John L. McKelvey

Operative treatment of adenocarcinoma of the endometrium in obese women

Abstract A series of 98 very obese patients with adenocarcinoma of the endometrium is presented in which a surgical applicability rate of 90 per cent was achieved. The results show that standard simple techniques for hysterectomy can be safely applied to this type of patient with no increase in operative mortality. The survival among these obese patients compares favorably with that among nonobese patients with the same disease and treated in the same manner.

Results of an experimental therapy of caroinoma of the cervix

Abstract 1. 1. Carcinoma of the cervix has been treated at the University of Minnesota Hospitals since the beginning of 1939 by means of daily x-ray therapy followed immediately by intravaginal and intrauterine radium. X-ray is given over as close to 28 days as possible and the details of this therapy are arranged so as to supply 3,000 tissue roentgens diffusely to the pelvis in this time. This is followed on the day of the last x-ray treatment by the insertion of radium which is left in place for 100 hours. Under ideal anatomical circumstances, two intrauterine portals in tandem and three vaginal portals in the Kaplan colpostat are used. Each contains 10 milligrams of raduim for a total dosage of 5,000 milligram hours. This is decreased as the availability of space for these portals is decreased. 2. 2. Every single patient has been followed to death or to Jan. 1, 1949. Every single patient has satisfactory biopsy control. There is no questionable carcinoma in the material. 3. 3. The following results have been obtained on reportable material. The League of Nations classification is used. Absolute five-year cure rate, 53.6 per cent (S.D. ± 2.8 per cent) Stage I, five-year cure rate, 80.2 per cent (S.D. ± 4.0 per cent) Stage II, five-year cure rate, 54.1 per cent (S.D. ± 4.8 per cent) Stage III, five-year cure rate, 29.5 per cent (S.D. ± 5.2 per cent) Stage IV, only 1 patient of 16 cured. 4. 4. Adenocarcinomas, carcinomas of the cervical stump, and a few cases which were treated with surgery as well as x-ray are included. Because of their small number and the surprising similarity of the results with them to those of the general group of squamous-cell carcinomas, they do not influence the expression of results. 5. 5. The techniques described have significantly improved the results previously obtained and are recommended.

The obstetric significance of the posterior occiput position.

The occiput posterior position has been considered a serious complication of labor. Evidence is presented that it is a normal, frequently occurring position and that the outlook for mother and child is normal. Difficulties arise with the occiput posterior mainly at midpelvis. Indications for midpelvic study, their recognition and their interpretation are discussed.