB carcinoma was defined as squamous carcinoma clinically confined to the cervix with invasion greater than 5 mm from the basement membrane or any adenocarcinoma confined to the cervix. The average age of the patients was 38.3 years. The histologic types were squamous in 72%, adenocarcinoma in 16%, and adenosquamous in 10.5%. The mean operating time was 5 hr and 40 min with an average blood loss of 1800 cc. There were two ureterovaginal and two vesicovaginal fistulae for an overall fistula rate of 2.6%. Actuarial survival for these 153 patients is 84%. This extends the previous series of R. C. Park, W. E. Patow, R. E. Rogers, and E. A. Zimmerman, Obstet. Gynecol. 41, 117-122 (1973) of 122 cases collected from 1961 to September 1971 to 275 cases. In comparing the two time periods, no significant differences were found in operative technique or complications, but there was a change in the incidence of adenocarcinoma and mixed cell types and a difference in survival. A relatively higher incidence of more aggressive tumors may indicate the need for different therapeutic approaches in the future.

Whole abdominal and pelvic irradiation in patients with minimal disease at second-look surgical reassessment for ovarian carcinoma.

Aggressive cytoreductive surgery followed by combination chemotherapy for stage III ovarian carcinoma has resulted in a significant percentage of complete clinical responses. However, 30-50% of patients with no clinical evidence of disease are found to have residual carcinoma at second-look surgical reassessment. Because recent reports have indicated a high degree of effectiveness utilizing abdominal and pelvic irradiation as primary therapy for ovarian carcinoma with small residual disease, the authors treated eight patients found to have residual disease of less than 1 cm at second-look reassessment with either open field or split field abdominal and pelvic irradiation. All eight patients had initially undergone aggressive cytoreductive surgery and seven of the eight patients had received multidrug chemotherapy. Patients were treated either at the National Cancer Institute or the Naval Hospital Bethesda both with and without intraperitoneal radiation sensitizers. Fifty percent of the patients required early termination of therapy due to myelosuppression. All eight patients have recurred and three have died. Six of the eight patients have required major surgical procedures for gastrointestinal complications. Based on this experience, we cannot advocate this form of therapy in patients with minimal residual ovarian carcinoma following second-look surgical reassessment.

Intranasal retraction of nasogastric feeding tube: case report and suggestion for design modification.

A 61-year-old black woman was admitted with intermittent small bowel obstruction following multiple therapies for recurrent ovarian carcinoma. Conservative enteric therapy with central hyperalimentation was begun prior to surgical intervention. After approximately 3 wk without resolution, surgical bypass of the obstructed area was performed for palliation. With the return of bowel function, continuous enteral feeding was utilized. During placement of enteral feeding tube, the proximal end spontaneously retracted into the patient's nasal cavity with associated patient distress. After some difficulty, the feeding tube was removed. Simple design modification of the proximal portion of the nasogastric feeding tube should prevent such complication. The addition of "wings" to the proximal end should be considered as a modification to prevent similar occurrences.

Repair of urinary tract fistulas with bulbocavernosus myocutaneous flaps.

Urinary tract fistulas resulting from severe trauma or pelvic irradiation are often associated with extensive tissue loss, scar formation, and fibrosis. Two cases, one with a urethro-vaginal fistula secondary to trauma and one with a vesico-vaginal fistula secondary to irradiation, are presented. In neither case could the bladder, urethra, or vagina be repaired primarily. Using a bulbocavernosus myocutaneous "island" flap, the fistulas were successfully repaired. The anatomy of the graft and the operative procedure are described. This new procedure should be considered in urinary tract fistulas in which there is extensive tissue loss and scarring.

Endometriosis with ascites.

Endometriosis associated with massive ascites is an unusual combination unknown to most practicing gynecologists. Only 11 cases have been reported since this entity was first described by Brews in 1954. The authors report an additional case recently encountered at the Bethesda Naval Hospital. A review of the literature and tabular comparison of similarities among patients are presented. The possible etiologic mechanisms of the ascites are explored and recommendations for diagnosis and appropriate management are provided.