James G. Blythe

Debulking Surgery: Does It increase the Quality of Survival?

The purpose of this paper was to review the debulking operations at our institution relative to the quality of patient survival. Objective and subjective criteria were used to determine the postoperative quality of life. The subjective quality of survival was determined independently by the oncology physician, oncology nurse, and enterostomal therapist. The subjective criteria were the acceptance and care of ostomy (if one was present), the continuance of normal activities, continuing employment, confinement to bed, confinement to a wheelchair, the ability to enjoy life, and the ability to eat a regular diet. The objective criteria included the number of thoracentesis, paracentesis, surgical procedures, nonchemotherapy-related hospital admissions, and incidence of bowel obstruction(s) per patient survival months. Group A, 19 patients, had debulking surgery performed on the gynecologic oncology service primarily for stage III ovarian carcinoma. Group B, 17 patients, had stage III ovarian carcinoma and the disease could not be debulked. Fifteen of the nineteen Group A patients utilizing all of the above subjective parameters seemed to enjoy life. Utilizing these parameters it is clearly evident that extensive, arduous surgery to remove the majority of masses greater than 2 cm in carefully selected patients is worthwhile. The quality of life will be good in the majority of instances, no matter how short the quantity.

Once-daily valacyclovir hydrochloride for suppression of recurrent genital herpes.

Abstract Objective: To document the frequency of genital herpes recurrences in men and women with histories of recurrent genital herpes during 1 year of continuous, suppressive therapy with valacyclovir hydrochloride (HCl). Methods: In an open-label clinical trial conducted at 11 centers, 127 subjects (46 women and 81 men) with histories of recurrent genital herpes (at least 6 recurrences per year) were treated with valacyclovir HCl (500 mg once daily), and their clinical status was followed up for 1 year. Genital herpes recurrences were documented in diaries, and quarterly clinic visits were made for evaluating lesion recurrences and drug safety. In cases of recurrence, subjects self-treated with valacyclovir HCl 500 mg twice daily for 5 days, then resumed once-daily treatment. Results: After the first 3 months of suppressive therapy, 81% of subjects were free of recurrence. Recurrence-free rates remained undiminished during the second, third, and fourth quarters (84%, 84%, and 91%, respectively) and were similar for men and women. Thirty of 46 women (65%) and 56 of 81 men (69%) remained recurrence free during the study and therapy was well tolerated. Adverse events were mild, infrequent, and not considered related to the study drug. Conclusion: Valacyclovir HCl was highly effective and well tolerated as continuous suppressive therapy in men and women with recurrent genital herpes. Potential benefits of the once-daily regimen of valacyclovir HCl include improved patient compliance.

Para-aortic node biopsy in cervical and endometrial cancers: Does it affect survival?

Two hundred ten patients with endometrial and cervical carcinoma had para-aortic node biopsies. Nineteen of the 210 patients (9.0%) had positive para-aortic nodes. These 19 patients received pelvic irradiation, and 18 patients received para-aortic irradiation. The incidence of para-aortic nodal involvement in cervical carcinoma was directly related to the stage of the disease. Eleven of the 12 patients with cervical carcinoma and positive para-aortic nodes received both pelvic and para-aortic irradiation. Three of these patients are alive without disease, resulting in a survival rate of 25%. These patients are surviving for 16, 30, and 41 months. The incidence of positive para-aortic nodes in endometrial adenocarcinoma was related to the uterine length and the histologic grade. The survival rate for patients with endometrial adenocarcinoma and positive para-aortic nodes in this study was 57.1%. Four patients have survived for 1, 30, 60, and 71 months. There were no surgical deaths or radiation therapy complications directly attributable to para-aortic biopsy or irradiation.

Infectious morbidity after primary cesarean sections in a private institution

Primary cesarean sections were performed on 395 patients between January 1, and December 31, 1976. A retrospective review of 322 of these patients indicated that the incidence of postoperative intrauterine infection was the same in both monitored and nonmonitored patients. The incidence of postoperative intrauterine infections was not significantly related to ruptured membranes or the duration of ruptured membranes. The most significant factor associated with postoperative morbidity was the type of anesthesia.

Ovarian remnant syndrome: Study in laboratory rats

OBJECTIVES This study was designed to answer two questions: (1) will devascularized ovarian rat tissue reimplant on intact or denuded peritoneal surfaces, and (2) will any revascularized tissue become functional, as evidenced by follicle formation and vaginal cornification? STUDY DESIGN A total of 110 young female Sprague-Dawley rats were divided into four study groups and a control group. Bilateral oophorectomy was performed on the rats in the first three study groups. In these groups the ovaries were sutured to the left peritoneal surfaces, where the devascularized tissue might become revascularized. The vascularized ovary was sutured to the right denuded peritoneal surface in the rats in group 4, and an oophorectomy was performed on the rats in the control group. The study animals were killed and evaluated at 3, 6, or 9 weeks postoperatively. RESULTS Seventy-five percent of the devascularized ovarian tissue revascularized. Forty-three percent of the viable ovarian tissue demonstrated follicular growth that increased with time to death. Thirty-seven percent of the rats showed the effects of estrogen on the vaginal epithelium. CONCLUSIONS This study indicates that devascularized ovarian tissue may reimplant on intact or abraded peritoneal surfaces, where in time it may resume functioning. These findings suggest that great care must be taken when using the laparoscope to collect ovarian specimens.

Cervicography: A preliminary report

Cervicography is a photographic method to document abnormal cervical lesions. Screening for abnormal cervical lesions, one of the seven proposed purposes for cervicography, was investigated in this study. We evaluated 578 cervigrams obtained from patients with normal cervical cytologic tests. The evaluated cervigrams were placed in one of four categories. Seventy-nine (13.7%) of the patients had normal cervigrams; in 152 (26.4%) the result was unsatisfactory; in 159 (27.5%) the cervigram was technically defective; and in 188 (32.5%) the result was suspicious. One hundred one of the patients with suspicious cervigrams had colposcopic evaluations. In 69 patients colposcopically directed biopsies were done; 14 patients had koilocytotic atypia, seven had grade 1 cervical intraepithelial neoplasia, three had grade 2 cervical intraepithelial neoplasia, and one patient had an invasive cervical carcinoma. Although cervicography has not been proved to be cost effective, it is a method worthy of further evaluation.

Paraaortic lymph node biopsy: a twenty-year study.

OBJECTIVES Paraaortic lymph node biopsy is a controversial but proved technique to determine the extent of spread of cancers from the uterine cervix or endometrium. This article explores the following questions. Does the presence of positive paraaortic lymph nodes result in modification of the patients therapy? Does the evidence gained from a paraaortic lymph note biopsy improve patient survival? STUDY DESIGN Five hundred sixty-eight patients had paraaortic lymph node sampling in conjunction with another operative procedure between 1976 and 1995. Five hundred seven (89.3%) of these patients had either endometrial or cervical cancer. RESULTS Paraaortic lymph node biopsies led to a survival rate of 9.1% for cervical carcinoma and 46.6% for endometrial carcinoma and were associated with acceptable morbidity. CONCLUSIONS We believe that paraaortic lymph node biopsies should be part of the routine evaluation of patients with gynecologic cancers. The knowledge gained by this procedure along with appropriately administered radiation therapy can save lives.

Cervical bacterial flora in patients with gynecologic malignancies

Radiation and gynecologic oncologists agree that pelvic irradiation in the presence of pelvic inflammatory disease, parametritis, or pyometra can be catastrophic. A temperature elevation in a patient having intrauterine radiation is very perplexing. This study was designed to investigate one of the three reported etiologies for this condition. Some investigators have suggested an exacerbation of a quiescent infection as a possible etiology because of the necrotic condition of many cancerous cervices. Aerobic, anaerobic, and fungus cultures were performed on 32 patients prior to intrauterine administration of cesium. The organisms cultured were similar to those identified as the normal cervical flora. The frequency of the organisms seemed independent of the amount of irradiation. The number of organisms cultured did not vary with the use or nonuse of cleansing vaginal suppositories. This study indicated no increase in bacterial growth in these cancerous necrotic cervices; also it did not indicate the growth of any unusual pathologic bacteria.

Comparison of the Cytobrush plus plastic spatula with the Cervex Brush for obtaining endocervical cells

Objective: To compare the effectiveness of the Cytobrush plus plastic spatula with that of the Cervex Brush for obtaining acceptable yields of endocervical cells in Papanicolaou smears. Methods: We collected 309 smears over a 6‐month period, 132 with the Cytobrush plus spatula and 177 with the Cervex Brush. About one‐third of the patients in each group were pregnant. Numbers of endocervical cells in the smears were described as none, few, moderate, or many. Results: Moderate or large numbers of endocervical cells were collected from 60.5% of the women in the Cervex Brush group and 65.2% of those in the Cytobrush‐spatula group. The percentages were not statistically different. Conclusion: The Cytobrush plus spatula and the Cervex Brush sampling methods were equally effective in obtaining endocervical cells in routine Papanicolaou smears. (Obstet Gynecol 1993;82:569‐72)

Managed care: A ball control game

Abstract Our necks are under persecution; we labor and have no rest. Servants have ruled over us. Our inheritance goes to strangers; our houses are aliens. Lamentations 5:2-8 (Am J Obstet Gynecol 1997;176:1225-9.)