Correction of the bilateral complete cleft lip: transformation to a unilateral incomplete cleft lip closure.

The complete lip alveolus and cleft palate is the most difficult of all bilateral clefts to treat because of the deformity of and tissue insufficiency in the prolabium. A bilateral concomitant procedure is impractical for treatment of this condition because of the problems that have to be resolved postoperatively, including a short columella, a lack of philtrum, labial horizontal and vertical insufficiency, and vermilion and alveolar vestibulum insufficiency. A two-stage procedure called the transformation method has been developed to circumvent these problems, and the authors present it here. With this method one side is closed completely using the maximum amount of tissue available. Concomitantly, incomplete closure is performed on the other side. The result at the end of the first stage of the procedure is a condition approximating unilateral incomplete closure. The results were obtained from 6 patients who underwent complete bilateral closure and were followed for at least 2 years with satisfactory results.

Complete hydatidiform mole coexisting with a live fetus after gamete intrafallopian transfer. A case report.

BACKGROUND: Molar pregnancy with a coexisting live fetus is a rare occurrence. We report the only known case with a surviving coexistent fetus after gamete intrafallopian transfer (GIFT). CASE: After GIFT, a 28-year-old primary infertility patient was diagnosed as having a complete hydatidiform mole coexisting with a live fetus at 13 weeks of gestation. At 36 weeks of gestation, a cesarean section was performed due to elevated serum human chorionic gonadotropin (hCG) levels, and a male infant with a normal appearance and weighing 2,688 g was delivered. CONCLUSION: If the patient desires to try to carry the fetus to viability after counseling on the possible associated risks of malignancy, it is possible to achieve fetal viability if (1) there is decline in the serum hCG level after it peaks before the second trimester, (2) ultrasound reveals degeneration of the molar part, and (3) there are no complications of pregnancy.

A report on more than 10,000 vaginal hysterectomies performed without ligation of the paracervical ligaments.

OBJECTIVE: To review 10,016 cases of total vaginal hysterectomy (TVH) performed in our department by a method without ligation of the paracervical ligaments. METHODS: From 1955 to 1997, a total of 10,016 TVHs without ligation of the paracervical ligaments were performed at the Department of Obstetrics and Gynecology, Sapporo Medical University Hospital. RESULTS: Of all 22,509 gynecological operations, 44.5% were TVHs, and 8.7% were total abdominal hysterectomies (TAHs). The operative time of our TVHs ranged from 31-60 minutes in 44.1% of the cases, and from 61-90 minutes in 35.3% of the cases. Blood loss was less than 300 ml in 85% of the cases. Abdominal conversion from the vaginal approach occurred in 110 cases (1%). Operative complications also occurred only in 0.7% (69) of the cases. CONCLUSION: TVH without ligation of the paracervical ligaments is a safe and convenient method that has very few complications and that can be utilized by many gynecologists.

A case of a malignant mixed tumor in the vagina.

Malignant mixed tumors in the vagina are extremely rare. We experienced a case of a malignant mixed tumor (synovioid variant). Surgical treatment was performed, followed by 3 courses of chemotherapy. Up to the present time, 4 years after the first treatment, no signs of recurrence have been observed.

CA 125 is dominantly expressed by arrest of G0/G1 phase in uterine cervical adenocarcinoma cell line.

Our purpose is to evaluate at which phase of the cell cycle CA 125 is dominantly expressed in a uterine cervical adenocarcinoma cell line (CAC-1). By a flow cytometric analysis of CA 125 expression, approximately 50% of the cells treated with interferon-gamma (IFN) were positive after 24 h. In cell cycle, the G0/G1 arrest was observed in cells treated with IFN after 24 h. The pattern for the transition of the relative rate of CA 125 expression was similar to that of the population of G0/G1. Furthermore, in the G0/G1 phase, the positive rate of CA 125 expression in cells treated with IFN was 80% of the expression in all cells after 24 h. Additionally, flow cytometry with Ki-67 demonstrated that G1 arrest occurred at 24 h, and then G0 arrest was induced by IFN after 48 h of incubation. The increased expression of CA 125 appeared mainly in the G1 phase rather than in G0.

HELLP syndrome in a pregnant patient with a past history of splenectomy for idiopathic thrombocytopenic purpura. Case report.

CASE: We present a case of HELLP syndrome occuring in a patient who at the age of 8 years had undergone a splenectomy for idiopathic thrombocytopenic purpura. She was diagnosed as having HELLP syndrome 37 weeks of gestation and had a cesarean section.

[Experimental and clinical study on chemotherapy for cervical adenocarcinoma].

We examined the effectiveness of 5 anticancer agents in nude mice transplanted with 4 kinds of uterine cervical adenocarcinoma. MMC, CDDP, ACM, ACD and VP-16 were selected. The therapeutic effects were assessed in terms of growth inhibition rates and histological effects in the transplanted tumors of nude mice. From this study, the following results were obtained: In single agent administration, MMC was effective in all tumors, and CDDP was effective in 3 kinds of tumors as indicated by the results showing growth inhibition rates. Histological findings for the agents did not correlate with therapeutic findings. In combined administration, MMC + CDDP was the most effective as indicated by the results showing growth inhibition rates; this combination showed an additive effect and MMC and CDDP were considered to be key drugs for treating cervical adenocarcinoma. On the basis of these results, we used combination chemotherapy with MMC, CDDP and ACM (PAM regimen) in high risk and advanced patients. We found an improved prognosis in advanced patients. There were one complete response and three partial responses in 7 advanced cases including one suffering recurrence. The combination therapy including MMC, CDDP and ACM was found to be effective against cervical adenocarcinoma.

Morphology of adenocarcinoma in situ and microinvasive adenocarcinoma of the uterine cervix. A cytologic and ultrastructural study.

Adenocarcinoma in situ (AIS) and microinvasive adenocarcinoma of the uterine cervix and normal endocervical columnar epithelium were studied by cytology, morphometry and electron microscopy to identify differentiating features and to ascertain the cellular origin of cervical adenocarcinoma. Smears from AIS showed the characteristic cytology, consisting of glandular rosettes, palisading and crowded sheets; most nuclei had a relatively uniform oval shape. Smears from microinvasive adenocarcinoma showed more crowded sheets, with enlarged, round and irregular-shaped nuclei and prominent oval nucleoli. These nuclear features were confirmed by the morphometric results. Ultrastructurally, reserve cells in the normal tissues contained tonofibers and secretory granules and showed squamous and adenomatous features. The ultrastructural features of microinvasive adenocarcinoma were similar to those of well-differentiated invasive adenocarcinoma. The cells from both contained tonofibers and secretory granules. These findings suggested that the reserve cell is the cell of origin for cervical adenocarcinoma.

Minimal-deviation adenocarcinoma (adenoma malignum) of the uterine cervix; four case reports.

Four cases of minimal-deviation adenocarcinoma (adenoma malignum) of the uterine cervix are analysed in this clinicopathological study. Four patients, one Ib, two IIb and one IIIb stage, showed poor prognosis, which included three patients who died within 36 months, because of diagnostic delays of 5 years, 6 months and 1 year due to cytohistologically benign appearances. Cytologically, the nuclei were somewhat more irregular in size and shape than those of normal columnar epitherial cells. Slightly multilayered cell clusters were arranged as honeycombs, palisades or sheets with glandular openings. The characteristic histological features were the presence of sharp points projecting from the glands and marked variation in the size and shape of the glands. Ultrastructurally, intestinal metaplastic cells containing both microvilli with core filaments and rootlets, and secretary granules in the same cell were present in the specimens of two evaluable patients. These features indicate a disorder of differentiation. In order to diagnose this tumor accurately, comprehensive analysis should be required concerning the clinical features, cytohistological findings and ultrastructural findings.

Cervicovaginal and endometrial cytology in ovarian cancer.

The clinical significance of cytologic examination was studied in 114 patients with ovarian cancer who had received preoperative cytologic examinations. The overall positive rate of the cytologic examinations was 26.3% (30 of 114): 22 (19.3%) of the 114 cases had positive cervicovaginal smears while 13 of 31 endometrial aspiration smears (41.9%) were positive. The positive rate was not related to the volume of ascites but rather to its presence or absence. Thus, if ascites was observed, the positive rate was about 2.1 times higher than if it was absent. In two of four cases of ovarian cancer with no endometrial invasion but a positive cytologic examination of ascitic fluid, fallopian tube specimens contained cancer cells; this suggests that ovarian cancer cells may reach the cervix and/or vagina by passing through the fallopian tube, particularly if ascites is present. Since cytologic examination, especially of endometrial aspiration smears, shows a high positive rate if ovarian cancer cells are observed in the abdominal cavity, cytology should be used as an important ancillary method for the assessment of ovarian cancer.

Postoperative changes in vaginal smears after vaginal reconstruction with a free skin graft.

Surgical vaginal reconstruction was performed by a free skin graft in two patients without a vagina. The postoperative changes in vaginal smears collected from the artificial vaginas were observed for about two years. Marked operation-induced inflammatory changes were observed until the second postoperative month. After the third postoperative month, the background became relatively clear. Cyanophilic and eosinophilic superficial cells, intermediate cells and Döderlein bacilli were observed occasionally in addition to keratotic cells. Six to 12 months after surgery, the vaginal smears showed little abnormality, except for the presence of keratotic cells. The changes in the vaginal smears after the third month show that the artificial vaginal epithelium changed cytologically to an almost normal vaginal mucosa that, although not histologically complete, responded to hormones. The presence of Döderlein bacilli suggests that the regional environment of the artificial vagina was almost the same as that of the normal vagina.

The cytological features and DNA content of cervical adenocarcinoma.

The relationship among cytological features, DNA content, and degree of histological differentiation of cervical adenocarcinoma was investigated in an attempt to discover a more accurate means of screening for this cancer. In highly differentiated adenocarcinoma (so-called adenoma malignum), the nuclei were only somewhat more irregular in size and shape than those of normal columnar epithelial cells. The cells were arranged in slightly multilayered clusters. The cells of well-differentiated adenocarcinoma were usually columnar in shape, and they exfoliated side by side in clusters. In moderately differentiated adenocarcinoma, solitary cells with markedly atypical nuclei were combined with multilayered cell clusters. The cells from poorly differentiated adenocarcinoma were roundish, occurred as solitary cells or irregularly overlapping cell clusters, and showed markedly atypical nuclei. As the degree of histological differentiation decreased, as determined by measurement of the DNA content of the cells, the DNA distribution covered a wider range in terms of ploidy, and the number of cells exceeding tetraploid DNA content increased.

Yolk sac tumors of the ovary and the human yolk sac.

In the present study a comparison was made between human yolk sacs and yolk sac tumors. Tubules surrounded by several to as many as 10 endodermal cells and intracellular tubules in one endodermal cell were frequently observed. The tubules were seen abundantly in the yolk sac of a 4-week pregnancy, and they resembled the reticular pattern of the yolk sac tumor. It was also observed that the papillary endoderm, which contained blood cells in the center and protruded into the endodermal tubules, resembled the Schiller-Duval body of yolk sac tumor. Ultrastructurally the tumor cells were similar to the yolk sac endoderm. alpha-Fetoprotein was positive in the yolk sac endoderm until approximately the seventh week of pregnancy. Yolk sac tumor was also alpha-fetoprotein-positive. In other words, our study of human yolk sacs of 4- to 11-week pregnancies presumes that the yolk sac tumor resembles the endoderm of 4- to 7-week pregnancies.

[Nuclear DNA content and chromosomal counts of cultured cells derived from human cervix with normal and abnormal epithelia].

In order to examine the cellular properties of each cultured cell derived from normal and abnormal epitheliums of the cervix, we measured the nuclear DNA content and chromosomal counts of these cultured cells. The following results were obtained. The nuclear DNA content of cultured cells derived from normal, mild, moderate, severe dysplasia, carcinoma in situ (cis) and invasive carcinoma was distributed among low 2c-high 4c, low 2c-6c, low 2c-7c, low 2c-10c, low 2c-11c and low 2c-13c respectively. A number of the cells exceeding 4c apparently increased from lesions of moderate dysplasia. In the chromosomal counts, approximately 90% of the primary and subcultured normal cells showed diploid cells and 3-6% of these cells showed tetraploidy. The chromosomal counts of the invasive carcinoma were widely distributed, but the number with diploid to hypotriploid was larger than those of cis. From these results, mild dysplasia cannot be considered to be a precancerous lesion. Cis and invasive carcinoma have different cellular patterns.

[Morphological studies of cultured cells derived from human cervix with normal and abnormal epithelium].

Primary explant tissue cultured cells and their subcultured cells were studied morphologically as basic research into the neoplastic process in the uterine cervix, or into the cellular difference between carcinoma in situ (cis) and invasive carcinoma. We cultured cells derived from normal squamous epithelium, dysplasia, cis and invasive carcinoma, and these cultured cells were observed by light and electron microscopy. The following results were obtained: A cultured medium with D-valine substituted for L-valine was used, and it was found that the medium clearly inhibited the outgrowth of fibroblasts, but did not inhibit the outgrowth of the epithelial cells. The cultured cells from the normal, dysplasia and cis could be passaged three times. These cultured cells derived from the normal and each abnormal epithelium had different growth patterns. In addition, the morphological features of these cultured cells resembled those of each in vivo. There was no difference in the findings for the subcultured cells.

[Studies on the appropriated interval of mass screening for cervical cancer].

In order to study the appropriate interval for cervical cancer screening, we investigated mainly the screening history of 1,086 cervical squamous cancer cases detected by mass screening. 1) The cancer detection rate (CDR) for the 2-year successively screened group who were class I in the first screening was 0.051% and all cases were carcinoma in situ (CIS). In the 2-year interval screened group, detection rates for CIS, microinvasive cancer and stage 1b cancer were 0.053%, 0.035% and 0.018%. But there is no significant difference in CDR between the 2-year successively screened group and 2-year interval screened group (p less than 0.05). 2) In the 2-year successively screened group who were class II in the first screening, the CIS and microinvasive cancer detection rates were 0.044% and 0.022%. There is no significant difference in CDR between class I group and class II group. In the group who were class I in the first screening, we detected most cases in the stage 0 and a few cases in the stage Ia and Ib by mass screening at 2-year intervals. If the detection of a few cases in stage Ib is permitted, we can enforce mass screening for cervical squamous cancer at 2-year interval and it is considered that class II group can be screened at same interval as class I group.