The feasibility and efficacy of laparoscopic oophorectomy in the management of pelvic pain after hysterectomy.

We aim to assess the feasibility and efficacy of laparoscopic oophorectomy in women with pelvic pain after hysterectomy in this retrospective review of 35 consecutive women presenting with pelvic pain who had had their ovaries conserved at the time of hysterectomy. Pain was attributed to the presence of these residual ovaries if there was an adnexal mass--or the pain improved following ovarian suppression with a GnRH analogue. The procedure was completed laparoscopically in 32 (91%) women. Overall, 27 (77%) women reported symptomatic relief following surgery. We conclude that laparoscopic oophorectomy is safe and provides symptomatic relief in this group of women.

Chemosensitivity testing predicts survival in ovarian cancer.

The aim of this study was to assess the use of the MTT assay for chemosensitity testing to identify drug resistance and predict survival in patients with advanced ovarian cancer. Samples of ascitic fluid and/or solid biopsies were taken from 120 patients with FIGO stage III or IV ovarian adenocarcinoma at presentation. Cells were exposed for 48 hours to four concentrations of clinically relevant drugs including platinums, anthracyclines and alkylating agents. Cell survival was measured using the 3-4,5-dimethyl-2, 5-diphenyl tetrazolium bromide (MTT) assay allowing patients to be grouped as "sensitive" or "resistant" in vitro. Clinical data including age, residual disease, histological grade, treatment, response after initial treatment and overall survival were collected. There was a highly significant (p<0.0001) correlation of in vitro sensitivity with in vivo response in the patients who completed their therapy, with an 83% positive predictive accuracy for resistance. This translated in the longer term to an increased survival for the patients found to be sensitive in vitro to their therapy with a 5-year survival rate of 24% compared to 12% for the resistant group (p=0.033). These results suggest that MTT chemonsensitivity testing can predict response in ovarian cancer leading to the prospect of increased survival in this devastating disease by customising therapy to individual patients.

The significance of cone biopsy resection margins.

This 12-year retrospective study examines the significance of margin involvement with dysplasia at cone biopsy in relation to follow-up. Of 300 cone biopsies, 123 (41%) had margin involvement. These cases of margin involvement were associated with more severe dysplasia (P less than 0.0001) and a higher chance of subsequent abnormal cytological follow-up (P less than 0.0001) and residual dysplasia at subsequent surgery (P less than 0.0001). Involvement of the endocervical margin at the initial cone biopsy was a sensitive predictor of future abnormality, with an incidence of subsequent abnormal cytology of 29% and residual disease of 82% in those undergoing further surgery. In those cases where the margins had been clear, the incidence of abnormal cytological follow-up was 8%, with 12% residual disease in those undergoing subsequent surgery. Margin involvement was a better predictor of residual disease at repeat surgery than abnormal follow-up cytology (positive predictive value, 79% vs 60%, respectively).

Assay of plasma glycine by HPLC with electrochemical detection in patients undergoing glycine irrigation during gynaecological surgery.

A method for the measurement of plasma glycine by HPLC with electrochemical detection after derivatization with phenylisothiocyanate (PITC) is described. The absorption of glycine in eighteen women undergoing intrauterine glycine irrigation during transcervical resection of endometrium was assessed by measurement of plasma glycine before, immediately after and 24 h after surgery. The plasma glycine concentration was normal in all women before surgery (range 120-386 mumol/l) but had risen dramatically in some patients after surgery (range 180-24,800 mumol/l) before returning to normal levels over the following 24 h (range 173-553 mumol/l). No clinical consequences were observed despite the large increases in plasma glycine; mild hyponatraemia occurred in only one patient. These findings, albeit in a limited number of patients, support the hypothesis that the symptoms sometimes associated with the use of glycine buffers are most likely due to water overload with hyponatraemia rather than a toxic affect of glycine itself.

Histological differences between colposcopic-directed biopsy and loop excision of the transformation zone (LETZ): a cause for concern.

Colposcopic examination and biopsy were performed on 100 patients with abnormal cervical cytology. All were suitable for ablative therapy but were treated by loop excision of the transformation zone (LETZ) as outpatients. Histological comparison between the colposcopic biopsies and LETZ samples showed poor agreement with only 43% of cases illustrating identical degrees of dysplasia. The dysplasia was underestimated by colposcopic biopsy in 16% of cases and overestimated in 41% of cases, when compared to the LETZ specimen. Microinvasive carcinoma was diagnosed in 3 cases on the LETZ histology, having been missed by the preceding colposcopy and colposcopic biopsy. The disparity between histological findings is of great concern and would not have been detected if the patients were treated by ablative therapy. It is the authors' view that LETZ should replace ablative therapy in the treatment of localized cervical dysplasia and that it may avoid the need for pretreatment colposcopic biopsy. LETZ limits the possibility of inadequate treatment and also provides a method of audit for the colposcopist.

Fluconazole levels in plasma and vaginal secretions of patients after a 150-milligram single oral dose and rate of eradication of infection in vaginal candidiasis.

Mean peak concentrations of fluconazole in plasma and vaginal secretions of females after a 150-mg single oral dose were shown to be 2.82 micrograms/ml and 2.43 micrograms/g, respectively. Our results indicate that clinically efficacious concentrations of fluconazole in vaginal secretions are easily achieved after this single oral dose.