Surgical second look in ovarian cancer: a randomized study in patients with laparoscopic complete remission--a Northeastern Oncology Cooperative Group-Ovarian Cancer Cooperative Group Study.

PURPOSE: The usefulness of extensive and repetitive surgery for patients with ovarian cancer still remains unproven (at least for some conditions). We planned an accurate prospective test of the hypothesis that patients with advanced-stage disease, after they had reached a clinical complete remission (CR), may benefit from surgical second look (SSL). PATIENTS AND METHODS: One hundred two patients in CR (as assessed by clinical findings, markers, and visualization by computed tomographic [CT] scan and laparoscopy), after initial debulking and first-line chemotherapy, were randomized to two arms, which were well balanced for predictive criteria such as age, stage at presentation, histology, grading, date of randomization, and residua after first surgery. Forty-eight patients were randomly assigned to receive follow-up evaluation only, while 54 were assigned to receive second surgery (eight of them refused). Of 46 surgical patients, 35 had negative and 11 positive surgical findings (24% clinically false-negative). RESULTS: Despite the microscopic residua found at open surgery, and the fact that the patients were then treated with second-line chemotherapy, SSL did not increase the probability of survival in this setting. In an analysis of the results according to the intention-to-treat criteria, after a 60-month follow-up period, the overall survival rates in the two groups of patients (SSL v no SSL) were 65% and 78%, respectively (P = .14). Multivariate analysis according to predictive criteria confirmed there was no significant difference between the two groups (P = .39). CONCLUSION: Our study shows the following: (1) our second-line treatment is scarcely effective; (2) SSL accurately defines complete responders to first-line chemotherapy; (3) SSL per se does not prolong survival; and (4) if confirmed, a less invasive procedure could replace SSL as a valuable method in new first-line regimens in ovarian cancer patients with clinical CR confirmed by laparoscopy.

A prospective study of fifty-three consecutive calcium heparin treated pregnancies in patients with antiphospholipid antibody-related fetal loss.

OBJECTIVE: In this study the efficacy and safety of calcium heparin administered alone for the prevention of fetal loss related to antiphospholipid antibodies (aPL) were evaluated. METHODS: Fifty-three consecutively ascertained pregnancies were followed in 53 patients who had a history of at least 2 consecutive miscarriages during the first trimester and/or 1 fetal death during the second or third trimesters. In addition, all patients had at least 2 positive aPL tests more than 8 weeks apart before pregnancy, or a positive aPL test at the beginning of pregnancy. They were treated with calcium heparin alone, self-administered subcutaneously 3 times daily at dosages varying between 15,000 and 37,500 units. Treatment was started soon after a sonogram demonstrated a live embryo and was continued throughout pregnancy until the end of puerperium. RESULTS: All pregnancies terminated favourably between the 25th and 40th weeks (mean +/- SD: 36.69 +/- 2.91) with planned caesarean section in 27 cases and vaginal delivery in 26. Delivery was brought forward due to maternal and/or fetal complications in 18 cases (33.96%). Calcium heparin was associated with intravenous immunoglobulin therapy in 2 patients with fetal problems unresponsive to anticoagulant treatment alone. The newborns, 30 females and 25 males, had a mean birth weight of 2,828.3 g +/- 706.5 and a mean Apgar score at 5 minutes of 9.60 +/- 0.68. No malformations were observed. Thirty of the 37 examined placentas (81.08%) showed signs of thrombotic events. Only minor side effects of calcium heparin were observed during treatment. CONCLUSION: Our study suggests that calcium heparin administered alone using the dosages and timing described here is effective in achieving the delivery of viable infants, and that it is well tolerated.

[Non-invasive instrumental method in uncontrollable post-partum hemorrhage (an alternative to hemostatic hysterectomy)]. / Tecnica strumentale non invasiva nelle emorragie irrefrenabili del post-partum (in alternativa all'isterectomia emostatica).

A new non-invasive instrumental technique which is useful to stop the most severe post-partum haemorrhages is described. This technique is proposed as an alternative to more invasive methods such as the binding of uterine or hypogastric arteries, which is itself a trauma, not always effective and could promote the obstetric shock. The method proposed by the authors is not invasive, can be performed in a few minutes and performed without the help of anaesthesia. Very encouraging results were achieved and have allowed to avoid the use of the so-called "haemostatic" hysterectomy.

[Premature membrane rupture. Comparison of diagnostic tests]. / Rottura intempestiva delle membrane. Test diagnostici a confronto.

BACKGROUND: Objective of this study was to evaluate the accuracy of the vaginal pH-test, the Fern-test, the research of foetal cells and of foetal fibronectin in vaginal discharge, which are used to diagnose premature rupture of membranes. METHODS: To this aim 40 pregnant patients between 24th and 37th weeks gestation have been examined, considered at risk for sub-clinic loss of aminiotic fluid: 23 were affected by preterm labour and 17 by suspected rupture of membranes. RESULTS: Subsequently amniotic sac was confirmed to be ripped in 10 cases (25%): 2 (8.7%) in the 23 patients with preterm labour, and 8 (47%) in the 17 patients with suspected PROM. Sensibility, specificity and accuracy were respectively: 70, 97 and 90% for pH-test; 70, 100 and 93% for Fern-test; 50, 93 and 82% for foetal cells; 100, 90 and 93% for fibronectin test. CONCLUSIONS: In personal experience fibronectin test appeared to be the most sensible and accurate marker. Fern-test was the most specific, while the research of foetal cells appeared to be the least reliable.

Toxoplasmosis. Two observations and a specification.

On the basis of two interesting observations of toxoplasmic disease the Authors attempt to interpret the various pathological pictures, comparing two different formulations of toxoplasmic disease: that of Sabin and that of more modern AA.

[Vaginal topical chemical contraception with C-film]. / Contraccezione chimica topica vaginale con C-film.

PIP: C-film is a plastic sheet of 4 sq cm, 28% of which is made up of a spermicidal agent; the plastic leaf is folded and introduced deep into the vagina; its spermicidal action lasts 1-2 hours. Tests conducted in Europe and in the U.S. have shown C-film to be highly acceptable, safe, and to have a Pearl index of 2.5. The authors investigated the use of C-film on 37 patients, for a total of 924 woman-months. There were only 3 pregnancies, of which 1 was due to incorrect use of the device, and 6 cases of vaginitis which resolved spontaneously. This contraceptive method may be particularly recommended to young women and to women over 40 as an alternative to hormonal contraception or the IUD.^ieng

Pelvic and mammary Burkitt-like lymphoma with simultaneous development of leukemia.

The authors report the case of a young nun who came to their attention because of the simultaneous development of mammary and pelvic lymphoblastic lymphoma and acute leukemia showing aspects typical of nonendemic Burkitt's lymphoma. The rapid tumoral growth and the equally rapid spontaneous cell lysis led to severe renal insufficiency and metabolic acidosis which were ultimately the cause of death. Given the rareness of the clinical situation and the diagnostic problems involved, the authors examined the literature dealing with this subject.