A rapid solid-phase radioimmunoassay specific for human chorionic gonadotropin in gestational trophoblastic disease.

A rapid solid-phase radioimmunoassay (RIA) specific for human chorionic gonadotropin (hCG) has been used for the measurement of serum hCG activity in patients with molar pregnancy and gestational trophoblastic disease (GTD). Serum hCG regression as determined by the specific RIA method after evacuation of uncomplicated molar pregnancy was noted to occur over a longer duration of time than previously reported from this Center using a nonspecific RIA system which measures human luteinizing hormone (hLH) and hCG simultaneously. Therapy for proliferative trophoblastic disease was withheld after evacuation of molar pregnancy while the serum hCG level regressed normally, but was instituted when the serum hCG level rose or plateaued for more than two consecutive weeks. Serum hCG levels in patients requiring chemotherapy for GTD were also more accurately monitored with the specific RIA method than with the nonspecific technic. Therapy was based solely on the hCG titer rather than the subsidence of toxicity, as has been our practice in the past. As a result, the duration of hospitalization, total dose of drug required for remission, and toxic side effects were substantially reduced without sacrificing the effectiveness of chemotherapy.

Zinc chloride spray--magnesium hydroxide ointment dual topical regimen in the treatment of obstetric and gynecologic incisional wounds.

A randomized, double-blind, placebo-controlled study was conducted to determine the safety and efficacy of dual topical therapy with zinc chloride spray and magnesium hydroxide ointment in healing incisional wounds. The participants were 100 obstetric and gynecologic patients with abdominal and perineal incisional wounds; 85 completed the treatment regimen, 15 were lost to follow-up. Spray and ointment were applied twice daily and dressings were changed at each application for seven consecutive days. The condition of the wound (the length of the incision, the presence and extent of dehiscence, and signs of infection, such as inflammatory changes and purulent discharge) as well as the degree of pain experienced by the patient were evaluated and recorded on the first, fourth, and seventh days. A more marked decrease in the size of the wound, a shorter healing time, a better control of infection, less dehiscence, and more effective pain control were observed in patients in the treatment group as compared with those in the placebo group. No side effects were noted in patients in either group. The dual topical therapy with zinc chloride spray and magnesium hydroxide ointment proved to be safe and effective in accelerating wound healing in obstetric and gynecologic patients.

Actinomycin D as the primary agent for gestational trophoblastic disease.

Thirty-one patients with nonmetastatic trophoblastic disease (NMTD) and 39 patients with metastatic trophoblastic disease (MTD) of gestational origin were treated primarily with actinomycin D. Complete and sustained remission was achieved with actinomycin D alone in 94% of patients with NMTD and 67% with MTD. In the nonmetastatic group, 93% of patients without choriocarcinoma (non-CCA) achieved remission with actinomycin D, as compared to 100% (only 3 patients) with CCA. in the metastatic group, 76% of patients without CCA achieved remission with actinomycin D, as compared to 56% where CCA was present. Fourteen of the 15 patients who failed to respond completely to actinomycin D alone subsequently responded to methotrexate (10 patients), triple therapy (3 patients), methotrexate plus triple therapy (1 patient), and methotrexate plus vinblastine (1 patient). One patient died with widespread metastases despite intensive chemotherapy with actinomycin D and triple therapy. No serious toxic side effects were encountered even in treated patients with pre-existing laboratory evidence of impaired hepatic function.