摘要:

From 1958 to 1974, 283 cases of microcarcinoma of the cervix were treated. Of these, 196 showed early stromal invasion, ie, only microscopically visible epithelial protrusions into the stroma. In 87 cases, measurable microcarcinoma was present with a maximum invasion depth of 7 mm and a maximum volume of 420 cu mm, respectively. Vascular invasion was present in 10 cases which did not alter the diagnosis of the disease. All cases were diagnosed in cone specimens after step sectioning. In 98 cases a Schauta radical vaginal operation without lymphadenectomy was performed. A Wertheim hysterectomy with lymphadenectomy was done in only 10 cases. One hundred and twenty-six cases were treated by simple hysterectomy, while conization was the only therapy in 44 cases. Five cases were treated by irradiation therapy. One hundred and eighty-eight patients were followed for 5 years or more, and 254 patients were followed for a minimum of 3 years. The longest period of observation was 18 years. In 3 cases, residual disease which proved to be carcinoma in situ, was found immediately after surgery. In 1 case, severe dysplasia developed in the vagina after 14 years. There was 1 case of a larger microcarcinoma with lymphatic invasion that led to an apparent progression of the disease with fatal outcome. In 9 other cases with microlymphatic invasion, no recurrence was observed. Based on this extensive experience, it is concluded that microcarcinoma with a tumor volume of less than 500 cu mm is, in general, not associated with metastatic spread. Microinvasive carcinoma of such a size may therefore be considered to be a localized disease and may be treated by local therapeutic measures. Such therapy must be based on a histologic study of cone specimens, including step sections from which the tumor volume can be estimated. The depth of invasion alone is of little value for the accurate assessment of the biologic potency of this tumor.

ISSN:0029-7844    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

Feminizing ovarian tumors and polycystic ovarian disease may cause endometrial cancer by abnormal, unopposed endogenous estrogenic stimulation. We reviewed the clinical course of 72 endometrial cancer patients with a concomitant feminizing ovarian tumor or polycystic ovarian disease and compared tumor characteristics and treatment results with those exhibited by 523 patients treated for endometrial cancer alone. With functioning ovarian tumor and with polycystic ovaries, the cancer tended to be more often low-grade, low-stage, and superficial than did endometrial cancer alone. The high S-year and 10-year survival rates observed in our functioning ovarian tumor-polycystic ovary patients support the conclusion that endometrial carcinoma with a coexistent endogenous estrogenic stimulus has a more favorable prognosis (P<0.01) than endometrial carcinoma alone.

ISSN:0029-7844    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

The addition of intraperitoneal colloidal radioactive chromic phosphorus following total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy in women with Stage I ovarian cancer does not cause significant morbidity. Moreover, our preliminary results suggest that this regimen appears to increase the rate of local control of disease. In 21 unselected patients, there was 1 incident of small bowel obstruction. Fourteen of these patients have been followed for at least 11/2 years; all are alive without evidence of disease. These facts suggest that a national prospective study to investigate the efficacy of this treatment for Stage I ovarian cancer is warranted.

ISSN:0029-7844    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

Ureters tolerate radiation well as manifested by the low incidence of injury. However, ureteral injury can occur with high dose radiation especially when the majority is delivered by radium. Eight such cases are presented. A retrospective study of 100 asymptomatic women treated with radiation for cervical carcinoma over 5 years previously demonstrated only 4 incidences of ureteral injury if dilatation was used as the indicator. To the contrary, 5 patients had improvement of their pretreatment intravenous pyelogram following radiation. Emphasis was placed on closer follow up of the ureters by intravenous pyelograms after high-dose radiation.

ISSN:0029-7844    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

A total of 1580 new patients underwent colposcopic evaluation in the Dysplasia Clinic at Nassau County Medical Center. Of these patients, 186 had abnormal Papanicolaou smears associated with pregnancy, 150 were referred because of in utero exposure to diethylstilbestrol, and 1244 were referred because of abnormal cervical cytologic smear or suspicious cervical or vaginal lesion. Further analysis of this latter group revealed that 1184 (95%) patients had satisfactory colposcopic evaluation, and directed biopsy showed the following: 10 cases of invasive cervical carcinoma, 9 of carcinoma in situ with microinvasion, 118 of cervical carcinoma in situ, 110 of severe dysplasia, and 424 cases of mild to moderate cervical dysplasia. All of these patients subsequently were treated accordingly. Evaluation of final histologic specimen revealed a very high correlation with colposcopically guided biopsies. In 54 patients, where colposcopic evaluation was unsatisfactory, diagnostic cold knife conization was performed. Final histologic diagnosis disclosed a more advanced lesion in 30 patients (or 56%) of this group. The result of this study shows that satisfactory colposcopic evaluation is a highly accurate method of evaluation of abnormal cervical and vaginal cytologic smear.

ISSN:0029-7844    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

Twelve patients with either severe preeclampsia (9) or eclampsia (3) were treated with intravenous diazoxide, 300-mg bolus, for the reduction of diastolic blood pressure (< 110 torr) after the usual and customary measures had been initiated to include parenteral Mg SO4and diazepam. Diazoxide precipitously decreased both systolic and diastolic blood pressure proportionately (35-50%); the nadir was invariably reached in 5-15 minutes. Diastolic pressure never fell below 50 torr, and mean arterial pressure always exceeded 70 torr. Oliguria was not apparent. The vasodepressor response was fairly persistent for 4 hours in all but 3 patients; 2 of these received a second 300-mg dose. Significant changes in fetal heart activity (bradycardia, dysrhythmia) were observed in only 1 patient. Labor was immediately ablated in all patients, but could be restimulated with oxytocin. All pregnancies were terminated within 7 hours (mean, 3.7 hours), seven of them by cesarean section. Eleven newborns did well. We conclude that the immediate reduction in maternal arterial blood pressure is without apparent hazard to the mother as well as the fetus.

ISSN:0029-7844    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

One hundred forty-four toxemic patients were studied by continuous electronic maternal and fetal monitoring. Ninety-seven were treated by intravenous bolus of 2 g MgSO4every 1-2 hours, and 47 by intravenous drip MgSO4at a rate of 1 g hour. Clinical doses of MgSO4do not affect maternal ECG, temperature, uterine contractions, or fetal heart rate. Intravenous bolus administration is frequently associated with slowing of maternal respirations and hypotension and occasionally with transient apnea.

ISSN:0029-7844    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

A high incidence of post cesarean section febrile morbidity has caused a number of investigators to recommend using prophylactic antibiotics for patients undergoing this procedure. Recent data suggest that such prophylactic antibiotics should be reserved for high-risk patients. Since previous studies have not adequately defined the high-risk patient, we analyzed 129 patients undergoing cesarean section to identify the factors which predispose to postoperative febrile morbidity. Two different statistical programs identified four factors (general anesthesia, obesity, hematocrit, <30%, and labor prior to delivery) which were significantly associated with post cesarean section febrile morbidity (P<0.025). Patients with 2 or more of these risk factors were highly likely to experience this postoperative complication (P<0.001).

ISSN:0029-7844    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

To investigate the function of the adrenals in newborn infants that were exposed to exogenous corticosteroids during fetal life, 54 newborns were subjected to a rapid ACTH test (0.015 mg kg) on the first day of life. In 42 cases, maternal administration of 12 mg betamethasone had been given for 3 days, and in 2 cases, treatment with corticosteroids had persisted throughout gestation; 10 newborns of untreated mothers served as controls. Plasma cortisol concentrations before and 60 minutes after the ACTH injection were determined by radioimmunoassay. In all newborns with short-term antenatal exposure to betamethasone, the initial cortisol levels (at an average age of 21 hours) were independent of the different treatment-birth intervals. All newborns showed an ACTH-induced rise of plasma cortisol, and their response did not differ quantitatively between groups with different intervals after treatment or against the controls. One infant of the long-term treated women had a low initial plasma cortisol level and showed a weak response to ACTH. The study suggests that antenatal short-term betamethasone treatment does not affect the adrenal responsiveness to corti trophic stimuli 1 day after birth, and that adrenocortical depression in the neonate might appear after sustained maternal corticosteroid administration throughout gestation.

ISSN:0029-7844    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

Clitoromegaly was observed in a 73-year-old woman who had bilateral ovarian benign cystic teratomas that contained only epithelial derivatives. Scattered in the stroma of these ovaries were clusters of hyperplastic cells. The plasma testosterone production rate was 2.4 rug day, a value that is ten times greater than that of normal postmenopausal women. The elevated plasma concentrations of testosterone and androstenedione decreased to normal by the second day after bilateral oophorectomy. Ovarian venous concentrations of testosterone and androstenedione were also increased and were considerably greater than those in peripheral blood. Estrone production was 68 Mg day, most of which could be accounted for by the extra glandular formation from androstenedione. Estradiol production was 71 Mg day, of which 75% was computed to arise from extra glandular formation and the remainder likely arose by ovarian secretion. The modest increase in estrogen production was associated with slight cystic hyperplasia of the endometrium. From this study we conclude that the hyperplastic ovarian stroma was the source of the excessive androgen production.

ISSN:0029-7844    

出版商:OVID    

年代:1977

数据来源: OVID