Michael B. Dillon

Peritoneal cytology in endometrial cancer: a review.

Utilization of literature review to evaluate peritoneal cytology as a test for the detection of malignant cells in the peritoneal cavity is limited by the size of the study populations, varied use of preoperative radiation, the lack of consistent methodology for specimen retrieval and processing, and the inherent subjectivity of cytologic interpretation. A standardized methodology for retrieval and processing of peritoneal cytologic specimens should be developed to allow meaningful comparisons of future studies. However, certain conclusions are permitted from published data: 1. The incidence of positive peritoneal cytology is 11.4 per cent among 3091 patients with FIGO stage I endometrial cancer. 2. The depth of the uterus does not influence the incidence of positive peritoneal cytology. 3. Positive peritoneal cytology is predictive of other known prognostic factors including advanced histologic grade, depth of myometrial invasion, and pelvic/periaortic lymph node metastases. 4. The presence of malignant cells in the peritoneal washings from some patients with no myometrial invasion and the high incidence of lymph node metastases in other patients with positive peritoneal cytology suggest that malignant cells gain access to the peritoneal cavity in a variety of ways. It is unclear whether each of these modes of access result in viable tumor cells with the potential for viable metastasis. The high incidence of lymph node metastasis in such patients suggests that lymphatic dissemination of malignant cells plays a significant role in the development of positive peritoneal cytology. In this setting positive peritoneal cytology clearly identifies that individual at high risk for recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)

Single-dose and multidose prophylaxis in vaginal hysterectomy: A comparison of sodium cephalothin and metronidazole

A total of 79 patients underwent vaginal hysterectomy and were randomly assigned to three regimens of prophylactic antibiotics: multidose intravenous sodium cephalothin, single-dose intravenous sodium cephalothin, and single-dose oral metronidazole. Control groups were selected from two previous studies conducted at our institution. The incidence rates of infectious morbidity following all three regimens of antibiotics were substantially lower than in the control groups. There was no statistically significant difference in the incidence of standard febrile morbidity and serious pelvic infections among the three groups. The fever index was lowest in the single-dose sodium cephalothin group.

A prospective randomized study of doxycycline as a prophylactic antibiotic in patients undergoing radical hysterectomy

A prospective randomized study was undertaken to evaluate doxycycline as a prophylactic antibiotic in patients undergoing radical abdominal hysterectomy and pelvic lymphadenectomy. Although 69 patients were initially randomized, 64 patients (34 study, 30 control) are the basis of this report: 5 patients were omitted because large pelvic lymph nodes positive for tumor were found at laparotomy and radical hysterectomy was abandoned. The two study groups were similar in both preoperative and operative risk factors. There was a statistically significant reduction in the 7- and 14- day febrile index in the doxycycline group. The rate of cuff and/or pelvic cellulitis was 2.3 times higher in the control group. Thus, single-dose doxycycline as a prophylactic antibiotic reduced both febrile morbidity and the rate of serious infections in the radical hysterectomy patient.

Mixed Mullerian tumors of the uterus: Clinical and pathologic correlations

The 10‐year experience at The Johns Hopkins Hospital with 61 cases of mixed Mullerian tumors were reviewed. The patients had a mean age of 63.7 years and the similar constitutional factors of diabetes mellitus, hypertension and nulliparity of endometrial adenocarcinoma. Only one patient had estrogen exposure. Eighteen percent had had prior exposure to pelvic radiation. The life table survival of the 61 patients was 41.1% at 5 years. The 2‐year life table survival was 76% for disease confined to the uterus and 16.5% for extrauterine disease. There was no difference in survival between homologous and heterologous tumors. The surgical staging and the autopsies reviewed documented widely disseminated disease even when the tumor appeared to be confined to the uterus. It thus appears essential in order to improve survival these patients require aggressive staging and consideration of systemic adjuvant chemotherapy.

New methods applied to the analysis and treatment of ovarian cancer.

Abstract The development of rigorous staging methods, appreciation of new knowledge concerning ovarian cancer dissemination, and administration of new treatment techniques have been applied to ovarian cancer. The method of staging consists of peritoneal cytology, total abdominal hysterectomy-bilateral salpingo oophorectomy (TAH-BSO), omentectomy, nodal biopsy, diaphragmatic inspection and is coupled with maximal surgical resection. An additional examination being evaluated for usefulness in future staging is intraperitoneal 99 Tc sulfur colloid scans. Nineteen patients have entered the pilot studies. Sixteen patients (5 Stage 2, 10 Stage 3 micrometastatic, and 1 Stage 4) have been treated with colloidal 32 P, i.p. followed 2 weeks later by split abdominal irradiation (200 rad fractions pelvis-2 hr rest-150 rad upper abdomen) to a total abdominal dose of 3000 rad with a pelvic cone down to 4000 rad. Five of these patients received Phenylalanine mustard (l-PAM) (7 mg/m 2 ) maintenance therapy. The 3 year actuarial survival was 78% and the 3 year disease free actuarial survival 68%. Seven patients were treated with intraperitoneal tumor antisera and 47 remain in complete remission as of this writing. The specificity of the antiserum has been demonstrated by immunoelectrophoresis in 44 patients, and by live cell fluorescence in 1 patient. Rabbit IgG levels revealed significant increasing titers in 46 patients following i.p. antiovarian antiserum. Radiolabeled IgG derived from the antiserum demonstrated tumor localization and correlation with conventional radiography and computerized axial tomography (CAT) scans in 2 patients studied to date. Biomarker analysis reveals that free secretory protein 66, alpha globulin 56, and CEA(carcinoembryonic antigen) 36 were elevated in the 6 patients studied. Two patients whose disease progressed demonstrated elevated levels of all three biomarkers. There has been no significant acute toxicity nor morbidity with the use of antiserum nor with the integration of colloidal isotopic therapy and external irradiation.

The use of custom molds for intracavitary treatment of carcinoma of the cervix.

Abstract In situations of distorted anatomy, applicators that are available commercially may not yield an optimal distribution of radium for the treatment of cervical cancer. Custom fabricated vaginal molds of thermoplastic material can be made easily; they are inexpensive to produce, and may achieve a more ideal radium distribution in cases of cancer of the cervix in the presence of unusual anatomical configurations. The rapid and easy preparation of custom molds for use in cases of distorted anatomy is described with two case illustrations.

The diagnosis and management of cervical intraepithelial neoplasia in the patient under the age of twenty-one

The diagnosis and management of 260 patients between the ages of 15 and 21 with cervical intraepithelial neoplasia is discussed. These patients represented 22% of all new patients seen in the Colposcopy Clinic of The Johns Hopkins Hospital between January 1975 and December 1979.