Surgery for diverticular disease results in a higher hernia rate compared to colorectal cancer: a population-based study from Ontario, Canada.

BACKGROUND: Incisional hernias are a well described complication of abdominal surgery. Previous studies identified malignancy and diverticular disease as risk factors. We compared incisional hernia rates between colon resection for colorectal cancer (CRC) and diverticular disease (DD). STUDY DESIGN: We performed a retrospective, population-based, matched cohort study. Provincial databases were linked through the Institute for Clinical Evaluative Sciences. These databases include all patients registered under the universal Ontario Health Insurance Plan. Patients aged 18-105 undergoing open colon resection, without ostomy formation between April 1, 2002 and March 31, 2009, were included. We excluded those with previous surgery, hernia, obstruction, and perforation. The primary outcomes were surgery for hernia repair, or diagnosis of hernia in clinic. RESULTS: We identified 4660 cases of DD. These were matched 2:1 by age and gender to 8933 patients with CRC for a total of 13,593. At 5 years, incisional hernias occurred in 8.3% of patients in the CRC cohort, versus 13.1% of those undergoing surgery for DD. After adjusting for important confounders (comorbidity score, wound infection, age, diabetes, prednisone and chemotherapy), hernias were still more likely in patients with DD [HR 1.58, 95% Confidence Interval (CI) 1.43-1.76, P < 0.001]. The only significant covariate was wound infection (HR 1.63, 95% CI 1.43-1.87, P < 0.001). CONCLUSION: Our study found that incisional hernias occur more commonly in patients with DD than CRC.

An evaluation of routine follow-up of patients treated for endometrial carcinoma.

This retrospective review evaluates the outcome benefit of a standard follow-up protocol for 435 patients treated for endometrial carcinoma between 1981 and 1986. Routine follow-ups consisting of physical examinations and vaginal cytologies were done every 3 months for the first year, 4 months for the second year, and 6 months thereafter. Chest X rays were done biannually. Demographic, histopathologic, therapeutic, and follow-up data were studied. Exclusions due to incomplete follow-up (70), persistent disease (40), or other primary malignancies (8) left 317 patients with a disease-free state assigned to follow-up. Recurrences developed in 53 patients being followed, 40 (75%) of whom were symptomatic. Family physicians primarily diagnosed recurrences in 34 patients while recurrences in only 11 of the 53 patients (21%) were detected on routine follow-up at the cancer center (5 by examination and 6 by chest X ray). Therefore, only one recurrence was detected for every 206 routine follow-up visits. Vaginal vault cytology was not diagnostic in any patient. Seventy percent of recurrences occurred within 3 years. There was no statistical difference in survival between the group detected on routine follow-up and those who were symptomatic (P = 0.55). Routine follow-up of patients treated for endometrial cancer did not improve detection of recurrences or survival.

Experimental demonstration of an automatic alignment system for optical interferometers.

An automatic alignment system, based on a differential phase-sensing technique described in a companion paper [Appl. Opt.33, 0000, (1994)], has been experimentally demonstrated on the 10-m prototype laser interferometric gravitational wave detector in Glasgow. The alignment system developed was used to control the orientations of two mirrors in a 10-m-long suspended Fabry-Perot cavity with respect to the direction defined by the input laser beam. The results of the test and a discussion of the performance of the system are given.

Automatic alignment of optical interferometers.

We present a description of a system for automatic alignment of optical interferometers. The technique relies on using differential phase modulation to permit the detection of the phase difference between two fundamental-mode Gaussian beams at the output of an interferometer. Measurements of the spatially varying phase difference between the two beams by use of one or more multielement photodiodes permits information to be derived about the mismatch in overlap between the phase fronts at the output of the interferometer.

Tubo-ovarian abscess containing tapeworm proglottids and ova: a case report.

We report a case of pelvic inflammatory disease complicated by a tubo-ovarian abscess containing Taenia spp. proglottids and ova which migrated through a fistula with the sigmoid colon.

Estrogen and progesterone receptor, human papillomavirus, and DNA ploidy analysis in invasive carcinoma of the cervix in pregnancy.

From 1980 to 1991, 13 patients had pregnancy-associated invasive carcinoma of the cervix: four carcinomas were stage IA; eight were stage IB; and one was stage IVB. Gestational ages range from 8 weeks to 3 months postpartum. Two patients are dead of disease and a third is alive with metastases. Results of immunoenzyme studies for estrogen receptors (ER) were variably positive in all except one tumor, whereas results of studies for progesterone receptors (PR) were uniformly negative. Thus, these hormone receptor studies are unlikely to be of prognostic significance. Six tumors contained human papillomavirus (HPV) DNA by in situ or dot blot hybridization (three, HPV 16; two, HPV 18; one, HPV 31/33/35). Thus, neither ER nor PR expression appears to be related to the infecting HPV type. Using flow cytometry, three tumors were determined to be aneuploid and a fourth, tetraploid. To correlate HPV or DNA flow cytometry data with prognosis will require study of larger numbers of patients from multiple centres.

Verrucous carcinoma of the genital tract: is it a distinct entity?

Between 1974 and 1985, 16 patients (7 men, 9 women) with a diagnosis of genital verrucous carcinoma were identified from the cancer registry of the Tom Baker Cancer Centre in Calgary. All the men had lesions on the penis. In the women, five lesions were on the vulva, four were on the cervix and two were on the vagina (two women each had two involved sites). The histologic slides from the surgically excised specimens were reviewed, and, by applying strict criteria, all cases could be reclassified as giant condyloma (five cases), intraepithelial neoplasia with or without condylomatous features (eight cases) or invasive squamous cell carcinoma (five cases). The authors believe that, in genital lesions associated with the human papillomavirus, a diagnosis of verrucous carcinoma is nonspecific and may lead to inappropriate clinical management.

Malakoplakia of the omentum and endometrium.

A rare case of malakoplakia involving the omentum and endometrium is presented. This is the first documented case of malakoplakia in the Thai population.

Changing terminology and screening recommendations in cervical cytology screening programs.

In summary, we have presented proposed new diagnostic terminology and screening frequencies for cervical cytology with some of the surrounding debate. As Thailand develops its own cervical screening program for squamous cell carcinoma, an awareness of these new recommendations may help in the design of a local program in the most cost effective manner.

Laser therapy of vulvar lichen sclerosus et atrophicus.

Seven patients with a histologic diagnosis of lichen sclerosus et atrophicus of the vulva were treated by laser ablation of the affected area to a depth of 1.0 to 2.0 mm. The inpatient procedure was performed under general anesthesia with a carbon dioxide laser unit. Healing was complete 6 weeks postoperatively. All but one patient was free of recurrent symptoms at follow-up, which ranged from 12 to 37 months. Laser ablation is an acceptable treatment for patients who have symptoms due to lichen sclerosus of the vulva that are refractory to other measures.

Cervico-vaginal screening in an STD clinic.

From May 1986 to March 1988, there were 3,622 "new" female clients at the Calgary Sexually Transmitted Disease (STD) Clinic of whom 2,278 registered for the first time. A cervico-vaginal (Pap) smear was obtained from those who had not had one in the previous 6 to 12 months and any history of venereal warts (VW) was recorded. 621 smears were accessed of which 611 were suitable for inclusion in this study. 65 (10.6%) smears revealed human papillomavirus (HPV) and/or cervical intraepithelial neoplasia (CIN). Any history of VW increased the likelihood of an abnormal smear by 5.3 times. Those with currently visible VW were more likely (8.8 times) to have an abnormal smear than those with a past history (3.5 times). These data re-affirm the recommendation of the first "Walton Report" that Pap smears should be obtained in STD Clinics.

Evaluation of surgical staging in stage I low malignant potential ovarian tumors.

The charts and pathology specimens of 27 patients with ovarian tumors of low malignant potential were reviewed in an attempt to document the rationale for a second laparotomy in those patients with clinical stage 1 disease and who did not have a complete staging laparotomy at their initial surgery. Four of 13 patients with serous tumors, none of 12 patients with mucinous tumors, and one patient with a mixed tumor of LMP were upstaged at the staging laparotomy. The major morbidity rate associated with the procedure was 7.4%. The low yield of a staging laparotomy in patients with mucinous tumors (0%) does not warrant a second operation. The higher yield of a staging laparotomy in patients with serious tumors (30.8%) suggests that the likelihood of upstaging the disease exceeds the potential morbidity, and for this reason, the procedure may be warranted. However, the specific role of a staging laparotomy even in those with serous tumors awaits further study of the prognostic significance of invasive versus noninvasive implants.

Occurrence of Pneumocystis carinii organisms in a peritoneal effusion from a patient with the acquired immunodeficiency syndrome.

We describe a unique case of Pneumocystis carinii organisms within a peritoneal effusion of a patient with acquired immunodeficiency syndrome (AIDS). The patient, a 28-yr-old homosexual male with profound immunosuppression, presented with splenomegaly and ascites. A peritoneal tap was performed for diagnostic purposes. Cytologic examination of the cytospin specimen showed reactive mesothelial cells along with aggregates of debris reminiscent of the foamy exudates seen in the alveoli of lungs infected with the Pneumocystis carinii organism. A modified methanamine silver stain was performed and revealed the presence of scattered Pneumocystis carinii in the specimen. Extrapulmonary Pneumocystis carinii infection is occasionally seen in AIDS, but we could find no other reports of its detection in peritoneal fluid.

Malignant transformation occurring in mature cystic teratomas of the ovary.

Two cases in which tumours of contrasting malignant potential arose in mature cystic teratomas (dermoid cysts) of the ovary are presented: one patient had a spindle-cell sarcoma and the other a trabecular carcinoid. The first patient's clinical course was characterized by rapid recurrence of the tumour and death 3 months after surgery. The second patient is alive and well with no evidence of residual carcinoid, although the follow-up time is short. Since the surgical procedure of choice differs substantially if malignant transformation occurs in an ovarian dermoid cyst, the pathologist should be consulted intraoperatively in selected cases.

Nonisotopic human papillomavirus DNA typing of cervical smears obtained at the initial colposcopic examination.

To determine the prevalence of human papillomavirus (HPV) infection in 401 patients attending colposcopy for the first time, scraped cervical cells were investigated using dot blot hybridization and biotinylated DNA probes to HPV 6 and 11 (low-risk types) and 16, 18, and 33 (high-risk types). The HPV DNA was isolated from 52% of patients (low-risk types = 4%, high-risk types = 48%). Seventy-five percent had a cervical intraepithelial neoplasia (CIN)-condyloma. Low-risk types were infrequent (7%) and high-risk types (41%) predominant in condyloma/CIN I lesions when converse rates were expected. As CIN I lesions harboring high-risk types are at some risk of progressing to a higher grade dysplasia, colposcopic examination and treatment of this subgroup would seem justified. As expected, high-risk types were statistically associated with increasing grades of dysplasia. This hybridization method identified typeable HPV DNA in 60% of patients with a CIN-condyloma, and highlighted a unique HPV profile for this patient cohort.

Intestinal differentiation in ovarian mucinous tumours.

Fifty-five ovarian mucinous tumours, 22 benign, 16 borderline and 17 malignant, were examined for intestinal differentiation (ID). This was defined by the presence of one or more of endocrine, absorptive, goblet or Paneth cells, and identified by routine haematoxylin and eosin as well as histochemical and immunoperoxidase techniques. Twenty benign (91%), 14 borderline (88%) and all malignant tumours contained foci of ID. The frequency of ID was not significantly different between the mucinous tumour types (chi-squared test for independence). Follow-up was available on all patients with borderline tumours: 14 were stage Ia, including both cases without ID, and 2 were stage Ic at presentation. All are alive and free of disease at 9-39 months (median 15.5 months). We conclude that the presence of ID in borderline mucinous tumours is unlikely to be of prognostic significance, and that a subdivision of these tumours into müllerian and intestinal types is unnecessary.

Ependymoma of the uterosacral ligament.

Extraspinal ependymomas have been described in the subcutaneous sacrococcygeal and presacral areas. Since 1984, eight pelvic ependymomas have been reported that have originated in the ovary, broad ligament, mesovarium, and omentum. This report documents an additional case arising from the right uterosacral ligament in a 48-year-old woman. The diagnosis of ependymoma was supported by a histologic pattern of true rosettes and pseudo-rosettes, glial fibrillary acidic protein (GFAP) positivity, and electron microscopic findings of cilia, blepharoplasts, and intermediate filaments. The tumor was positive for cytokeratin and vimentin. Ultrastructurally, neurosecretory granules were present within the cytoplasm. These features have not been described previously in pelvic ependymomas. These tumors, although easily confused with serous papillary carcinoma, should be distinguished from serous papillary carcinoma because of their apparently better prognosis and tendency for late recurrence.

Non-isotopic detection of HPV DNA in cervical smears using dot-blot hybridization.

Infection of the cervix with specific types of the human papillomavirus (HPV) results in condylomatous, dysplastic and/or neoplastic epithelial changes. To enable routine screening of premalignant cervical lesions for HPV DNA, we have developed a sensitive method of detecting HPV -6, -11, -16, -18 and -33 in cervical scrapes using a non-isotopic, dot-blot hybridization assay. Cloned, genomic HPV DNA is labelled with biotin-11-dUTP by nick translation, and used to screen for HPV types under high stringency conditions. DNA is extracted from cervical cells and spotted on nitrocellulose membranes. Cervical cells, from 20 patients attending colposcopy were screened for HPV types. All patients had a dysplasia or condyloma. HPV DNA was isolated from 80%. The method visualized an amount of target DNA as low as 1 pg without background. Compared with Southern blot hybridization utilizing radiolabelled probe, this assay is equally sensitive and specific. The technique is easy to do, and may significantly contribute to the management of cervical dysplasia.

Human papillomavirus DNA determination of anal condylomata, dysplasias, and squamous carcinomas with in situ hybridization.

Infection with types 6, 11, 16, and 18 of the human papillomavirus (HPV) is associated with condylomatous, dysplastic, or carcinomatous changes in the genital tract. Emerging evidence suggests that a similar series of lesions develops in the anal canal after exposure to the same HPV types. In situ hybridization was performed with the use of biotinylated DNA probes to HPV 6, 11, 16, and 18, so as to determine the frequency of HPV DNA in 45 perianal and/or anal condylomata, 6 anal intraepithelial neoplasias, and 13 anal squamous cell carcinomas. Of the 33 perianal and/or anal condylomata in which HPV DNA was detected, 13 contained HPV 6 and 11, 12 HPV 6, 7 HPV 11, and 1 HPV 6, 11, and 18. Two of four severe anal dysplasias contained HPV 16, whereas one case each of mild and moderate anal dysplasia contained HPV 6. No HPV DNA was detected in the anal squamous cell carcinomas. The study demonstrated the presence of HPV DNA in 73% of condylomata and 67% of anal dysplasias. The observations suggest that the cloacogenically derived anal epithelium is susceptible to infection by the same HPV types as infect the similarly derived epithelium of the lower female genital tract and that these HPV types result in some similar lesions, i.e., condylomata and dysplasias in both sites. A role in the genesis of anal cancer was not found in this study.

The cytokeratin profiles of ovarian common "epithelial" tumors.

An improved immunohistochemical determination of the cytokeratin profiles of epithelia and their neoplasms is possible using monoclonal antibodies that will either identify all 19 cytokeratins (AE1/3) or delineate specific subsets (35 beta H11, 34 beta E12, 34 beta B4 and Cam 5.2). Ovarian common "epithelial" tumors (CET) contain cytokeratin filaments. To determine the nature and differences in the cytokeratin profiles of ovarian CET, eight benign Brenner tumors, four serous cystadenofibromas, 28 mucinous tumors, 27 serous tumors and six endometrioid, five clear cell and five undifferentiated carcinomas, as well as nine normal ovaries were immunostained with the above five antibodies. AE1/3 staining was predominant, while Cam 5.2 and 35 beta H11 displayed the most frequent staining thereafter. Statistically significant staining differences were found between a number of tumor groups using the antibodies 35 beta H11, 34 beta E12 and Cam 5.2. In this study, all ovarian CET, except the benign Brenner tumors, displayed a predominantly low molecular weight cytokeratin profile. The same profile in the normal surface epithelium lends credence to the belief that these tumors are derived from this epithelium. A significant staining difference between some of the tumor types using some of the antibodies suggests a possible ancillary, diagnostic role of cytokeratin profiling in situations where exact tumor typing is difficult.