Treatment of cervical-carcinoma by wertheim-meigs surgery - long-term follow-up results in a well-defined Swedish region.

In a retrospective analysis of a complete geographic series of cervical carcinomas treated by Wertheim-Meigs radical surgery, a number of important prognostic factors were evaluated and long-term survival data are presented. In all, 367 women with FIGO stage I-II tumors were included. The main histopathologic types were squamous cell carcinoma in 84% and adenocarcinoma in 12%. The mean age of the patients was 42.5 (range 19-68) years. In 125 women (34%), adjuvant radiotherapy was administered pre- or postoperatively. The median period of follow-up was 12 (range 2-27) years. In 88% of the specimens surgery (93% in stage I and 66% in stage II) was classified as radical with regard to the excision margins. This was an important and highly significant prognostic factor. If the margins were wide and free of tumor, the 10-year survival rate was 93%, but if margins were infiltrated by the tumor, the survival rate was 14%. Pelvic lymph node involvement was recorded in 52 cases (14%). The frequency of lymph node spread was associated with tumor stage (IA O%, IB 14%, IIA 32%). The probability of survival of the complete series was 93% at 5 years and 84% at 10 years. In cases of lymph node involvement, the 10-year survival rate was 57%. The preoperative tumor stage had a highly significant influence on long-term tumor-specific survival. Tumor grade was also a significant prognostic factor, but not the histologic type (squamous, adenosquamous, or adenocarcinoma). Age and parity were also insignificant prognostic factors. The tumor recurred in 59 cases (16%). The mean time to relapse was 28 months. The 10-year survival was 29% for this group of patients. Peroperative complications were recorded in 50 patients (14%). Excessive bleeding (11%) and urinary tract injuries (3%) were most frequent. Postoperatively, 101 patients (28%) had some kind of complication associated with the surgical procedure. Surgical complications were more frequent among women over 50 years of age. Bladder dysfunction (11%) and obstruction of the ureter (8%) were recorded most frequently. In 19 cases (5.2%), urinary tract or intestinal fistulas were diagnosed during the period of follow-up. With increasing experience of the surgeons and fewer stage II tumors, the frequency of fistulas associated with the surgical procedure decreased to 2.4% during the latter part (1975-90) of the period. Adjunctive postoperative radiotherapy increased the risk of late complications. In 8 cases (6.4%), serious complications associated with the combination of surgery and radiotherapy were reported.

Fibrinopeptide A and intravascular coagulation in normotensive and hypertensive pregnancy and parturition.

Fibrinopeptide A (FpA), fibrin monomers, fibrinogen, fibrin degradation products (FDP) aand platelets have been studied during pregnancy, parturition and during toxemia and compared with normal non-pregnant controls in order to evaluate thrombin activity under these conditions. We found a significant rise in fibrinopeptide A levels in late pregnancy and even more so during parturition with a maximum immediately after placental expulsion. We also found elevated FpA levels in toxemic patients, but no significant differences from normal pregnancies. Fibrin monomers were more often elevated during delivery and toxemia during normal pregnancy. One case report concerning a patient with deficient thrombin activation and heavy postpartum bleeding is added. Our studies indicate an increased thrombin activity and fibrinogen turnover in both normal and toxemic pregnancies. During normal childbirth, coagulation activity seemed to reach a maximum immediately after placental separation.

alpha 2-Antiplasmin and alpha 2-macroglobulin--the main inhibitors of fibrinolysis--during the menstrual cycle, pregnancy, delivery, and treatment with oral contraceptives.

alpha 2-Antiplasmin and alpha 2-macroglobulin have been studied during the menstrual cycle, pregnancy and parturition in healthy women, and during use of various types of contraception in both healthy and diabetic women, and compared with a reference group of healthy men and women. alpha 2-Antiplasmin showed a slight sex difference, with higher values in women. The luteal phase of the menstrual cycle showed slightly higher values than the other phases. alpha 2-Antiplasmin increased during pregnancy, decreased (probably due to consumption) during labor and increased again in the puerperium. Treatment with neither combined contraceptive pills nor low dose progestogen pills gave any changes in alpha 2-antiplasmin. alpha 2-Macroglobulin showed low values during menstruation. The increase during pregnancy and treatment with combined contraceptive pills is in accordance with earlier findings. It is concluded that synthesis and metabolism of alpha 2-antiplasmin are under hormonal influence. The role of alpha 2-antiplasmin in the decreased fibrinolysis in pregnancy is discussed.

Determination of fast-acting plasmin inhibitor (alpha2-antiplasmin) in plasma from patients with tendency to thrombosis and increased fibrinolysis.

The physiologically important alpha2-antiplasmin has been measured by aid of a chromogenic tripepetide substrate. Low values in patients' plasmas are found in situations with increased fibrinolysis such as streptokinase therapy and liver cirrhosis, whereas high values are found postoperatively, postpartum and after an acute thrombosis.