Matti Forss

Adenocarcinoma of the uterine cervix

In Finland, the incidence of cervical cancer has shown a decreasing tendency since the 1960s. The same trend, however, has not been noticed in the incidence of cervical adenocarcinoma. The reason for this is not known, although many studies have shown differences in the cause, epidemiology, and biology of the epidermoid and adenocarcinoma of the uterine cervix. A total of 106 new patients with cervical adenocarcinoma were treated at our institution from 1976 to 1980, which represents 20.4% of all cervical carcinomas treated. The mean age of the patients was 58.1 years (range, 29 to 82 years) and the peak incidence was in the group 60 to 69 years of age. Most of the patients were postmenopausal (71.7%) and the main symptom was abnormal vaginal bleeding (78.3%). The proportion of Stage I was 61.3%. Combined operative and radiation therapy was used in 74.5% of the patients. The overall 5‐year survival rate was 65.1% (corrected 74.5%), which did not differ from that of patients with squamous cell carcinoma. The most significant prognostic factors were the size of the tumor, presence of pelvic lymph node metastases, and the stage of the disease.

Endometrial carcinoma in the cancer family syndrome

The study group consisted of 26 women with endometrial adenocarcinoma belonging to 19 cancer families. Age at the onset of cancer, the stage and histologic differentiation of the tumor, initial symptoms, other malignancies, 5‐year survival, and transmission of cancer to descendants were studied. The focus was on the importance of endometrial carcinoma in the tumor spectrum. The diagnosis of cancer family was delayed in 14 of the 19 families because endometrial carcinoma was not included in the primary diagnostic criteria. This delay may have been harmful to 16 family members who had carcinomas later in life. In ten of the 14 women with multiple malignancies, endometrial adenocarcinoma was the primary malignancy diagnosed, thus enabling the suspicion of a gene carrier and screening for subsequent malignancies. The authors concluded that endometrial carcinoma is a significant component of cancer family syndrome and should be included in the main criteria of Lynch syndrome II.

Endometrial adenocarcinoma with clinical evidence of cervical involvement: Accuracy of diagnostic procedures, clinical course, and prognostic factors

Background. The accuracy of clinical staging is known to be insufficient in stage II endometrial carcinoma. Also the optimal management of this disease is controversial. In this study we evaluate diagnostic accuracy and prognostic factors with special reference to treatment modalities of stage II endometrial carcinoma.

Wound complications in patients with carcinoma of the vulva: Comparison between radical and modified vulvectomies

OBJECTIVE To evaluate complications after different vulvectomies performed because of vulvar cancer. STUDY DESIGN Retrospective analysis of 149 patients who underwent vulvectomy. RESULTS Wound infections was found in 58%. Overweight, central or bilateral location of the tumor, and non-radical surgery were significant predictors of wound infections. Patients with a wound infection had more often wound breakdown (P<0.001), prolonged healing time (P<0.000), and lymphedema (P<0.001) than patients without infection. Antimicrobial prophylaxis did not prevent wound infection. Wound infections were found in 75% after radical en bloc vulvectomy (RV) and in 47% after modified vulvectomies (MV) (P<0.001). Also wound breakdown (47 versus 20%) (P<0.001) and lymphedema (48 versus 12%) (P<0.0001) were more common in RV group than in MV group. Lymphocysts were found in 7%, and showed no association with wound infection or type of operation. The mean hospital stay was 26 days in patients with wound infection and 12 days in patients without infection, 31 days in RV group and 12 days in MV group, respectively. CONCLUSIONS Wound infections are major determinants for both acute and late complications. Postoperative complications reduce with increasing use of modified vulvectomies.

Pre‐operative serum level of tumour‐associated trypsin inhibitor and residual turnour size as prognostic indicators in Stage III epithelial ovarian cancer

Objective To evaluate the use of the pre‐operative tumour‐associated trypsin inhibitor (TATI) level and residual tumour size at primary surgery as a prognostic indicators for patients with Stage III epithelial ovarian cancer.

Effect of exercise on Maternal Hemodynamics and Placental Blood Flow in Healthy Women

Intervillous placental blood flow responses to standardized exercise during late pregnancy were studied using a Xenon technique in 25 healthy women. Thirteen of them were studied twice between the 32nd and 38th weeks of pregnancy, with mean 32 (range 22 to 40) days between the studies. At the end of a 6–min exercise, mean maternal heart rate had risen from 77±10 (SD) to 154±11 beatshin, amounting to 63% of maximal oxygen uptake. Stroke volume rose by 9%, cardiac output by 65% and cardiac index by 71% as a consequence of exercise, but peripheral vascular resistance declined by 41 %. The placental blood flow was at a similar level after the exercise as before the exercise, being 95±19 (mean±SD) mllmin1100 ml of intervillous space before, 98±24 one min after, and 93 ±16 30 min after the cessation of exercise. No change was found in the level of placental blood flow between the 32–34th and 37– 38th weeks of pregnancy. The placental blood flow had a positive correlation with maternal weight, mean arterial blood pressure and with dia‐stolic blood pressure. Maternal heart rate, cardiac output, cardiac index, placental weight and the birth weight of the infant was not correlated with placental blood flow. It is concluded that in normal pregnancy a short submaximal exercise has little effect on placental blood flow measured after exercise.

Deoxyribonucleic acid flow cytometric analysis of cervical adenocarcinoma: prognostic significance of deoxyribonucleic acid ploidy and S-phase fraction.

Paraffin-embedded tumor samples from 125 patients with cervical adenocarcinoma were analyzed by deoxyribonucleic acid flow cytometry. Thirty-one percent of the tumors were aneuploid. Triploid deoxyribonucleic acid content predominated (51.3%) and one third of the deoxyribonucleic acid aneuploid tumors were tetraploid, whereas near-diploid deoxyribonucleic acid aneuploidy was seen infrequently. Deoxyribonucleic acid aneuploidy was associated with tumor size, histologic grade, clinical stage, and high S-phase fraction. Deoxyribonucleic acid ploidy and S-phase fraction value were independent prognostic parameters, together with the presence of lymph node metastases and tumor size. In conclusion, our results indicate that flow cytometric deoxyribonucleic acid analysis helps to predict the prognosis and may thus influence the choice of treatment.

Therapeutic and prognostic considerations in primary carcinoma of the vagina.

We analyzed 46 patients with primary carcinoma of the vagina treated between 1969 and 1990. Median age of the patients was 67 years (range 33‐89 years). Most (52%) of them were obese and 35% were nulliparous. Four (9%) had suffered from other gynecologic carcinoma and had been operated six to 23 years before the current carcinoma. Forty (87%) patients had squamous cell carcinoma. Stage 0 (carcinoma in situ) was found in three (7%) cases and stage I IV in 21 (54%), 10 (22%). four (9%) and eight (17%,) cases, respectively. Most (81%) of the patients were treated with radiotherapy (alone or in combination with other treatments): combination of brachytherapy and external radiotherapy were used in 45% of the cases. Surgery was used in all stage 0 cases and in 52% of stage I cases. Recurrence of the disease was found in 20 (43%) cases during the follow‐up of 10 years. Most often (40%) site of the recurrence was the vagina. Both 5‐ and 10‐year survival were 38%. Stage and extent of the tumor were independent prognostic factors in stepwise multivariate analysis.

Radiotherapy of malignant melanoma of the uvea with I‐125 seeds

Abstract Nineteen patients with malignant uveal melanomas were treated with I‐125 applicators. There were 10 males and 9 females with a median age of 61 years (range 42–76). The tumour was located in the choroid in 12 eyes and in the choroid and ciliary body in 7 eyes. The size of the tumours was 7–18 mm in maximal basal diameter (median 12), 5–16 mm in minimal basal diameter (median 10), and 5.5–15 mm in thickness (median 8.5). The volume of the tumours was 123–1890 mm3 (median 540). All tumours were classified as large (T3). For the irradiation, a computer program, which calculates three‐dimensional dose distribution of I‐125 seeds in gold plaques, was developed. By modifying the seed positions, activity and the orientation, patients can be treated individually. Iodine‐125 emits low energy photons, ideal for intraocular tumour therapy and tissue. Extra‐ocular tissue located behind the applicator can be completely shielded by a 0.5 mm gold layer. The dose at the apex of the tumour ranged from 30 to 120 Gy (median 93). The treatment time ranged from 44 to 600 h (median 235). Preliminary results are good. After a median follow‐up of 6 months, the tumour growth has been arrested in all eyes and in 10 eyes the tumour has decreased in size.

Acute effects of smoking on fetal heart‐rate variability

Summary. Smoking a standard filter cigarette caused an acute decrease both in the interval index and the differential index of fetal heart‐rate variability in eight healthy pregnant women at term. The maximum effect occurred 5–10 min after smoking and the indices returned to the presmoking level in 20 min. We suggest that smoking has a dual effect on the fetus: one being narcotic, leading to a lowered interval index, and the other hypoxic, leading to a lowered differential index.