Fred T. Given

Vaginal length and sexual function after colpopexy for complete uterovaginal eversion

OBJECTIVE Our objective was to evaluate vaginal length and sexual function after colpopexy for complete uterovaginal eversion. STUDY DESIGN Measurements of postoperative vaginal length were performed on 59 patients having various types of repair for complete uterovaginal eversion. Sexual function was evaluated when possible. Controls were 61 normal premenopausal and postmenopausal patients both with and without a uterus. Anatomic measurements from the introitus to the middle of sacrospinous ligament and to the sacral promontory were obtained from 21 fresh autopsy specimens. RESULTS Average vaginal length for controls was 9.2 cm in premenopausal patients with a uterus and 8.5 cm for patients without a uterus and averaged 8.5 and 8.2 cm, respectively, for postmenopausal patients with and without a uterus. Vaginal length after posterior culdeplasty was 9.2 cm, 8.2 cm after sacrospinous fixation, and 11.3 cm after sacral colpopexy. CONCLUSION If maximum vaginal length is the objective, it is best maintained with a sacral colpopexy.

Preoperative radiation therapy in the management of squamous cell carcinoma of the vulva: Preliminary report

Fourteen cases of squamous cell carcinoma of the vulva treated preoperatively by use of cobalt-60 irradiation directed to the vulva and inguinal areas are reviewed. Toral dose varied from 3,600 to 5,500 rads according to reaction and tolerance. No treatments had to be interrupted due to excessive radiation effects. Surgical procedures were performed six weeks after irradiation. Histologic investigation of the surgical specimen showed no sign of tumor in five cases, almost complete regression in three, and a substantial reduction of the lesion in the remainder of the cases. In situ lesions surrounding the invasive tumors were cleared in three cases. Lymph node involvement was found in only two patients, one of whom did not receive preoperative radiation to in inguinal areas. Only one local recurrence was encountered and this was in the abdominal skin outside of the irradiated area. The healing process does not seem to be impaired after radiation treatment in spite of the fact that in many patients a very extensive type of surgical procedure was carried out.

The process of carcinogenesis for endometrial adenocarcinoma could be short: development of a malignancy after endometrial ablation.

Endometrial ablation has been proposed as an alternative to hysterectomy for the treatment of dysfunctional uterine bleeding. We describe what we believe to be the first reported case of an endometrial adenocarcinoma that may have developed shortly after endometrial ablation.

Normal pregnancy and delivery following conservative surgery and chemotherapy for ovarian endodermal sinus tumor.

Management of younger patients with early stage ovarian endodermal sinus tumor who desire to have children can be a challenging problem. However, after an adequate and thorough staging procedure for the patients tumor status, a Stage Iai endodermal sinus tumor may be treated with conservative surgery only, followed by chemotherapy. Successful pregnancy and delivery following unilateral adnexectomy and chemotherapy for ovarian endodermal sinus tumor have been reported only once [J. P. Forney, Obstet. Gynecol. 52, 360 (1977)]; the second reported case is presented here. It should be pointed out that strict follow-up and reliability of the patient are mandatory for such conservative therapy.

Complications from intraperitoneal radioactive phosphorus in ovarian malignancies

A retrospective study of the use of phosphorus-32 in the treatment of 73 cases of ovarian malignancy to evaluate the safety and morbidity is presented. The surgically confirmed major complication rate with P-32 alone was 4 of 54 cases (7.4%). The addition of external radiation raised the surgically confirmed complication rate to 4 of 19 cases (21%) and with the addition of those diagnosed and treated only medically the rate rose to 8 of 19 cases (42%). In Stage I cases, Grades 1 and 2, there was only 1 death in 26 patients (96%), whereas for Grade 3 tumors only 6 of 12 patients (50%) were living at the end of 2 years.

Malignant melanoma presenting as a unilateral ovarian neoplasm

A 45-year-old female with a unilateral ovarian melanoma without residual ovarian teratoma or clinical evidence of primary lesion is described. The clinical and pathological differential diagnosis is discussed.

Radioactivity in blood and urine following intraperitoneal instillation of chromic phosphate in patients with and without ascites

Systemic distribution of radioactive colloidal chromic phosphate P 32 after intraperitoneal instillation was studied in 10 patients with ovarian or endometrial malignancies. Seven patients without ascites received chromic phosphate P 32 for positive peritoneal washings, rupture of the capsule of the cyst during operation, or minimal Stage III disease. Three patients received chromic phosphate P 32 for recurrent ascites after multiple abdominal paracenteses. Blood and urine radioactivity measurements were performed at selected intervals. There was a clear statistically significant difference (p less than 0.01) between chromic phosphate P 32 activity levels in whole blood, red blood cells, and plasma in patients with and without ascites.

Repair of old complete perineal lacerations

Our subjects were 32 patients whose old complete perineal lacerations were repaired in the 10 hospitals in the South Hampton Roads Metropolitan area over a 20-year period. The layer technique of repair (26 patients) and the Warren flap procedure (6 patients) were used. Function improved in 24 of 26 patients (92%) with adequate follow-up. Function was completely restored in 22 of 26 patients (85%). The use of a careful mechanical and antimicrobial bowel prep is emphasized, as is the debatable use of the paradoxical incision (Miller).

Retroperitoneal fibrosis complicating stage IB squamous cell carcinoma of the cervix

A patient with Stage IB squamous cell carcinoma of the cervix associated with benign retroperitoneal fibrosis and hydroureters is reported. It is suggested that staging laparotomy is indicated in such a case to assess whether hydroureters are related to benign fibrosis or cancer metastasis.

THE USE OF LAMINARIA JAPONICA IN INTRACAVITARY RADIATION THERAPY WHEN ANESTHESIA IS CONTRAINDICATED

Laminaria tents have been used to dilate the cervix for interruption of pregnancy and other intrauterine procedures. Their use is presented in 5 patients with cervical and endometrial carcinoma where general anesthesia was contraindicated. Cervical dilation was sufficient with a single Laminaria to carry out intrauterine and intravaginal instrumentation for radiation therapy with no local or general anesthesia.