Adjuvant Cytotoxic Chemotherapy Following Wertheim Radical Hysterectomy for Cervical Cancer

Patients at high risk of recurrence or metastases following radical surgery for Stage 1B and 2A cervical carcinoma include those with pelvic node metastases, lymphatic or vascular space permeation in the cervix by tumour cells, large size of the primary tumour, involvement of the full thickness of the cervix and parametrial spread. We report the initial results of adjuvant chemotherapy using a combination of cisplatinum, bleomycin and vinblastine in 22 patients who had undergone Wertheim radical hysterectomy and were thought to be at high risk of developing recurrence. The mean duration of follow-up was 23 months. All are alive after follow-up ranging from 13 to 43 months. Three patients developed recurrences--one in the pelvis, another at the posterior aspect of the urethral meatus and the third developed pulmonary secondaries at 20 to 23 months after surgery. Toxicity from the chemotherapy was acceptable.     

Validity and reliability of an interviewer-administered questionnaire to measure the severity of lower urinary tract symptoms of storage abnormality: the Leicester Urinary Symptom Questionnaire

OBJECTIVE: To develop a valid and reliable interviewer-administered questionnaire to measure the presence and severity of storage abnormality symptoms of incontinence, urgency, frequency and nocturia. SUBJECTS AND METHODS: Subjects were 930 men and women aged >/=40 years, taking part in a randomized controlled trial of a continence nurse practitioner (CNP) service. Criterion validity was tested by comparing questionnaire responses to 24-h pad test and 3-day urinary diary. Responsiveness was assessed by comparing questionnaire responses before and after treatment. Questions about urgency were investigated for construct validity in patients taking part in the trial who underwent urodynamic investigation (243). Test-retest and inter-rater reliability was measured at approximately 6 days in subjects recruited to an associated epidemiological study (104 and 102, respectively). RESULTS: The questionnaire responses showed significant associations with pad-test and diary measures. Questions about the severity of daytime incontinence performed better than those measuring night-time incontinence. The response categories of soaked, wet, damp and almost dry had better associations with the pad test than other measures of the severity of incontinence. Test-retest and inter-rater reliability was good for all questions, and all were responsive to change in symptoms, showing significant differences before and after treatment. CONCLUSION: There is a clear need for standardization of measurement using well-validated instruments. This interviewer-administered questionnaire is valid, reliable and sensitive to change in a wide range of severity of symptoms, and in both men and women aged >/=40 years. The questionnaire provides a useful assessment tool for primary and secondary care in research and clinical settings.     

Cerebral air embolism due to disconnection of a central venous catheter

A case of cerebral air embolism complicating disconnection of a central venous catheter is presented. In the context of increasing use of central venous catheterization this case highlights the risk of cerebral air embolism associated with the use of central venous catheters. In this case there was no patent foramen ovale and air must have passed from the venous to the cerebral circulation through physiologic shunts in the lung. Possible means of entry of air with central venous catheters, pathogenetic mechanisms relating to cerebral air embolism, treatment and preventative measures are also discussed.     

Multiple Polypoid Endometriosis-A Rare Complication Following Withdrawal of Gonadotrophin Releasing Hormone (GnRH) Agonist for Severe Endometriosis: A Case Report

EDITORIAL COMMENT: We accepted this case report for publication because the condition of multiple pelvic polypoid lesions seems previously unreported, is an interesting clinical puzzle, and may be a rare complication of hormone therapy. Sections of these polyps have been reviewed by very senior pathologists one of whom confirmed that 'they consist of an endometrial glandular component, a mesenchymal component and large numbers of blood vessels. One possibility is that simply these are very much altered foci of endometriosis-though I find it difficult to believe that these lesions are due to hormonal therapy for if they were I am sure such lesions would have been recorded before now'. Can any reader provide further relevant information?
Summary: A 30-year-old female who initially had typical endometriosis treated according to a standard regimen later developed numerous highly vascular endometrial polyps on the vagina, cervix, ureter, serosal surfaces of the uterus, pouch of Douglas (POD) and other areas of pelvic peritoneum as well as the endometrium 8 months after withdrawal of treatment with Zoladex gonadotrophin releasing hormone (GnRH) agonist used for treatment of this disease. We postulate that these polyps developed as a rebound phenomenon upon withdrawal of Zoladex. We believe this is the first report of this complication following use of GnRH analogue.