Edward C. Hill

Chlamydial infection in women with cervical dysplasia

The prevalence of antibodies to chlamydiae, particularly to TRIC (trachoma-inclusion conjunctivitis) agents, was studied in women with cervical dysplasia and in women attending selected clinics (obstetrics, cancer-screening, and gynecology). In addition, attempts were made to isolate TRIC agents and herpesviruses from the cervices of these women. TRIC agent recovery rates 4.1 per cent for women with dysplasia, 5.4 per cent for pregnant women, 7.8 per cent in the womens clinic, and 0.8 per cent in the cancer-screening clinic. Herpesvirus recovery rates were lower, on the order of 1 per cent or less in each clinic. Complement-fixing antibodies to chlamydial group antigen were detected in 21.5 per cent of women with dysplasia. With a more sensitive fluorescent antibody method, 77.6 per cent of the women with dysplasia or cervical cancer were shown to have antibodies to chlamydiae. In general, antichlamydial antibodies were less prevalent in the other clinic populations. The results of this study indicate that women with cervical dysplasia or cancer may have a high prevalence of antibodies to sexually transmitted agents other than herpesvirus type 2.

Clear cell carcinoma of the cervix and vagina in young women: A report of six cases with association of maternal stilbestrol therapy and adenosis of the vagina☆

Abstract Six young women, between the ages of 16 and 20 years, with clear cell carcinoma (4 of the vagina and 2 of the cervix) were treated at the University of California, San Francisco, Medical Center from 1968 through 1971. Irregular vaginal bleeding was the primary symptom. The lesions were described as papillary, fungating, nodular, or granular and showed no predilection for a specific level in the lower reproductive tract. A high degree of associated adenosis of the vagina was noted. Pelvic lymph node metastases were found in 3 patients. Radical pelvic operation has been effective in the management. Two patients have developed isolated distant metastases, but all 6 are living and well one to 4 years following the initiation of treatment. In 5 cases there was a reliable history of maternal hormone administration during pregnancy. There is good evidence that these tumors are of the paramesonephric (Mullerian) duct rather than the mesonephric (Wolffian) duct in origin.

Vaginal reconstruction after exenteration with use of gracilis myocutaneous flaps: The University of California, San Francisco experience☆

At the University of California, San Francisco Medical Center we have performed 18 vaginal reconstructive procedures with gracilis flaps at the time of anterior, posterior, or total pelvic exenteration. We have compared these patients with 13 other patients undergoing exenteration during the same interval who chose not to have vaginal reconstruction. There was no significant difference between the two groups with respect to age, weight, operating time, blood loss, or duration of postoperative hospitalization, but there were significantly fewer serious complications in the patients receiving gracilis flaps. The results of a questionnaire indicated that the perineal cosmetic results are highly acceptable, although residual scarring on the legs is a common source of minor complaint. Sexual adjustment can be complete or nearly complete in surviving patients. Given the major contribution to wound healing, reduced postoperative morbidity, excellent cosmetic results, and the opportunity for complete sexual rehabilitation, we believe the gracilis myocutaneous flap neovagina remains the procedure of choice for most women undergoing major exenterative procedures.

Pelvic exenteration: A critical analysis of a ten-year experience with the use of the team approach

Abstract Forty-one exenteration operations were performed by the authors, a surgeon and a gynecologist, with the use of the team approach, at the University of California Medical Center, San Francisco, from 1961 through 1969. Eleven anterior, one posterior, and 29 total exenterations were done for a variety of pelvic malignancies, predominantly carcinoma of the cervix, centrally recurrent following radiation therapy. Intestinal obstruction was the most frequent complication. One patient died within 30 days following the operation. Life Table calculations reveal a 3 year survival rate of 43.7 per cent and a 5 year survival rate of 34.5 per cent. Pelvic exenteration, with the use of the team approach in a hospital physically equipped and properly staffed for the treatment of malignant disease, can salvage a significant number of patients with otherwise incurable malignant disease.

Radical surgery in the management of clear cell adenocarcinoma of the cervix and vagina in young women

The treatment of clear cell adenocarcinoma of the cervix and vagina in young women has varied widely from one institution to another. Since 1956, 16 such patients have been treated primarily with radical surgery at the University of California, San Francisco. The operations have ranged from radical hysterectomy and bilateral pelvic lymph node dissection with preservation of the ovaries to total pelvic exenteration, depending upon the location and extent of the disease. Vaginal reconstruction has been carried out in most of the patients who required vaginectomy. Eleven of the 16 patients are living and well. The remaining five have died of disease, two of them after relatively long disease-free intervals.

Panel discussion. Estrogens: Do the risks outweigh the benefits?

4 doctors present their views on the therapeutic value of estrogen treatment. 1 doctor cited professional experience in which not a single woman he had treated with estrogens had died from endometrial cancer. A 2nd doctor was convinced of the need for long-term estrogen replacement therapy if a woman was to remain physically active after manopause. However endometrial biopsy should be performed at regular intervals in patients with obesity diabetes hypertension or polycystic ovarian disease. A technic for endometrial sampling is also described. Another doctor reviews the physiologic and pharmacologic aspects of estrogens in the perimenopausal and postmenopausal period and emphasizes the prophylactic effect of estrogens against osteoporosis while acknowledging the risks. The 4th doctor focuses on the possible effect of estrogens in promoting breast cancer.

ARE CHLAMYDIAL INFECTIONS THE MOST PREVALENT VENEREAL DISEASE

We studied two population groups (more than 1,600 patients) to determine the prevalence and clinical associations of genital tract infections with chlamydiae and herpesviruses. Base-line isolation rates for asymptomatic women having routine pelvic examinations were much lower than rates for symptomatic women. In both groups, chlamydiae were more prevalent than herpesviruses. Chlamydial infection was associated much more commonly with cervicitis (36.6%) than with vaginitis only (4.1%). Among 282 symptomatic men, the cultures of 19.9% yielded chlamydiae, and 4.3%, herpesviruses. Chlamydiae were recovered from 35.5% (27 of 76) of specimens from men with nongonococcal urethritis, and from an even larger proportion, 57% (24 of 42), of the specimens from men with frank discharge.