Risk factors for a complicated clinical course among women hospitalized with pelvic inflammatory disease.

The aim of this study was to identify factors ascertainable at initial presentation that predict a complicated clinical course in HIV-negative women hospitalized with pelvic inflammatory disease (PID). We used data from a cross-sectional study of women admitted for clinically diagnosed PID to a public hospital in New York City. A complicated clinical course was defined as undergoing surgery, being readmitted for PID, or having a prolonged hospital stay (> or = 14 days) but no surgery. Logistic regression was used to identify independent predictors of complications. In adjusted analyses, older age (> or = 35 years) was a risk factor for prolonged hospital stay (adjusted odds ratio [OR] = 3.9; 95% confidence interval [CI] = 1.3-11.6) and surgery (OR = 10.4; CI = 2.5-44.1); self-reported drug use was a risk factor for readmission for PID (OR = 7.7; CI = 1.4-41.1) and surgery (OR = 6.2; CI = 1.8-20.5). Older age and self-reported drug use appear to be independent risk factors for a complicated clinical course among women hospitalized with PID.

Kaposi sarcoma presenting as a vulvar mass.

BACKGROUND: Kaposi sarcoma has become a common manifestation in people with AIDS, especially men. A few reports of Kaposi sarcoma in women with AIDS have involved nongenital areas. However, of the few patients with genital Kaposi sarcoma reported in the United States, none was believed to be human immunodeficiency virus (HIV)-positive. Genital Kaposi sarcoma associated with HIV has been reported in other parts of the world. CASE: A 29-year-old black woman presented with severe vulvar pain, vaginal discharge, and a vulvar mass. She had been diagnosed with AIDS 25 months earlier. Biopsy of the vulvar mass revealed Kaposi sarcoma; viral analysis of the tumor was positive for herpes simplex virus type 2. Sequencing of polymerase chain reaction product verified the presence of human papillomavirus 26. CONCLUSION: We report an HIV-associated Kaposi sarcoma presenting as a vulvar mass. This report should alert health care providers to include Kaposi sarcoma in the differential diagnosis of vulvar lesions.

Prognostic factors in malignant mesodermal (mullerian) mixed tumors of the uterus.

Clinicopathologic studies of 16 homologous and 19 heterologous malignant mesodermal (Mullerian) mixed tumors of the corpora uteri showed that homologous tumors were more common in black women than in white women; in the former, tumors were diagnosed at a younger age and in more advanced stages than in the latter. Fifty-five percent of women with clinical stage I disease had a higher surgicopathologic stage. The most significant prognostic factors were pathologic extent of disease and vascular invasion in the myometrium. There was no difference in outcome between homologous and heterologous tumors. Initial surgery for staging is essential for the adequate evaluation and treatment of these patients.

Vascular invasion in Stage I carcinoma of the cervix.

Vascular invasion was identified as an important prognostic variable for all lesion sizes in 138 patients with Stage I cervical carcinoma. A matched pairs analysis, controlling for lesion size and extracervical spread, showed that vascular invasion was significantly associated with poor outcome. Regression analysis also indicated that vascular invasion contributed prognostic information beyond that available from lesion size and extracervical spread. Studies of adjunctive therapy based on the prognostic variables are recommended.

5-fluorouracil/chemosurgery for intraepithelial neoplasia of the lower genital tract.

Sixteen patients with lower genital intraepithelial neoplasia were treated by 5-fluorouracil (5-FU)/chemosurgery: colposcopically directed excision of neoplastic epithelium pretreated with topical 5-FU. 5-FU loosens the neoplastic epithelium, facilitating its removal from the underlying stroma in a safe, minimally traumatic fashion. 5-FU/chemosurgery was undertaken in patients with vaginal neoplasia or those with lower genital neoplasia who were immunosuppressed or had a neoplastic syndrome, because conventional methods are often difficult or inadequate for these problems. In all 16 patients, the neoplasia went into remission. Two immunosuppressed patients developed recurrences of lesser dysplasia when 5-FU maintenance therapy was interrupted because of pregnancy. It was found that 5-FU/chemosurgery, followed by monthly 5-FU maintenance, may be the best treatment for intraepithelial neoplasia of the vagina or lower genital intraepithelial neoplasia in patients who are immunosuppressed or have a neoplastic syndrome.

Ureterovaginal fistula as a complication of radical pelvic surgery.

The main objection to radical hysterectomy and pelvic node dissection as a method of primary treatment for cervical carcinoma is the inherent danger to the ureters that may result in ureterovaginal fistula formation. The purpose of this paper is twofold: (1) to show that with adoption of certain surgical and clinical measures our incidence of fistula formation has been significantly reduced, and (2) to discuss the management of ureterovaginal fistula when it occurs.

The barrel-shaped cervical carcinoma.

Twelve patients had barrel-shaped cervical carcinoma among 493 new patients with primary invasive cervical carcinoma, at the Downstate Medical Center, New York from January, 1964 to December, 1972. The incidence of barrel-shaped lesions among invasive carcinoma of the cervix was 2.43%. All 12 patients were treated with external radiation to the whole pelvis followed by two radium applications. In six patients an extrafascial hysterectomy was performed 6 to 12 weeks after radiation. Six patients died and six survived (50%). Six patients survived for over 2 years after therapy with no evidence of recurrence. Of these, four are alive and well for over 5 years. All six patients died within 20 months after therapy. The barrel-shaped cervical carcinoma fared poorly (six deaths among 12 patients or 50%) when compared with the over-all Stage I and Stage II cervical carcinoma (87 deaths among 339 patients or 25.5%).