[Retrospective study of post-cesarean endometritis. 1992-1993, Notre-Dame Hospital, Montreal, Canada]. / Etude rétrospective de l'endométrite post-césarienne. 1992-1993, Hôpital Notre-Dame, Montréal, Canada.

OBJECTIVE: Determine whether certain factors of risk can be identified for post-cesarean section endometritis. METHODS: The hospital charts of patients who underwent cesarean section between April 1, 1992 and March 31, 1993 at Notre-Dame Hospital in Montreal, Canada were evaluated retrospectively. Completed descriptive variables were recorded for all patients. chi 2 analysis and linear regression analysis were used to determine significant values with p < or = 0.05. RESULTS: There were 372 cesarean sections. In this group 52 developed endometritis (14%). These results are similar to those reported in the literature. Seven variables were found to be significant with the chi 2 test: cystitis (p = 0.04), anemia (p = 0.047), cesarean delay (p = 0.049), positive urine culture (p = 0.0000), ruptured membranes > 8 h 30 (p = 0.019), 4 or more vaginal exams (p = 0.034), blood loss > or = 1,000 cm3 (p = 0.026). After linear regression analysis, only three variables remained significant: urine culture (p = 0.000), ruptured membranes > or = 8 h 30 (p = 0.02) and blood loss > or = 1.000 cm3 (p = 0.0005). CONCLUSION: The population at Notre-Dame Hospital is similar to that described in the literature. The incidence of cesarean section and endometritis were also similar with other populations. Physicians should be aware of the importance of urine cultures after withdrawing urine drains since most of the germs found can cause endometritis. It would be important to search for causal germs by direct culture of endometrial material.

Laparoscopic staging of early ovarian cancer.

The relevance of staging in early ovarian carcinoma is reviewed in light of the advances in surgical laparoscopy. Data from the literature suggest that a lymphadenectomy should be performed instead of a sampling. We have realized the former through laparoscopy. In this paper we propose a detailed surgical technique, similar to the laparotomy approach, that ensures an adequate nodal evaluation. Ten patients underwent a completion of staging by laparoscopy, including peritoneal washings for cytology, peritoneal and ovarian biopsies, an infracolic omentectomy, and a lymph node dissection. The use of laparoscopy for staging of early ovarian carcinoma appears to be a valuable alternative to traditional surgical staging.

Vaginal intraepithelial neoplasia.

This study comprised the largest number (76) of cases of vaginal intraepithelial neoplasia (VaIN) so far reported. Women diagnosed with VaIN were older (mean age 50.2 years) than those diagnosed with cervical intraepithelial neoplasia (CIN). Many of the women had previously undergone (71.2%). In the majority of cases, the diagnosis was made after cytologic testing. In 92.4% of the cases, the lesions affected the upper third of the vagina. Grades of VaIN were distributed as follows: grade 1 52.6%, grade 2 191.%, grade 3 28.9%, with a 15-year interval between VaIN 1 and 2 as a group and VaIN 3 as another group. The cases of VaIN were divided into five groups: VaIN de novo; VaIN + CIN; VaIN postradiotherapy; VaIN + CIN + VIN; and incidental finding of VaIN on the surgical specimen. The therapeutic modalities were heterogeneous; CO2 laser therapy was used most frequently (54.2%). Failures are attributed mainly to the multifocal character of the lesions (particularly with human papilloma virus infection) or their localization in the vaginal angles. Overall, the number of cases, the duration of follow-up (39.2 months), and the unsatisfactory results with CO2 laser therapy have led us to propose a therapeutic decision tree where in which 5-fluorouracil plays a major role, CO2 laser and surgical therapeutic modalities having limited and precise indications.

Efficacy of sequential cyclical hormonal therapy in endometrial cancer and its correlation with steroid hormone receptor status.

Forty-six eligible women with metastatic endometrial cancer were randomly allocated to receive monthly cycles of either CAF (cyclophosphamide, adriamycin, 5-fluorouracil) or CAF plus Provera 200 mg daily for 3 weeks followed cyclically by Tamoxifen 20 mg daily for 3 weeks. Overall response rates of 15 and 43% were seen with CAF and CAF plus hormonal therapy. Using a multivariate analysis of the results, this difference is significant (P value 0.05). In 8 patients with operable endometrial cancer, negative estrogen receptor concentration (ER less than 15 fmole/mg protein) and Grade 3 disease, the clinical course was aggressive in 4 patients with systemic and local relapse. In 10 other similar patients (negative ER and Grade 3) who received adjuvant cyclical hormonal therapy only 1 relapsed and the other 9 are disease-free for an average of more than 31 months. Sequential cyclical hormonal therapy with ER and progesterone receptor analysis has a place in the management of endometrial carcinoma.

Choriocarcinoma associated with undetectable levels of human chorionic gonadotropin.

A case of choriocarcinoma is presented which developed during close follow-up for hydatidiform mole. Serum levels of beta subunits of human chorionic gonadotropin (beta-HCG) were assessed by radioimmunoassay (RIA) before, during, and after diagnosis of choriocarcinoma and remained below the sensitivity level of the assay. To our knowledge, this is the fourth reported case where choriocarcinoma was not associated with the presence of elevated beta-HCG levels.

[Complications of the treatment of cervix neoplasms by radiotherapy]. / Les complications du traitement du cancer du col utérin par radiothérapie.

Of 939 patients treated by radiotherapy for carcinoma of the cervix at the hôpital Notre-Dame in Montreal, between 1979 and 1981, 275 (29.3%) had digestive, urologic, gynecologic, vascular, osseous and cutaneous complications. Surgery was necessary to treat 73 complications in 55 patients (5.9%): 42 digestive (25 occlusions, 13 fistulas and 4 perforations); 22 urologic (16 occlusions, 5 fistulas, 1 hemorrhage); 6 gynecologic (3 hemorrhage and 3 uterine necrosis); 1 cutaneous, 1 vascular and 1 osseous necrosis. No direct correlation was found between the incidence of the complications and certain predisposing factors such as the type of radiotherapy, patients' age, stage of the disease and gynecologic surgery before radiotherapy. However, there was a strong correlation between the incidence of complications and the dose of radiotherapy and the need for gynecologic surgery after radiotherapy. High morbidity was observed in the 55 patients treated surgically: they had to undergo a mean of 2.36 operations each, 2.98 general anesthetics, 1.81 hospitalizations (mean duration 75.7 days); 21 had one or more definitive stomas. The death rate was 5.45%. Surgical treatment was individualized. Limited resections were performed for occlusions, fistulas and perforations whenever it was technically feasible to treat digestive and urologic complications. A bypass procedure was used when resection would have been too extensive or dangerous. The majority of rectal lesions were treated by colostomy and a Hartmann procedure.

Value of lymphography in Stage IB cancer of the uterine cervix.

In many neoplasms, lymphography is a reliable method with which lymph node metastases are demonstrated, but its accuracy in Stage IB cancer of the uterine cervix remains to be more firmly established. One hundred patients with Stage IB cancer of the uterine cervix underwent lymphography before radical hysterectomy with pelvic lymphadenectomy was contemplated. All the lymphographic findings were reviewed without knowledge of the pathologic parameters of the patients and were classified as being either positive (five cases), suspicious (15 cases), or negative (80 cases). The pathologic studies revealed lymph node metastases in 18 patients--in five with positive lymphographic findings, in three with suspicious findings, and in 10 with negative ones. The five true positive cases were compared to the 13 false negative or suspicious lymphographic results. It appears that the former have a greater number of involved lymph nodes and a greater mean size of the metastases. Thus, in Stage IB cancer of the uterine cervix, lymphography demonstrates an excellent specificity (100%) but a low sensitivity (27.8%).

[A case of cylindroma of the cervix (author's transl)]. / A propos d'un cas de cylindrome du col utérin.

The authors, in this article, report on a case of the relatively rare condition of cylindroma of the cervix (adenoid cystic carcinoma). The typical features as seen under the optical and electron microscope are broadly as well as the different techniques available to treat this rare lesion, which is more fulminating in its evolution than the similar condition when it occurs in the skin or the breast.

[A case of doubly differentiated epithelioma of the cervix (a mixed carcinoma) (author's transl)]. / A propos d'un cas d'épithélioma à double différenciation du col utérin.

Following a clinical case of doubly differentiated epithelioma of the cervix, we have reviewed the histological, epidemiological and clinico-pathological characteristics of this epithelioma. This lesion, which is particularly found in young patients, is often associated with pregnancy, and has a strong predilection for lymphatic spread. Finally, this tumour is very aggressive and seems to respond neither to radiotherapy nor to surgery.