Maximum Effort in the Management of Ovarian Cancer, Including Pelvic and Para-aortic Lymphadenectomy

Patients treated for ovarian cancer at the Mercy Hospital for Women, Melbourne over a 5 1/2 year period were studied with an emphasis on the need for lymphadenectomy. There were 80 patients identified with ovarian cancer. Forty patients underwent pelvic and/or para-aortic lymphadenectomy and 25 (62.5%) were found to have lymph node metastases, in 7 of the 40 women the lymphadenectomy resulting in upstaging of the disease. FIGO has adopted a surgicopathological approach to the staging of ovarian cancer and this requires lymphadenectomy to be performed. The importance of accurate staging in clinically early ovarian cancer and maximum surgical effort in advanced disease is discussed with particular regard to the place of lymphadenectomy.     

Cervical Entrapment of a Polythene Vaginal Ring Pessary — a Clinical Curiosity

An extremely rare complication of cervical entrapment of a polythene ring pessary within an epithelial 'tunnel' of the cervix is reported. The pessary was removed by dividing a segment of it with bone cutting forceps.     

Unusual skeletal metastases in carcinoma of the cervix

In a series of 1347 patients with carcinoma of the cervix, 62 or 4.6% had metastatic spread to the bones. Bone metastasis correlated with more advanced disease, occurring in 39.1% of patients with Stage II disease. The role of isotope bone scanning and of the radiographic skeletal survey in the investigation of carcinoma of the cervix is considered. Eight patients having unusual radiographic appearances of skeletal metastases are discussed.     

An analysis of the psychometric properties of the translated versions of the European Organisation for the Research and Treatment of Cancer QLQ CX24 questionnaire in the two South African indigenous languages of Xhosa and Afrikaans

This study evaluates the psychometric properties of the Xhosa and Afrikaans version, the European Organization for Research and Treatment of Cancer (EORTC) of the Quality of Life Questionnaire Cervical Cancer Module (QLQ‐CX24). Translated Xhosa and Afrikaans versions, EORTC QLQ‐CX24 and the core questionnaire (the EORTC QLQ‐C30) were completed by 66 Xhosa and 142 Afrikaans speaking women newly diagnosed with cervical cancer. Construct reliability and validity of the EORTC QLQ‐CX24 questionnaire were assessed via factor analysis, multi‐trait scaling analyses and known group comparisons. The mean age was similar in the groups with a mean age of the Xhosa group (52 year) and Afrikaans group (49.2 year) (P = 0.25). The study groups had a high unemployment rate of, respectively, 52% (Xhosa) and 51% (Afrikaans) (P = 0.35). The Xhosa group had a statistically significant higher incidence of advanced stage (III and IV) disease (P = 0.006). Scale reliability was confirmed by Cronbach's α coefficients for internal consistency, which ranged from 0.73 to 0.81 (Xhosa) and 0.73 to 0.76 (Afrikaans). Clinical validity of both language versions was demonstrated by the ability to discriminate among different stages of cervical cancer. The translated Xhosa and Afrikaans versions of the EORTC QLQ‐CX24 were found to be reliable and valid measure of quality of life of women with cervical cancer.     

The Use of 16.16-dimethyl-PGEl- A-methyl ester (Cervagem) Vaginal Pessaries for Cervical Dilatation Prior to Evacuation for Second Trimester Termination

The results of a study of 101 consecutive second trimester terminations by Dilatation and Evacuation (D & E) under ultrasound control is presented. All had a Cervagem pessary inserted into the vagina prior to the procedure. The PGE1 analogue was assessed as 'effective' in 97% of patients. Concomitant ultrasound resulted in no patient leaving the operating table with retained products. The high efficacy of the single pessary associated with a low incidence of side-effects makes this combination the method of choice for nearly all second trimester terminations.     

Nerve Entrapment - An Important Complication of Transverse Lower Abdominal Incisions

Summary: Eleven patients with atypical lower abdominal pain following gynaecological surgery were clinically assessed for the features of nerve entrapment syndrome. Eight iliohypogastric nerves in 6 patients were subsequently explored and divided with satisfactory results in all patients. Diagnostic criteria for this syndrome are suggested, and the surgical management is described.