Chromosome 11 abnormalities in Bowen disease of the vulva.

Chromosomal cytogenetic abnormalities are common in tumor cells and are often the basis for more detailed chromosomal mapping of tumor suppressor and oncogenes. Chromosome 11 abnormalities are frequently recognized in various neoplasms. We report a case of Bowen disease (squamous cell carcinoma in situ) of the vulva with an isolated 11p cytogenetic abnormality. A chromosome 11 paint confirmed two copies of chromosome 11 in all analyzed metaphases. An 11p subtelomeric probe confirmed an abnormality of 11p15-->pter indicative of a deletion. Previous studies of invasive vulvar cancers also frequently show 11p cytogenetic abnormalities, but never as an isolated finding. The patient suffered from other diseases that may also be related to this locus. Breakage and p53 studies were normal. It is possible that an 11p abnormality in Bowen's disease is a precursor in the evolution of invasive vulva cancer.

Hyperbaric oxygen therapy following radical vulvectomy: an adjunctive therapy to improve wound healing.

The objective of the study was to evaluate the effect of postoperative hyperbaric oxygen (HBO) therapy on wound breakdown following radical vulvectomy. A prospective, observational study was performed on patients undergoing radical vulvectomy from October 1990 to March 1993 at Scott and White Memorial Hospital, Temple, Texas. HBO therapy was initiated in the postoperative period. Retrospective review of all patients coded as radical vulvectomy from 1987 to 1990 provides for a historical comparison. Eight patients were enrolled in the study. Six patients had radical vulvectomies with lymph node dissections (LND) and two did not. One wound breakdown was observed in the HBO-treated patients. Retrospective review identified 22 patients as having undergone radical vulvectomy with or without LND. Seven of 9 patients with LND and 3 of 13 without LND had wound breakdowns. A significant difference (P = 0.035) was found comparing patients treated with LND and HBO to retrospective controls with LND. Hospitalization was shorter in the HBO-treated patients. This small study showed a reduction in wound breakdown for patients undergoing radical vulvectomy with LND and HBO therapy compared to similar patients not treated with HBO. This observation supports the need for randomized studies examining the efficacy of HBO therapy in this group of patients.

Pelvic schwannoma in pregnancy. A case report.

Schwannomas are benign nerve sheath tumors that may originate at any anatomic site. Usually they are found on the peripheral nerves of the head, neck or flexor surfaces of the upper extremities. Rarely does a schwannoma originate in the pelvis and present as a retroperitoneal pelvic mass. Only two previous cases of a pelvic schwannoma complicating pregnancy have been presented in the English-language literature. We present a third case.

Bilateral attachment of the vaginal cuff to iliococcygeus fascia: an effective method of cuff suspension.

OBJECTIVE: The objective of this study was to determine the anatomic success, defined as no persistent or recurrent support defects, of suspension of the vaginal cuff to iliococcygeus fascia. STUDY DESIGN: Forty-two women treated by suspension of the vaginal cuff to iliococcygeus fascia and repair of coexisting pelvic support defects between March 19, 1987, and June 11, 1992, had site-specific analysis of pelvic support performed preoperatively and at consecutive postoperative visits. The findings at the 6-week postoperative visit and subsequent visits were compared for support of the vaginal cuff and additionally for the urethra, bladder, cul-de-sac, and rectum. RESULTS: Two patients (5%) have had recurrence of their cuff prolapse during follow-up, one of whom required further surgery. She also had recurrence of an inguinal hernia that had been repaired at the original surgery. The other patient who had had five previous pelvic procedures developed asymptomatic prolapse of the cuff halfway to the hymen. Six additional patients have had loss of support at other sites in the follow-up period, one of whom had repeat surgery. CONCLUSION: Ninety-five percent of women experienced no persistence or recurrence of cuff prolapse 6 weeks to 5 years after the procedure.

Preoperative and postoperative analysis of site-specific pelvic support defects in 81 women treated with sacrospinous ligament suspension and pelvic reconstruction.

OBJECTIVES: The objectives of this study were to identify factors that predict long-term success, defined as the absence of anatomic defects, in women undergoing pelvic reconstruction and to identify which defects most frequently persist or recur. STUDY DESIGN: Eighty-one women treated by sacrospinous ligament suspension and pelvic reconstruction between 1984 and 1990 had site-specific analysis performed preoperatively and at consecutive postoperative visits. The findings at the 6-week postoperative visit and subsequent visits were compared for each of five sites: urethra, bladder, cuff, cul-de-sac, and rectum. RESULTS: The Fisher exact test showed that patients with no support defects at the 6-week visit were less likely to require subsequent repair than patients who had any defect at that visit (p = 0.003). Thirteen patients with subsequent or persistent cystoceles had no bladder repair performed at the time of the study procedure. However, even with repair the bladder was the most likely site for persistence or recurrence. CONCLUSION: Absence of any pelvic support defect at the 6-week postoperative visit is associated with a 3% likelihood that the patient will require subsequent reconstructive surgery within 2 to 5 years. The anterior segment provides the greatest challenge to restoration of normal anatomy.

Comparison of clinical and surgical-staging in patients with endometrial carcinoma.

The preoperative clinical and radiologic findings and staging were compared with the operative and pathological findings and surgical staging in 62 consecutive patients with endometrial carcinoma. Overall, the tumor grade was changed in 33.8% of the patients, and the histologic type of tumor was changed in 27.4% of the patients. The preoperative clinical staging was changed in 51% of the patients after surgery. The change for the stage was as follows: stage I, 30.4%; stage II, 62.5%, stage III, 60%; and stage IV, 0%. The endocervical curettage was found to have a 50% false-positive rate and a 13% false-negative rate.

Multidisciplinary management of the elderly patient with ovarian cancer.

The management of ovarian cancer in the aged patient is multifaceted. Diagnosis may be difficult and delayed, and aggressive surgery is often compromised. Multimodality therapy is desirable, but may have to be modified. The primary physician, surgeon, gynecologist, and medical oncologist must thoroughly understand the disease and how it effects the elderly patient.

Vaginal removal of the ovaries in association with vaginal hysterectomy.

Because of the paucity of reports documenting the risks of removing the ovaries through the vagina in association with vaginal hysterectomy, we undertook a review of our experience. Seventy-seven patients underwent vaginal oophorectomy in conjunction with other vaginal surgery. Twenty-eight of them had indications for removal of the ovaries. In 47 the ovaries were removed electively in the perimenopausal period. There was no significant increase in morbidity, and only one patient had major bleeding problems associated with the procedure.

Management of condylomata acuminata with the carbon dioxide laser.

Ninety-four patients with condylomata acuminata of the lower genital tract and perianal region were treated with the carbon dioxide laser. Most were managed in the outpatient clinic, but 1 to 4 treatments were required depending upon extent of involvement. Of 90 patients, 75 (83.3%) were free of lesions on all follow-up examinations after initial treatment. Of 15 patients with recurrent lesions, 13 underwent a second laser treatment; 7 of these 13 have been subsequently free of condylomata. The overall success rate was 91%. The carbon dioxide laser provides an appealing method of management of condylomata acuminata because of its precision, rapid healing without scarring, and safety when used during pregnancy.