James Henry Ferguson

INTRAEPITHELIAL CARCINOMA, DYSPLASIA, AND EXFOLIATION OF CANCER CELLS IN THE VAGINAL MUCOSA.

Abstract One hundred and fifty-one women had positive cancer smears among a selected group of 663 who were carefully followed. Although apparently cured of cervicouterine disease, uncompleted study of the 151 women has already disclosed 15 cases of vaginal intraepithelial carcinoma and 12 of dysplasia. Exfoliation of cancer cells frequently ceased after punch biopsy and partial vaginectomy. This unexpected frequency of positive vaginal smears and tissue suggests these vaginal neoplasms have a low invasion potential and supports the field theory of carcinogenesis.

CONE BIOPSY OF THE CERVIX

A SUMMARY of the experience with 486 diagnostic conizations of the cervix on one hospital service will be presented. The value of these conizations of the cervix will be measured by making comparisons with the punch biopsies and the hysterectomy specimens, when available, in the same patients. The price paid in complications and disabilities for these conizations will have to be considered. Physicians practising without the benefit of vaginal cytology recognize little or no need for diagnostic conization of the cervix. When one has responsibility for a growing number of patients who have had cytological examinations, he finds he has an increasing number of patients who have a positive cancer smear that is difficult to explain. These puzzling patients may have no lesion, no symptoms suggestive of cancer, and the punch biopsy specimen cannot be considered cancer. It is recognized that possibly only by examination of the entire uterus and the cervix can the exact diagnosis be determined. Because a hysterectomy may be undesirable, or may, as in the presence of invasive carcinoma, be inadequate treatment, hysterectomy is not an accepted method of solving the diagnostic problem. A large specimen of the cervix and a curettage of the remaining cervical-uterine cavity will usually disclose the cause of the positive smear. Conization of the cervix is one method of obtaining the large specimeii that is necessary for a true diagnosis. At the University of Miami-Jackson Memorial Hospital we have had a yearly rise in the number of cytological examinations, reaching 13,000 such examinations in 1950. For over four years we have been obtaining cytological examinations on all of our obstetric and gynaecological patients, both in-patients and out-patients. With this load has come the increased need to obtain cone specimens in order to explain the increasing number of puzzling positive cytologic reports (Fig. I ) . The experience reported here is heavily

Inevitable and incomplete abortion An evaluation of aggressive management

Abstract 1. 1. A study of 951 consecutive cases of inevitable and incomplete abortion seen over a 28 month period is presented. 2. 2. No feature of etiologic significance was detected. 3. 3. It is felt that prompt transfusion, preoperative oxytocin infusion, and surgical evacuation of the uterus will reduce mortality and morbidity, as well as the period of hospitalization. The use of antibiotics prophylactically is not advocated, but there should be no hesitation when their use is indicated. 4. 4. The range of hospitalization was from a few hours to 14 days. Seven hundred ninety-six (83.7 per cent) of 951 patients were discharged within 48 hours of admission. 5. 5. The over-all complication rate was 5.3 per cent. There were no deaths among the 951 patients treated.

The use of relaxin in the management of the retained dead fetus.

Abstract The recent recognition of the threat of hypofibrinogenemia in the presence of a retained dead fetus places increased value on the emptying of the uterus. The hormone relaxin appears to be able to make the cervix more favorable for the induction of labor. The use of relaxin followed by a dilute Pitocin infusion in the treatment of 20 patients with dead fetuses has been described. This management appears to be worthy of further trial.

HEPATITIS AND NEOPLASIA OF THE CERVICAL EPITHELIUM

Of 56 women with hepatitis an unselected 36 had a cervical smear made for cancer cells and some patients had appropriate tissue examinations. The prevalences of exfoliation of cancer cells and of neoplastic changes in the cervical epithelium among the women tested were found to be much greater than would be expected in any random sampling. No explanation for these coincidences is offered. A plea is made to practitioners with greater opportunities than the authors for study of hepatitis to have these cervical cancer screening tests done on their women with hepatitis.Hepatitis e Neoplasia in le Epithelio CervicalEx un gruppo de 56 feminas con hepatitis, un non-seligite serie de 36 esseva studiate per frottis cervical pro cancere, e in certes del casos appropriate examines histologic esseva effectuate. Le incidentia de exfoliation de cellulas de cancere e illo de neoplastic alterationes del epithelio cervical in le feminas studiate esseva multo plus grande que lo que esserea a expectar in un gruppo de selection aleatori. Nulle explication pro iste coincidentias es presentate. Le autores urge que lor collegas con opportunitates plus extense que le lores de studiar hepatitis accepta le plano de subjicer lor patientes feminin con hepatitis al mentionate tests discriminatori pro cancere cervical.