Endometrial cancer: a comparative analysis of the therapeutic results and causes of failure after treatment by radiation combined with surgery or radiation therapy alone

The present study involved 215 endometrial carcinoma patients. Ninety-nine were treated by combined irradiation and surgery (preoperative external irradiation and intracavitary insertion followed by total hysterectomy and lymphadenectomy). Radiotherapy alone was used with 116 patients i.e. whole pelvis external irradiation and Heyman radium packing (40 patients) or afterloading techniques with Fletcher-Suit-Delclos applicators and cesium (76-patients). The 5-year NED survival rate was 78.7% in the combined therapy group and 44% in the exclusive radiotherapy group. The locoregional recurrence rates were 10% in the combined group and 28% in the exclusive radiotherapy group. These results are discussed in relation to data in the literature and to biases introduced due to patient selection in this nonrandomized study. Five-year survival rates, locoregional recurrence rates and sites of failures are analyzed according to the different treatments. Modifications of the external irradiation and intracavitary techniques allowed us to obtain better results and fewer complications.     

Stage I adenocarcinoma of the endometrium. A clinical and histopathological study of 65 cases treated with preoperative radium.

To determine if preoperative irradiation should be abandoned in favor of post-hysterectomy irradiation, 65 cases of stage I endometrial carcinomas were analyzed. When no residual tumor or no myometrial invasion was found in the irradiated uterus (38 cases), a 5-year cure rate of 97.3% was obtained. When residual tumor or myometrial invasion was found, there was a 5-year cure rate of 100% in grades 1 and 2 (7 cases) but only a 20% cure rate in grade 3 lesions (5 cases). On the basis of these data there appears to be no reason to abandon preoperative irradiation in stage 1 cases. More extensive irradiation and surgery should be considered, however, in grade 3 lesions invading the myometrium.     

The value of laparoscopy alone or combined with hysteroscopy in the treatment of interstitial pregnancy: analysis of 22 cases

Objective  

The purpose of this study was to investigate the value of laparoscopy alone or combined with hysteroscopy in treating clinically stable interstitial pregnancy.     

Bedtime intermediate-acting insulin in the treatment of secondary failure to oral hypoglycemic agents.

Low-dose bedtime insulin therapy in combination with oral hypoglycemic agents (OHAs) has become an alternative treatment for NIDDM subjects with secondary failure to OHA. To assess its clinical efficacy, patient compliance, and its possible side effects, 33 patients with secondary OHA failure were recruited in this study. All of the subjects had experienced poor glycemic control for at least six months on their maximal OHAs before the institution of the bedtime insulin injection. Monotard HM (human insulin zinc suspension) was given at an initial dose of 0.15-0.2 U/kg body weight and was adjusted thereafter. As a whole, low-dose bedtime insulin with OHAs improved glycemic control. According to the clinical response, 10 patients (30.3%) were graded as responders, 12 (36.4%) were partial responders, 10 (30.3%) were non-responders, and one (3%) discontinued insulin therapy. There was no difference in demographic features among these three groups of patients. During this period, eight (25%) cases experienced mild hypoglycemic symptoms. In conclusion, combination of OHAs with a low-dose bedtime insulin injection is an alternative therapy for NIDDM patients with OHA failure.     

Photocoagulation of the endometrium with the Nd:YAG laser for the treatment of menorrhagia. A report of ten cases

Nd-YAG laser photocoagulation was performed on ten patients with chronic menorrhagia in an attempt to either decrease the menstrual flow sufficiently to obviate the need for hysterectomy or to obtain amenorrhea. The entire endometrial lining was treated, from the fundus down to 4 cm from the external cervical os. A blanching technique was accomplished by holding the fiber tip 5-10 mm from the endometrial surface. Patients were followed for an average of 12 months. All noted a marked reduction in the amount of menstrual flow; two became amenorrheic. One patient subsequently underwent hysterectomy for a preexisting uterine prolapse and progressive symptoms of dyspareunia and pelvic pain.     

Stage IB carcinoma of the cervix, the Norwegian Radium Hospital, 1968-1970: results of treatment and major complications. I. Lymphedema

Different methods of treatment have been debated over the years for Stage IB carcinoma of the cervix, especially in view of the results and complications. We have reviewed the experience of the Norwegian Radium Hospital for carcinoma of the cervix, Stage IB, for the years 1968, 1969, and 1970; most of the patients receive preoperative intrauterine and intravaginal radium, followed by radical hysterectomy and pelvic lymphadenectomy; if the nodes are involved, they also receive external pelvic irradiation. During this period, 437 patients had Stage IB; the 5 year survival was 80.2% (not corrected). We focused our attention on lymphedema following such a method of treatment; of 402 patients operated upon, 23.4% developed lymphedema ranging from mild to moderate to severe; 20 patients (5%) had severe lymphedema; factors involved are analyzed.     

Long-term analysis of causes, sites and results of treatment of urogenital fistulas at the Charité Gynecologic Clinic

Analyses of aetiology, localisation, and curing of urogenital fistulae permit conclusions as to efficiency of public health services. Recorded are 810 fistulae in 45 years which were analysed by 15-year periods. The ratio of obstetric to gynaecological fistula causes has remained unchanged through the entire period under review (10:90). However, substantial shifting was observed within either main group. In obstetrics, vesicocervical and vesicovaginal fistulae following caesarean section, have been predominant and on rising trend for 30 years. In gynaecology, vesicovaginal fistulae in the wake of vaginal and abdominal hysterectomy have considerably increased in the last 15 years. The present of benign to malignant primary diseases is 70 to 20%, as compared to 40:50% in the past. Vesicovaginal fistulae have continued to account for 60% of the general incidence. Urethral fistulae have gone up from 6 to 13%, while ureteral and trilocal fistulae have dropped from 20 to 16 and 11 to 7%. Fistula incidence figures at present are 0.01% obstetric as well as 0.2-0.5% benign and 0.7-1.4% malignant gynaecological causes. Rates of healing improved from 90 to 96% in obstetrics and stayed constant in gynaecology (94% benign and 80% malignant). The worst prognosis has continued to be recordable from trilocal fistulae. Current principles of therapy are, finally, put to discussion, together with modifications to the therapeutic régime. The conclusion is drawn that operations on women for urogenital fistulae should be performed only in urogynaecological centres and that fistula prophylaxis should be further intensified, especially in the context of gynaecological standard operations.     

Molecular distribution of trace metals in the normal and in the copper treated human secretory endometrium.

The properties of gel exclusion chromatography were employed in a study of the molecular distribution of copper, zinc, and calcium in the urine secretion and the high speed supernatants of normal and copper-treated human secretory endometria. Under basal conditions it was found that while copper and calcium existed bound and unbound in nearly equal proportions, zinc was present in the soluble fraction of endometrial tissue preferentially unbound (70%). When control and copper-T200 user women were compared, the amount of copper bound to proteins was nearly twice as great while the amount of protein-bound zinc remained approximately equal under both conditions. In the case of zinc as in the case of calcium, the main differences were reflected in the amount of free metal.     

A comparison of gross and microsurgical techniques for repair of cornual occlusion in infertility: a retrospective study, 1968-1978.

A 10-year experience is recounted moving from traditional gross implantation methods to microsurgical anastomosis in the repair of cornual occlusion in infertility. Two gross surgical implantation techniques, one involving reaming out the intramural portion of the uterine tube and the other dissecting it out via a transfundal incision, are compared with microsurgical uterotubal anastomosis. The author reports a 4.7 times improvement in the term pregnancy rate after turning to microsurgery and describes his method for anastomosing the transected ampulla or isthmus to the intramural portion of the tube.     

Low-dose methotrexate treatment in ectopic pregnancy: a retrospective analysis of 164 ectopic pregnancies treated between 2000 and 2008

Purpose

Ectopic pregnancy is an acute, potentially life-threatening condition. The aim of this study was to compare the results of surgery and methotrexate treatment in women with ectopic pregnancy, along with a review of the literature.

Methods

164 women with ectopic pregnancy, treated from 2000 to 2008 at the university gynecology department, were examined in a retrospective analysis. Patients with diagnosed ectopic pregnancy underwent one of the following treatments: Salpingotomy, salpingectomy or administration of a single dose of 30 mg methotrexate. The main outcome measures were treatment success rate, rate of patients wishing to have children after the ectopic pregnancy, and rates of pregnancy, live births, recurrent ectopic pregnancy, miscarriage, use of assisted reproduction and side effects.

Results

There were no significant differences in success rates between the groups (methotrexate 83.9 %, salpingotomy 88.2 %, salpingectomy 96.8 %). Significantly more patients in the salpingotomy group wished to become pregnant afterward than in the salpingectomy group. No significant differences were observed between the groups in the rates of intrauterine pregnancy, live births, recurrences, miscarriages, or side effects.

Conclusions

With defined inclusion criteria, similar results can be achieved with low-dose single administration of 30 mg methotrexate in comparison with surgical treatment for ectopic pregnancy. On the basis of the data presented here, further research to establish optimal dosages for methotrexate is needed.     

Surgical correction of female infertility. An analysis of results and failures in 101 cases

During the 1970s, surgery undertaken to remedy infertility at Sabbatsberg Hospital in Stockholm involved macrosurgical techniques. The patients described here had the same pathology on either side. Sixty-three underwent different procedures for the correction of tubal pathology at laparotomy, while 20 patients had lysis of adhesions performed at laparoscopy. A further 18 patients were operated on for ovarian endometriosis. The results in terms of conceptions (ranging from 43 to 60%, depending upon the type of operation) were similar to those reported from microsurgery, but the incidence of ectopic pregnancy was higher. Second-look laparoscopy revealed the presence of adhesions and tubal block in a significant number of patients, though less often in those who ultimatively conceived. There was no difference in semen findings between patients who conceived and those who did not. Postoperative adhesions are responsible for many surgical failures, but refined methods of surgery may reduce the risk of future ectopic gestation. Only a limited number of cases remain where persistence of infertility may be due to minor anatomical or functional defects not amenable to present-day clinical evaluation.