Uterine Inversion as a Result of a Large Prolapsed Carcinosarcoma of the Uterus

BackgroundUterine inversion is most commonly seen in labour and delivery. However, it can be associated with uterine tumours, including gynaecologic malignancy.CaseIn a 66-year-old woman, uterine inversion identified at laparotomy that was found to be associated with uterine carcinosarcoma (malignant mixed mesodermal tumour) represents an unusual presentation. Surgical approach necessitated a vertical hysterotomy to amputate and deliver the uterine tumour.ConclusionUterine inversion in gynaecologic oncology may be associated with sarcoma or malignant mixed mesodermal tumour. This can represent a diagnostic and surgical challenge and should be considered.     

Prenatal diagnosis of radial ray defects by ultrasound: A report of 6 cases

Objective

All of the medical records of fetuses with the sonographic finding of radial ray defects (RRDs) between 2008 and 2015 were retrieved. The associated sonographic findings, cytogenetic results, and necropsy findings were correlated.

Prolactin in normal pregnancy: relationship of maternal, fetal, and amniotic fluid levels.

Serum prolactin was measured simultaneously by a homologous radioimmunoassay in 92 parturients and their offspring at term, and in maternal serum and amniotic fluid during various stages of normal pregnancy. Serum levels of 208 +/- 8 ng. per millilter were found in maternal blood; the corresponding levels in the cord serum were 354 +/- 14 ng. per milliliter. Prolactin levels in amniotic fluid were found to be 2- to 10-fold higher than the corresponding levels of the mothers. The possible source of the amniotic fluid prolactin molecule, which is identical with the human pituitary molecule, is discussed.     

Surgical complexity score and role of laparoscopy in women with advanced ovarian cancer treated with neoadjuvant chemotherapy

ObjectivesTo evaluate surgical complexity scores (SCS) and minimally invasive surgery (MIS) at interval debulking surgery (IDS) in advanced epithelial ovarian cancer (EOC) patients receiving neoadjuvant chemotherapy (NACT).MethodsA multi-institutional study of NACT with IDS for advanced EOC was conducted. Demographic data were abstracted and SCS assigned based on IDS findings. Disease-specific overall survival (DSS) was defined as the time from completion of adjuvant chemotherapy to death due to disease. Cox proportional hazards regression models were used for univariate and multivariate survival analyses.Results282 patients were identified; 80.5% had high-grade serous histology and 54.6% were <75 (median 63.9; range 34.1–84.8). Approximately 84% were optimally cytoreduced (61% R0; 23% <1 cm). In multivariate analyses, age 75+ (p ≤ 0.001), residual disease (>1 cm; p = 0.03), and SCS ≥ 3 (p = 0.04) were significantly predictive of worse DSS when morbidity and ASA score were also in the model. When optimally debulked was defined as R0, only age 75+ (<0.001) was significantly associated with decreased DSS. In the R0 cohort, SCS did not significantly predict DSS. However, subset analysis defining optimal ≤1 cm, revealed higher SCS was associated with a 1.6-fold increased risk of death (p = 0.02).Fifty-one patients underwent laparoscopic IDS. Twenty-four (47%) were converted to laparotomy to achieve optimal debulking in 21 patients (87.5%); while 25 had laparoscopic optimal cytoreduction (19/25 [76%] R0).ConclusionsIn women with advanced EOC treated with NACT, older age, SCS ≥ 3, and residual disease >1 cm at IDS were predictors of worse survival. MIS appears safe and feasible with acceptable optimal cytoreduction rates.     

Some epidemiologic aspects of carcinoma of the vulva in Israel

A nationwide study of squamous cell carcinoma of the vulva in Israeli Jewish women has been conducted for a comparison of the incidence, the age pattern and the ethnic distribution of squamous cell carcinoma of the vulva to those of squamous cell carcinoma of the cervix. The mean annual incidence rates by age in squamous cell carcinoma of the vulva rise continuously to age 70+ while in squamous cell carcinoma of the cervix a plateau is reached at age 40 to age 69. In contrast to the relatively low incidence of squamous cell carcinoma of the cervix in Israeli Jewish women, the age-specific incidence rates of squamous cell carcinoma of the vulva are similar to those of white women in the United States. On the other hand, there is a trend to a higher incidence of both squamous cell carcinoma of the cervix and squamous cell carcinoma of the vulva in the North African ethnic group of Israeli Jewish women.     

Amniotic fluid infection as determined by transabdominal amniocentesis in patients with intact membranes in premature labor

The rate of microbial infection of amniotic fluid among patients in premature labor with intact membranes and the effect of this condition on perinatal morbidity and mortality are not known. To study this question, specimens of amniotic fluid were collected by transabdominal amniocentesis from 31 patients in premature labor with intact membranes. Microorganisms were isolated from 25% (8/31) of the specimens; 87% (7/8) of these mothers underwent delivery within 48 hours of amniocentesis, and 75% (6/8) of positive cultures were from mothers who never febrile. Perinatal morbidity was significantly greater among mothers with positive amniotic fluid cultures, as evidenced by earlier gestational age at delivery (31 vs. 36 weeks), lower newborn weight (1,704 vs. 2,613 grams), and longer hospitalization (39 vs. 9 days). A few simple, commonly available laboratory tests (amniotic fluid Gram stain, lactic dehydrogenase levels, and white blood cell count) appear to be useful in making a rapid diagnosis. The data suggest that the presence of microorganisms in the amniotic fluid of afebrile patients in premature labor with intact membranes represents an infectious process rather than an innocuous condition and raises questions with regard to current obstetric trends in the management of premature labor. The routine evaluation of similar patients by transabdominal amniocentesis is not recommended unless prospective studies can demonstrate a decrease in perinatal morbidity and mortality with this approach.     

Isolation of cytomegalovirus from the amniotic fluid during the third trimester

A case is presented in which cytomegalovirus was isolated from the amniotic fluid at 36 weeks' gestation in a pregnancy complicated by cytomegalovirus hepatitis at 10 weeks of gestation. Abnormalities noted in the newborn infant included an undescended testis, right equinovarus, and hypotonia. All cultures revealed cytomegalovirus. Subsequent immunoglobulin studies, chest x-ray film, and bone films were all normal.     

Human chorionic gonadotropin levels in complete and partial hydatidiform moles and in nonmolar abortuses

The rates of regression of human chorionic gonadotropin (hCG) in patients with complete hydatidiform moles, partial hydatidiform moles, and nonmolar abortions were compared. No difference in rates of regression was found among the three groups, but levels of hCG immediately after uterine evacuation were significantly higher in the group with complete hydatidiform moles. Differences in the time required for hCG levels to become undetectable were attributed to the difference in the degree of initial elevation of hCG.