O. Eduardo Talledo

Renin-angiotensin system in normal and toxemic pregnancies

The importance of the renin-angiotensin system in the pathogenesis, of arterial hypertension has directed attention to the possible role it may play in toxemic hypertension. Pressor response to angiotensin II and norepinephrine was studied in 13 patients in the third trimester of pregnancy. Arterial pressure was measured by percutaneous catheterization of the femoral artery with the patients, lying on their sides throughout the tests (opposite to the catheterized artery). Seven were pre-eclamptic, 4 had hypertensive vascular disease, and 2 had pyelonephritis. Pre-eclamptic patients showed increased sensitivity to infusions of angiotensin and norepinephrine while patients with uncomplicated hypntension reacted as did the normotensive pregnant women.

Another look at the second- assessment procedure for ovarian epithelial carcinoma

Over a 10-year period, 65 of 196 patients (33%) with ovarian epithelial malignancy, previously treated with chemotherapy, had a second-look operation if the disease was clinically absent. All procedures were done by one of three gynecologic oncologists, and 48% of the patients had a positive second-look procedure. Of patients with original stage I, II disease, 25% had a positive second-look operation, contrasting with 61% of patients with stage III, IV. Significant perioperative morbidity occurred: one patient had intraoperative vascular collapse; 15% had prolonged ileus; 17% had small bowel resections at the time of the second-look operation or in the postoperative period. Of all patients with negative second-look operations, 24% have had recurrent disease from 5 to 23 months after the procedure. These recurrences were in the liver or distant sites in 63% of the patients. Second-look operations, if still indicated by negative noninvasive techniques, should be performed in tertiary care centers under study situations in a standard fashion.

Computed tomography in evaluation of gynecologic malignancies: A retrospective analysis

The results of preoperative computed tomography and operative findings were assessed retrospectively in 52 patients with cervical, uterine, and ovarian neoplasms. Overall sensitivity and specificity for all disease states was 57% and 79%, respectively. Overall diagnostic accuracy was 69%. The use of computed tomography was felt to be helpful in evaluation of lymphadenopathy due to cervical cancer and in patients with suspected ovarian neoplasms. In uterine neoplasms, however, computed tomography did not add useful information.

Renin-angiotensin system in normal and toxemic pregnancies. II. Inactivation of angiotensin in normal pregnancy.

Abstract Angiotensinase activity was measured in 19 patients with “toxemia of pregnancy.” The results indicate that angiotensin inactivation is decreased in this syndrome and it approaches values found in the nonpregnant state.

Adenoid cystic carcinoma of the cervix in women under age 40

Adenoid cystic carcinoma of the cervix, traditionally associated with a poor prognosis, occurs in postmenopausal patients in the vast majority of cases reported. Only four cases have been reported in women less than age 40, and none in women less than age 30. Three new cases of adenoid cystic carcinoma of the cervix are reported in women aged 24, 27, and 38 years. All three patients were treated with radical pelvic surgery; lymph node metastases and vascular involvement were prominent. Adjuvant chemotherapy with cisplatin was used in two patients, one of whom has had long-term survival. A review of the literature is also presented.

A clinical-pathologic study of mixed mullerian tumors of the uterus over a 16-year period—The Medical College of Georgia experience

From 1972 through 1987, 40 patients at the Medical College of Georgia were assessed with a diagnosis of mixed müllerian tumors which constituted 3.5% of all female genital tract malignancies. The mean patient age was 65.3 years; 60% of the patients had stage I disease. Of those patients with clinical stage I disease, more advanced disease was found at celiotomy in 33%. Retroperitoneal nodes were positive for malignancy in 35% of 20 patients who underwent node sampling. Cell washings were positive in 12%, and 9% had omental metastases. Forty-seven percent had homologous tumors; 53% of tumors were heterologous. Relatively poor prognosis was associated with large tumor volume, vascular invasion, nodal metastases, and disease outside the uterus. The overall survival rate was 32%; 14 of 24 patients with stage I disease are dead of disease. Of patients dead of disease, 92.5% had distant metastases. Adjuvant therapy with a combination of VP-16, cisplatin, and irradiation was beneficial in four high-risk patients.

Extraperitoneal lymph node dissections with use of a midline incision in patients with female genital cancer

Recent investigations have suggested that extraperitoneal, as compared to transperitoneal, lymph node dissections may result in significantly less morbidity in patients who later have external beam irradiation. Some incisions designed to perform such dissections do not afford easy access to the opposite side. With use of a midline incision carried down to the preperitoneal space, 30 patients underwent bilateral pelvic lymph node dissections. When necessary, access to the para-aortic nodes by an extraperitoneal approach was accomplished by use of a modification of this midline incision. Operating time to complete the pelvic dissection ranged from 35 to 90 minutes. The mean estimated blood loss for the dissection was 135 ml. The advantages of this extraperitoneal approach include easy access to lymph nodes on either side, ability to use the peritoneum as a pack, and an easier access to the obturator space nodes.

Pelvic exenteration—Medical College of Georgia experience

Between 1959 and 1983, 42 pelvic exenterations were performed. The early experience shows a rather high surgical mortality; 7 out of the first 10 cases. This has been improved with experience and better pre- and postoperative care. There has been no postoperative mortality in the last 20 patients. The combined published reports show an operative mortality of 15-17%.

Primary Mass Closure of Midline Incisions with a Continuous Running Monofilament Suture in Gynecologic Patients

Over a 42-month period, 210 patients had a lower midline incision, usually extending around the umbilicus, that was closed with a continuous, running number 2 polypropylene suture. Patients in this study had various predisposing factors for wound disruption. Over 60% were operated upon because of gynecologic cancer. Additional high-risk factors included obesity in 56%, diabetes in 28%, previous irradiation or chemotherapy in 17%, and ascites in 8%. The operative procedures performed ranged from hysterectomies with node sampling to bowel resections and exenterations; wound complications were noted in seven patients. One patient had an incisional hernia. No eviscerations occurred. The closure is safe, expedient, and cost-efficient, and distributes tension equally over a continuous line.