Hans Grundsell

OUTCOME OF PREGNANCY AFTER CONIZATION

Abstract. The outcome of 635 pregnancies in 197 women before and after conization is reported. After conization a significant increase in premature deliveries occurred in young women (age 21‐25), nulliparae representing the highest risk. The rate of premature deliveries in this age group was 4.4% before conization and 30.6% after conization. No such increase could be found in any other age group.

Prognostic factors in early invasive carcinoma of the uterine cervix: A clinical, histopathologic, and statistical analysis of 343 cases

Three hundred forty-three cases of early invasive carcinoma of the uterine cervix were analyzed. Depth of infiltration and lateral extension of the tumors varied between 0.2 and 9.0 mm and 0.4 and 17.2 mm and were found to be of no prognostic importance. A multivariate statistical analysis revealed several risk factors: an epithelialized portio at diagnosis, suspected or evident tumor invasion in capillary-like spaces, absence of tumor-free margins at conization, and treatment with conization or simple hysterectomy, especially in the presence of the above-mentioned factors. Tumors of a large cell keratinizing type were prognostically favorable. Confluent growth was not associated with increased risk of recurrence or death from recurrence. Cervical biopsies proved to be inadequate as diagnostic material. Recurrences were almost always local and developed late. In absence of risk factors conization is sufficient treatment. In the presence of risk factors treatment should be the same as that performed for frankly invasive Stage IB carcinomas.

Operative management of vaginal vault prolapse following hysterectomy

Summary. Nine women suffering from vaginal vault prolapse had an abdominal sacropexy between 1972 and 1983. Marlex mesh was used to anchor the vaginal vault to the promontory of the sacrum and was completely buried retroperitoneally. The women had all had previous attempts at surgical correction. There were no intra‐ or post‐operative complications. No recurrences of vault prolapse occurred during a mean follow‐up period of 3.9 years. One woman developed a moderate cystocoele 4 years after sacropexy.

Estradiol-17β and progesterone concentrations in human endometrium during the menstrual cycle

Abstract Plasma and endometrial levels of E 2 and P were measured on different days of the menstrual cycle. The tissue concentrations of the steroids were determined in terms of wet weight, protein and DNA. There was a good correlation between the various modes of expression of tissue concentrations; the best being between protein and DNA and the least satisfactory between wet weight and DNA. P concentrations not only in plasma but also in the endometrium were significantly higher in the secretory phase than in the proliferative phase. No significant differences in plasma or tissue levels of E 2 in the different phases of the menstrual cycles could be demonstrated.

Treatment of condylomata acuminata with the carbon dioxide laser

Extensive and/or recurrent condylomata acuminata in 78 women were treated with the CO2 laser. Urethra, clitoris or the anal canal were inved in about one‐fourth of the cases. Most were treated as outpatients with the more extensive lesions staged for multiple treatments. After a follow‐up period of 6–33 months, 91% of women were free from disease and treatment failures occurred in 9%, some of which may have been new infections. No serological investigations were performed.

Laser miniconization in mild and moderate dysplasia of the uterine cervix

Abstract Mass cytologic screening for cervical cancer often reveals only mild dysplasia not indicating conization but necessitating continual checkup. Such routine checkups are often insufficient, beside which the patients find them frustrating. Therefore a new method, called miniconization, for treatment of patients with vaginal smears showing mild or moderate dysplasia (cervical intraepithelial neoplasia /CIN/ I–II), was developed. With the CO 2 laser handpiece a 5mm-thick disc of the cervix, including the whole transformation zone, was removed. This was followed by endocervical curettage. The advantage of the method over cryosurgery, electrocoagulation, and laser vaporization, for example, is that the tissue specimen as a whole disc including the transformation zone can be sectioned and examined histologically. Another advantage is the decreased risk of postoperative bleeding, which enables ambulant care. One hundred and fifty-one patients have hitherto been treated and carcinoma in situ has been found in 15.2% and microinvasive carcinoma in 1.3% of all these patients in whom vaginal smears showed mild or moderate dysplasia (CIN I–II).

Prognosis of adenocarcinoma of the uterine cervix.

Abstract In a material of 42 patients with adenocarcinoma of the uterine cervix, Stages I and II, large tumor extension was recorded in 7 out of 8 patients in Stage IIA and in 5 out of 13 patients in Stage IB, all of whom had been given preoperative radiotherapy. Four patients out of 7 primarily given conization or hysterectomy for supposed preinvasive cancer had tumors growing deeply within the cervical stroma. The unexpected large tumor extension probably explains the less favorable prognosis for patients with cervical adenocarcinoma. The 2- and 5-year tumor death rates were approximately 21% and 1023, respectively. A combined radiotherapeutical and surgical approach is presented.

Giant Condyloma Acuminatum with Focal Malignant Degeneration

Buschke, in 1896, (3) described two cases of giant condy~oma acuminatum occurring on the penile shaft. In 1925 a similar tumor of the penile shaft was described by the same author and Loewenstein (4). The tumor was described as a generally slow growing, locally invasive, verrucose tumor which commonly involves the male external genitalia, oral cavity and, rarely, the female genitalia. Condyloma acuminatum is generally considered to be a benign epithelial hyperplasia, although some authors have incriminated it as a premalignant lesion (6, 9). Condyloma acuminatum is auto-inoculable and transmissible and has been shown to be caused by a filterable virus, which is apparently identical with or related to the virus that causes the common wart, verruca vulgaris (8). Dawson et QI. suggested the possibility of malignant change in a case of giant condyloma acuminatum ( 5 ) . This is strongly supported by well-known experiments with virus-induced tumors in rabbits (10, 16). Ackerman (1) was the first to use the term verrucous carcinoma. The lesions he found were located in the mouth and pharynx. Kraus & Perez-Mesa (12) reported the first case involving the female genitalia. Vulvo-vaginal lesions are rather rare, however. Partridge et d. (14) have reviewed the literature and 36 cases of verrucous carcinoma have so far been reported. We report here another case of giant condyloma acuminatum, in the vulvar region with malignant degeneration and discuss aspects of treatment. ed small tumors in the vulvar region but was afraid to mention them to anyone. Physical examination revealed a grotesque tumor in the vulva and the left peri-anal region. The vulvar tumor mass consisted of two separate parts measuring 6 x 8 x 9 cm and 6 x 10 x 13 cm respectively. The anal tumor was 3 x 5 x 6 cm (Fig 1). The urethra and the vagina were unaffected. Macroscopally there was no suspi-

Progesterone and estradiol concentration in human kidney and renal cell carcinoma

Abstract Renal carcinoma and renal tissue, five each, were analyzed for their concentration of progesterone (P) and estradiol-17-β (E2). Concentrations of these steroids were also measured in blood samples from each of the five patients. The mean plasma P and E2 concentrations were 0.5 ng/ml and 44.8 pg/ml. The tissue concentrations of P were 8.2 ng/g and 5.9 ng/g for normal kidney and carcinoma tissue respectively. The difference between the two values was significant (P

Effect of Copper and Plastic Intrauterine Devices on the Norepinephrine Content of Rabbit Oviduct and Uterus

An intrauterine device (IUD) consisting of either a plain or a copper-coated polyethylene catheter was inserted in one of the uteri of rabbits. Sham-operated uteri served as controls. The norepinephrine (NE) content was compared only between uteri within the same animal. Both copper and plastic IUDs markedly reduced the NE content in the uterus, but not in the oviduct, within 1 week after insertion. NE in both organs was present exclusively in the adrenergic nerve system. There was no difference in the action of the two types of IUDs. The effect of an IUD was probably eliminated by interruption of the preganglionic nerve connections. The results showed that the uterine adrenergic neurons are influenced by the presence of an IUD.