Female genital alteration: a compromise solution.

Despite 30 years of advocacy, the prevalence of non-therapeutic female genital alteration (FGA) in minors is stable in many countries. Educational efforts have minimally changed the prevalence of this procedure in regions where it has been widely practiced. In order to better protect female children from the serious and long-term harms of some types of non-therapeutic FGA, we must adopt a more nuanced position that acknowledges a wide spectrum of procedures that alter female genitalia. We offer a revised categorisation for non-therapeutic FGA that groups procedures by effect and not by process. Acceptance of de minimis procedures that generally do not carry long-term medical risks is culturally sensitive, does not discriminate on the basis of gender, and does not violate human rights. More morbid procedures should not be performed. However, accepting de minimis non-therapeutic f FGA procedures enhances the effort of compassionate practitioners searching for a compromise position that respects cultural differences but protects the health of their patients.

Pegylated liposomal doxorubicin HCL (PLD; Caelyx/Doxil): experience with long-term maintenance in responding patients with recurrent epithelial ovarian cancer.

BACKGROUND: We hypothesized that a response to pegylated liposomal doxorubicin (PLD, Caelyx/Doxil) followed by maintenance is beneficial and safe in recurrent ovarian cancer. PATIENTS AND METHODS: Sixteen patients have received PLD for more than 1 year for recurrent ovarian (14) or fallopian tube (2) cancer. All had stable disease or better responses to PLD + carboplatin (5) or topotecan (9) doublets or to PLD alone (2). PLD maintenance therapy 30-40 mg/m(2) was given every 4-8 weeks. This analysis focuses on cardiac status, overall tolerance, and time to recurrence. RESULTS: Termination of PLD was due to progression in all patients. Noteworthy was the lack of cumulative myelosuppression and, with one exception, clinical cardiac toxicity. This patient was hospitalized with cardiogenic shock and fever complicating grade 4 pancytopenia from topotecan ten months after discontinuation of PLD. Seven patients continue to receive PLD after a median of 1680 mg/m(2) (1180-2460 mg/m(2)). Four of these had documented relapses after 3-6 years on maintenance occurring in the setting of lengthening of the treatment interval. Maintenance PLD was reinstituted after 'reinduction' with a platinum. CONCLUSIONS: PLD appears to be safe as long-term maintenance in ovarian cancer and may be important for a continued response.

Intraperitoneal therapy as consolidation for patients with ovarian cancer and negative reassessment after platinum-based chemotherapy.

Although three large phase III trials have documented the benefit of IP chemotherapy, this therapy as consolidation has been studied in only a few pilot studies. These small studies have included patients with a variety of baseline prognostic characteristics, and only one series had a comparator group of surgically documented pathologic complete response to uniform systemic chemotherapy. No randomized trials have been done to assess the impact of IP consolidation on progression-free survival or survival in either positively or negatively reassessed patients. It is hoped that the current experience will trigger further consideration of future phase III trials to assess the value of IP consolidation after initial induction with chemotherapy (ie, chemical debulking).

Diagnostic x-rays and risk of epithelial ovarian carcinoma in Jews.

PURPOSE: To test the hypothesis that there would be ethnic differences in susceptibility to ionizing radiation from diagnostic x-rays. METHODS: In a hospital-based study we compared reports of diagnostic x-rays to the lower abdomen and pelvis in incident cases of epithelial ovarian carcinoma (N = 161), community controls (N = 156) and convenience controls (N = 87). RESULTS: Thirty-nine per cent of cases and 31% of controls recalled x-rays more than 10 years before; 27% of cases and 14% of controls reported four Jewish grandparents. Comparing the cases with community controls, the odds ratio (95% confidence interval) for Jews versus non-Jews among women reporting no x-rays was 1.02 (0.37-2.79); among women reporting x-rays the estimate for Jews was 8.91 (2.00-39.6). Consistent results were seen with inclusion of convenience controls. Jewish cases reported an excess of pelvic diagnostic x-rays from age 20 onward and an excess of barium enemas and pyelograms. CONCLUSIONS: These preliminary findings require confirmation in other studies. They suggest that the known excess risk of this carcinoma in Jews might be associated with exposure to x-rays and add to a previous observation of an altered susceptibility to ionizing radiation in Jews. If confirmed, they would suggest a need for continued vigilance to evaluate the risks and benefits of diagnostic x-rays in individuals, regardless of ethnic origin, who might carry mutations in DNA repair genes.