The incidence and treatment of intestinal and urological complications after combined radiotherapy for uterine carcinomas.

OPNE HUNDRED AND SIXTY-FOUR PATIENTS WITH GYNECOLOGICAL CARCINOMAS (104 ca colli uteri, 60 cacorporis uteri) were examined retrospectively two to seven years after combined internal-external radiotherapy. Thirty-seven per cent of the patients displayed mild intestinal symptoms during the therapy. The frequency of symptoms remained unchanged after the termination of therapy, though they tended to become more severe. Twenty-five per cent of the patients had urological symptoms during the therapy. Their rate remained the same during the arly follow-up, but increased subsequently, because the frequencies of infections and hematuria had increased. Fourteen patients developed a complication requiring operative treatment five to fifty-seven months after the discontinuation of therapy. Three of them had both intestinal and urological complications, while six had only urological complications. The intestinal complications were repaired with smallgut resections and colostomies, while the urological complications (ureteral strictures) were repaired with different diversion operations with good operative results. Thirteen of the patients with serious complications are alive. One patient had died of profuse rectovaginal bleeding. The mean radiation doses employed were not different in the group with serious complications. Evleven of the patients with complications suffered from different concurrent diseases, which may have diminished their radiation tolerance. The radiotherapy of gynecological malignancies ought to be preformed individually noticing the intestinal reactions during the therapy and the concurrent disease. The value of renography in early detection of urinary tract complications is stressed.

Effects of high-dose medroxyprogesterone treatment given for endometrial carcinoma on carbohydrate metabolism and liver function.

PIP: 16 patients with carcinoma of the endometrium were treated with 50-mg medroxyprogesterone im twice daily for 1 year and studied to determine what effect this high dose of progesterone had on carbohydrate metabolism and liver function. Oral glucose tolerance values (fasting and 2 hour) were significantly elevated (p less than .001) at 12 and 18 months. Conjugated bilirubin was significantly elevated (p less than .01) at 18 months, aspartate aminotransferase was significantly elevated (p less than .001) at 12 and 18 months. Insulin values were raised transiently at 3 months. It is conluded that the changes in carbohydrate and liver function were small, appeared slowly, and included only a few pathologically elevated values; consequently the use of high-dose progestogen treatment for a 1-year period is considered safe.^ieng

Effects of high-dose medroxyprogesterone given for endometrial carcinoma on serum proteins.

PIP: 29 women with endometrial cancer were treated with 50-mg medroxyprogesterone twice daily for 1 year and studied to determine what effect this dose of progesterone had on serum proteins. Total serum proteins were significantly (p less than .01) elevated at 3 months until 6 months after treatment. There was a transient decline in albumin at 1 month (p less than .01) which reelevated after 3 months. Alpha-1-globulin and alpha-2-globulin increased at the beginning of therapy (p less than .001 at 1 month) and returned to pretreatment levels at the end of therapy. Gamma globulin levels were significantly less after 1 year of therapy. Alpha-1-acid-glycoprotein was significantly elevated at 1 month and returned to normal after therapy ended. These protein levels are compared with those in pregnancy and during oral contraceptive therapy. It is concluded that these changes are smaller and even the reverse of those seen in pregnancy and oral contraceptive therapy; the changes are attributed to the effect of sex hormones on hepatic metabolic activities.^ieng

Hazards of grand multiparity.

PIP: The authors report the special obstetric characteristics of grand multiparas (GMs) and the extent to which the parturient's age affected the incidence of complications. 8 deliveries were chosen as the minimum of deliveries for classifying parturients as GMs in this study. In a series of 1567 deliveries over 10 years in the same hospital in Oulu, Finland, differences were noted between the obstetric behavior of GMs as compared with other parturients. Hypertensive disease was distinctly more frequent among GMs than among the other parturients (p0.001). The frequency of abruptio placentae, placenta previa, and retained placenta was also significantly higher in GMs. Although the difference was not statistically clear in this study, the incidence of uterine rapture has been reported to be higher in GMs than in other parturients. Unlike the majority of reports, this study showed breach presentation to be less frequent among GMs. The incidence of operative deliveries was roughly similar in both groups. Caesarean section, including repeat sections, was distinctly lower among GMs (p0.01). The maternal mortality rate of GMs in the series was significantly (p0.01) higher than that of the other parturients (.12%). The primary causes of death were abruptio placentae (0.19%), rupture of the uterus (0.12%), and eclampsia (0.06%); a state of shock was a feature common to all the fatalities. No difference appeared in the incidence of multiple pregnancy, nor in the incidence of prematurity. The difference in number of stillbirths was not statistically demonstrable between GMs (3.71%) and other parturients (2.68%). The incidence of hypertensive disease was definitely correlated to age, whereas high parity played a small part. Abruptio placenta is affected both by high parity and age; placenta previa is independent of age and predisposed by high parity. Under careful supervision and proper treatment, the GM, despite the higher risk of complications, does not run a greater risk of mortality than other parturients.^ieng