Oxamniquine cures Schistosoma mansoni infection in a focus in which cure rates with praziquantel are unusually low.

An outbreak of Schistosoma mansoni in northern Senegal was observed in 1988, and chemotherapy with praziquantel in this recently established focus resulted in very low parasitologic cure rates. Among other explanations, the emergence of a praziquantel-tolerant parasite strain was feared. To study this hypothesis further, 138 persons with endemic S. mansoni infection were randomly allocated to treatment with either 20 mg/kg oxamniquine or 40 mg/kg praziquantel. Parasitologic cure rates at 6 weeks were significantly higher in the oxamniquine group (79%) compared with those in the praziquantel group (36%; P = .0043). The reduction in egg counts was generally good, but 12% less reduced in the praziquantel group. These results confirm that cure rates with praziquantel were abnormally low, whereas oxamniquine performed satisfactorily, as in other areas in which S. mansoni is endemic. The possibility of a praziquantel-tolerant S. mansoni strain must therefore be studied carefully.

A comparison of medroxyprogesterone serum concentrations by the oral or intramuscular route in patients with persistent or recurrent endometrial carcinoma.

A randomized study, comparing serum medroxyprogesterone concentrations by the oral and intramuscular routes, was performed on 22 patients with persistent or recurrent endometrial adenocarcinoma by six institutions of the Gynecologic Oncology Group. The oral group (11 patients) received cutaneous Provera (medroxyprogesterone), 50 mg three times a day, and the intramuscular group (11 patients) received 300 mg of Depo-Provera (medroxyprogesterone) weekly for at least 2 months. Serum levels were evaluated at 0, 2, 4, 6, 8, 10, and 12 hours after administration and every day for the first week and weekly thereafter for 8 weeks. The mean serum levels (nanograms per milliliter) of medroxyprogesterone in the oral group were consistently higher than the corresponding mean levels of the intramuscular group. In addition, from the first through eighth weeks, the measurements (medians) for the oral group were statistically higher than those for the intramuscular group. Although the study indicates a significant increase in serum levels achieved by the oral route, the follow-up period of patients under study is too early to evaluate its clinical effectiveness as compared to the intramuscular route.

PIP: 22 patients with persistent or recurrent endometrial adenocarcinoma being seen by the 6 institutions of the Gynecologic Oncology Group were studied in a randomized way to compare serum levels of medroxyprogesterone after oral and intramuscular administration. Regimen A, the oral group, consisted of 11 patients who received cutaneous Provera in 50-mg doses 3 times per day; the intramuscular group, Regimen B, consisted of the other 11 subjects who received 300-mg doses of Depo-Provera weekly for at least 2 months. 3 ml of blood was drawn for both regimen groups at 0,2,4,6,8,10, and 12 hours after administration on Day 1, daily thereafter for the 1st week, and weekly thereafter for the course of the study. Mean serum levels of medroxyprogesterone, measured by radioimmoassay in ng/ml, were consistently higher in the oral group than the corresponding mean levels in the intramuscular group. Also, from Weeks 1-8, the medians for the oral group were statistically higher than those for Regimen B. The apparent efficacy of the oral route is indicated, but its clinical effectiveness remains untested, for this study has limited follow-up time.

Surgical treatment of stages IB and IIA invasive carcinoma of the cervix by radical abdominal hysterectomy.

From 1963 to 1977, 349 radical abdominal hysterectomies with bilateral pelvic lymphadenectomy were performed for Stage IB (331 patients) and Stage IIA (18 patients) cervical cancer at the New York Medical College, with no operative deaths. Definitive diagnosis was obtained from the biopsy specimen in 281 patients. Twenty-nine patients were pregnant when the diagnosis was established. The average operating time was 4 hours and 48 minutes with an average blood loss of 900 ml. Eleven fistulas were noted: ureterovaginal, 7; vesicovaginal, 3; rectovaginal, 1. Since 1972, there have been no fistulas in 130 radical hysterectomies. Metastatic carcinoma of the regional lymph nodes was discovered in 27 patients for an incidence of 7.7%. Postoperative total pelvic external irradiation was utilized in 40 patients (27 with positive nodes, 10 with microscopic carcinoma in vascular channels, and an additional three patients with an inadequate vaginal extirpation margin). A total of 62% of those patients with poor prognostic criteria receiving postoperative irradiation are alive and well. Two hundred nineteen patients have been followed up for at least 5 years and the survival rate was 90%. Our data support the view that radical abdominal hysterectomy with bilateral pelvic lymphadenectomy is the treatment of choice for patients with Stages IB and IIA cervical cancer in the nonpregnant state, unless there are major medical contraindications.

Metastasis to the vagina from carcinoma of the breast.

Carcinoma of the breast, metastatic to the ovary, is encountered frequently. The potential routes of dissemination include transcoelomic spread, lymphatic spread and vascular (arterial or venous) transportation. A case report of vaginal metastasis secondary to bilateral breast carcinoma is cited and the potential mechanisms for dissemination described.

Androstenedione metabolism in patients with endometrial cancer.

The plasma concentration of androstenedione and the instantaneous conversion of androstenedione to estrone was increased in patients with endometrial cancer as compared to postmenopausal control subjects. Moreover, the per cent of estrone derived from androstenedione was increased in the cancer group.

PIP: Androstenedione metabolism was studied at the New York Medical College-Metropolitan Hospital Center in 14 patients with endometrial cancer. 5 normal postmenopausal patients served as controls. A priming dose of 15 mcCi of 7 tritiated-androstenedione was given followed by 30 mcCi of the same steroid for 130 minutes at a rate of .38 ml/minute. Blood samples were collected at 130, 145, and 160 minutes. There is a significantly higher conversion of androstenedione to estrone (p less than .05) but not to estradiol (p greater than .7) in endometrial cancer patients as compared with the controls. The mean plasma concentration was significantly elevated (p less than .02) in the cancer patients compared with the postmenopausal controls. There was no statistical difference in plasma levels of estrone and estradiol (ps greater than .3 and greater than .4, respectively) in the 2 groups of patients. It "appears that estrone may have a significant effect on the estrogen-responsive organs such as the endometrium."

Improvement of faculty teaching performance in a department of obstetrics and gynecology by student evaluation.

The primary purpose of a faculty evaluation program is to upgrade the over-all quality of teaching and to identify the strengths and weaknesses of the individual teacher. Effective medical educators can thereby be suitably identified by objective and subjective criteria. Improvement of faculty teaching performance enhances student learning and can improve recruitment into our discipline.

Testosterone metabolism in endometrial cancer.

Plasma testosterone (PCT), metabolic clearance (MCRT), and production rates (PRT) of testosterone and conversion ratio of testosterone to androstenedione (CRppTA) were performed on 11 patients with endometrial cancer and on a control group of five postmenopausal women. The PCT, MCRT, and PRT of patients with endometrial cancer are in the normal postmenopausal range. The conversion of testosterone to androstenedione in patients with endometrial cancer was significantly decreased.

The pill and the breast.

Estrogen and progesterone, although of a synthetic type in contraceptive pills, play a major role in the development, growth and function of the breasts. There is no statistically valid evidence to indicate that the widespread use of estrogens for contraceptive purposes and for the menopausal syndrome has increased the incidence of benign, premalignant or malignant breast lesions. However, if a cancer is present in a woman's breast, estrogen can increase its rate of growth. Furthermore, while the effect of exogenous estrogen administration to the population as a whole may be null, there may be a subgroup in which their use may have different effects, with a possible increase in breast cancer incidence in nulliparous or late parous women and a decrease in those with early parity. Patients with a dominant lump, suspicious diagnostic aid changes, serous, serosanguineous, bloody or watery nipple discharge or other adverse breast changes should not receive exogenous estrogens unless the lesion is found to be completely benign on biopsy. Even then, patients with gross cystic disease will continue to have these changes as long as estrogens are administered, and so they should avoid the use of estrogens. Patients in the high rist group for developing breast cancer should be cautioned about the potential dangers of the use of estrogens, whether in birth control pills or in other preparations for the menopause, and if they use them, these patients should be followed carefully by breast self-examinations, periodic examinations by physicians and diagnostic aids. Finally, serious consideration should be given to the inclusion of estriol in all estrogen preparations for its impeding or blocking effect against the potential carcinogenic properties of estradiol and estrone and to the addition of progesterone for its estrogen-antagonistic effect.

Comprehensive cytologic screening in patients undergoing voluntary abortions.

PIP: This is a report of comprehensive cervical screening performed for all patients requesting abortion at the New York Medical College Metropolitan Hospital center from July 1, 1970 through December 1, 1972, a total of 6619 patients. Those with negative cytology had abortions performed. At first patients with abnormal smears had multiple punch biopsies and endocervical curettage at the time of uterine evacuation. They remained hospitalized until the pathology report was available. Later the uterine evacuation was deferred and patients with abnormal smears were referred to the colposcopy clinic where the atypical areas of the transformation zone were biopsied and the endocervical canal curetted. Cervical conization was performed immediately following suction curettage in patients with carcinoma in situ and in patients with severe dysplasia. Of the 6619 patients, 6367 had negative smears, 160 atypical, 28 with moderate or severe dysplasia or carcinoma in situ, and 2 invasive carcinoma. Of the 160 with atypical cytology cervical punch biopsies were negative in 104 with mild dysplasia in 56. Of the 28 with more severe changes cervical punch or cone biopsy revealed carcinoma in situ in 16, severe dysplasia in 5, moderate dysplasia in 5, and mild dysplasia in 2. The 2 patients thought to have invasive carcinoma were shown to have carcinoma in situ. Invasive carcinoma was not shown in any woman requesting pregnancy termination. Mean age of the 30 patients with severe changes was 24.7 years, the youngest 19 and the oldest 28. Mean parity of this group was 3. Ethnic background of all patients was similar to the population served. Age range for the total group was 13 to 42 years with 90.6% under 30 and 60% para 1 or less. When concimitant sterilization was desired hysterectomy was performed in cases of moderate dysplasia as well as severe dysplasia and carcinoma in situ. Patients with dysplasia are thought to run almost 100 times the risk of cervical cancer than those with negative smears. Cytologic screening is considered an integral part of any abortion program.^ieng