[Follow-up of non-negative cervical cytological smears in the county of Funen]. / Opfølgning af ikkenegative cervixcytologiske prøver i Fyns Amt.

The outcome of screening for cervical cancer in the county of Funen was evaluated in two sequential periods (1.7.-31.12.1989 and 1.7.-31.12.1992), comprising 17,493 and 18,135 respectively. About 10.5% of the screened women had a define non-negative smear. From the first and the second period 80% and 85.1% of the non-negative smears respectively were followed up within six months. The follow-up of positive smears was 96% in both periods. Four point nine percent and 3.3% respectively of the non-negative smears were not followed up within 18 months. No women were actually lost in the screening system, unless they renounced further follow-up themselves. The follow-up was improved from the first to the second period, presumably as a result of a better general acquaintance with the screening procedures. The study indicates that reorganization of a screening programme requires both time and adjustment. Moreover, it is important that a successful screening programme frequently adjusts its procedures.

Can manipulation of a pelvic tumour influence the serum level of cancer antigen 125 and cancer-associated serum antigen?

Cancer antigen 125 (CA 125) and cancer-associated serum antigen (CASA) were measured in 24 women with pelvic masses before and after a gynaecological examination and ultrasonography. CA 125 decreased median 16% after manipulation (P < 0.0001) and CASA decreased median 8% (P = 0.0077). The decline was found in patients with benign tumours as well as in patients with malignant tumours.

An association of hypothalamic hamartoma, central precocious puberty and juvenile granulosa cell tumour in early childhood.

A case of central precocious puberty from infancy due to a hypothalamic hamartoma and associated with an ovarian juvenile granulosa cell tumour is presented. Central precocious puberty was diagnosed by gonadotropin stimulation tests and LHRH agonist therapy was successful. A MR scan, but not a CT scan, demonstrated the hypothalamic hamartoma. The possible influence of early LH stimulation for the development of the granulosa cell tumour is discussed.

[Clinics for counseling on cancer genetics. Experiences with genetic studies and counseling on familial breast cancer and colorectal cancer]. / Cancergenetisk rådgivningsklinik. Erfaringer med genetisk udredning og rådgivning ved familiaer cancer mammae og familiaer cancer colorectalis.

Five to ten percent of cases of breast cancer and colorectal cancer are familial. These families can be divided into high-risk families and moderate-risk families. Cancer in high-risk families can often be explained by dominant inheritance of a gene causing increased susceptibility to cancer. There is a great demand for genetic counseling in these families, and the structure of and experiences from a familial cancer clinic at Odense University Hospital is described. The establishment of a familial cancer clinic involves three steps: 1) Identification of families with increased cancer susceptibility; 2) Molecular tests to identify gene carriers; 3) Clinical examinations for early detection of tumors. Achievement of these three steps requires the involvement of several medical specialties to ensure patient care. Experience with familial cancer clinics is still limited and the involvement of genetic testing and clinical examination programs at risk individuals are insufficiently examined. The rapidly improving techniques for genetic testing make it urgent that it is implemented as part of already established clinical programs.

[Patients with early stages of endometrial cancer should be spared adjuvant radiotherapy. Danish Endometrial Cancer Group]. / Patienter med tidlige stadier af endometriecancer bør skånes for adjuverende strålebehandling.

In an attempt to create uniform nationwide guidelines for the management of all stages of endometrial carcinoma, and to limit the use of adjuvant radiation therapy in stage I disease to high-risk patients only, a protocol was developed by the Danish Endometrial Cancer group (DEMCA). From September 1986 through August 1988, 1214 women in Denmark with newly diagnosed carcinoma of the endometrium have been treated according to this protocol. This figure represents all endometrial carcinomas diagnosed in Denmark during this two-year period. The primary treatment was total abdominal hysterectomy and bilateral salpingo-oophorectomy, no preoperative radiation therapy was delivered. In 1039 cases no macroscopic residual tumour and/or microscopic tumor tissue in the resection margins was found following surgery. Based on surgery and histopathology, these patients were classified as: P-stage I low risk (n = 641), P-stage I high risk (n = 235), P-stage II (n = 105) and P-stage III, Group 1 (n = 58). No postoperative radiation therapy was given to P-I low risk cases. P-I high risk, P-II, and P-III (Group 1) cases received external radiation therapy. Recurrence rate at 68-92 months follow-up was 45/641 (7%) in P-I low risk, 36/235 (15%) in P-I high risk, 30/105 (29%) in P-II, and 27/58 (47%) in P-III (Group 1) cases. Fifteen of 17 vaginal recurrences in P-I low risk cases were salvaged (mean observation time 61 months). In this population-based investigation it has been shown that P-stage low-risk patients are adequately treated by total abdominal hysterectomy and bilateral salpingo-oophorectomy, and that no pre- or postoperative radiation therapy is necessary.

[Endometrial resection. Peroperative complications and postoperative course]. / Endometrieresektion. Peroperative komplikationer og postoperativt forløb.

The effectiveness of transcervical resection of the uterine endometrium was assessed in 106 consecutive women admitted for surgical treatment for menstrual disorders, suitable for treatment with endometrial resection. No hormonal pretreatment was given. Amenorrhoea occurred in about 25%; 80% were satisfied after the initial treatment and 86% were satisfied if the procedure was repeated after at least one year postoperatively. The results were the same in 34 (32%) who had fibroids or polyps in the uterine cavity. No serious operative or postoperative complications appeared. Seven patients (6.6%) required temporary tamponade to control bleeding. It is concluded that endometrial resection is an advance in the management of menstrual disorders. The satisfaction in the patients is high and the complication rate low.

[Complete invasive mole in a 50-year old woman]. / Komplet invasiv mola hos en 50-årig kvinde.

A 50-year-old woman was admitted for hysterectomy due to persistent vaginal bleeding and enlargement of the uterus. Before operation a significant increased beta-HCG was measured. Histologic examination of uterine contents obtained by aspiration showed trophoblastic disease. An decrease in beta-HCG was registered postoperatively. However, two weeks later it rose again and the patient started treatment with methotrexate. It is recommended that the treatment of patients with invasive gestational trophoblastic disease is centralized.

A prospective randomized comparison of 6 and 12 cycles of cyclophosphamide, adriamycin, and cisplatin in advanced epithelial ovarian cancer: a Danish Ovarian Study Group trial (DACOVA).

Two hundred-two patients with FIGO stages III and IV epithelial ovarian cancer were randomized to 6 or 12 cycles of cyclophosphamide, Adriamycin, and cisplatin (CAP). Patients in complete clinical response underwent a second-look laparotomy, 1 month after cessation of chemotherapy. Patients randomized to 6 cycles and found to be in partial remission at second-look were to receive a further 6 cycles of CAP. Rate of complete pathological response was 23% for 6 cycles of CAP and 25% for 12 cycles; the median survival was 23 months for 6 cycles and 27 months for 12 cycles, and 3-year survival was 29% for 6 cycles and 35% for 12 cycles. None of these differences were statistically significant. Fifty-four patients randomized to 6 cycles were found to be in partial surgical remission at second-look laparotomy, and 24 of these patients agreed to a further 6 cycles and a third-look laparotomy. Six of these 24 patients had a complete pathological response at third-look, improving the complete response rate to 28% in those originally randomized to 6 cycles. However, 3 of these patients all had macroscopic tumors removed at second-look, and two had microscopic disease at second-look. Among patients achieving complete response mean cumulative doses in the CAP 6 cycle group were approximately 50% of those in the CAP 12 cycle group. However, when all patients were considered, this difference was only approximately 15% owing the continuation of chemotherapy in the partial responders of the 6 cycle group and early stopping for chemotherapy in the CAP 12 cycle group due to toxicity or progression. Patients in complete pathological response also showed similar survivals for 6 and 12 cycles. In conclusion, the study did not show a correlation between mean cumulative doses and complete pathological response and survival.

Is radical hysterectomy always necessary in early cervical cancer?

A semiquantitative histopathologic grading system was used in combination with flow cytometric measurements of tumor cell DNA content to predict the risk of lymph node metastases in early cervical cancer. A retrospective study of 126 stage IB patients showed that a group with no risk of lymph node involvement could be identified by the use of both the histopathologic score and the DNA index. The results were confirmed in a prospective investigation of 59 new patients. Simple hysterectomy may be advised in low-risk patients.

A randomized study of cyclophosphamide and cis-platinum with or without doxorubicin in advanced ovarian carcinoma.

Two hundred sixty-seven patients with advanced epithelial ovarian carcinoma were randomized to cis-platinum and cyclophosphamide versus cis-platinum, cyclophosphamide, and doxorubicin. Complete pathological response, evaluated at second-look laparotomy and survival, showed no differences between the two treatment groups. Recurrence-free survival after negative second look was 61% at 24 months.

The immunological profile of mycosis fungoides.

The immune reactivity of 25 patients with mycosis fungoides was studied twice with a 6 month interval using a panel of T lymphocyte surface markers and functional tests. Patients with clinically inactive disease (stage I + II) had normal T lymphocyte biology. Patients with clinically active disease (stage II-IV) had T lymphopenia, alterations in T cell subpopulations (T gamma and T mu) and a reduced lymphocyte reactivity in vitro following mitogen (PHA, Con A, PWM) and antigen (PPD) stimulation. They also had a reduced secretion of immunoglobulin in vitro after PWM stimulation, apparently due to the alterations in their T lymphocyte subpopulations. The observed changes in the peripheral blood T lymphocyte population and the in vitro function of lymphocytes were not shared by lymphocytes from histologically affected lymph nodes. The natural killer cell activity in blood lymphocytes was found to be normal in all patients.

Pelvic infection after elective abortion associated with Chlamydia trachomatis.

Two groups in Denmark and Sweden, totalling 943 healthy women in the first trimester of pregnancy who were undergoing elective abortion, were examined in a prospective study. Group 1 consisted of 432 women from Denmark, all examined prior to and 2 weeks after the operation. At the first examination, samples were taken from the cervix for the isolation of chlamydiae and gonococci. Chlamydia trachomatis was isolated from 23 (5.3%) of the women. Postoperatively, 15 patients developed acute pelvic inflammatory disease (PID). Five of these patients harbored C trachomatis before the operation, and all 5 developed a significant change in the titer of immunoglobulin G microimmunofluorescence antibodies to the organism. In group 2, 25 (4.9%) of the 511 women from Sweden harbored C trachomatis before the intervention. Patients with chlamydiae were treated, before or in conjunction with the operation, with antibiotics active against chlamydiae. None of the women with cultures positive for chlamydiae showed signs of PID postoperatively. The difference in the postoperative frequency of PID in chlamydia-positive patients between groups 1 and 2 was significant (2P = .0393, Fisher exact test). Gonorrhea was diagnosed in 1% of the women in both groups. Only 1 of these patients developed PID postoperatively, but no pili antibodies to Neisseria gonorrhoeae were found during the course of the disease. It is concluded that women applying for abortion should be examined and treated not only for gonorrhea but also for infection with C trachomatis either before or, at the latest, in conjunction with the abortion.

Infection with Chlamydia trachomatis, Mycoplasma hominis and Neisseria gonorrhoeae in patients with acute pelvic inflammatory disease.

Of 166 women with acute pelvic inflammatory disease, Mycoplasma hominis was isolated from the cervix of 91 (54.8%), Chlamydia trachomatis was isolated from 37 (22.3%), and Neisseria gonorrhoeae was isolated from nine (5.4%). Of the 91 women from whom M. hominis was recovered, 39 developed a significant change in titer of serum antibodies to the organism within one month after admission. Of the 85 patients from whose cervix M. hominis was not isolated, 11 displayed a significant change in titer of antibody to the organism. A change in the titer of IgG antibodies to C. trachomatis was found in 20 women (54.1%) who had Chlamydia-positive cultures and in 14 (10.9%) whose cultures were negative for Chlamydia. The results of the cultural and serologic studies suggest that M. hominis was associated with pelvic inflammatory disease in approximately one-third of the patients, or in half of those women from whose cervix the organism was isolated. In approximately every fifth woman studied, C. trachomatis seemed to be associated with the pelvic inflammation.

Chlamydia trachomatis infection of the Fallopian tubes. Histological findings in two patients.

In two patients with acute salpingitis, C. trachomatis was isolated from the cervix. In one of the patients, the organism was also recovered from the Fallopian tubes, and in the other, chlamydial inclusions were found in Giemsa-stained tubal epithelial cells. A significant change in micro-immunofluorescence antibodies to C. trachomatis occurred in both patients during the course of the disease. The Fallopian tubes of both patients were removed and studied by conventional histological techniques and, in the case of one of them, by transmission electron microscopy.

Affinity chromatographic purification of the pregnancy zone protein.

An immunospecific affinity chromatographic method for purification of human pregnancy zone protein (PZP) directly from serum is described. Highly purified goat-anti-human PZP-immunoglobulin was applied as a ligand. Recovery of PZP varied from 56--75%. The impurities constituted maximally 5--10% of the total protein in the eluate. The purification factor was approximately 100.