Kankipati S. Raju

A randomised prospective study of laparoscopic vaginal hysterectomy versus abdominal hysterectomy each with bilateral salpingo-oophorectomy.

Objective To identify differences in the peri‐operative outcome of women undergoing hysterectomy with bilateral salpingo‐oophorectomy performed either by abdominal hysterectomy and bilateral salpingo‐oophorectomy or by laparoscopic‐assisted salpingo‐oophorectomy and vaginal hysterectomy. To identify any potential management implications, including financial differences, between these two forms of operations.

Adipose tissue of human omentum is a major source of dendritic cells, which lose MHC class II and stimulatory function in Crohn's disease

Adipose tissue is reported to contain monocyte‐like pre‐adipocytes, which may mature into macrophages, contributing to local inflammation. Dendritic cells (DC) can be derived from monocytes and initiate and regulate primary immune responses. We hypothesized, therefore, that adipose tissue may provide DC involved in local immune activity. To test this, we studied cells from human omental adipose tissue samples from 17 patients with benign gynecological disease. The hypothesis that adipose tissue DC are involved in inflammatory disease was tested by comparing these cells with those from 18 patients with Crohns disease, where hypertrophy of adipose tissue suggests involvement in disease. A high proportion of the 1.33 ± 0.12 × 105 CD45‐positive cells/mg, obtained from control omenta, expressed CD11c, CD1a, and CD83; costimulatory molecules CD40, CD80, and CD86; and major histocompatibility complex (MHC) Class II but little CD14, CD16, or CD33. Omental cells showing morphological characteristics of DC were also observed. Metrizamide gradient‐enriched DC from these populations were potent stimulators of primary proliferation of allogeneic T cells in mixed leukocyte reactions. Increased numbers of CD45+ cells from omentum of Crohns patients (4.50±1.08×105 CD45+ cells/mg) contained higher percentages of CD11c+ and CD40+ cells (80.8±3.8% vs. 63.4±6, P=0.032; 77.9±4% vs. 58.8±6.5, P=0.029, respectively), but MHC Class II and stimulatory capacity were almost completely lost (P=<0.001), suggesting innate activation but lost capacity to stimulate adaptive immune responses. Granulocytes were also present amongst the omental cells from Crohns patients. Results indicated that omentum may provide DC, which could “police” local infections and contribute to and/or reflect local inflammatory activity.

HUMAN PAPILLOMAVIRUS TYPE 16 IN INFANTS : USE OF DNA SEQUENCE ANALYSES TO DETERMINE THE SOURCE OF INFECTION

Perinatal transmission of human papillomavirus type 16 (HPV-16) and persistence of virus DNA in infants until 6 months of age has been described. To confirm the origin of infant infections as maternal, we determined the nucleotide sequence of the upstream regulatory region (URR; bp 7540 to 157) of HPV-16 in samples from 13 HPV-16 DNA-positive mothers and their infants at 6 weeks and 2 years of age. Identical HPV-16 variant URR sequences were found in two mother/infant samples and similar variants were found in three sets. Four mothers with samples which contained prototypic HPV-16 sequences delivered infants who also had the prototypic sequence. Four mothers with variant URRs delivered infants who harboured either prototypic or different URR variants. Thus, concordant variants or prototypic sequences were detected in nine of 13 mother/infant samples, indicating that up to 69.2% of HPV-16-positive infants acquire virus from their mothers.

Laparoscopic-assisted vaginal hysterectomy with bilateral oophorectomy versus total abdominal hysterectomy and bilateral salpingo-oophorectomy—Implications for gynecologic practice in the United Kingdom

A prospective, randomized study was conducted to identify differences in the perioperative outcome of patients undergoing either routine total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH-BSO) or laparoscopic-assisted vaginal hysterectomy and bilateral salpingo-oophorectomy (LAVH-BSO). We also assessed potential management implications, including financial differences, between the operations. Of 40 women requiring hysterectomy for a range of benign conditions, 20 underwent LAVH-BSO and 20 TAH-BSO. The respective mean operating times were 97.5 and 54 minutes. Patients in the former group required significantly less postoperative oral analgesia, 4.1 doses compared with 11.7 doses on average. The length of postoperative stay was shortened from 6 to 3.8 days on average for LAVH-BSO. The potential cost savings was 17.9% per case for LAVH-BSO compared with TAH-BSO. Thus, LAVH-BSO was a safe alternative to TAH-BSO, with less morbidity and earlier hospital discharge. Possible cost savings suggest the need for changes to current operating and inpatient hospital resources.

Routine hysteroscopy for patients with a high risk of uterine malignancy

Summary. Seventy patients with abnormal vaginal bleeding were examined with a Storz hysteroscope. The examination took an average of only 5 min. Sixty patients had the examination under general anaesthesia, five under paracervical block and five had no form of anaesthesia. All tolerated the procedure well. There were no complications directly related to the hysteroscopic examination. There was complete correlation between the histology of the endometrium obtained at subsequent curettage and the hysteroscopic findings.

First steps in the development of an information and counselling service for women with an abnormal smear result

A study was conducted to develop and evaluate an information leaflet and to investigate the acceptability of a counselling service for women with an abnormal smear result. A newly constructed information leaflet which addressed concerns related to receipt of an abnormal smear result and its medical management was compared for ease of readability with five other leaflets in current use and found to be superior. 144 women were given the leaflet either prior to a colposcopy examination or outpatient ablative treatment and randomly assigned to two recruitment strategies to examine the acceptability of a counselling interview. There was no significant difference between the two strategies and an uptake rate of 80% suggested that women welcomed such an opportunity. An interview evaluation schedule yielded a 98% positive response rate which indicated that the women were satisfied with the counsellor and found the interview useful. Significant differences emerged before and after medical intervention. Patients reported less anxiety, improved mood, and less distress related to the smear result and subsequent medical procedures immediately after the medical interventions (P less than 0.001).

SR8—The establishment and characterisation of a new ovarian carcinoma cell line and xenograft model

A new cell line, SR8, and xenograft model of ovarian carcinoma has been established in this laboratory over the past 20 months from a patient with advanced ovarian cancer. Electron microscopic examination of SR8 cells demonstrated the presence of desmosomes and tonofilaments; SR8 cells expressed epithelial membrane antigen (EMA) and glandular associated cytokeratin, all of these confirmed the epithelial origin of this cell line. In addition, SR8 cells expressed CA125, as did the original ovarian tumour. EGF-R and TP53 expression was identified by immunocytochemistry (ICC) in this line. Nearly all the SR8 cells (93%) expressed HLA-class I antigen while 13.5% expressed HLA-DR. SR8 cells showed near-diploid and -triploid chromosome populations with several clonal and non-clonal rearrangements. Subcutaneous and intraperitoneal xenografting of SR8 cells resulted in invasive tumour production at both sites in 3/4 and 4/4 female nude mice, respectively. These xenografts exhibited similar morphology as that of original tumour and were found to express EMA, cytokeratin, CA125 and TP53. The potential research applications of this cell line are discussed.

Primary adenocarcinoma of the cervix: treatment and results

Summary. Between 1972 and 1983,49 patients with adenocarcinoma of the cervix were treated in four ways: (i) radiotherapy alone, (ii) pre‐ or postoperative radiotherapy and a total abdominal hysterectomy and bilateral salpingo‐oophorectomy, (iii) Wertheims hysterectomy, and (iv) pre‐ or postoperative pelvic radiotherapy and Wertheims hysterectomy. The 5‐year survival results for patients with FIGO Stage I disease was 90%; with Stage II disease 60%; with Stage III disease 11% and none survived with Stage IV disease. All the patients, except one (Stage 111), with well‐differentiated tumours are alive and disease‐free, irrespective of the type of treatment they received whereas only one patient out of the 13 who had poorly differentiated tumour is alive and disease‐free. Three patients had bowel damage, one after radiotherapy alone and two after Wertheims hysterectomy and postoperative radiotherapy. No major surgical complications occurred in this series.

A pilot study to assess the feasibility, safety and cost of robotic assisted total hysterectomy and bilateral salpingo-oophorectomy

The aim of this study was to evaluate the safety, feasibility and cost-effectiveness of robotic assisted total hysterectomy and bilateral salpingo-oophorectomy (RATHBSO). Sixteen women underwent this new procedure for a variety of gynaecological indications. Outcome measures included operating time, estimated blood loss, length of hospital stay and cost. No intra-operative complications were recorded. Fifteen patients were discharged on day 1 following the procedure, and one patient stayed an extra day for pain relief. The cost of the procedure compared favourably with other surgical hysterectomy techniques. We conclude that RATHBSO is a feasible and safe surgical technique with all the advantages of minimal access surgery and equivalent cost.

Cholera toxin-induced alteration of the phenotype and behaviour of an ovarian carcinoma cell line, SR8.

Cholera toxin (CT) has been reported to cause a variety of effects on several different cell types. Recently, CT has been shown to increase the susceptibility of ovarian carcinoma cells to cytotoxicity mediated by a variety of effector cells (natural killer, lymphokine‐activated killer cells and tumour‐associated lymphocytes derived from ascites of ovarian cancer patients) of both autologous and allogenic background. In the present study, CT demonstrated several effects on a newly established ovarian carcinoma line (SR8)1 when added to the culture medium at a concentration of 12.5 ng/mL for 2 days. Cholera toxin altered SR8 morphology to a uniform polygonal cellular shape, with less cell dispersion than the non‐CT treated cells. Cholera toxin prolonged the population doubling time by approximately 10 h. The CT‐treated SR8 cells exhibited reduced epidermal growth factor receptor expression (39 versus 50%), and increased carbohydrate antigen 125 expression (45 versus 2%) in both immunocytochemical and quantitative flow cytometric analyses. These changes in morphology and tumour marker expression were reversible when CT was removed from the culture. The CT‐treated SR8 cells showed reduced capacity to generate tumours in female nude mice in comparison with non‐CT treated cells, which produce both subcutaneous and intraperitoneal xenografts with local invasion in an animal model. Cytogenetic analysis of the cell line SR8 before and during treatment with CT showed no new clonal rearrangements. The possible mechanisms involved and the influence of CT on the biological behviour of ovarian tumour cells are discussed.