Flow cytometry of peritoneal washings in gynecologic neoplasia.

A prospective, double blind study was initiated to compare flow cytometry to cytopathology in detecting malignant cells within peritoneal washings. Deoxyribonucleic acid (DNA) histograms were generated using 4',6-diamidino-2-phenylindole (DAPI) as a DNA fluorochrome. Evaluation of these data revealed a correlation of 84.5% with the cytologic findings. Two specimens demonstrated euploidy in the presence of cytologically malignant cells (false negative), 28 of 128 specimens (21.8%) manifested aneuploidy with negative cytologic findings (false positive). Further evaluation of this latter subgroup revealed 22 of the 28 to possess unequivocal histologic evidence of malignancy, thus yielding an actual false positive rate of 4.7%. This preliminary study demonstrates that flow cytometry is a highly sensitive, accurate, and analytic method for the detection of malignant cells within peritoneal washings and that it may augment the cytologic examination. However, additional comparative studies are necessary to conclusively demonstrate its apparent diagnostic potential.

Treatment of advanced or recurrent endometrial adenocarcinoma with cyclophosphamide, doxorubicin, cis-Platinum, and megestrol acetate.

A prospective clinical trial using combination chemotherapy consisting of cyclophosphamide, doxorubicin, cis-Platinum and megestrol acetate (CAP-M) was initiated to study its effect on advanced or recurrent endometrial adenocarcinoma. Fifteen patients were clinically evaluable. Nine patients (60%) demonstrated an overall objective clinical response resulting in either complete regression of disease (33%) or a reduction in tumor size. For all responders the mean progression free interval was eight months, with a range of five to 11 months. Similarly, a mean survival time of 12 months with a range of five to 21 months was observed. An additional four patients showed no progressive disease for a mean of seven months duration. Reversible cis-Platinum-induced nephrotoxicity occurred in two patients. This is the first reported series of endometrial cancer patients using nonhormonal cytotoxic agents, including cis-Platinum, in conjunction with a progestin. This preliminary experience is encouraging and appears worthy of further clinical evaluation.

Use of the ultrasound aspiration transducer in midtrimester amniocentesis.

Midtrimester amniocentesis was performed on 2,100 consecutive patients over a four-year period. A specially designed ultrasonic aspiration transducer was used to guide the needle into the amniotic cavity under direct vision by following the path of the needle tip ultrasonically as it entered the fluid. This technique has made the aspiration of amniotic fluid relatively simple and safe. We obtained an adequate amount of amniotic fluid in 99.2% of the patients at their initial visits. The incidence of grossly bloody taps was 0.8%, and the total number of bloody amniotic fluid specimens was 2.37%. The rate of primary culture failure was 0.53%. The total fetal loss within eight weeks after amniocentesis was 0.9% as compared with 0.52% in a control population composed of pregnant women between 16 and 24 weeks of gestation. The estimated amniocentesis-related fetal loss was 0.38%.

Discordant anencephalus in a Pergonal-induced triplet pregnancy.

A patient with a triplet pregnancy had one infant affected by anencephalus. This pregnancy resulted from ovulation stimulation by gonadotropins. Several cases of association between anencephalus and induction of ovulation by clomiphene have been reported. The association with gonadotropins, however, has been reported only once. The event was prenatally diagnosed by ultrasound studies in the first and second trimesters. The association of anencephalus with ovulation stimulation is discussed briefly.

Fetal heart rate acceleration in relation to the oxytocin challenge test.

Fetal heart rate (FHR) acceleration was evaluated in 1570 oxytocin challenge test (OCT) results, which were performed on 565 high-risk patients. In positive OCTs a significant decrease or lack of FHR acceleration was noted. Fetuses with positive OCTs and lack of FHR acceleration were more compromised than those with better FHR acceleration.. Negative OCTs were associated with a good FHR acceleration approximately 95% of the time. Study of FHR acceleration in suspicious OCTs proved to be helpful in determining the significance and prognosis of a suspicious OCT.

Oxytocin challenge test in high-risk pregnancy.

Seven hundred sixty-seven oxytocin challenge tests (OCT) were performed on 333 high-risk maternity patients. All of the patients had pregnancies complicated by diabetes mellitus, suspected postmaturity, preeclampsia, intrauterine growth retardation, hypertension and other disorders. In conjunction with OCT, 24-hour urinary estriol determinations were performed. Negative OCT's were reassuring for fetal well-being. There were 26 positive OCT's on 24 patients. A positive test was significant in identifying endangered fetuses existing in a markedly unfavorable environment. In our experience, we found the OCT more reliable and more predictable than urinary estriol determination. The oxytocin challenge test proved to be significant in the successful management of these 333 high-risk patients.