Ovarian prostatic tissue originating from hilar mesonephric rests.

Nonteratoid prostatic differentiation in the ovary of a parous, phenotypically normal, postmenopausal woman is reported for the first time, to the authors' best knowledge. The patient was a 70-year-old woman who underwent bilateral oophorectomy following pelvic ultrasound examination that showed enlargement of the left ovary and an equivocally abnormal Doppler signal. Histologic examination showed a normal right ovary and a left ovary enlarged by hilar cystic dilatation related to a proliferation of mesonephric remnants exhibiting various types of epithelial metaplasia, including hyperplastic rete and epididymal-like and clear cell epithelia resembling the lining of the seminal excretory system. These were closely associated, occasionally even merging, with a discrete area of prostatic acinar and smooth muscle differentiation in the cyst wall. The identity of the prostatic tissue was confirmed immunohistochemically by positive staining with prostate specific antigen and prostatic acid phosphatase. The lesion was associated with an incidental, microscopic hemangioma. A developmental malformative origin of this abnormality cannot satisfactorily be explained by current embryologic concepts. A hypothesis of a metaplastic induction of prostatic tissue by mesonephric remnants is proposed, since complex metaplastic changes coexisted within the cysts and even showed epithelial transitions with the prostatic acini.

The influence of pelvic lymph node disease on survival for stage I and II carcinoma of the cervix.

Two hundred and eighteen patients were referred to the Oxford Radiotherapy Department in the 5 years 1973-77 with stages I and II tumours of the uterine cervix. One hundred and eighty-one underwent pre-operative intracavitary radiotherapy followed by Wertheim hysterectomy and pelvic lymphadenectomy. Twenty-three per cent of these patients had metastatic disease in pelvic lymph nodes. Fifty-five per cent of patients with positive pelvic nodes died of carcinoma of the cervix compared with 9% of negative node cases. Prognostic factors are discussed and management of carcinoma of the cervix reviewed.

Prospective study of different methods and routes of administration of prostaglandin E2 to improve the unripe cervix.

Methods of vaginal and extra-amniotic prostaglandin administration to achieve ripening of the cervix as a preliminary to induction of labour are described. Three groups of twenty patients with unfavourable induction features were studied, each receiving prostaglandin E2 the evening prior to planned induction. One group received PGE2 500 micrograms suspended in a viscous medium extra-amniotically. One group received PGE2 3 mg suspended in a viscous medium into the vaginal vault. A third group received a 3 mg PGE2 vaginal pessary to the posterior fornix. Improvement in cervical status at time of induction occurred in all groups but no single group had a significant advantage when regarding mean improvement, the induction-delivery interval or the number of patients in whom labour began before formal induction. However, with regard to relative cost, ease of preparation and storage, as well as patient and medical staff convenience, Prostaglandin E2 in pessary form is a superior form of administration.

Evaluation of colposcopy in the postmenopausal woman.

Cytology, colposcopy and histology findings in 121 postmenopausal and 120 premenopausal women referred to the Oxford colposcopy clinic were compared; 88% of postmenopausal and 69% of premenopausal women were referred by their general practitioners. Cervical smear reports, within the preceding 5 years, were available for 21% of the postmenopausal and 54% of the premenopausal women. Colposcopic assessment was technically unsatisfactory in 53% of the postmenopausal women because the transformation zone was not completely visible, this contributed to a cone biopsy rate of 71% in this group. Only 17% of postmenopausal women with cervical intraepithelial neoplasia (CIN) were managed with local ablative techniques compared with their use in 61% premenopausal patients overall and in over 70% of the women under 35 years. Local ablation was used in 10 of 14 women using hormone replacement therapy. The cytological false negative rate for postmenopausal Papanicolaou class III, IV and V smears was 9% but for persistent class II inflammatory smears it was 43%. Nine of 23 postmenopausal women with persistent inflammatory dyskariosis despite antibiotic or antifungal treatment were found to have colposcopic appearances of CIN and four had microinvasion or invasion. Colposcopy revealed probable microinvasive or invasive disease in 17 postmenopausal women, seven of whom had class II or III cytology.

Sonographic diagnosis of a non-previa placenta accreta.

An unusual case of placenta accreta diagnosed before delivery and managed conservatively is reported in a third-trimester pregnant woman with no past obstetric history. Ultrasound revealed a large echo-poor area where the decidual interface was absent. Uterine vessels immediately under and around the placental abnormal insertion site appeared dilated. In one area, where the myometrium could not be identified at all, the basal plate of the placenta appeared to float inside uterine vessels. A Cesarean section was performed at term and after partial delivery of the placenta a wedge resection of the accreta area was made. Brisk bleeding was controlled by rapid reconstitution of the myometrium. It is suggested that non-previa placenta accreta can be diagnosed antenatally in a low-risk population using gray-scale ultrasound imaging and enabling, in most cases, conservative management.

Ivalon sponge hysterosacropexy for genital prolapse in patients with bladder extrophy.

Two patients with bladder extrophy are presented. Both had had corrective surgery in childhood and subsequently presented with recurrent procidentia after a previously unsatisfactory repair operation. Both were treated by hysteroscaropexy (a new procedure) which is described in detail and when reviewed 12 months later were symptom-free with good genital tract support.

Successful pregnancy and birth after IVF in a woman with cystic fibrosis.

As survival increases, patients with cystic fibrosis (CF) are often confronted with reproductive issues. Initial reports gave conflicting advice regarding the outcome of pregnancy in CF. However a recent large longitudinal study of pregnancies in CF women suggested that pregnancy has little impact on morbidity or mortality. Reduced fertility in CF women has been described, possibly due to thickened cervical mucus, and intrauterine insemination (IUI) has been used to overcome this. We report the first woman with CF, to our knowledge, to be successfully treated with IVF after repeated failed attempts at IUI.

Plasma prostaglandin concentrations after cerclage in early pregnancy.

A prospective, randomized controlled study was made to measure the circulating levels of 13, 14-dihydro-15-keto-prostaglandin F (PGFM) in two groups of women having cervical cerclage early in the second trimester of pregnancy. One group of patients was given omnopon by intramuscular injection for 24 hours after operation and the other salbutamol by intravenous infusion. A significant rise in circulating PGFM was found in both groups after cervical cerclage and the magnitude of the rise was similar in the two groups; levels of PGFM in both groups had returned to the preoperative levels within 24 hours of operation. The levels of PGFM before and after operation showed no relation to the eventual outcome of the pregnancy, which was successful in 80 percent of patients.