A comparison of complementary and alternative medicine use by gynecology and gynecologic oncology patients.

Our objective was to describe and compare the use of complementary and alternative medicine (CAM) in gynecology and gynecological oncology patients. Five hundred and twenty-nine gynecology and gynecological oncology patients completed a questionnaire regarding CAM use. Overall, 56.3% of gynecology and gynecological oncology patients reported current use of CAM. Therapies used included nutritional supplements (20%), prayer as medical therapy (17%), exercise as medical therapy (12%), megavitamins (10%), and green tea (10%). While 69.5% believed CAM to be beneficial, only 31.6% discussed these therapies with their physician. The women spent a mean of $656.22 on CAM (range $0-$7,000), with 31.7% receiving some insurance reimbursement. Gynecologic oncology patients (n = 161) used CAM significantly more than gynecology patients (n = 368) (66% vs. 52%, 95% CI = 0.046-0.230, P = 0.004). Gynecological oncology patients also spent more for CAM, with a mean expenditure of $711 versus $622 by gynecology patients. Within the gynecological oncology patient group, there were 69 patients currently receiving modern medical treatments for cancer; among these patients, 58% reported using CAM; of these, 39.3% communicated their use of CAM to their physician. Patients in this group spent an average of $1,178 on CAM during their illness, with only 6.3% receiving insurance reimbursement. Benefits from CAM were perceived by 54.5% in this group. We concluded that cancer patients have a higher usage rate and expenditure for CAM, particularly while they are receiving medical therapy, and are more likely to discuss the use of alternative therapies with their physicians. CAM was perceived as helpful by patients despite the lack of scientific data about its effect.

Hemolytic anemia and benign pelvic tumors. A case report.

BACKGROUND: Hemolytic anemia associated with benign pelvic neoplasms is very rare. Sixteen cases have been reported in the English-language literature. CASE: A 27-year-old woman complained of dizziness, fatigue and headache. Physical examination revealed jaundice and mild tachycardia. Laboratory evaluation indicated intravascular hemolysis, and workups for hematologic and infectious disease etiologies were negative. Multiple blood transfusions and steroids failed. Computed tomography showed a large, complex pelvic mass (10 x 10 x 6 cm). Exploratory laparotomy and excision of bilateral dermoid cysts were performed, and the anemia resolved. The patient was healthy, without recurrence, seven years later. CONCLUSION: It is important to seek to identify pelvic tumors in patients presenting with hemolytic anemia because this condition is often resistant to standard medical therapy and resolves only after removal of the neoplasm.

Complementary and alternative medicine use in the Amish.

OBJECTIVE: To examine the rate of utilization of complementary and alternative medicine (CAM) in Amish women, a population that traditionally uses non-mainstream medicine. METHODS & RESULTS: Sixty-six Amish women completed a survey concerning their use of CAM. Thirty-six percent of the Amish women used at least one form of CAM, primarily reporting a use of diet and nutrition programs, herbal therapies, and chiropractic medicine. In addition, ten pregnant Amish women reported using echinacea, St. John's Wort, red clover, garlic and ginseng. CONCLUSION: This survey highlights the need to address potential adverse effects of herbal therapies in young women who are a member of a group that may use non-mainstream medicine.

Primary fallopian tube carcinoma with isolated torsion of involved tube.

BACKGROUND: Primary fallopian tube carcinoma (FTC) is an aggressive but rare tumor. Worldwide, more than 1,500 cases have been published, and about 20 new cases are added every year. Isolated fallopian tube torsion (IFTT) is an unusual and uncommon event. CASE: We report a 69-year-old Caucasian woman, Gravida 4, Para 3, with a long history of hypertension, diabetes mellitus with retinopathy and neuropathy, and history of extensive coronary artery disease, for which a triple-by-pass graft was performed. She was placed on anticoagulation therapy. Subsequently, she developed intermittent vaginal bleeding. RESULTS: We reviewed and discussed the symptoms and work-up of the patient in detail. She underwent exploratory laparotomy, and primary FTC with isolated torsion of the involved fallopian tube was diagnosed. Peritoneal washings, omentectomy, total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. CONCLUSION: Review of the English literature on the presenting symptoms and diagnostic management of primary FTC and IFTT is presented.

Functioning liver metastases on an I-131 whole-body scan: a case of malignant struma ovarii.

A 46-year-old women was examined for severe constipation. Pelvic examination revealed a large pelvic mass extending to the level of the umbilicus. Computed tomography showed a large multicystic, septated mass in the pelvis and a small amount of fluid in the cul de sac. In addition, multiple ill-defined, mixed-attenuation hepatic lesions were identified. A malignant ovarian neoplasm with liver metastases was considered, so the pelvic mass was resected. Interestingly, histopathologic analysis revealed malignant struma ovarii of the follicular type. Biopsy of the liver lesions confirmed metastatic disease with similar histopathologic findings. All thyroid laboratory values were in the normal range. The patient then had a total thyroidectomy to optimize thyroid ablation therapy with I-131. This revealed a small follicular adenoma but no evidence of cancer. An I-131 whole-body scan was performed and showed uptake in multiple functioning liver metastases.

Presence and characteristics of receptors for [D-Trp6]luteinizing hormone releasing hormone and epidermal growth factor in human ovarian cancer.

This study was undertaken to establish the presence and characteristics of receptors for [D-Trp6]LH-RH on the membranes of human ovarian cancer. Specific binding of [125I, D-Trp6]LH-RH was found in 29 of 37 (78.4%) ovarian cancers and in 6 of 11 (54.5%) non-malignant human ovaries. Ligand binding was dependent on time and plasma membrane concentration in a fashion expected of a peptide hormone. Saturation, kinetic and displacement data were consistent with the presence of a highly specific, single class of non-cooperative binding site. On the basis of receptors affinity, LH-RH-receptor-positive ovarian cancers could be divided into two groups: high affinity group (Kd=2.71 +/- 0.60 nM; Bmax=0.46 +/- 0.07 pmol/mg membrane protein) comprising 55% of tumors, and low affinity group (Kd=78.0 +/- 19.6 nM; Bmax=9.44 +/- 2.68 pmol/mg membrane protein) which included 45% of tumors. LH-RH antagonist Cetrorelix showed an affinity to LH-RH receptors on ovarian cancers 14 times higher than the agonist [D-Trp6]LH-RH. Using 125I-epidermal growth factor, specific high affinity receptors were also detected in membranes from 13 of 24 (54%) ovarian cancers and 5 of 11 (45%) non-malignant ovaries. The demonstration of LH-RH receptors in human ovarian cancers provides a rationale for the use of therapeutic approaches based on LH-RH analogues in this malignancy. The probable involvement of growth factors in the development of ovarian cancers suggests the merit of trying a combined therapy based on analogs of LH-RH and somatostatin for this carcinoma.

A randomized, multicenter, double-blind, placebo-controlled, dose-finding study of ORG 2766 in the prevention or delay of cisplatin-induced neuropathies in women with ovarian cancer.

OBJECTIVE: The objective was to evaluate the efficacy of Org 2766 (a hexapeptide analogue of ACTH) in the prevention or delay of cisplatin-induced neuropathy during chemotherapy in women with ovarian cancer as measured by vibration perception threshold (VPT). METHODS: In this randomized, multicenter, double-blind, placebo-controlled study, 196 women with ovarian cancer were treated with cisplatin 75-100 mg/m2, cyclophosphamide 600-1000 mg/m2 plus placebo or two dose levels of Org 2766. The cisplatin-induced neuropathies were monitored by determining the VPT with the Vibratron II. VPT was determined for both the most sensitive great toe and the index finger on a monthly basis during treatment and months 1, 2, and 3 postchemotherapy. Once the blind was broken, it was found that 174 women (59 in placebo, 58 in 2 mg, and 57 in 4 mg) had enough data to allow evaluation. RESULTS: Over the course of follow-up, the VPT was found to increase. This is consistent with the development of cisplatin-induced peripheral neuropathies. The baseline VPT for the index finger was less than that of the great toe (0.65 vs 2.13), but the percentage change in VPT was the same for both (percentage increase in VPT of about 350%). When the VPTs are compared according to the dose of Org 2766 given, there appears to be no difference in the rate of change or degree of neuropathies that developed in these women receiving cisplatin and cyclophosphamide. CONCLUSIONS: The development of cisplatin-induced neuropathies is confirmed by measurement of the VPT. The rate of development of neuropathies seems to accelerate after the sixth course of cisplatin. When the development of neuropathies is evaluated on the basis of Org 2766 dosage, it is found that there is no difference in the rate or degree of neuropathies seen. Instead of providing protection from and delay of onset of peripheral neuropathies caused by cisplatin, these results suggest that the administration of Org 2766 appears to cause an increase in the rate of change and degree of neuropathies (P > 0.05).

Pure embryonal rhabdomyosarcoma of the fallopian tube.

Rhabdomyosarcoma is a neoplasm of childhood which commonly arises in the genitourinary tract. Reported locations include the bladder, prostate, paratestis, vagina, uterus, cervix, and ovary. Rhabdomyosarcomas have been reported to occur in the fallopian tube only as a component of a malignant mixed müllerian tumor. We present a case of pure embryonal rhabdomyosarcoma of the fallopian tube in a 17-year-old. The diagnosis was confirmed by immunohistochemical stains. The strongest evidence for the primary location of this pure embryonal rhabdomyosarcoma was the gross appearance of the tumor at laparotomy. Additionally, rhabdomyosarcomas arising from adjacent organs have never been reported to grow into the fallopian tubes.

Wound seeding associated with endometrial cancer.

We report a patient with well-differentiated adenocarcinoma of the endometrium who developed a recurrence in the anterior abdominal wall probably secondary to wound seeding at the time of her original surgery. She underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy. She then received 15 mCi of 32P for positive peritoneal washings. She was free of disease until 2 years later when a large lower incision mass developed. She had no evidence for intra-abdominal disease and a radical resection with a myocutaneous flap was undertaken. Radical resection for isolated metastases may be of benefit for patients with endometrial cancer. Patients with positive cytology should be observed closely for incisional recurrence.

The effect of immediate intraperitoneal carboplatinum on wound healing.

The effect of introducing intraperitoneal carboplatinum on wound healing immediately after wound closure was studied using a rat model. All animals were opened through a midline incision. A bowel anastomosis was then performed in a single-or two-layer fashion using 6-O suture. Immediately after closing the abdominal wall, each animal was percutaneously injected with either normal saline for controls (n = 11), or carboplatinum, 3 (n = 8), 9, (n = 19, or 12 mg/kg (n = 4). Abdominal and skin incisions were closed separately using 4-O silk suture. Animals were sacrificed 7 days postoperatively. Adhesions were blindly assessed on the following scale: 0 (no adhesions), 1 (filmy adhesions), 2 (firm adhesions), and 3 (dense adhesions). Anastomoses were assessed for leakage. Three centimeters of the incision were harvested to evaluate wound breaking strength. Analysis of abdominal wound breaking strengths showed control = 1320 g +/- 220, 3 mg = 1055 g +/- 155, 9 mg = 891 g +/- 127, and 12 mg = 594 g +/- 165 (P < 0.025). Evaluation for dense adhesions resulted in control = 27%, 3 mg/kg = 50%, 9 mg = 63%, and 12 mg = 100% (P < 0.0001). Immediate instillation of intraperitoneal carboplatinum had a significant effect on wound healing with a decrease in abdominal tensile strength directly related to the dose instilled. It also had a significant effect on adhesion formation with a higher dose leading to a higher incidence of adhesion formation. Based on animal model data, it appears that the immediate instillation of intraperitoneal carboplatinum at the time of laparotomy incision closure could lead to significant problems with wound strength and adhesion formation.

Magnetic resonance imaging to avoid laparotomy in pregnancy.

OBJECTIVE: To determine whether magnetic resonance imaging (MRI) in pregnancy would help define a benign pelvic mass, thereby avoiding laparotomy. METHODS: During a 2-3-year period, five pregnant women with adnexal masses suspected to be leiomyomas underwent MRI. RESULTS: Four patients had evidence of leiomyoma and one had a benign cystic teratoma. All avoided laparotomy because of the almost certain radiologic findings of a benign process. In two women, there was an important effect on the pregnancy; one had fetal growth retardation and the other an outlet obstruction precluding vaginal delivery. Four of the patients underwent cesarean delivery. CONCLUSIONS: Magnetic resonance imaging can be used in the differential diagnosis of an adnexal mass in pregnancy. This will enable some pregnant patients to avoid laparotomy and its concomitant risks.

Adenocarcinoma of the uterine cervix: prognostic factors and patterns of recurrence.

Survival data, prognostic factors, and patterns of recurrence were analyzed for 70 women with adenocarcinoma of the uterine cervix treated between 1968 and 1982. The 5-year survival rates for stages I, II, and III-IV were 82, 90, and 38%, respectively. Control of pelvic tumor was achieved in 82, 80, and 12.5% of cases of stage I, II, and III-IV disease, respectively. When radiation therapy techniques alone were employed, pelvic control was achieved in 100% of stage I and 75% of stage II cases. Tumor grade was an important prognostic factor in stage I disease, with 92% of patients with grade 1 and 2 lesions surviving 5 years, in contrast to 68% of patients with grade 3 lesions (P less than 0.05, log rank test).

Ovarian clear cell carcinoma. A clinicopathologic analysis of 44 cases.

The clinical aspects and pathologic findings in 44 cases of pure clear cell carcinoma of the ovary are presented. The patients ranged in age from 28 to 78 years (mean, 50.6 years); 54% were nulliparous. Thirty-three percent of the patients had endometriosis in the involved ovary, and an additional 25% had endometriosis only in sites distant from the tumor. Microscopically, three architectural patterns (papillary, tubulocystic, and solid) and four cell types (clear, hobnail, eosinophilic, and flattened) were seen. A predominant tubulocystic architectural pattern was a good prognostic factor (p less than 0.01); however, no significant difference in survival by cell type was found. Grading of the tumors by conventional architectural and cytologic criteria had no predictive value for survival. Stage at presentation was the most important prognostic factor (p less than 0.001), with a 5-year overall survival of 34% and stage I survival of 55%. The poor stage I survival reflects the 15 patients (34%) in the study with stage Iaii lesions. In the 25 patients who developed recurrence, both distant organ involvement (40%) and lymph node involvement (40%) were frequent. Ovarian clear cell carcinoma has unusual pathologic and clinical features, and it represents a distinct histologic type of ovarian carcinoma.

Ovarian malignant mixed mesodermal tumor response to cis-diamminedichloroplatinum.

A patient with primary, bulky, Stage III, malignant mixed mesodermal tumor (MMMT) of the ovary achieved a partial response to postoperative cis-Diamminedichloroplatinum (DDP). These rare tumors have previously been relatively resistant to chemotherapeutic agents. The use of DDP resulted in significant palliation in our patient and should be strongly considered in the postoperative therapy of patients with MMMT of the ovary.

Clear cell adenocarcinoma of the ovary: a clinical analysis and comparison with serous carcinoma.

Forty-four patients with clear cell adenocarcinoma of the ovary diagnosed between 1944 and 1981 were compared with a matched cohort of 55 patients with the most common epithelial malignant lesion, serous adenocarcinoma, in terms of their presentation and clinical course. None were lost to follow-up. Median follow-up was 9 years. Fifty percent of clear cell patients presented in Stage I versus 31% of serous patients. Patients with clear cell carcinoma presented more often with pelvic masses (84% vs 65%) and had larger (diameter greater than 10 cm) primary tumors (73% vs 29%). Forty-nine percent of clear cell patients were nulligravid compared with 24% of serous patients and endometriosis was strikingly more common in clear cell patients (58% vs 12%). When compared stage for stage, clear cell tumors were uniformly associated with poorer 5-year survival rates with an overall rate of 34%. In patients with recurrent disease, lymph node involvement was much more common in patients with clear cell carcinoma (40% vs 7%). Parenchymal organ involvement was also more common in the clear cell group (40% vs 13%). Ovarian clear cell adenocarcinoma has distinctly different clinical behavior compared to serous carcinoma and should be regarded as an aggressive epithelial histologic type.

Adenocarcinoid tumor of appendix presenting as unilateral Krukenberg tumor.

We report a case of adenocarcinoid tumor of the appendix that presented initially as a unilateral Krukenberg tumor (a signet ring cell mucinous adenocarcinoma with prominent cellular stroma). The primary tumor in the appendix was discovered 10 months later at the time of a "second look" laparotomy. The ovarian metastasis showed both goblet cell elements and tubular formations with numerous argyrophilic cells, indicating that both components of these tumors may metastasize, a finding at variance with the conclusions of some authors who suggest that only the mucinous component may metastasize. Theories of histogenesis of these tumors are discussed, and 12 previously reported cases presenting as Krukenberg tumors (all bilateral) are reviewed. Because the primary tumor in the appendix may be small and easily missed, appendectomy is recommended in all patients with Krukenberg tumors when another primary site cannot be identified at the time of surgery.