Primary ovarian carcinoid tumors.

Primary ovarian carcinoid tumors were reviewed from Mayo Clinic and Colorado Tumor Registry data. A total of 17 patients with this diagnosis were identified. Histologic analysis of these carcinoid tumors revealed 9 (53%) were insular, 5 (29%) were trabecular, and 4 (26%) were strumal carcinoid with or without a mature dermoid component. There were 11 patients with stage I and 6 patients with stage III or IV disease at diagnosis. Carcinoid syndrome was found in 29% of patients. Pressure or pain with defecation was noted in 41% of cases. Recurrence of tumor occurred in 1 of 11 patients with suspected stage I disease 13 years after initial diagnosis. Overall survival was excellent in the 11 patients whose disease was confined to one ovary (100% 5-year survival), but only 1 of 6 patients survived (33% 5-year survival) if advanced stage at diagnosis. Systemic chemotherapy for advanced disease achieved a complete response in 1 patient and stable disease in another. Although rare, primary ovarian carcinoid tumors treated with surgery alone and found to be confined to the ovary can be expected to have an excellent overall outcome.

Adenoid cystic carcinoma of the Bartholin's gland: the University of Michigan experience.

Adenoid cystic carcinoma of the Bartholin's gland has been encountered in 11 patients at the University of Michigan Medical Center since 1936. At the time of presentation the average age was 48.9 years, the lesion size was between 0.5 to 4 cm. The presenting symptoms were pain and/or pruritis associated with a solitary mass. Early in this series, excisional biopsy was used to treat eight patients. The last three patients have been treated with a radical vulvectomy and unilateral or bilateral groin lymph node dissection. Local recurrence has occurred in five patients and distant recurrence in four patients. In spite of the high recurrence rate, 5- and 10-year survival has been high with all seven evaluable patients surviving 5 and 10 years. However, adenoid cystic carcinoma of the vulva is associated with late recurrences and metastases: three patients were dead of disease at 12, 15 and 31 years after initial diagnosis.

Allylamine toxicity in embryonic myocardial myocyte reaggregate cultures: The role of extracellular metabolism by benzylamine oxidase.

The cardiotoxicity of allylamine (AA) is considered to be mediated by metabolism to the highly reactive aldehyde, acrolein (ACR). The toxicity of AA to myocardial myocyte reaggregate cultures (MMR) was assessed by measuring percentage beating as a marker of functional viability. The studies demonstrated that AA toxicity could be prevented by inhibitors of benzylamine oxidase (BZO) but not by inhibitors of monoamine oxidase A or B. Addition of exogenous BZO markedly potentiated the toxicity, an effect that could be blocked by semicarbazide, an inhibitor of BZO. The present studies support the view that AA is metabolized by BZO to the proximate toxicant, ACR. In serum-free cultures, high concentrations (0.5-2.5 mm) of AA were required to cause any loss of viability, and as the concentration of serum in the medium was increased so the loss of viability was induced by AA; in MMR maintained in 50% foetal calf serum, all viability was lost after 3 hr of exposure to 100 mum-AA. Mercaptoethanesulphonate (MESNA), a scavenger of reactive species that is known not to penetrate myocytes, prevented the toxicity both of 100 mum-AA and 100 mum-ACR to MMR in serum-supplemented medium. In contrast, when MMR in serum-free medium were exposed to high concentrations of AA, MESNA had no moderating effect. These findings suggest that AA undergoes extracellular metabolism to ACR in serum-supplemented medium because of the presence of BZO in serum. It is clear that extracellular metabolism is of great importance in the pathogenesis of AA-induced toxicity to MMR in serum-supplemented medium. The toxicity of AA was also prevented by the iron chelator desferrioxamine (DF) at a concentration shown not to inhibit significantly the activity of BZO. ACR toxicity too, was inhibited by DF. This suggests a role for free radicals in the toxicity of AA to MMR, as DF chelates iron, thus preventing the catalysis of free radical reactions (Halliwell and Gutteridge, 1986). Addition of alpha-tocopherol succinate, an inhibitor or lipid peroxidation, to the cultures also reduced the toxicity of AA, which provides some evidence of the role of lipid peroxidation in the mechanism of AA toxicity to MMR. That process too, commonly involves free radical mechanisms. The results are discussed with reference to the action of AA in vivo, in order to consider whether extracellular metabolism might be of importance in the mechanism of toxicity to the whole animal.

Invasive vaginal carcinoma: analysis of early-stage disease.

From 1960 through 1987, 89 patients with stage I (44 patients) or II (45 patients) vaginal carcinoma (excluding melanomas) were treated primarily at the Mayo Clinic. Treatment consisted of surgery alone in 52 patients, surgery plus radiation in 14, and radiation alone in 23. The median duration of follow-up was 4.4 years. The 5-year survival (Kaplan-Meier method) was 82% for patients with stage I disease and 53% for those with stage II disease (p = 0.009). Analysis of survival according to treatment did not show statistically significant differences. This report is consistent with previous studies showing that stage is an important prognostic factor and that treatment can be individualized, including surgical treatment for primary early-stage vaginal cancer.

Cervical mucus immunoglobulins as an indicator of ovulation.

A practical and accurate method of determining ovulation using cervical mucus is described. Ovulatory cycles from 32 healthy women were assessed using hormonal and nonhormonal methods. Cervical mucus extractable immunoglobulins were assayed for the complete cycles of nine women and randomly collected from 23 additional women with normal cycles. All normal ovulatory women showed a minimum concentration present at midcycle when optimum conditions for fertilization existed. Using newer laser nephelometry techniques, the content of extractable immunoglobulin G and immunoglobulin A per sample weight confirmed the cyclic nature of the concentration of immunoglobulin in cervical mucus, and correlated well with previously defined biophysical properties of cervical mucus. Nephelometry proved to be rapid, accurate, and an inexpensive technique for determining ovulation and has potential for clinical use.