Modified suburethral sling procedure for treatment of recurrent or severe stress urinary incontinence.

The most suitable material used to perform suburethral sling procedures for recurrent or severe stress urinary incontinence remains controversial. A comparison was made between two commonly used materials, synthetic Gore-Tex (expanded reinforced polytetrafluoroethylene) and autologous fascia lata. Both groups showed improved urethral pressure profiles postoperatively, but there was no difference in the magnitude of change between groups. The objective cure rate at six months for the Gore-Tex group was 100.0 versus 87.5 percent for the fascia lata group (p = 0.155). While there was no statistical difference between the incidence of de novo detrusor instability or length of postoperative bladder drainage (p = 0.104 and p = 0.978, respectively), there was a trend toward more postoperative complications of urinary obstruction in the Gore-Tex group.

Prevalence of abnormal urodynamic test results in continent women with severe genitourinary prolapse.

Twenty-two clinically continent women with severe genitourinary prolapse were evaluated urodynamically to determine the prevalence of urodynamic abnormalities that could lead to potential urinary incontinence. Urodynamic testing found an occult incontinence disorder in 13 women (59%), of whom four had urine loss during cough pressure profiles after pessary placement, four had uninhibited detrusor contractions during retrograde medium-fill water cystometry, and five had both stress urinary incontinence and an unstable bladder. Therefore, nine of the 22 patients (41%) had uninhibited detrusor contractions during urodynamic testing. However, uroflowmetry did not reveal voiding dysfunction in this group, although peak flow rates appeared to be lower in the subgroup of women manifesting uninhibited detrusor contractions. Associated symptoms of frequency, nocturia, and urgency occurred in 41% of the women in this study; four of nine (44%) who had normal urodynamic test results, five of 13 (38%) who had abnormal test results, and five of nine (56%) who had an unstable bladder. Therefore, associated symptoms could not be used to determine which women would have abnormal urodynamic test results. These preliminary results suggest that women with genitourinary prolapse may be at risk for an occult incontinence disorder that is masked by the prolapse and that could manifest after corrective surgery for prolapse. Urodynamic testing is suggested for women with genitourinary prolapse who present with or without symptoms of incontinence, so that more data can be obtained to determine the importance of abnormal test results.

Unusual metastases from a malignant melanoma. A case report.

An unusual case of malignant melanoma metastatic to the lung and to the ovaries occurred 9 and 11 years, respectively, after the initial, extragenital diagnosis. The primary lesion invaded to Clark's level IV with a thickness of greater than 4 mm, normally grave prognostic indicators. A metastatic lung nodule seen radiographically remained unchanged for two years before discovery of the intraperitoneal disease. The case illustrates the clinical variability and unpredictable biologic behavior of malignant melanoma.

Circadian gating of S phase in human ovarian cancer.

Cell proliferation in 30 patients with ovarian cancer was analyzed using flow cytometry to determine changes in the percentage of cells in S phase. By this measure, proliferation in tumor cells appears to follow a cyclical pattern of peaks and troughs that is out of phase with the circadian rhythm in proliferation of normal tissues. In round-the-clock monitoring of replication stages in tumor cells recovered from i.p. lavage fluid in postsurgery patients, peaks of tumor and nontumor cell DNA synthesis commonly occurred at different times of day. When patients were grouped so that only tumor cell proliferation was being measured, a highly significant 24-h rhythm nearly 12 h out of phase with nontumor cell proliferation was found. This peak in the percentage of S-phase cells occurs most commonly in mid- to late morning and appears to offer an opportunity for timing chemotherapy to coincide with high tumor cell vulnerability and low toxicity to normal tissue.

Tumor DNA content as a prognostic feature in advanced epithelial ovarian carcinoma.

Tumor DNA content (ploidy) was determined in 84 patients with epithelial ovarian carcinoma. Stage II-IV. A total of 251 DNA histograms generated by flow cytometry on cells derived from paraffin-embedded specimens were analyzed retrospectively. Of the 84 patients, 44 had tumors which were aneuploid, whereas 33 had diploid, and 7 had tetraploid tumors. Cox regression analysis revealed that age (P less than 0.001), stage (P less than 0.001), and ploidy (P less than 0.001) were independent prognostic features. The median survival time was 19 months and 48 months, respectively, in aneuploid and euploid tumors (P less than 0.001). The size of residual after surgery lost its significance when corrected for stage. Multivariate analysis in Stage III tumors revealed that ploidy was the most important prognostic factor (P less than 0.001) followed by age (P less than 0.025). A remarkable stability of cellular DNA content was found when the primary tumor was compared to the following groups: (1) various metastatic specimens from the primary operation in the same patient; (2) specimens analyzed sequentially from primary, secondary, and tertiary exploratory laparotomy; and (3) peritoneal washings before and after intraperitoneal chemotherapy.