Sacrospinous colpopexy.

Sacrospinous colpopexy is a useful procedure in the cure of pulsion enterocele, high rectocele, and posthysterectomy vault prolapse. It allows the surgeon to correct coincident cystocele and rectocele and permits restoration of a relatively normal and comfortable vaginal depth and axis. It is a quick procedure, avoids intraabdominal trauma, has a high success rate and a low complication rate (1) and is useful in the management of patients who wish to maintain coital function. This paper retrospectively reviews the techniques, results and complications of 107 sacrospinous colpopexies performed in 104 patients over an 8-year interval.

Proton MR and human cervical neoplasia: ex vivo spectroscopy allows distinction of invasive carcinoma of the cervix from carcinoma in situ and other preinvasive lesions.

The concept that high-resolution (8.5-T) hydrogen-1 magnetic resonance (MR) spectroscopy can be used as an adjunct to conventional histologic diagnosis of cervical neoplasia was investigated. Cervical biopsy specimens (n = 159) were examined with H-1 MR spectroscopy and the results compared with results of histopathologic analysis. A high-resolution lipid MR spectrum was observed in 39 of 40 invasive carcinomas, whereas the 119 preinvasive samples showed little or no lipid spectrum but were characterized by a strong unresolved resonance between 3.8 and 4.2 ppm. Peak ratios of the methylene/methyl and the unresolved/methylene resonances allowed accurate distinction between invasive and preinvasive epithelial malignancy (P < .0001). Since MR spectroscopic examination does not destroy the specimen, the specimens remained intact for further testing and histopathologic analysis. The authors conclude that H-1 MR spectroscopy can independently allow distinction between invasive and preinvasive lesions of the cervix and has the potential to assist in clinical management of cervical cancer.

Colposcopic differentiation of abnormalities arising in the transformation zone.

When metaplastic cervical epithelium is exposed to the factors responsible for neoplasia, the transformation zone becomes atypical. These changes, visible as acetowhite epithelium, altered vascular patterns, and irregular surface contour, are easily recognized through the colposcope in most patients. It is possible to grade the changes to determine the severity of the abnormality and so, in consultation with the patient, decide on the best management course. However, there will always be lesions where colposcopy is indeterminate, and biopsy of such lesions is mandatory. Combined colposcopy and histology are still the mainstays of clinical management. As yet, more refined investigations, such as HPV-subtype determination, have not demonstrated any advantage for these patients.

Changing character of cervical cancer in young women.

To examine the hypothesis that the pattern of cervical cancer is changing data on women presenting with the disease over 34 years were studied retrospectively. During 1953-86, 2628 women with cervical cancer were referred to a large tertiary referral hospital in Sydney; 418 were aged 35 or less. During the period of review the proportion of young women with the disease increased from under 9% in the 1950s and 1960s to about 25% in the 1970s and 1980s; a similar but less pronounced trend was apparent for the whole of New South Wales in the 1970s and 1980s. The prevalence of less common morphological types of cervical cancer increased throughout the period, particularly in the young. Pelvic lymph node metastases were identified in younger patients with stage Ib and IIa tumours more commonly in the later years of the study, suggesting that the disease was becoming more severe. Overall rates of recurrence improved over time, but an apparent increase in early recurrences was observed in young patients with Ib and IIa tumours and without nodal disease. The results suggest that the clinical and pathological behaviour of cervical cancer changed over the period of review.

Ovarian carcinoma: abdominopelvic irradiation following reexploration.

Twenty patients with ovarian cancer, who following reexploration were left with residual disease nodules of less than 2 cm diameter, received abdominopelvic irradiation. Of these patients 18 had previous chemotherapy. Fifteen patients completed treatment, 13 of whom had prior chemotherapy. Six of the 18 patients with invasive tumors were alive and disease free 18-53 months postradiotherapy, while only 4 patients had died at the time of follow-up. No patient with residual nodules greater than 1 cm remained disease free. There was no difference in outcome between patients with microscopic or macroscopic less than 1 cm residuum. Complications were acceptable with 3/20 (15%) developing treatment-related intestinal obstruction.

Papillomavirus and cervical cancer: a clinical and laboratory study.

It is now widely accepted that HPV types 16, 18, 31, and 33 are associated with the development of high grade intraepithelial neoplasia and malignant lesions in the cervix. On this basis, the identification of HPV types in cervical scrape samples has been advocated as a supplement to cytological screening tests. However, little is known of the distribution of the virus at different sites in the lower female genital tract or of how this distribution may change during the natural course of HPV infection. In this survey, HPV DNA dot hybridizations and, in some instances, Southern blot hybridizations with mixed HPV 6/11 and 16/18 probes were undertaken to detect HPV DNA in cervical scrapes and biopsies of the cervix, vagina, and vulva. A total of 92 women attending a Sydney hospital were screened: 59 of these patients had cervical disease, either invasive cervical carcinoma (CaCx) or cervical intraepithelial neoplasia (CIN), grades I-III. A group of 33 women who lacked evidence of cervical abnormalities served as controls. HPV DNA, predominantly type 16/18, was detected in the cervical biopsies of 96% of the CaCx patients, 80% of the CIN III patients, and 65% of the CIN I-II patients. In contrast only 9% of the cervical biopsies from the control group contained detectable HPV 6, 11, 16, or 18 DNA. A high proportion of the women with cervical abnormalities had evidence of concurrent vaginal and/or vulval papillomavirus involvement. The significance of these findings for routine screening and subsequent management of patients with HPV-associated cervical disease is discussed.

Combination chemotherapy followed by surgery or radiotherapy in patients with locally advanced cervical cancer.

Forty-seven patients with locally advanced cervical cancer at high risk of relapse received three cycles of chemotherapy with PVB (cisplatin, vinblastine and bleomycin) before definitive local treatment with either radical surgery or radiotherapy. Thirty-one of the 47 patients (66%) responded to initial chemotherapy, and 11 of them have relapsed compared with 13 of the 16 non-responders. Median time to recurrence was 31 weeks for PVB non-responders but has not yet been reached for PVB responders. After a median follow-up of 128 weeks, 14 of the 31 responders (45%) are alive and disease free compared with 3 of the 16 non-responders (19%). There was a positive correlation between response to chemotherapy and subsequent response to radiotherapy. PVB was in general well tolerated although one death is probably attributable to chemotherapy. A randomized study comparing radiotherapy alone with initial PVB chemotherapy followed by radiotherapy is in progress.

Bowel complications in the management of ovarian cancer.

In a consecutive series of 163 patients referred with malignant ovarian tumours there were 24 (14.7%) who developed major bowel complications; 21 patients were operated upon for bowel obstruction and had a mean survival time of 8.1 months; 8 of the 24 patients are alive with cancer and 4 are alive without evidence of residual tumour. It is concluded that laparotomy is indicated when bowel complications occur in patients with ovarian carcinoma.

Protein synthesis in vivo by Schistosoma mansoni cercariae.

Cercariae of Schistosoma mansoni were labeled with [14C]leucine in vivo and their protein studied by one- and two-dimensional electrophoretic fluorography. With molecular weight (Mr) and isoelectric point (pI) as parameters, polypeptides from different stages of cercarial embryogenesis were compared with each other and with those of adult worms. Up to six polypeptides with different isoelectric points were found in a single electrophoretic band of the same Mr. Three polypeptides of high molecular weight were synthesized by cercariae 3 days before escape, and were similar to polypeptides synthesized by adults. The most prominent cercarial polypeptides synthesized three days before emergence (during tail elongation) are two which comigrate electrophoretically with actin and heavy chain of myosin. The rate of actin synthesis decreased at 48 and 24 h, with little or no synthesis in the 4 h preceding emergence. Many polypeptides found in cercariae labeled 4 h before emergence differ in pI and Mr from those synthesized in earlier stages of embryogenesis. From the water in which the cercariae emerge, labeled polypeptides were precipitated which are identical to several found both in shed, washed cercariae and the infected hepatopancreas. Polypeptides of high Mr are not synthesized by cercariae in the period shortly before escape; this stage is represented by polypeptide products with Mr values of 35 000, 53 000 and 58 000.

Biochemical basis for the continuous copulation of female Schistosoma mansoni.

Sexual dimorphism in blood flukes of the family Schistosomatidae is marked, and until the male clasps the female in the gynaecophoric canal the female cannot attain sexual maturity or migrate out of the liver. When previously-paired egg-producing females are transferred to a new host without males, the vitelline cells necessary for egg production degenerate. By means of sensitive fluorographic analysis of electrophoresed polypeptides, we have now found molecular evidence of an obligatory continuous relationship between the sexes in Schistosoma mansoni. The male worm retains little of the protein it produces in greatest abundance, and this protein is electrophoretically identical to the most abundant protein found in, but not synthesised by, the female.

Chromosome analysis of Schistosoma rodhaini (Trematoda: Schistosomatidae).

The chromosome number of Schistosoma rodhaini Brumpt is 2n=16, with apparent sexual dimorphism quantifiable in chromosome pair no. 2. A method for dissociating host tissue coupled with hypotonic treatment yields permanent mitotic chromosome spreads with very defined centromere regions. The karyotype of S. rodhaini is very similar to that of its sibling species, S. mansoni Sambon, except there is a pericentric inversion in the S. rodhaini nucleolar organizer chromosome pair, S. rodhaini does not have any satellited chromosomes, and S. rodhaini has slightly shorter short arms of the group I chromosomes than S. mansoni. This distinction of chromosomes of similar species of schistosomes will be important for field identification of parasites and in elucidating the evolution of the schistosomes.