Use of the ultrasound surgical aspirator in ovarian cancer: a case-control study.

BACKGROUND: This study was undertaken to evaluate the use of the ultrasound surgical aspirator in ovarian cancer and to determine if cytoreduction was improved with its use. METHODS: The study is a retrospective case control trial. Twenty-six consecutive ovarian cancer patients who had the ultrasound surgical aspirator used during their surgery were retrospectively compared to 25 consecutive ovarian cancer patients who did not have the ultrasound surgical aspirator used during their surgeries. The latter group had their surgeries immediately before the ultrasound surgical aspirator was introduced into the hospital. Both groups were similar in age, stage, histology type, grade, and median number of chemotherapy cycles. RESULTS: Patients that had the ultrasound surgical aspirator used had a 69% optimal cytoreduction rate compared to 16% in the control group (p = .001). This was statistically significant (p = 0.001). Survival time was equal in both groups. CONCLUSIONS: Results of the study showed that use of the ultrasound surgical aspirator may permit more patients to be optimally cytoreduced.

Vulvar metastases secondary to transitional cell carcinoma of the bladder. A case report.

BACKGROUND: Gynecologists are frequently asked to evaluate patients with vulvar lesions. Although the differential diagnosis of a vulvar lesion is varied, the main concern is to rule out a vulvar malignancy. Primary vulvar carcinoma is uncommon, and a metastatic cancer from an extragenital site involving the vulva is even more rare. CASE: A 78-year-old woman with a history of a transitional cell carcinoma (TCC) of the bladder presented with two painful vulvar lesions, which represented the first manifestation of metastatic disease. This is the fifth reported case of TCC from the bladder with metastases to the vulva. CONCLUSION: The differential diagnosis of a vulvar lesion, especially in a woman with a prior history of renal tract malignancy, should include metastatic lesions.

Malignant rhabdoid tumor of the vulva. Case report.

The poor prognosis of malignant rhabdoid tumor is emphasized and histopathological criteria for distinction from epithelial sarcoma of the vulva are discussed. Immunohistochemical analyses were performed by using nine different antigens including vimentin, cytokeratin, epithelial membrane antigen, carcinoembryonic antigen, desmin, muscle-specific actin, S-100 protein, AP-15, neuron specific enolase. This is the sixth reported case of a malignant rhabdoid tumor of the vulva. The patient died eight months after the initial diagnosis in spite of a combination of surgery, adjuvant chemotherapy and external radiotherapy.

The benefits of group music at the 1996 music weekend for women with cancer.

BACKGROUND: Music therapy has been proven to benefit cancer patients physically and emotionally. The Music Weekend for Women with Cancer was developed as a novel opportunity for participants to experience the healing powers of music amidst others who had a shared understanding of their illness. MATERIALS AND METHODS: Fourteen female mixed cancer patients, three spouses, and one daughter attended the weekend from Friday evening through Sunday afternoon. Workshops and events centered on the use of music as a vehicle for expression of emotions, reflection, relaxation, communication, and enjoyment. Questionnaires were collected before the weekend to describe our population as well as three months after the weekend to assess any changes in their utilization of music and mood state. RESULTS: Although insufficiency of post-weekend data limited the potential for assessing the effects of the weekend on the participants' utilization of music and mood state, the extremely positive evaluations supported the role music can play in helping patients and families explore their reactions to cancer. CONCLUSIONS: Events such as this answer the call in the literature for more opportunities to use music and the arts in cancer education. The authors hope this weekend will serve as a prototype for future events that aim to offer the benefits of music.

1,2-Diarylpyrroles as potent and selective inhibitors of cyclooxygenase-2.

Series of 1,2-diarylpyrroles has been synthesized and found to contain very potent and selective inhibitors of the human cyclooxygenase-2 (COX-2) enzyme. The paper describes short and practical syntheses of the target molecules utilizing the Paal-Knorr reaction. Electrophilic substitution on 1 proceeds in a regioselective fashion, and the method was used to generate a number of tetrasubstituted pyrroles. Detailed SAR on the series has been studied by modifications of the aryl rings and the substituents in the pyrrole ring. Diarylpyrrole 1 is a very potent (COX-2, IC50 = 60 nm) and selective (COX-1/COX-2 = > 1700) inhibitor whereas the isomeric 2 is completely inactive against COX-2. Modifications of the substituents on the fluorophenyl ring in 1 yields very potent inhibitors of COX-2 (IC50 = 40-80 nm) with excellent selectivity (1200 to > 2500) vs COX-1. Analog 20 containing a sulfonamide group is an excellent inhibitor of COX-2 with an IC50 of 14 nm. Tetrasubstituted pyrroles containing groups such as COCF3, SO2CF3, or CH2OAr at position 3 in the pyrrole ring give excellent inhibitors (COX-2, IC50 = 30-120 nm). In vivo testing in the carrageenan-induced paw edema model in the rat establishes that the 1,2-diarylpyrroles are orally active antiinflammatory agents. Compound 3 is the most potent inhibitor of edema with an ED50 of 4.7 mpk.

Potential for an external vaginal antiitch cream containing benzocaine to cause methemoglobinemia in healthy women.

OBJECTIVES: Our purpose was to assess the potential for an external vaginal antiitch cream (20% benzocaine, 3% resorcinol) to significantly increase levels of methemoglobin above normal in healthy women. STUDY DESIGN: Fifty-five women reporting external vaginal itch were recruited for the study. Each patient was used as her own control with methemoglobin levels being measured before and after use of the cream. Women were instructed to apply a 1-inch strip of cream by fingertip to the external genital area three or four times a day for 7 consecutive days. RESULTS: There were no significant differences in methemoglobin levels before and after use or in levels from a subgroup of women aged > 50 years compared with levels in a younger population. CONCLUSIONS: This preparation appears to be safe when used as directed; however, the results cannot be extrapolated to the very young. Nevertheless, lavish or frequent application over wide areas of excoriation might lead to toxic concentrations and methemoglobinemia. Therefore patients with serious vaginal disease should be advised against self-treatment beyond the 7-day limit imposed by the Food and Drug Administration for over-the-counter external analgesic medications.

Gynecologic oncology patients in the surgical ICU. Impact on outcome.

OBJECTIVE: To determine the risk factors and outcome for survival of gynecologic oncology patients in the surgical intensive care unit (SICU). STUDY DESIGN: A chart review from January 1987 through May 1992 yielded 73 gynecologic oncology patients with a malignancy who had undergone surgery with a minimum stay of three days in the SICU. Of these 73 patients, 49 patients died of malignancy, 5 were alive with disease, and 19 were alive without evidence of disease. RESULTS: The median survival of the 73 patients was 123 days; that of 48 ovarian cancer patients was 50 days. Twenty patients (27.4%) died in the hospital. CONCLUSION: This study, with multivariate analysis, showed that multiple medical conditions, especially cardiac disease, and a stay of longer than five days in the SICU had a significant impact on survival, with ovarian cancer patients staying longer and having poorer survival. These results will help in triaging patients for postsurgical management.

Prolonged stays of OB/GYN patients in the surgical intensive care unit. A cost-benefit analysis.

OBJECTIVE: To delineate costs between various obstetric and gynecologic (OB/GYN) patients with stays in the surgical intensive care unit (SICU). STUDY DESIGN: A chart review identified 86 OB/GYN patients who had a minimum SICU stay of three days between January 1987 and May 1992. RESULTS: Our study showed that the total cost of these cases was $3,344,010, with a median of $29,780 (range, $20,230-180,610) and that the difference between patients with malignancies and those without (median, $20,340) was not statistically significant (P = .11). However, cases of malignant disease that had either a prexisting medical condition or an SICU stay of more than five days cost more than any other cases (P = .038). The SICU share of total hospital cost ranged from 20.7% in patients with malignancy to 40% in patients without malignancy. CONCLUSION: As health care costs come under closer scrutiny, the critically ill patient should not be placed at risk of lessened chances of survival because perceived savings result in decreasing quality of care.

Chromosome abnormalities in primary endometrioid ovarian carcinoma.

Specific and recurrent chromosome abnormalities may occur in regions of the genome that are involved in the conversion of normal cells to those with tumorigenic potential. Ovarian cancer is the primary cause of death among patients with gynecologic malignancies. We performed cytogenetic analysis in a subgroup of epithelial ovarian tumors, the endometrioid tumors, which are histologically indistinguishable from endometrial carcinoma of the uterus. We studied 10 endometrioid tumors to determine the degree of cytogenetic similarity between these two carcinomas. Six of 10 endometrioid tumors showed a near-triploid modal number, and one had a tetraploid modal number. Eight of the 10 contained structural chromosome abnormalities, of which the most frequent were 1p-- (5 tumors), 6q-- (4 tumors), 19q+ (4 tumors), and chromosome 3 rearrangements (4 tumors). These cytogenetic results resemble those reported for papillary ovarian tumors and differ from those of endometrial carcinoma of the uterus. We conclude that despite the histologic similarities between the endometrioid and endometrial carcinomas, the genetic abnormalities in the genesis of these tumors differ significantly.

Phase II trial of hydroxyurea, dacarbazine (DTIC), and etoposide (VP-16) in mixed mesodermal tumors of the uterus: a Gynecologic Oncology Group study.

OBJECTIVE: The purpose of this study was to evaluate the efficacy of this three-drug regimen--hydroxyurea, dacarbazine (DTIC), and etoposide (VP-16)--in patients with advanced or recurrent mixed mesodermal tumors (MMT) of the uterus who had not undergone previous chemotherapy. The study was performed as a groupwide phase II study of the Gynecologic Oncology Group. STUDY DESIGN: Thirty-three evaluable patients received hydroxyurea 2 g in divided doses on Day 1, 700 mg/m2 DTIC and 100 mg/m2 VP-16 on Day 2, and VP-16 100 mg/m2 on Days 3 and 4. Thirty-two patients were evaluable for response. Twenty-six patients had previously undergone abdominal hysterectomy and 11 had received prior radiation therapy, for whom one dose level reduction of the first course was required. RESULTS: Two patients exhibited complete response and three patients showed partial responses for an overall response rate of 15.7% (95% confidence interval: 5.3-32.8%). Seventeen of 32 patients had stable disease on therapy. Toxicity was acceptable and there were no treatment-related deaths. CONCLUSION: This regimen reveals moderate activity in patients with advanced or recurrent MMT.

Characterization of 5-lipoxygenase inhibitors in biochemical and functional in vivo assays.

Several potent and selective inhibitors of 5-lipoxygenase (5-LO) have been recently developed with excellent activity in certain in vivo assays of leukotriene production. The efficacy of three such inhibitors that have been in clinical trials (zileuton, A-78773 and ZD2138) were evaluated in: 1) ex vivo whole blood assay, 2) dermal Arthus reaction, and 3) functional airway response. In addition, a model of eicosanoid production in rat lung was developed that provides a simple assay for evaluation of the biochemical efficacy of 5-LO inhibitors in the lung. Bronchoalveolar lavage of rat lung with calcium ionophore A23187 resulted in rapid and robust production of PGE2, 6-keto-PGF1 alpha, thromboxane (TxB2), and leukotriene B4 (LTB4). Supplementation of lavage fluid with archidonic acid markedly augmented production of all eicosanoids except LTB4. All three inhibitors were potent and selective blockers of LTB4 production in the ex vivo whole blood assay and in the dermal Arthus reaction. In contrast, higher doses of inhibitor were needed to block LTB4 production in the rat lung lavage model than were needed to block ex vivo whole blood LTB4 production when both end points were measured in the same animal. Similarly, zileuton and A-78733 were less effective in suppressing the functional airway response to antigen in sensitized guinea pigs, whereas both inhibitors were effective in suppressing LTB4 production in the ex vivo whole blood assay. These results demonstrate that different 5-LO inhibitors have markedly distinct efficacy for inhibition of leukotriene production, depending on the animal model.(ABSTRACT TRUNCATED AT 250 WORDS)

Chorioamnionitis caused by Capnocytophaga: case report.

Intraamniotic infection is a significant cause of perinatal morbidity. Capnocytophaga, a gram-negative anaerobe found in the oral cavity, has been implicated as an unusual cause of neonatal sepsis. We report a patient in whom this unusual organism was identified and describe the postpartum and neonatal courses.

Selective vascular embolization in benign gynecologic conditions.

Eight patients with benign obstetric and gynecologic conditions required embolization. There was a total of 11 embolizations, and embolizing agents were chosen depending on the abnormality requiring embolization. Gelfoam, Ivalon and alcohol were used to treat vascular malformations. Ovarian veins were embolized with coils. Postoperative bleeding was managed with Gelfoam, coils and/or Ivalon. Four patients had bleeding after hysterectomy or vaginal suspension. One patient had postdelivery bleeding. All the bleeding was controlled after embolization. A uterine arteriovenous malformation was managed with embolization, allowing the patient to carry her next pregnancy to term. The symptoms of a vulvar hemangioma and ovarian syndrome were controlled with vascular embolization. Morbidity was minimal. Embolization is the primary treatment of choice in obstetric and gynecologic patients with postoperative bleeding or symptomatic vascular malformation.

In vivo characterization of zymosan-induced mouse peritoneal inflammation.

Intraperitoneal administration of zymosan to mice resulted in marked biosynthesis of eicosanoids and influx of neutrophils with distinct time course profiles. 6-Keto-prostaglandin-F1 alpha (6-KPA) increased between 30 and 60 min and rapidly decreased thereafter. Leukotriene (LT)C4 levels showed similar patterns, but were sustained for several hours. LTB4 increased in a biphasic manner with peak increases between 2 to 3 hr. Repeated injections with zymosan suggested that incoming neutrophils generate most of the LTB4. Myeloperoxidase (MPO), an enzyme marker for neutrophils, continued to increase throughout the time course. Mast cells regulate LTB4 biosynthesis and neutrophil trafficking, whereas resident macrophages contribute to 6-KPA and LTC4 biosynthesis. The complement fragment C5a has a minimal role in zymosan-induced inflammation. Selective 5-lipoxygenase (5-LO) inhibitors, zileuton [N-(1-benzo[b]thienyl-2yl-ethyl)-N-hydroxyurea], TZI-41127 [2-(4-hydroxy-3,5-dimethylphenyl)-5-methoxy-3-methylindole] and cyclooxygenase (CO) inhibitors selectively modulated eicosanoid biosynthesis. Both 5-LO and CO inhibitors attenuated influx of neutrophils to varying degrees. A LTB4 receptor antagonist, SC-41930 [7-(3-(4-acetyl-3-methoxy-2-propylphenoxy)-propoxy]-3,4-dihydro-8- propyl-2H-1-benzopyran-2-carboxylic acid) and an LTD4 receptor antagonist, LY-171883 [1-(2-hydroxy-3-propyl-4-(4-1H-tetrazol-5-yl)butoxy-phenyl) ethanone)] (i.v.) attenuated influx of neutrophils and associated LTB4 biosynthesis. These results suggest that both 5-LO and CO metabolites regulate neutrophil influx in this model. Marked eicosanoid biosynthesis and cellular influx in response to zymosan provides an attractive experimental paradigm to evaluate anti-inflammatory effects of inhibitors of arachidonate CO or 5-LO pathways.

Role of mast cells in calcium ionophore (A23187)-induced peritoneal inflammation in mice.

Several lines of evidence document a critical role for mast cells in immune complex-mediated inflammatory models. However, their role in nonimmune models of acute inflammation is largely unknown. In the present investigation, the role of mast cells was examined in calcium ionophore (A23187)-induced mouse peritoneal inflammation. Intraperitoneal injection of A23187 (20) micrograms/mouse) elicited marked and transient increases in immunoreactive levels of 6-ketoprostaglandin-F2 alpha, leukotrienes B4, C4, D4, E4, and F4. There were no discernible differences in levels of these mediators in male Swiss Webster mice, mast cell-deficient mice (WBB6F1-W/W'), and age-matched controls (WBB6F1-+/+), suggesting a minimal role of mast cells in eicosanoid biosynthesis in this model. However W/W' mice showed smaller increases in levels of myeloperoxidase, a marker for neutrophils, compared to +/+ mice. Both W/W' and +/+ mice have lower constitutive levels of peritoneal N-acetyl-beta-D-glucosaminidase (NAG), a marker for mononuclear cells. Similar to the changes seen in myeloperoxidase, W/W' mice exhibited a blunted NAG response compared to +/+ mice. These results suggest that mast cell products other than eicosanoids may contribute to the changes in cellular trafficking in response to intraperitoneal A23187. These results also suggest that mast cells are required for full expression of inflammatory responses.

Cytogenetic and FISH analysis of endometrial carcinoma.

Endometrial cancer is a common gynecologic tumor, yet reports of cytogenetic studies are few. We studied chromosomes from seven primary specimens of endometrial cancer. Six had abnormal chromosomes; five had a diploid-hyperdiploid modal number and one was triploid. One specimen had a normal karyotype. Chromosome 1 was frequently involved in abnormalities (five tumors) with i(1q) in two tumors, and one tumor each had der(7)t(1;7)(q12;p11) and +add (1)(p13). One additional tumor had trisomy 1 in the single cell which could be fully analyzed. Trisomy 7 was noted in two tumors, and trisomy 10 in one. Because trisomies of these chromosomes have been reported in other cases of endometrial cancer, we used fluorescent in situ hybridization (FISH) with centromere probes to determine the prevalence of trisomies 7 and 10 in these specimens. No additional tumors were found to have trisomies 7 or 10 by FISH. Our data, in combination with published literature, suggest that additional copies of 1q or portions of 1q constitute the primary change in this tumor. Extra copies of genes in this region may play an important role in tumorigenesis in endometrial carcinoma.

Comparative evaluation of arachidonic acid (AA)- and tetradecanoylphorbol acetate (TPA)-induced dermal inflammation.

The effects of topical application of arachidonic acid (AA) or phorbol ester, tetradecanoylphorbol 13-acetate (TPA), on edema response, vascular permeability, MPO, NAG, and generation of eicosanoids were studied in two murine models of cutaneous inflammation. AA produced a short-lived edema response with a rapid onset that was associated with marked increases in levels of prostaglandins (PGE2, 6-keto-PGF1 alpha, PGF2 alpha), thromboxane B2 (TxB2) and leukotriene B4 (LTB4), with smaller increases in levels of LTC4. TPA produced a longer-lasting edema that was associated with marked influx of neutrophils and predominant formation of LTB4 along with significant changes in levels of TxB2. Circulating T lymphocytes have no apparent role in the acute inflammatory responses induced by either agent. Arachidonic acid-induced vascular permeability preceded the edema response and neutrophil influx, whereas TPA-induced vascular permeability paralleled the edema response and influx of neutrophils. Mast cells appear to be important in the complete expression of inflammatory response, i.e., edema, cellular influx, and vascular permeability induced by either AA or TPA, as these responses were blunted in mast cell-deficient mice. Inhibitors of CO or 5-LO attenuated inflammatory responses in both models. The LTB4 receptor antagonist, SC-41930, inhibited the inflammatory response to TPA but had little effect on that initiated by AA. This suggests that LTB4 is an important mediator in the phorbol ester-induced inflammatory response, whereas peptidoleukotrienes and prostaglandins regulate vascular permeability responses in the arachidonate model.

Cytogenetic profile of uterine sarcomas.

BACKGROUND: Diagnostic and consistent chromosomal abnormalities have been reported in several soft tissue sarcomas, but few studies have reported the frequency of chromosomal abnormalities in uterine sarcomas. METHODS: Cytogenetic studies were performed on specimens of uterine sarcoma from 14 patients. The specimens included five of leiomyosarcoma (LMS), four of endometrial stroma sarcoma (ESS), and five of malignant mixed mesodermal tumor (MMMT). RESULTS: Chromosomal abnormalities were detected in 10 of 14 (71%) patients. Chromosome 1 was involved in 7 of 13 (54%) of the patients, chromosome 11 in 6 of 13 (46%), and chromosome 7 in 6 of 13 (46%). A site-specific chromosomal abnormality, del(11)(q22) was found in two patients with LMS and three patients with MMMT, and 7q31 also was involved frequently. Marked genomic instability characterized the MMMT studied. CONCLUSIONS: These findings suggest that abnormalities of chromosomes 1, 7, and 11 may play a role in tumor initiation or progression in uterine sarcomas. Genomic alterations in the region 11q22 may be specific for malignant smooth muscle tumors of the uterus.

Prognostic factors in early-stage uterine sarcoma. A Gynecologic Oncology Group study.

BACKGROUND: A clinicopathologic evaluation of clinical Stage I and II uterine sarcoma was done by the Gynecologic Oncology Group from 1979-1988. METHODS: After all eligibility criteria were met, 453 cases were evaluable and analyzed for prognostic factors. RESULTS: Of the 301 mixed mesodermal tumors (MMT), 167 were homologous (HO), and 134 were heterologous (HE). Fifty-nine tumors were leiomyosarcomas (LM). The remaining 93 sarcomas were predominantly stromal cell and adenosarcomas. For this study, only the MMT or LM tumors were analyzed. The recurrence rate for all MMT was 53% (HO, 44%; HE, 63%). The recurrence rate for LM was 71%. The site of the first recurrence included the pelvis in 21% of MMT and 14% in LM. Factors significantly related to progression-free interval (PFI) by univariate analysis among MMT were adnexal spread, lymph node metastases, tumor size, lymphatic-vascular space involvement, histologic grade, cell type, age, peritoneal cytologic findings, and depth of uterine tumor site of invasion. The prognostic factors based on multivariate analysis were adnexal spread, lymph node metastases, histologic cell type (HO versus HE), and grade of sarcoma. For LM, the mitotic index was the only factor significantly related to PFI.