Squamous cell carcinoma of the cervix: HPV 16 and DNA ploidy as predictors of survival.

In this study, the hypothesis that DNA ploidy and the presence of HPV 16 and HPV 18 DNA affects survival of patients with squamous cell carcinoma of the cervix was tested. Archival paraffin blocks from biopsy and surgical specimens were obtained from 127 women diagnosed in 1977-1984. Determination of DNA ploidy was by flow cytometry and HPV 16 and HPV 18 DNA status by polymerase chain reaction with subsequent dot-blot hybridization. For each patient, age, stage, treatment modality, and 5-year survival were correlated with ploidy and HPV status. HPV 16 DNA was present in 53% of the tumors. HPV 18 was not detected in this population. HPV 16 DNA was found twice as often in Stages IB and IIA than in advanced-stage disease (III and IV). These advanced-stage tumors were more commonly aneuploid. Neither HPV status nor DNA ploidy were predictive of survival for any stage of disease or therapeutic modality.

Clinical stage I adenocarcinoma of the endometrium--analysis of recurrences and the potential benefit of staging lymphadenectomy.

Two hundred forty-eight consecutive patients with clinical Stage I adenocarcinoma of the endometrium were seen between 8/77 and 8/88. Twenty-one were medically not operable and eleven others had papillary serous tumors. The remaining 216 were managed by a consistent operative protocol except that routine preoperative cesium was discontinued after 12/83. Patients received postoperative pelvic radiation on the basis of the depth of invasion, extrauterine pelvic disease, and/or cervix involvement. No patient underwent a pelvic lymphadenectomy. Only palpably suspicious nodes were removed. Twenty-one of these two hundred sixteen patients developed a recurrence. These 21 cases are analyzed for the probability of a staging lymphadenectomy having prevented their recurrence. Median follow-up of all 216 patients is 61 months with a mean time to recurrence of 26.5 months. No patient was lost to follow-up. Patients who recurred are analyzed by grade, depth of invasion, surgical stage, time to recurrence, site of recurrence, survival, protocol breaks, and frozen section discrepancies. No patient recurred on the pelvic side-wall. All patients found to have positive para-aortic nodes have died. No patient who received vaginal and/or pelvic radiation recurred in the pelvis. We conclude that staging lymphadenectomy would not have improved the outcome for these patients.

Successful treatment of a persistent cyst, developing after ovarian transposition, with leuprolide acetate.

Persistent ovarian cysts are considered to be the most troublesome complication of ovarian transposition. Transabdominal drainage or surgical removal is often required. This paper reports the successful use of leuprolide acetate, a GnRH agonist, in the treatment of a symptomatic and persistent ovarian cyst which developed after ovarian transposition. The benefits of this therapy over others are discussed.

Management of epithelial ovarian neoplasms using a platinum-based regimen: a 10-year experience.

One-hundred and twenty-four patients with primary advanced (n = 103) and recurrent (n = 21) ovarian carcinoma completed a course of platinum-based chemotherapy (cyclophosphamide/doxorubicin/cisplatin or cyclophosphamide/cisplatin) or developed progressive disease while on therapy and were evaluated. All patients were treated between August 1, 1977 and December 31, 1987. The 5-year survival for patients with primary disease was 27% for stage III (n = 73) and 7% for stage IV (n = 30). The 5-year survival based on residual disease was 91% for microscopic disease (n = 13), 24% for disease less than 2 cm (n = 27), and 8% for disease greater than or equal to 2 cm (n = 64). The 5-year survival for the patients treated with recurrent disease was 5% (n = 21). Borderline tumors have been excluded. Long-term toxicity, including cardiac toxicity, renal toxicity, and a 5% incidence of second primary tumors, is evaluated.

Serum albumin: its relationship to marrow and renal toxicity from platinum-based combination chemotherapy.

One hundred and three patients treated with CAP chemotherapy were evaluated to determine the relationship between low prechemotherapy serum albumin (less than 3 g/dl) and low WBC nadir (less than 2000 cells/mm3). Additionally, the relationship of serum albumin to renal toxicity (delta serum creatinine) was examined. Low prechemotherapy serum albumin appears to be a marker for advanced disease, but does not appear to predict marrow or renal toxicity.

Synergistic effects of cis-platinum and cytosine arabinoside on ovarian carcinoma cell lines, demonstrated by dual-parameter flow cytometry.

Ovarian cancer tends to remain confined to the peritoneal cavity even after widespread dissemination. In order to test the in vitro cytotoxic effect of cis-platinum (CP) and cytosine arabinoside (ara-C), a combination which, in theory, is particularly suitable for intraperitoneal (IP) administration, ovarian cancer cells were exposed to each drug alone and in combination and then sampled serially for 336 hr with cell counts and flow cytometry (FCM). We used dual parameter FCM analysis to study changes in DNA and nuclear protein simultaneously. There was good correlation between the degree of cell kill noted in the counts and the duration of observed cytokinetic disturbances in all the treated series. CP and ara-C alone produced temporary cytotoxic and cytokinetic changes. Together, the two agents produced an enhanced CP effect which lasted 336 hr and was accompanied by continued evidence of cell kill in the counts. We conclude that CP and ara-C in vitro act synergistically on ovarian cancer to achieve a high level of cell kill after a single simultaneous application.

Carcinoma of the fallopian tube: clinical management.

From 1970 to 1986, 36 women were diagnosed to have primary fallopian tube cancer. Fifty-three percent of the patients were Stage III with a median adjusted survival of 27 months. Although varied adjunctive therapies were employed, none provided a clear survival benefit. Five "second-look" procedures were performed. Only one was negative, occurring in a Stage IIIC patient treated with combination chemotherapy. She has continued without evidence of disease 26 months following diagnosis. Recurrent disease was uniformly fatal, despite efforts at salvage therapy. Disease biology and response to therapy parallels that of similar stage epithelial carcinoma of the ovary.

Human dura mater allografts in repair of pelvic floor and abdominal wall defects.

Freeze-dried human dura mater has been used as an allograft for reconstructive gynecologic surgery since 1980. So far, 33 grafts have been placed. This versatile and immunologically inert material has been used to reconstruct the pelvic floor after exenterative procedures, replace rectus fascia in the repair of wound dehiscence and ventral or parastomal hernias, and cover the femoral vessels after nodal dissection. In seven patients, dura mater was grafted into infected sites without subsequent rejection. Biopsy of an allograft one year after implantation confirmed the natural tendency of the body to convert the dura mater to a viable and neovascularized tissue. This reconstructive material is a safe and versatile allograft for gynecologic oncologists.

Vaginal delivery after cesarean section: a five-year study.

All pregnancies that were complicated by a previous cesarean section were reviewed for a five-year period from 1978 to 1982. Of 799 such pregnancies, 216 underwent a trial of labor, and 66% experienced successful vaginal delivery. When the primary cesarean section was for cephalopelvic disproportion, 54% delivered vaginally, 75% breech, and 70% for fetal distress or other nonrepeating indications. There was no evidence of uterine scar disruption in the vaginally delivered group. Vaginal delivery after previous cesarean section can be a safe alternative for carefully selected patients cared for in the proper environment.

The effect of acidosis in hypokalemic periodic paralysis.

Metabolic acidosis was produced in two patients with hypokalemic periodic paralysis by the administration of ammonium chloride over a period of three days. The challenging test of glucose and insulin produced a substantially smaller reduction of both serum potassium concentration and muscle strength than when the patients were tested in normal acid-base balance. The findings agree with earlier work on acetazolamide, suggesting that metabolic acidosis provides protection against episodes of muscle weakness in periodic paralysis.

Hyperkalemic periodic paralysis. Effects of potassium, exercise, glucose, and acetazolamide on blood chemistry.

Effects of strenous exercise, followed by rest, and of potassium administration on blood chemistry values were studied in two patients with hyperkalemic periodic paralysis and in normal volunteers. These procedures produced attacks of flaccid paralysis that occurred concomitantly with rapid rises in serum potassium concentrations and decreases in blood glucose and inorganic phosphate levels. With the exception of the serum potassium level which rose following exercise and potassium administration, there were no changes in the blood chemistry values of the normal volunteers. During the induced attacks of paralysis, the expired breath of the patients had a very strong odor of ketosis. Results of subsequent glucose tolerance tests were abnormal. Following 24 hour administration of acetazolamide, the studies were repeated. The drug appeared to cause lesser effects of stimuli on serum potassium levels and a stabilizing effect on blood glucose levels.

Acetazolamide treatment of hypokalemic periodic paralysis. Probable mechanism of action.

Following administration of glucose and insulin to three patients with hypokalemic periodic paralysis, serum K+ fell 1.9 mM. After administration of acetazolamide, 250 mg four times daily, serum K+ fell 0.9 mM, a substantial difference. In normal persons glucose and insulin lowered serum K+ 0.5 mM, and this was not changed substantially by acetazolamide. The metabolic acidosis induced by the drug appears to be responsible for the change in decrement of serum K+ and for the amelioration of symptoms in the patients. The findings agree with earlier reports that metabolic acidosis lowers the rate of entry of K+ into muscle, thus opposing the heightened or pathological entry of K+ into muscle cells during attacks of the disease.