Naturally occurring apicomplexan acute interstitial pneumonitis in thick-billed parrots (Rhynchopsitta pachyrhyncha).

This report describes acute interstitial pneumonitis due to an apicomplexan parasite with schizogony in endothelial cells of pulmonary vessels accompanied by early and metrocyte stages of sarcocysts in the heart of a thick-billed parrot (Rhynchopsitta pachyrhyncha). The pattern of this disease is similar to that of the acute phase (approximately 10-15 days postinoculation) of experimental infections of budgerigars, Melopsittacus undulatus, with high doses of sporocysts of Sarcocystis falcatula.

Pathology of experimental Sarcocystis falcatula infections of canaries (Serinus canarius) and pigeons (Columba livia).

Sarcocystis falcatula is an apicomplexan parasite with a broad range of avian intermediate hosts. The pathology and pathogenesis of infection with this parasite has been studied experimentally in the budgerigar (Melopsittacus undulatus). The present study quantitatively examines the pathology of this parasite in canaries (Serinus canarius) and pigeons (Columba livia) and compares it with that found in budgerigars. The general progression of merogony and cyst formation is similar qualitatively to that seen in budgerigars, but it differs quantitatively. The principal site of precystic merogony is in pulmonary endothelial cells. The magnitude of pulmonary meront burdens (at similar inoculated dosages) varies in different intermediate host species. Merogony is less persistent than in budgerigars. Among the various species of birds, the magnitude of precystic merogony correlates differently with the magnitude of skeletal muscle cyst burdens. The distribution of cyst burdens among various muscles also differs. The composition of inflammatory cells differs among various avian species' response to S. falcatula. Pathologic changes quantitatively parallel tissue meront burdens (except possibly in the liver of canaries), resulting in an interstitial pneumonitis, hepatitis, and mild inflammatory lesions of other organs.

Necessity for endocervical curettage in elderly women undergoing colposcopy.

A retrospective study of 164 women aged 45 and older undergoing colposcopy for abnormal Papanicolaou smears showed that 49% had adequate colposcopy and 51%, inadequate colposcopy. Of those with adequate colposcopy, 23% had positive endocervical curettage (ECC). That finding required conization, which detected one case of microinvasive and two of invasive cervical carcinoma. Of those with inadequate colposcopy, 64% had positive ECC. All patients with inadequate colposcopy underwent conization, which detected 4 cases of microinvasive and 11 of invasive carcinoma. Therefore, women with inadequate colposcopy had a higher risk of invasive disease. ECC is a necessary step in the colposcopic evaluation of elderly women.

Carcinoma in situ of the vulva. A clinicopathologic study of 50 cases.

The authors reviewed 50 cases of carcinoma in situ of the vulva treated at the University of Texas Medical Branch, Galveston, from 1975 to 1984. Sixty-two percent of the patients were premenopausal. The most frequent complaint was vulvar itching. Twenty-six percent of the patients were asymptomatic. Recurrences were frequent (25%) and were associated with multifocal lesions, involved surgical margins and the bowenoid histologic type. Superficially invasive carcinoma was detected in 8% of patients, mostly postmenopausal women with simplex histologic types. Immunohistochemical studies failed to detect papillomavirus- or herpesvirus-associated antigens in any of the cases. Follow-up of 48 patients from six months to ten years revealed no mortality from invasive cancer.

Necessity of endocervical curettage in colposcopy.

The use of endocervical curettage was evaluated in 200 patients undergoing colposcopy, biopsy, endocervical curettage, and conization. It is suggested that endocervical curettage be performed only in cases of satisfactory colposcopy, since patients with unsatisfactory colposcopy should undergo conization.

Ovarian steroid secretion in postmenopausal women with and without endometrial cancer.

The concentrations of testosterone (T), androstenedione (A), estradiol (E2), and estrone (E1) were measured in peripheral and ovarian venous serum obtained at the time of bilateral oophorectomy from 15 postmenopausal women with endometrial cancer and 9 without cancer. The cancer and noncancer (control) patients were matched for age, weight, and years since menopause. In women with endometrial cancer, significantly higher ovarian than peripheral venous concentrations were found for all hormones measured [T, 3781 +/- 1255 (+/- SE) vs. 213 +/- 43 pg/ml (P less than 0.01); A, 5352 +/- 1845 vs. 1299 +/- 187 pg/ml (P less than 0.04); E2, 52 +/- 11 vs. 23 +/- 3 pg/ml (P less than 0.02); E1, 81 +/- 12 vs. 32 +/- 2 pg/ml (P less than 0.001)], but in the control patients, only the concentration of T was significantly higher (623 +/- 108 vs. 156 +/- 21 pg/ml; P less than 0.001). Ovarian venous concentrations of T and A were significantly higher in thin women with cancer than in obese women with cancer. These results suggest that the ovaries of postmenopausal women with endometrial cancer secrete significantly more T and A than do the ovaries of women without cancer, while secreting only minimal amounts of E2 and E1. This increase in ovarian steroid secretion might play a role in the pathogenesis of endometrial cancer.

Frozen section evaluation of cervical conization specimens.

Frozen section evaluation was done on 96 conization specimens. One patient had invasive carcinoma, which was correctly diagnosed on frozen section. No patient received inappropriate therapy on the basis of an erroneous diagnosis made from the evaluation of frozen sections. The mean time from initiation of surgery to the surgeon's receipt of the frozen section diagnosis was 0.9 hours. There was no significant increase in the blood loss or intraoperative complication rate when frozen conization was added to either abdominal or vaginal hysterectomy.

Bleomycin, vincristine, and methotrexate with citrovorum factor rescue in the treatment of advanced squamous cell carcinoma of the cervix.

Fourteen patients with advanced or locally recurrent squamous cell carcinoma of the uterine cervix were treated with bleomycin, vincristine, and moderately high dose methotrexate with citrovorum rescue. Two patients (14%) had a partial response; no patient had a complete response. Two patients were felt to have significant bleomycin associated pulmonary toxicity. This chemotherapy regimen is not felt to be clinically useful in our patient population.

The colposcopy clinic in a residency training program. Five years' experience with colposcopically directed biopsies followed by conization or hysterectomy.

Five hundred fifty-four patients with abnormal cytologic smears were screened in a special clinic by gynecology residents under faculty supervision using colposcopy and biopsies. Two hundred fifty patients who were evaluated by colposcopy subsequently had conization or hysterectomy. Colposcopically directed biopsies were accurate (comparable to the surgical specimen) in 92%. Three patients had invasive cancer high in the endocervical canal that was found by conization after endocervical curettage and colposcopy had indicated less-severe disease. Persistent or recurrent dysplasia was found in approximately 5% after conization and in none after hysterectomy. Because 23% of patients were lost to follow-up after treatment and an additional 19% had inadequate follow-up, management of CIN III with local destruction (cryocautery, electrocautery, laser) does not seem advisable.

Carcinoma of the cervix: surgical staging and radiotherapy with 32 MeV betatron.

Fifty-six patients with squamous cell carcinoma of the cervix were staged by exploratory laparotomy. Twenty-eight of them received radiotherapy with 32 MeV Betatron and intracavitary radium. Twenty-one patients with Stage IB or IIA had a radical hysterectomy, five had post-operative pelvic irradiation, and two had primary exenteration. An overall 23.2% of patients had metastases in the paraaortic fields. Four patients with paraaortic node disease received extended field irradiation: 4500 rad in 5 weeks to paraaortic nodes. Two of them are alive and disease-free at 5.5 to 6.5 years.