Residual carcinoma in the surgical specimen of patients with endometrial adenocarcinoma undergoing preoperative radiation therapy. A study of 80 patients and a literature review

Controversy continues to surround the significance of residual endometrial adenocarcinoma in the uterus following radiation therapy. Eighty patients with FIGO stage IA, IB, and II endometrial adenocarcinoma treated by preoperative radiotherapy were studied. No correlation was noted between the histologic grade of the lesion and the stage of disease. The frequency and the site of residual carcinoma were not related to the stage of disease but less-differentiated tumors persisted more frequently than grade I lesions. The modality of preoperative radiotherapy did not affect the frequency of residual tumor. Residual carcinoma within the uterus had no effect on the site or frequency of recurrence nor on patient survival.     

Apgar scores and umbilical arterial pH in preterm newborn infants

One- and five-minute Apgar scores and umbilical cord arterial pH values were compared in preterm newborn infants of various gestational ages. The more premature the infant, the more likely the Apgar score was low in the presence of a pH greater than or equal to 7.25. Conversely, the closer to term, the more frequently an infant with a pH of less than 7.25 had an Apgar score of greater than or equal to 7. Therefore, in preterm infants, there is little congruity between the Apgar score and umbilical cord pH. Based on these findings, it is not appropriate to label preterm newborn infants as asphyxiated based on a low Apgar score.     

Accentuated cyclic activation of peritoneal macrophages in patients with endometriosis

Peritoneal fluid was collected from 107 women undergoing laparoscopic sterilization or diagnostic laparoscopy for evaluation of infertility. Cells consisting mainly of macrophages were separated and subjected to sophisticated flow fluorocytometric analysis. In this way more detailed information was obtained about activational characteristics of the pelvic macrophage population during the menstrual cycle. In normal women the macrophages, as compared to peripheral monocytes, showed evidence of elevated baseline activation, and a gradual increase in several markers occurred during the menstrual cycle. Cells increased in size, lost their ability to stain for myeloperoxidase, and increased in activity of both endoenzymes and ectoenzymes. These results suggest that female peritoneal macrophages are continuously responding to stimuli. The macrophage irritation was much more pronounced in women with mild endometriosis. This accentuated cyclic activation may represent an inflammatory response to bleeding from ectopic implants or retrograde menstruation or may be a consequence of some defect in the cell-mediated immune response in endometriosis.     

Neurological factors in chronic pelvic pain: Trigger points and the abdominal pelvic pain syndrome

A collection of neurological signs and symptoms, entitled abdominal pelvic pain syndrome, is identified as the most common cause of chronic pelvic pain. Techniques to identify abdominal wall, vaginal, and sacral components are described, with painful tissues commonly limited to a single dermatomic area. Superficial local areas of hyperpathia (trigger points) appeared not only to cause the pelvic pain but also to be responsive to local anesthetics for a duration in excess of the presence of the medication. Successful responses were noted in 89.3% of 131 patients, with 92.6% requiring five or fewer treatments and 68.2% followed up for longer than 6 months. The diagnosis of the abdominal pelvic pain syndrome is an important component in avoiding unnecessary operation in patients with pelvic pain.     

Susceptibility profiles of potential aerobic and anaerobic pathogens isolated from hysterectomy patients

A total of 1140 aerobic and anaerobic isolates were recovered from cultures of specimens from the reproductive tracts of 435 uninfected patients who underwent elective hysterectomy. Standard minimum inhibitory concentration susceptibility studies were performed on these isolates to 13 newer penicillins, cephalosporins, and some traditional antimicrobial agents. These data were generated to evaluate the in vitro efficacy of these antibiotics for potential use in prophylaxis or as a single agent for treatment of polymicrobial infections of the female pelvis. The minimum inhibitory concentration data for each antibiotic against 16 genera of aerobic and nine genera of anaerobic bacteria were determined and were used to compare the in vitro antimicrobial activity of newer antibiotics to that of the more traditional antibiotics. Of the antimicrobial agents tested, piperacillin had the highest in vitro activity against these isolates of any antibiotic tested.     

Risk factors for prematurity and premature rupture of membranes: A prospective study of the vaginal flora in pregnancy

Prematurity remains a major cause of perinatal mortality in the United States. Some research has indicated that infectious agents play a role in either initiating preterm labor, causing premature rupture of the membranes, or preventing tocolysis. This study attempted to determine if the presence of various vaginal pathogens in early pregnancy was associated with the subsequent development of premature rupture of membranes or preterm labor. We found that among 233 evaluable patients those with Trichomonas vaninalis were significantly more likely to have premature rupture of the membranes (p < 0.03), and those with Bacteroides sp. were more likely to be delivered of their infants before 37 weeks (p < 0.03) and to have infants weighing less than 2500 gm (p < 0.05). Those with Ureaplasma urealyticum more frequently began preterm labor (p < 0.05). Preterm premature rupture of the membranes was found significantly more often among patients with Bacteroides sp. Stepwise multiple logistic regression analysis indicated that those associations were not related to the number of previous abortions, deliveries, or preterm deliveries or to maternal age. We conclude that microbiologic screening in early pregnancy may aid in the assessment of patient risk for preterm delivery.     

Responses of the growth-retarded fetus to acute hypoxemia

Growth retardation in the human fetus associated with maternal cardiovascular disease is frequently accompanied by birth asphyxia and perinatal mortality. We have investigated the cardiovascular responses to acute hypoxemia in the fetal lamb with growth retardation secondary to embolization of the uteroplacental vascular bed. In the basal period, fetal arterial P_O2 and umbilical perfusion were significantly lower, and perfusion of the adrenal glands, brain, and heart was significantly higher, in embolized than in control fetal lambs. During imposed acute hypoxemia there was preferential perfusion of vital organs, the adrenal glands, brain, and heart in control and embolized fetuses. This preferential perfusion to the vital organs during hypoxemia was significantly more pronounced in embolized animals. Because of the increased compensation during acute hypoxemia, as reflected by the increased preferential perfusion of vital organs, the growth-retarded fetuses would probably decompensate sooner if the hypoxemia was prolonged.