Vulval cancer following or co-existing with chronic granulomatous diseases of vulva: an analysis if its natural history, clinical manifestation and treatment

In this study a series of postgranulomatous vulval carcinoma is analysed. The epidemiological and clinical aspects are studied and guidelines for management of such tumours are given. The problem of clinical staging of this variety of tumour is discussed (AU)

Uterine sarcoma in Jamaican women

A review of 55 cases of uterine sarcoma recorded in the Jamaican Cancer Registry for the period 1958-1973 showed an annual incidence of 0.45 cases per 100,000 population, representing a 2.9 percent tumour incidence among all female genital cancers. Clinicopathological studies of 34 cases revealed that these tumours in the Negro population showed little difference from reports elsewhere in their epidemiological, clinical, pathological and prognostic aspects. The only difference was in cases of leiomyosarcoma in the young premenopausal women with rapidly growing uterine masses together with a high mitotic count, who had a poorer prognosis compared with older patients with this tumour. Surgical treatment of patients with leiomyosarcoma was hysterectomy and bilateral salpingo-oophorectomy, while mesenchymal sarcomas were treated with extended hysterectomy. Both groups of patients had postoperative radiotherapy. The 5-year survival was 30 percent in the former and 10 percent in the latter group. Postoperative radiotherapy in both groups failed to improve this poor prognosis but adjunctive immunotherapy may have a role in future treatment schedules (AU)

Vulvar carcinoma in premenopausal Jamaican women

Between the years 1958 and 1973, 119 patients with primary invasive cancer of the vulva were treated at the University Hospital of the West Indies, Jamaica. Seventy-seven (64.7 percent) were premenopausal women. Because the pattern of the disease differed from that in late middle and older aged Jamaican women, the results of the disease are presented. The analysis stresses that vulvar carcinoma before menopause in our community is rare in the absence of various sexually transmitted granulomatous diseases of the vulva (AU)

Pregnancy in a Jamaican with Von Recklinghausen's disease

A rare case of pregnancy in a patient with von Recklinghausen's disease and disability due to childhood poliomyellitis is presented. The interesting but serious complication was the sudden onset of haemorrhage in the tumours which treated satisfactorily with conservation management. Posible complications are discussed and the literature on the subject is reviewed (AU)

Myomectomy in infertile Jamaican women

One hundred nineteen Jamaican women who underwent mycomectomy from 1964 to 1969 were followed up for 5 to 9 years. Infertility was the most common presenting complaint. Preoperative hysterosalpingograms were performed on 61 patients and were abnormal for the majority of these patients. Surgery revealed submucous fibroids in 41 patients and pelvic inflammatory disease in 51 patients. The pregnancy rate following myomectomy was 18.5 percent, but unsuccessful for all patients who underwent both myomectomy and tuboplasty. Twenty-three patients had a recurrence of myoma, and 13 of these underwent subsequent hysterectomny. (AU)

Out-patient therapeutic termination of pregnancy at the University Hospital of the West Indies

The case records of 260 patients who had theraputic abortion by suction curettage on an outpatient basis under local anaesthesis at the U.H.W.I. are analysed. This reveals that the procedure has many practical advantages in that it is safe with minimal complications. It also obviates the need for skilled anaestesia and reduces the need for specialist nursing care. The average hospital stay is 4-6 hours thus lessening the burden on an over-crowded in-patient service (AU)

Choriocarcinoma in Jamaica

Fifty-two cases of choriocarcinoma were recorded in the Jamaica Cancer Registry for the parishes of Kingston and St.Andrew, giving an incidence of 1:7,384 live births. This is intermediate between figures reported for Western metropolitan populations and for Far Eastern countries. Clinicopathological studies on 26 cases treated at the University Hospital in Jamaica revealed that 65 percent followed either normal pregnancy or abortion. Choriocarcinoma following a normal pregnancy or occurring without a previous history of pregnancy carried a poorer prognosis than those with a preceding hydatidiform mole. Many patients had primary neurological manifestations. The overall prognosis was poor due to late presentation with disseminated metastases. Of the 26 patients, 15 died of the disease within two years and only six appeared for a six-year follow-up (AU)

Defective luteal phase - Measurement and evaluation of the ovarian hormone before and during cyclofenil (bis-p-acetoxyphenyl) cyclo-hexylidenemethane (compound 6066) treatment

Total urinary oestrogens and plasma progesterone were measured in 50 infertile patients with the diagnosis of defective Luteal Phase (D.L.P.). Before treatment with Cyclofenil commenced, these patients showed wide variations in their urinary oestrogen pattern; but the plasma progesterone was uniformly low. The result of treatment achieved was dependent on the dose of Cyclofenil and on the baseline oestrogen configuration of the patient. The author believes that the follicular dysmaturity precedes luteal insufficiency in the majority of cases. Treatment, therefore, should be aimed at correcting the hormonal imbalance both at hypothalamico pituitary axis level and at the ovarian level rather than simple substitution therapy. Cyclofenil possesses both of these qualities. The pregnancy rate was 28 per cent (AU)

The use of colposcopy in early cervical cancer detection

This study was primarily designed to motivate Caribbean gynaecologists on the use and value of colposcopy, particularly in the early detection of cervical cancer. The technique used at the University Hospital of the West Indies has been described, and normal and a typical colposcopic appearances of the cervix have been illustrated. Although at the present time colposcopy cannot be used in mass population screening programmes, the method can be applied (in selected patients) in hospitals and in practitioners' offices in developing countries with very high incidences of cervix cancer. The major uses of colposcopy are discussed, and also some of its disadvantages (AU)

Carcinoma-in situ of the cervix treated with colposcopy guided epithelial conization: report of a 4-7 year follow-up study

Twenty-five patients with the diagnosis of carcinoma-in-situ (CIS) of the cervix were treated with colposcopy guided epithelial conization. During the follow-up study of 4-7 years duration, there was no recurrence of CIS in 20 of the 25 patients. Between 6 and 12 months after conization, 3 patients showed recurrence of CIS. Two of these patients were treated with further epithelial conization with no evidence of further recurrence 4 years after the second treatment. The third patient refused to accept further epithelial conization and modified radical hysterectomy was done without any evidence of residual tumour in the hysterectomy specimen. One patient showed stromal invasion in both colposcopically guided biopsy and bone biopsy. Modified radical hysterectomy specimen showed remnants of stromal invasion. One patient with Class IV smear failed to show any atypical transformation zone and cervicitis was proven on colposcopy guided biopsy following treatment with Flagyl. For two of the 25 patients, cytology was Class II and therefore failed to diagnose the pre-malignant condition; but colposcopy showed a grade 3 atypical transformation zone and the presence of CIS was confirmed histologically. Simultaneous use of cytology, colposcopy and colposcopically guided biopsy confirmed the diagnosis of CIS in all cases. The authors recommended colposcopically guided epithelial conization in younger patients, provided the malignant lesion is strictly intra-epithelial, and limited to the ectocervix. Routine follow-up with the aid of cyto-colposcopy remains the key factor in this schedule of therapy. (AU)

Prophylactic antibiotics in elective gynaecological and obstetrical major surgery

A prospective controlled study of 580 patients who underwent non-radical major gynaecological or obstetrical surgery examined the use of prophylactic antibiotics. The test group of patients (290) showed a significantly lower (P=0.01) incidence of the total complications and the non-infective complication rate as against those among controls (290). The duration of hospitalisation was significantly reduced for both vaginal and abdominal surgery in the test group of patients as against those in the controls. There was no evidence of increased incidence of bacterial resistance or superinfection. The authors recommend the use of prophylactic antibiotic on a short term basis (for a total duration of 4 days), commencing preoperatively to achieve a significant reduction in the infective postoperative morbidity and a shorter stay by the patients. (AU)

Clinical aspects of defective luteal phase and its treatment with cyclofenil. Syn: bis-(p-acetoxyphenyl) cyclohexylidenemethane (compound F 6066)

Fifty patients with variable duration of infertility due to defective luteal phase have been studied during a total of 446 menstrual cycles. Variables of atypical basal body temperature in such patients have been analysed, and correlated between various abnormal temperature pattern in defective luteal phase on the one hand, and hormonal and endometrial histology on the other have been defined. While it is stressed that atypical basal body temperature is only a gross indicator of the abnormal corpus luteal function, the various abnormal basal body temperature can provide useful information of defective follicular maturation and functions. Cyclofenil, a Cycloalkylidine derivative, has been found to be a relatively effective drug in correcting the complex hormonal behaviour in these patients leading to successful pregnancy outcome. The success of such an encouraging result depended on the strength of the drug used, and also on the gonadotrophin make-up of individual patients, viz., endogenous oestrogen level, signifying an intact and inter-dependent hypothalmico pituitary axis on the one hand and gonad capable enough to respond to stimulation from the pituitary control on the other. The endometrial sensitivity and its maturation is the ultimate result depending largely for its response on such a plan (AU)