A Cervical smear review in women developing cervical carcinoma with particular reference to age, false negative cytology, and the histologic type of the carcinoma - abstract

A review of all available cervical smears from 96 consecutive women diagnosed as having invasive cervical carcinoma during 1985 - 1991 was undertaken. The purpose of the study was to determine the incidence of confirmed negative smears prior to the histologic diagnosis of carcinoma and to investigate the relationship between the duration and grade of smear abnormality, the patient's age and the histological types of cervical carcinoma. The slides of the smears were mixed and examined "blind" by at least two pathologists separately. The degree of concordance was 95 percent. Thirty-four patients had microinvasive disease and 62 had invasive carcinoma. Review of 54 smears initially reported as "negative" revealed that 44 (81 percent) were assessed as abnormal; 42 ( 44 percent) of the 96 patients in this study had abnormal cytology reported correctly at varying time intervals prior to diagnosis of carcinoma and there was inadequate clinical follow-up of 16/42 (38 percent) of these women with knowm abnormality. The review revealed that 43 (70 percent) of the 61 younger (< 40 years) women had significant or high grade abnormality in smears (or histology) taken > 1 year before diagnosis of carcinoma. This study revealed that 81 percent of the reviewed smears were falsely reported as negative. There is evidence to suggest that the preinvasive phase of cervical cancer may be shorter in younger women and the less common types of cervical cancer occur more frequently in this group. The combination of inadequate clinical follow-up and false negative cytology may have allowed a significant proportion of these women to develop invasive cervical carcinoma (AU)

Accurate pre-operative diagnosis of ovarian cancer by a combination of clinical criteria, ultrasonography and CA 125 - abstract

Early pre-operative treatment of ovarian cancer is hindered by a lack of reliable criteria for its early diagnosis. This study was undertaken to assess the value of clinical criteria, ultrasonography and serum CA 125 values in the differential diagnosis of benign and malignant pelvic masses. Thirty-six consecutive patients who had elective surgery for investigation and management of an adnexal mass were enrolled in the study from May to October, 1988. All patients had a clinical examination, serum CA 125 measurement and ultrasound pre-operatively, and their menopausal status determined. Based on these findings, a scoring system was devised (Table). Twenty patients had serum CA 125 values < 35 U/ml and histology confirmed a benign ovarian lesion. The remaining 16 patients had serum CA 125 levels > 35 U/ml, and their tumours were confirmed to be malignant histologically. There were significant differences in age (p<0.01), menopausal status (p=0.01), clinical impression score (p<0.01), ultrasound score (p<0.001) and serum CA 125 level (p<0.001) in patients with benign as compared to malignant lesions. The most useful single diagnostic criterion was serum CA 125 levels, and diagnostic accuracy was increased by adding menopausal status and ultrasound findings (sensitivity > 90 per cent; specificty 95.2 per cent) (AU)

Role of ultrasound in the management of ovarian carcinoma - abstract

It is generally accepted that ultrasound (US) has only a limited role (assessment of the primary site and possible extensions) in the initial or preoperative management of ovarian cancer. Ultrasound is of value in monitoring response to therapy and in detecting and staging tumour recurrence. The accuracy of US in Stage III and IV ovarian cancer was tested in a group of 85 patients who were scanned at intervals from the time of primary surgery until just prior to second-look laparotomy. Results show that high values of accuracy were obtained for US of the pelvis (90 per cent) and liver (91 per cent), but US was insensitive to peritoneal disease unless ascites was present (Table). Ultrasound is a useful complement to laparoscopy in the follow-up of patients with ovarian cancer (AU)

Hypertensive disease in pregnant women delivering before 34 weeks gestation - abstract

Preterm delivery (delivery before 34 weeks gestation) accounts for the major part of perinatal mortality and morbidity which are worsened when hypertension is superimposed. This study analyses maternal characteristics, peripartum factors and mode of delivery in 419 consecutive preterm deliveries over the period January, 1986 to December 1989, in which 69 gravidae were hypertensive (diastolic blood pressure > 90 mm Hg) and the rest normotensive. Of the 69 hypertensive patients, 52 (75 per cent) had uncontrollable hypertension necessitating delivery and 19 (28 per cent) developed convulsions. The hypertensive mother was older, of higher parity, and had a higher frequency of previous stillbirths and Caesarean sections (CS). Acute foetal distress in labour, NST (Non-reactive non-stress test) and IUGR (Intrauterine growth retardation) were all more frequent in the hypertensive pregnancy (Table given). Ethnic origin was not associated with occurrence of hypertension in pregnancy. The overall perinatal mortality was 36 per cent in this series; and there were no maternal deaths (AU)

Genital tract malignancies in Trinidad

In Trinidad, genital tract malignancy is the leading cause of death and the commonest of all female cancers, constituting 38.9 per cent of all malignant neoplasms. This clinico-pathological study comprised 82 patients who were diagnosed as having a genital organ malignancy at the Mount Hope Women's Hospital, during a five year period between November, 1981 and October, 1986. The malignancies were categorized by site and broad-type, based on the Sixth International Classification of Diseases. Carcinoma of the cervix was the commonest malignancy (62.2) percent after the age of 25. It was 3.2 times more frequent than corpus uteri cancer, and the mean age at presentation was 54.4 years. Endometrial carcinoma was found only in post-menopausal patients presenting with bleeding at a higher mean age of 63.2 years (0.05>p>.02). Diabetes mellitus, obesity and hypertension were more commonly associated with endometrial carcinoma than with carcinoma of the cervix, but only hypertension significantly so(.01>p>.001). There was no significant difference in the incidence in both major ethnic groups in endometrial and cervical carcinoma. However, only one Muslim patient had a genital tract cancer (p<.05). Forty-four per cent of our patients with Stage I cervical carcinoma were in the reproductive age group (AU)

A clinico-pathologic study of ovarian neoplasm

A series of 96 patients who were diagnosed with 120 ovarian neoplasms at surgery have been reviewed. Nine types of benign ovarian cysts were encountered. Benign cystic teratoma with an incidence of 30 percent was the commonest tumor. The majority of these were in the 20 - 30 year age range. The mean age of the patients with mucinous cyst adenoma and benign cystic teratoma was significantly less (p< 0.05) than those with serous cyst adenoma. The incidence of ovarian malignancies of 8.3 percent was low, and none of the malignancies was bilateral. There was a high incidence of 8.3 percent of milignant change in benign cystic teratomas. Abdominal pain and swelling were the symptoms most frequently experienced in patients with benign ovarian neoplasms. (AU)

Pregnancy complicated by maternal heart disease - abstract

Forty pregnancies, complicated by maternal heart disease, from 1984 to 1986 were reviewed. Sixty-two per cent of rheumatic and 38 percent of congenital heart disease. There were no maternal nor perinatal deaths although 17 percent of the patients had cardiac failure. Heart failure occurred only in patients with acquired valvular defects, particularly mitral stenosis. Infective endocarditis did not occur. Therapeutic abortion was not practical and a conservative approach was adopted to obstetrical intervention and in drug therapy. This study reflects the remarkably good maternal and foetal prognosis in pregnancies complicated by heart disease. Obstetrical complications were minimal, spontaneous abortion rate was not higher than in non-cardiac mothers, and general anaesthesia can be used for patients undergoing either elective or emergency Caesarean Sections (AU)

Torsion of an ovarian dermoid on childhood mimicking acute appendicitis

The radiological features of an ovarian dermoid undergoing torsion are described in a 9-year-old child presenting with an acute abdomen. It is postulated that in the absence of any specific radiological signs of torsion, serial plain film radiology may be more sensitive in predicting this complication than ultrasonography. Cyst enlargement and the transabdominal migration of dental elements are specific features on plain film which should increase suspicion even when features of torsion may be absent on ultrasonography. (AU)

Clinical indicators of advanced endometrial pathology in postmenopausal bleeding - abstract

One hundred and nine patients with postmenopausal bleeding who underwent a fractional dilation and curettage were studied over a 52-year period. Malignancies were found in 20.2 percent of the study group; 11.9 percent were endometrial carcinoma and 7.3 percent squamous carcinoma of the cervix. Forty-five per cent of the patients were discovered to have some form of organic pathology. Compared with the 30 patients who had an atrophic endometrium, those with endometrial carcinoma had an increased mean age of menopause (64 vs 49 yrs), a lower parity (4.2 vs 7.5), a lower haemoglobin level (11.5 vs 13.2g/dl) and a larger uterine size (85 percent vs 10 percent>6wk size). Bleeding was for more than 1 month in 85 percent compared with 15 percent in the atrophic group and it was more frequently heavy, resembling menses (77 percent vs 37 percent). This study points to a low haemoglobin level, heavy menses like bleeding and bleeding for more than one month as clinical features indicative of the presence of advanced endometrial pathology (AU)

Pregnancy complicated by maternal cardiac disease

Forty pregnancies complicated by maternal cardiac disease were reviewed. Thirty-eight per cent were of congenital origin and sixty-two per cent rheumatic valvular. No therapeutic abortions were performed. No pregnancy was complicated by bacterial endocarditis, and there were neither perinatal nor maternal mortalities. Cardiac failure (17 percent) occurred only with mitral stenosis, especially when associated with other valvular lesions. Obststrical complications were minimal, and the spontaneous abortion rate (12.5 percent) was not higher than for non-cardiac partiurients. General anesthesia was used for all caesarian sections (26.5 percent) with no adverse outcome. This study reflects the remarkly good maternal and foetal prognosis in pregnancies complicated by cardiac disease. (AU)

Splenic metastases in ovarian carcinoma

We report two cases of ovarian carcinoma with splenic metastases detected by ultrasound and discuss their sonographic appearances. The importance of routinely including this organ during staging and follow-up studies in ovarian carcinoma using diagnostic imaging methods is emphasized (AU)

A five-year study of benign and malignant ovarian neoplasms - abstract

The few recorded series of the more common benign ovarian neoplasms are at considerable variance with one another with regard to basic information about these tumours. We have therefore reviewed ovarian neoplasms in order to determine the incidence, mean age, age range, race and parity of the patients with the various benign ovarian tumours, the frequency of bilateral occurrence, the ratio of benign to malignant tumours and the complications and presentation of these ovarian neoplasms in Trinidad. The 120 tumours, which were found in surgical patients admitted to Mt. Hope Women's Hospital between November 1981 and October 1986, were classified as recommended by Novak. Functional ovarian tumours less than 5 cm in diameter were excluded from our study. Nine types of benign ovarian tumours were encountered, with dermoid cysts being (33 percent) the commonest. The incidence of malignancy in ovarian neoplasms was 7 percent. The benign to malignant ratio in dermoid and serous cysts was 13.3 to 1 and 2.3 to 1 while wiht mucinous cysts it was 4.0 to 1. The presenting complaints of abdominal pain, swelling and abdominal mass were commonest. Torsion of benign simple cysts and haemorrhage into corpus luteum cysts were the most frequent complications. This review reveals that our incidence of malignancy in ovarian neoplasms is lower, the malignant change in dermoid cysts is higher, and the bilaterality of primary ovarian carcinoma is lower than that reported in the literature (AU)

Hyperthyroidism complicating pregnancy:results of treatment by antithyroid drugs in 34 pregnancies - abstract

Thirty-four pregnancies (36 infants) complicated by hyperthyroidism were seen at the General Hospital, Port-of-Spain, and the Mount Hope Women's Hospital during a 6«-year period. This retrospective study was done to determine the foetal and maternal morbidity and mortality associated with hyperthyroidism in pregnancy. The best form of therapy, whether anti-thyroid drugs alone or in combination, is evaluated, comparing our findings with other series from the 1950s to the 1980s. Hyperthyroidism was diagnosed following conception in 6 pregnancies, and detection and treatment commenced in 28 before conception. Treatment was with carbimazole alone in 26 with modified dosages of 5 to 15 mg daily. Carbimazole and propranolol were used in seven, and propylthiouracil in one pregnancy. The total foetal loss was 18 per cent with a perinatal loss of 9 per cent. There were no premature deliveries but one abortion in the group treated with carbimazole alone. In pregnancies treated with carbimazole and propranolol, there were four premature deliveries ending with perinatal death (including one death due to congenital abnormalities) and a second trimester abortion of one set of twins. No infant had goitre. Twenty-five (86 per cent) of the surviving infants were above the 25th centile for gestational age. There was a relative excess of infants with premature labour and birth weight less than the 25th centile in the pregnancies with treatment beginning following conception. The complication of hyperthyroidism in pregnancy can be treated effectively with minimal doses of anti-thyroid drugs alone (AU)

Incidence, aetiology and outcome of pregnancies complication by antepartum haemorrhage in Trinidad - abstract

A 4-year retrospective review of 124 consecutive cases of antepartum haemorrhage from 21,974 deliveries was performed in order to determine the incidence, aetiology and outcome of those pregnancies complicated by antepartum in our population. An incidence of 0.56 per cent was found. Placenta previa and placental abruption were present in 1 of every 600 and 1 in 470 pregnancies repsectively, while the incidence of an indeterminate cause of bleeding was 1 in 550 deliveries. Induced first trimester abortion was found to be a significant factor predisposing to placenta praevia. The higher incidence of the latter with advancing age and parity and the association of hypertensive disorders in pregnancy with an increased risk of abruption were confirmed in this study. In cases of abruptio placentae, when vaginal delivery was no imminent, caesarean section reduced foetal loss (AU)

Hepatic artery ligation for spontaneous hepatic rupture in pregnancy

Spontaneous rupture of the liver is a rare complication of pregnancy. Although hepatic artery ligation has been suggested as a possible line of management for these patients, less than five cases of its successful utilization have been documented. A case is reported of a patient with spontaneous rupture of the liver in pregnancy who survived following right hepatic artery ligation. (AU)

Evaluation of tubal patency in post-abortal infertile women

The status of the fallopian tubes was investigated by laparoscopy in 113 infertile women with and without previous abortions. Bilateral tubal block occurred in 67 percent of post-abortal patients, compared to 38 percent of those without previous abortions. The risk was significantly greater when the abortion was induced by instrumentation. Performing a prior hysterosalpingography in 26 of these patients, the false positive rate of the x-ray was found to be high, and it is concluded that while the salpingogram may be safely deleted, laparoscopic examinations remains the preferred method of assessing tubal patency in post-abortal infertile women (AU)

Pregnancy complicated by thyrotoxicosis

Of 17 pregnancies complicated by thyrotoxicosis, detection and treatment commenced in 11 before conception, and in 6 during pregnancy. Treatment consisted of carbimazole alone in 13, and carbimazole and propanolol in 4 pregnancies. There was one abortion in the group treated with carbimazole. In the four pregnancies managed with carbimazole and propanolol, there were two perinatal deaths. There was adequate response with minimal doses of anti-thyroid drugs, supported by clinical assessment and assays of thyroid hormones (AU)

Hysterectomy and its psychological aftermath

The psychological impact of hysterectomy was examined in a group of women from high socio-economic bracket. The incidence of post-operative depression was high and was found to have some bearing on loss of feminity, loss of reproductive potential and loss of husband's attention. The wisdom of performing hysterectomy for benign uterine disease in women below 40 years is being questioned since they were found to be more vulnerable to emotional repercussions (AU)

Rupture of the liver as a complication of pre-eclampsia case report and review of the literature

A case of spontaneous rupture of the liver associated with severe pre-eclampsia has been described. It is postulated that the hepatic lesion of pre-eclampsia precedes the formation of a subcapsular hematoma, with subsequent fatal rupture into the peritoneal cavity. (AU)