The perineal artery axial flap.

We have found the perineal artery axial flap to be useful in reconstruction of moderate defects of the perineum. The experimental surgical technique and clinical applications of the perineal artery axial flap are updated. Our experience with 10 patients over the past 5 years is reviewed. The advantages of this flap are that it is thin and the donor site morbidity is minimal.

Intraperitoneal P-32 after negative second-look laparotomy in ovarian carcinoma.

Thirty-one patients underwent a negative second-look laparotomy between 1976 and 1986. Fourteen patients received intraperitoneal chromic phosphate (P-32) after a negative second-look laparotomy. There has been no local recurrence (zero of 14) and no deaths attributable to recurrent disease. Local control and disease-free survival are 100%, with a minimum follow-up of 2 years and a mean follow-up of 4 years. Seventeen patients received no further therapy because of patient refusal, poor diffusion, or other contraindications to P-32 installation. Four of 17 patients undergoing negative second-look procedures without the addition of P-32 have subsequently recurred. This difference is highly suggestive (P = .076). There have been no major complications with the addition of P-32. The use of intraperitoneal P-32 after negative second-look laparotomies on ovarian carcinoma is well tolerated and effective in preventing recurrence.

The perineal artery axial flap in reconstruction of the vagina.

We present two patients in whom an aesthetic and functional vagina was re-created using a perineal artery axial flap, based on the terminal vessels of the internal pudendal artery. This flap provides thin, supple skin for reconstruction of moderately sized vaginal defects leaving a minimal donor defect.

Embolic management of rare hemorrhagic gynecologic and obstetrical conditions.

Severe life-threatening hemorrhage was controlled by angiographic management in 3 patients with bleeding due to unusual gynecological abnormalities and in 1 patient with a rare obstetrically related hemorrhage. Successful management of such rare causes of bleeding emphasizes that early angiographic intervention can, in selected patients, reduce the need for an immediate or subsequent surgical procedure and allow conservative management followed by disease-specific therapy.

Report of a successful delivery after nonsurgical management of a choriocarcinoma-related pelvic arteriovenous fistula.

A case of a pelvic arteriovenous fistula is described 5 years after treatment of trophoblastic disease. Hypogastric embolization, rather than an operation, was used to obliterate the fistula. Pregnancy occurred 1 year later and a healthy infant was delivered. This is the first report of a delivery after angiographic management alone.

Genital malignancy in pregnancy.

The clinical problems associated with the presence of genital malignancies occurring during pregnancy are presented. This report represents the clinical experience at one medical institution over a 20 year period. Eighty cases of cervical neoplasm, four cases of ovarian carcinoma, five vulva carcinomas, and one vaginal carcinoma are presented. The diagnostic and therapeutic approaches to malignant neoplasia of each area are discussed separately.

Ureteral injury following irradiation therapy for carcinoma of the cervix.

Ureters tolerate radiation well as manifested by the low incidence of injury. However, ureteral injury can occur with high-dose radiation especially when the majority is delivered by radium. Eight such cases are presented. A retrospective study of 100 asymptomatic women treated with radiation for cervical carcinoma over 5 years previously demonstrated only 4 incidences of ureteral injury if dilatation was used as the indicator. To the contrary, 5 patients had improvement of their pre-treatment intravenous pyelogram following radiation. Emphasis was placed on closer followup of the ureters by intravenous pyelograms after high-dose radiation.

Carcinoma of the endometrium: radiation followed immediately by operation.

A prospective study was established in August, 1967, to treat all adenocarcinomas of the endometrium by protocols of preoperative radiation followed immediately by operation. Two hundred and ninety-five women have been treated, 220 of whom had Stage I disease. In these cases, factors known to be associated with survival were studied, and their influence upon survival was noted. Preoperative radium followed immediately by operation was the primary method of therapy. Life tables demonstrated a five-year survival rate of 91 per cent with a low complication rate in patients with Stage I disease. Cell type, degree of differentiation, and depth of myomentrial invasion were the primary factors influencing survival.

Vacuum aspiration: an efficient outpatient screening technic for endometrial disease.

In an effort to find a safe, efficient, and inexpensive means of ruling out the existence of a neoplastic process causing abnormal vaginal bleeding form the uterine cavity, 103 patients over 34 years of age had preoperative aspiration (Vabra aspirator) of the endometrial cavity. The tissue obtained at the time of D&C and hysterectomy was correlated with that obtained by the outpatient diagnostic procedure. In this pilot study, the aspirator was 98% accurate in evaluating high-risk women with abnormal uterine bleeding for malignant disease. In the two neoplasms missed, both women had had a recent D&C.

Cryosurgery. Its use for the abnormal Pap smear.

During a two-and-one-half year period, 317 women were seen in the Colposcopy Clinic for evaluation of an abnormal Pap smear. Seventy-four (23%) desired to maintain their childbearing potential and were treated conservatively. Ten (14%) had inadequate colposcopy and underwent cold knife conization of the cervx. The remaining 64 were treated by adequate colposcopy, combined with cryosurgery; they are discussed in detail. All were managed economically as outpatients without anesthesia and no serious complications occurred. To date, only four have recurrent abnormal cervical cytology and several have delivered children. Adequate colposcopic examination combined with biopsies must proceed all cryosurgical procedures performed for abnormal cervical cytology.

Adenosis and adenocarcinoma of the vagina in young women: a review.

Prior to 1971, adenosis and primary adenocarcinoma of the vagina were unusual entities. Since then, a marked increase in both processes has occurred, felt to be related to maternal ingestion of Diethylstibestrol (DES) and other estrogenic compounds during the first trimester, with subsequent abnormalities in female offspring. To date, there are over 170 cases of adenocarcinoma reported, and there may be as many as one million patients with adenosis. Treatment of benign adenosis is somewhat of a controversy but adenocarcinoma is treated with surgery radiation or a combination thereof, depending upon the specifics of the patients. Four patients are presented, one treated surgically and three with radiotherapy, all with complete remission over one to two years. It behooves all phys-cians caring for young women to be aware of these disease processes for the maximum therapeutic benefit to be achieved.