Surgical management of a retroperitoneal pelvic desmoid tumour involving the sacrifice of external iliac vein and internal iliac vessels.

•Retroperitoneal pelvic desmoid tumours are rare with limited publications.•A rare case of a retroperitoneal pelvic desmoid tumour is discussed.•Excision was challenging requiring the sacrifice of some of the iliac vessels.•No other case reports document a surgical excision requiring this.•To date our patient suffers minimal morbidity and has had no recurrences.

The experience of chemotherapy-induced alopecia for Australian women with ovarian cancer.

This article describes the experience of chemotherapy-induced alopecia. Data resulted from an ongoing study, which sought to explore the experience of Australian women with a primary diagnosis of ovarian cancer. Phenomenological analysis of written accounts or interviews with 15 Australian women resulted in 13 of these 15 women giving priority to describing their experience of alopecia. The women described alopecia as the most distressing corporeal feature of the ovarian cancer experience. Factors which contributed to women's distress included: loss of sense of self and altered body image; reminder of their illness and potential for an early death; public statement about their private life, practical issues and re-growth. No literature was located, worldwide, which specifically explores the experience of alopecia for women with ovarian cancer. This article presents the first in-depth exploration of the experience of alopecia for Australian women with ovarian cancer. Insight gained from this study will inform understanding of the issues associated with alopecia for women with ovarian cancer and may facilitate the provision of optimal supportive care provided by health care professionals for female cancer patients with chemotherapy-induced alopecia.

Panniculectomy: a useful technique for the obese patient undergoing gynecological surgery.

OBJECTIVES: To establish the safety and efficacy of panniculectomy at the time of surgery for benign and malignant gynecological disease. METHODS: Retrospective review of the course of 57 patients undergoing radical gynecological surgery and panniculectomy between January 1992 and January 1997 at the Mercy Hospital for Women, Melbourne. Data were collected regarding indication for treatment, operative details, and complications of surgery. RESULTS: Of 57 patients in the study, 32 had a primary gynecological malignancy, 11 had benign gynecological disease, 3 had cervical dysplasia, 5 had endometrial hyperplasia, and the remaining 6 had incisional hernia repair. The mean age of patients was 55 years with a mean weight of 101 kg (range 70-145 kg). The mean operative time was 2 h 24 min, and blood transfusion was undertaken in 23 (41%) patients. Four (7.1%) individuals had a minor wound infection and 3 (5.4%) a moderate wound infection. One patient experienced a nonfatal pulmonary embolus and 2 patients experienced a deep vein thrombosis. There were no postoperative deaths. Long term, 6 patients developed an incisional hernia. CONCLUSIONS: Panniculectomy is a useful technique in obese patients. It improves surgical access facilitating radical surgery and is cosmetically pleasing to the patient. It has acceptable morbidity when compared to conventional midline vertical or transverse incisions in comparable populations.

Can women at risk of cervical abnormality be identified?

OBJECTIVE: To determine if use of a detailed risk factor profile accurately predicts the presence of cytological abnormality of the cervix or improves the appropriateness of referral for colposcopic assessment when women are found to have these abnormalities. DESIGN: Cross-sectional survey. SETTING: Family planning clinic. POPULATION: 1219 consecutive women, aged between 15 and 19 years, attending for contraceptive advice. Variables included age, social class, educational status, hormonal and obstetric history, smoking and alcohol habits, history of sexually transmitted diseases, the age of first intercourse, number of sexual partners, duration of each relationship, frequency of intercourse, contraception used and the age of each partner. MAIN OUTCOME MEASURES: Presence or absence of cytological abnormality and the presence or absence of histological abnormality in those with cytological abnormality referred for colposcopic assessment. RESULTS: Univariate analysis confirmed many of the known associations of cervical abnormality. Discriminant analysis identified five independent significant predictors of cytological abnormality and four independent predictors of dyskaryotic cytology. At best models, derived from identified variables correctly predicted 10.1% of individuals with cytological abnormality and 13.5% of those with dyskaryotic cytology. Of those referred for colposcopic assessment because of abnormal cytology, models were able to predict 23.5% of those with histological evidence of cervical intraepithelial neoplasia. CONCLUSIONS: Despite the availability of detailed information regarding the known correlates of cervical neoplasia in this age group, it was not possible to identify the majority of women with cervical abnormality. It is concluded that the strength of these associations is not sufficient to allow useful prediction of membership of a high risk group.

Cigarette smoking and histological outcome in women with mildly dyskaryotic cervical smears.

OBJECTIVE: To determine which patient related variables, available at the point of referral, predict the presence of high grade intraepithelial neoplasia when the smear result is mild dyskaryosis with or without co-existent koilocytosis. DESIGN: Multivariate analysis of prospective programme trial. SETTING: Academic Department Colposcopy clinics at Dudley Road Hospital, Birmingham, UK. SUBJECTS: One hundred and sixty-seven women, whose worst ever cervical smear was mild dyskaryosis with or without koilocytosis, referred to colposcopy clinics. All the women had complete data sets, as determined by the format of an ongoing programme, and all were treated by diathermy loop excision of the cervical transformation zone. MAIN OUTCOME MEASURES: Age, parity, contraceptive practice, smoking habit, duration of abnormal cytology and the grade of histology in the excised transformation zone. RESULTS: Forty-seven out of 78 (60%) smokers, compared with 18 out of 73 (25%) nonsmokers, had high grade disease. The other variables considered in the analysis were not significant or very weakly associated with histological grade when analysed in a univariate analysis. Stepwise logistic regression identified cigarette smoking as a powerful independent predictor of high grade disease. CONCLUSION: These data suggest a strong association between smoking and high grade intraepithelial neoplasia in a population of women whose worst ever smear report was mild dyskaryosis. Smoking is a variable that could be built into models to facilitate referral for colposcopic assessment.

Pregnancy outcome after large loop excision of the cervical transformation zone.

OBJECTIVE: Our purpose was to determine whether large loop excision of the cervical transformation zone affects the outcome of pregnancy after 20 weeks' gestation. STUDY DESIGN: In a retrospective case control study 40 women who had undergone large loop excision of the cervical transformation zone and were subsequently delivered at Dudley Road Hospital were identified between January 1989 and January 1992. Eighty controls were identified and matched for age, parity, and ethnic group from women delivered immediately before and after index cases. Variables included maternal performance in labor and smoking habits and perinatal outcome. Maternal factors analyzed included pregnancy gestation, length of the first and second stages of labor, use of oxytocin, analgesia, mode of delivery, estimated blood loss, whether labor was spontaneous or induced, and if preterm spontaneous rupture of membranes occurred. Perinatal outcome measures included whether the infant was liveborn, fetal weight, the presence of fetal abnormalities, and admission to the neonatal unit. RESULTS: Women delivered after large loop excision of the cervical transformation zone had infants of significantly lower birth weight than did controls. They were also significantly more likely to have admitted to smoking on admission. CONCLUSION: Previous studies investigating pregnancy outcome after local destructive methods of treating cervical intraepithelial neoplasia have been generally reassuring. However, in this study women who were delivered after large loop excision of the cervical transformation zone had significantly smaller infants. Although this may be related to the characteristics of women who have cervical intraepithelial neoplasia (for example, their smoking habits), larger adequately controlled studies should be performed before colposcopists can be justified in adopting a liberal attitude to treating all women with abnormal smears.

Analysis of human papillomavirus type 16 E6-E7 transcription in cervical carcinomas and normal cervical epithelium using the polymerase chain reaction.

Cervical biopsies were collected from Birmingham women having cervical intraepithelial neoplasia or invasive cervical carcinoma and normal controls, and examined for the presence of human papillomavirus type 16 (HPV-16) E6-E7 DNA and mRNA using an adaptation of the polymerase chain reaction. HPV-16 E6-E7 sequences were detected in all abnormal biopsies and in 90% of the normal biopsies examined, confirming previous studies describing the high prevalence of cervical HPV-16 infection. While we were unable to identify any qualitative differences in RNA transcripts from the p97 promoter, substantial quantitative differences in HPV-16-specific early region transcripts between normal and cytologically abnormal cervices were observed. These results suggest that although the level of E6-E7 transcription may contribute to the malignant phenotype, additional factors are likely to be important in the development of cervical neoplasia.

The polymerase chain reaction: a new epidemiological tool for investigating cervical human papillomavirus infection.

The polymerase chain reaction is an in vitro method for primer directed enzymatic amplification of specific target DNA sequences. The technique was used to detect human papillomavirus types 11 and 16 simultaneously in cellular DNA recovered from cervical smears in 38 women referred for colposcopy to evaluate cytological abnormality and 10 women with no history of cytological abnormality. The polymerase chain reaction was shown to be both specific and sensitive in detecting human papillomavirus DNA such that a single human papillomavirus molecule was detected in 10(5) cells. Of the 38 women with cytological abnormality, all were positive for human papillomavirus on testing with the polymerase chain reaction; 36 were infected with human papillomavirus type 16 and 22 dually infected with human papillomavirus types 11 and 16. Seven of the 10 women with no cytological abnormality were also infected with human papillomavirus type 11 or 16. The use of the polymerase chain reaction will facilitate epidemiological investigation of the aetiological role of human papillomavirus in cervical neoplasia. This preliminary analysis suggests that the prevalence of human papillomavirus infection is greater than previously reported.