An anatomical approach to oophorectomy during vaginal hysterectomy.

Oophorectomy is not always performed at the time of vaginal hysterectomy because of technical difficulties encountered in visualizing the ovaries and clamping and ligating the infundibulopelvic ligament. After uterine removal, a method that simplifies the approach involves separating the round ligament along the avascular space from the fallopian tube and ovary, then ligating the infundibulopelvic ligament separately from the round ligament, rather than clamping and ligating the infundibulopelvic and round ligaments together.

Hyperbaric oxygen as a prophylaxis for radiation-induced delayed enteropathy.

This trial was accomplished in C3H mice to determine whether hyperbaric oxygen (HBO) could be administered to prevent delayed radiation enteropathy. Fifty mice randomized into two equal groups received 30 Gy abdominopelvic irradiation in 10 fractions. The study group received a course of 30 HBO treatments beginning 7 weeks after the radiation exposure. The control group received only housing and nutritional support after irradiation. A third group of three animals had no radiation or HBO. All animals were sacrificed 7 months after radiation. Animals were inspected grossly for signs of enteropathy. In addition, a special stretch apparatus was used to quantify narrowing and rigidity of ileum just proximal to the ileocecal junction. Those animals who received HBO had fewer gross signs of enteropathy and had less narrowing and less rigidity in their harvested bowel segments. These differences were highly statistically significant. Treatment with HBO drastically reduces signs of radiation enteropathy. Further study including clinical trials are recommended.

Deoxyribonucleic acid ploidy and S-phase fraction are not significant prognostic factors for patients with cervical cancer.

OBJECTIVE: Our purpose was to determine the usefulness of deoxyribonucleic acid ploidy and S-phase fraction as prognostic factors in patients with cervical cancer. STUDY DESIGN: Paraffin-embedded tumor specimens were obtained from 123 patients with cervical cancer (mean age 51 years, range 21 to 87 years). The mean follow-up period was 6.4 years. Deoxyribonucleic acid ploidy and S-phase fraction were determined by flow cytometry. RESULTS: A total of 119 patients were evaluable for deoxyribonucleic acid ploidy and 92 were evaluable for S-phase fraction. The overall rate of deoxyribonucleic acid aneuploidy was 60%, and the median S-phase fraction was 12.5%. Neither factor was significantly related to stage of disease. In univariate survival analyses patients with deoxyribonucleic acid aneuploid tumors had slightly better early survival than did patients with deoxyribonucleic acid diploid tumors (median survivals 2.7 and 1.4 years, respectively, p = 0.08 [Wilcoxon]), but the overall survival was not significantly different, p = 0.37 (log-rank). In multivariate analyses deoxyribonucleic acid ploidy was not a significant predictor of survival. S-phase fraction was not statistically significant in either analysis. CONCLUSION: Deoxyribonucleic acid ploidy and S-phase fraction are not useful prognostic factors for patients with cervical cancer.

Human papillomavirus--associated vulvar verrucous carcinoma in a 20-year-old with an intact hymen. A case report.

A 20-year-old woman with vulvar verrucous carcinoma, the youngest such patient reported to date, had human papillomavirus DNA 6/11 identified with an in situ hybridization technique. In addition to her youth, the patient was unusual in that she had an intact hymen. Although she denied having engaged in sexual activity, venereal transmission of the virus may have occurred without vaginal penetration.

Use of tracheloscopy and directed biopsy for evaluating cervical involvement in endometrial carcinoma.

Accurate assessment of cervical involvement in endometrial carcinoma (stage II) is often difficult. The value of tracheloscopy as a possible method for improving accuracy was assessed. One hundred one patients with endometrial carcinoma were studied; 28 were suspected of having cervical involvement on endocervical curettage, and 26 were evaluable. Only five patients were documented to have cervical involvement using tracheloscopy. This finding suggests that there is general overtreatment of patients with false-positive endocervical curettage. However, a definitive statement concerning the incidence of stage II disease in the series cannot be made because many patients received traditional preoperative radiation therapy, which may have eradicated intracervical disease missed by tracheloscopy, therefore falsely confirming stage 1 disease on history from subsequent hysterectomy specimens.

The value of endocervical curettage as part of the standard colposcopic evaluation.

Whether to perform endocervical curettage (ECC) as part of a routine colposcopic examination in patients with an abnormal Papanicolaou smear remains controversial. Some studies consider ECC an essential part of a colposcopic examination regardless of the level of the squamocolumnar junction (SCJ); others consider it superfluous in cases where the SCJ can be visualized. Between January 1980 and December 1982, 278 new patients with abnormal Papanicolaou smears underwent colposcopy. Directed biopsies established the degree of cervical intraepithelial neoplasia (CIN) and ruled out invasive disease. ECC was done on every patient. A total of 51 patients (18%) had a positive ECC. Seven patients could not be evaluated because their records were incomplete. Of the 44 evaluable patients, 32 (73%) had satisfactory colposcopy. In the remaining 12 (27%) the upper limit of the transformation zone could not be seen clearly; in that group the degrees of CIN on colposcopic biopsy and ECC were in agreement in two cases; ECC revealed the degree to be less severe in four cases and more severe in six (50%). In the group with satisfactory examinations, 15 had the same degree of CIN on colposcopic biopsy and ECC; ten had less severe and seven (22%), more severe degrees of CIN on ECC. Of greatest clinical importance was that, overall, 11.5% had a positive ECC despite a satisfactory colposcopic examination. This study indicated that ECC provides unique and important information, justifying its inclusion as part of the standard evaluation of every patient undergoing colposcopy for abnormal cervical cytology.

Malignant transformation of vaginal endometriosis.

A well-documented case of extraovarian endometriosis undergoing malignant transformation is presented. A vaginal focus of endometriosis was biopsied over a 13-year interval during which time progression from benign to malignant disease was observed. Exogenous estrogen replacement was administered throughout the interval of transformation. The pathology, pertinent literature, and implications of the present case are discussed.

Tracheloscopically directed biopsy of the endocervical canal in stage II adenocarcinomas of the endometrium.

Endoscopic inspection of the endocervical canal (tracheloscopy) appears to be a rapid, reliable diagnostic technique to confirm the presence of endometrial neoplasms involving the endocervix found at fractional curettage. A series is presented in which 68% of patients with "positive" endocervical curettage were found to have no involvement of the endocervix by tracheloscopy and biopsy, which was confirmed by subsequent hysterectomy. The technique is discussed, and the use of this procedure in the staging of endometrial malignancies is recommended.

The possible relation between late pregnancy hypertension and 5-hydroxytryptamine levels in maternal blood.

The concentrations of the vasoactive substance, 5-hydroxytryptamine (5-HT), were estimated in whole blood samples from 12 pregnant women with hypertension in the third trimester. These were compared with a control group of 15 normotensive pregnant women of the same gestation. The hypertensive patients were admitted for observation and the whole blood 5-HT estimated again after four days bed rest: in all patients the blood pressure had, by this time, returned to within the normal range. No significant difference was found between the mean blood 5-HT concentrations of the hypertensive and the normotensive groups. A small, but not statistically significant, rise occurred in the hypertensive group after four days bed rest. Thus this study gave no evidence that 5-HT is implicated in hypertension in pregnancy.