Advanced carcinoma of the ovary with central nervous system relapse

Interdisciplinary protocols for management of advanced adenocarcinoma of the ovary have resulted in prolonged patient survival. A subset of patients is emerging in whom central nervous system (CNS) relapse occurs even following negative second-look procedures (SLP). Seven of 342 eligible patients entered in a National Cancer Institute of Canada Trial for Ovarian Cancer, from February 1, 1980 to March 31, 1984, had CNS relapse. All patients received adriamycin and cisplatin. SLP was performed in 5 patients, 3 of whom were complete responders (CR). Two additional patients failed to complete their chemotherapy and had progressive pelvic disease. The median age of these 7 patients was 57 years, their overall survival time was 28 months, compared with an average age of 58 years and survival of 21.6 months, for the entire group. Two patients had prolonged survival after their CNS relapse; 1 patient lived 26 months, and the other, who underwent craniotomy for primary management of the metastasis survived 18 months. Confirmation of metastatic disease was obtained in 4 of the 7 patients. The results of this study suggest that management of CNS involvement in adenocarcinoma of the ovary should be determined by overall performance status even in the presence of generalized disease.     

Domperidone; secretion in breast milk and effect on puerperal prolactin levels

Summary. The possible effect on the infant of dopamine antagonists used to promote lactation is cause for concern. Domperidone (Motilium) may be safer than other drugs in this group as it does not cross the blood-brain barrier. The mean serum level of prolactin 2 h after treatment with 20 mg of domperidone in the puerperium was 255 ng/ml compared with 150 ng/ml after a placebo. The mean domperidone level in all breast milk samples during treatment with 10mg, three times daily, was 2·6 ng/ml. This was significantly more than levels after a single 20 mg dose sampled at 2 h (0.24 ng/ml) and at 4 h (1·1 ng/ml), and considerably less than values available for metoclopramide and sulpiride, relative to the therapeutic dosage. The effectiveness of domperidone to augment lactation requires further study.     

Uterine activity in the second stage of labour and the effect of epidural analgesia

Summary. Uterine activity was measured during the second stage of normal labour in 20 patients with and 31 patients without epidural analgesia. There was a significantly lower uterine activity integral (UAI) in patients having epidural analgesia, and it is suggested t h a t this may contribute to the increased rate of instrumental delivery associated with epidural analgesia.     

Bladder neck electrical conductivity in the treatment of detrusor instability with biofeedback

Summary. A new method for controlling the symptoms and objective signs of detrusor instability was investigated in a pilot study. The method uses the activity of the bladder neck, monitored by a conductivity catheter, as a biofeedback signal. Voluntary closure of the bladder neck mechanism abolishes abnormal detrusor activity. Ten severely symptomatic women with detrusor instability were assessed clinically and urodynamically before and after a course of biofeedback. Statistically significant improvements in the symptoms of urgency and urge incontinence were found. Five of the seven women who agreed to have repeat cystometry had stable cystometrograms. There was a statistically significant fall in the mean maximum deflection at rest from 41·5 to 16·5 μA (P<0·05) measured during bladder neck electrical conductivity tests before and after treatment.