Vulvar melanoma at the M. D. Anderson Cancer Center: 25 years later.

The purpose of this study was to review the clinical course of patients diagnosed with vulvar melanoma. Charts of patients diagnosed between 1970 and 1997 were reviewed for demographics, lesion characteristics, disease duration and extent, and treatments. Actuarial survival curves were computed by the Kaplan Meier method and compared by Cox proportional hazards regressions. Fifty-one patients (median age 54) with vulvar melanoma presented with a vulvar mass (39%), pain (30%), bleeding (24%), and itching (20%). Anatomical distribution was mucosa of the vulva (65%), vulvar epidermal site (21%), or unspecified vulva (14%), with 20% having multifocal disease at diagnosis. Histologic types were superficial spreading or nodular (50% each). Median lesion characteristics were diameter 2 cm, Breslow index 4.4 mm, and Clark level IV. Distribution of patients per American Joint Committee on Cancer (AJCC) stage was 29%, 50%, 16%, and 7% for stages I, II, III and IV, respectively. Inguinal node metastases were unilateral in 16% and bilateral in 7%. Despite complete surgical resection, 32 patients (63%) recurred. Median survival for all patients was 41 months (range, 5-324), with 91% 5-year survival for patients with stage I and 31% for stage >or= IIA (P = 0.0002). As with cutaneous melanoma, the AJCC classification, Breslow's thickness, and Clark's levels are the major predictors of overall survival (P = 0.0001 each) and disease-free survival (P

The correlation of beta-subunit human chorionic gonadotropin level in the serum and first morning urine of patients with gestational trophoblastic disease.

The purpose of this cross-sectional study was to determine the correlation of beta subunit human chorionic gonadotropin (beta-hCG) level in the serum and first morning urine samples of patients with gestational trophoblastic disease (GTD). A total of 81 paired serum and first morning urine samples from 24 patients diagnosed with GTD, who had their follow-up at the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University. The paired serum and first morning urine samples were measured for beta-hCG level, using enzyme-linked immunosorbent assay (ELISA). After logarithmic transformation, serum beta-hCG level was strongly and significantly correlated to those of first morning urine samples, with the correlation coefficient of 0.97 (p < 0.01). Among the disease-remission group (serum beta-hCG of less than 5 mIU/ml), the correlation coefficient was 0.52 (p < 0.01), which was still statistically significant. Stronger statistical significance was found in the disease-active group (serum beta-hCG of 5 mIU/ml or higher), with the correlation coefficient of 0.95 (p < 0.01). We concluded that the level of serum beta-hCG was strongly and significantly correlated with those of first morning urine samples, especially in patients with active disease. Determination of beta-hCG level using first morning urine samples can be used as an effective mean in the follow-up of patients with GTD.

Benign cystic teratoma of the ovary : a review of 608 patients.

This retrospective study reports on 608 cases of benign cystic teratoma of the ovary treated at Siriraj Hospital over a ten-year period from 1988-1997. Mean age of the patients was 33.7 + 11.3 years. Approximately one-third of the patients (35.0%) were asymptomatic when the teratomas were discovered, of the rest, the common presenting symptoms were abdominal pain (52.9%) or palpable abdominal mass (30.6%). The tumors were between 6-10 cm in greatest diameter in more than half of the patients (53.6%) and in 78 patients (12.8%), the tumors were bilateral. Complications from the tumors were found in 72 patients (11.8%): 68 cases of torsion (94.4%); two were spontaneous rupture (2.8%); and two were infected (2.8%). The mean age of patients with twisted tumor was significantly less than that of patients with uncomplicated tumor (p = 0.02), and abdominal pain was found more commonly in the patients with twisted tumor (p < 0.001). Among cases with torsion, more than 90 per cent of the tumors were found to be of intermediate size (6-15 cm), while only 68.8 per cent were found in uncomplicated cases (p < 0.001). Surgical treatment was conservative in 63.8 per cent) and radical in 36.2 per cent of the patients.

Gemcitabine after bone marrow transplantation for refractory juvenile granulosa cell tumor.

A 19-year-old woman with refractory juvenile granulosa cell tumors had persistent disease after PVB (cisplatin, vinblastine and bleomycin) and multiple high doses of ICE (ifosfamide, carboplatin and etoposide) with peripheral stem cell support. She achieved stable disease for 4 months with low dose intensity gemcitabine of 500 mg/m2/week. The planned dose had been 1250 mg/m2/week. The dose intensity was limited by myelosuppression especially thrombocytopenia. The use of thrombopoietic, in addition to erythropoietic and myelopoietic, agents may permit higher dose intensity of gemcitabine after bone marrow ablative therapy with resulting greater anti-tumor activity.

Docetaxel and cyclophosphamide induced remission in platinum and paclitaxel refractory ovarian cancer.

Platinum-based chemotherapy is the standard treatment for advanced ovarian cancer, with response rates of 40-60%. In patients who fail platinum treatment, paclitaxel has resulted in response rates of 10-48%. Docetaxel has partial non-cross-resistance with and is twice as potent in vitro as paclitaxel in inhibiting microtubule disaggregation. The combination of docetaxel and cyclophosphamide is synergistic in pre-clinical studies and clinically active in breast cancer. We present the case of a patient with platinum and paclitaxel refractory ovarian cancer who achieved a remission with docetaxel and cyclophosphamide.

Carpal tunnel syndrome during pregnancy: prevalence and blood level of pyridoxine.

The prevalence of CTS in third trimester pregnant women in the study in 28 per cent. With the use of NCS it was able to detect nearly 80 per cent of them who had no symptoms or signs. There was no association between the level of vitamin B6 or B6 deficiency and CTS. Since CTS may result in a permanent disability if undiagnosed or left untreated it is essential to make an early diagnosis and treat it especially older women and those who are edematous.