Paul B. Underwood

The relationship of smoking to the outcome of pregnancy

Abstract 1. 1. Four thousand four hundred and forty postpartum women representing 16,158 pregnancies were interviewed regarding smoking habits and previous pregnancies. 2. 2. A significant decrease in birth weights of infants born to mothers who smoke was found. This increased directly with the number of cigarettes smoked per day and the socioeconomic status. 3. 3. A twofold increase in prematurity occurred in smokers again directly proportioned to the cigarettes smoked per day. 4. 4. A slight increaes in abortion rate was found among smokers, but generally not significantly elevated. 5. 5. No significant increase in stillbirths, major fetal anomalies, or maternal complications occurred between smokers and non-smokers, although there was a suggestion of an increase in the incidence of premature rupture of membranes in smokers. 6. 6. Smoking does not interfere with breast feeding to any significant degree.

Genital malignancy in pregnancy

The clinical problems associated with the presence of genital malignancies occurring during pregnancy are presented. This report represents the clinical experience at one medical institution over a 20 year period. Eighty cases of cervical neoplasm, four cases of ovarian carcinoma, five vulva carcinomas, and one vaginal carcinoma are presented. The diagnostic and therapeutic approaches to malignant neoplasia of each area are discussed separately.

Radical hysterectomy: A critical review of twenty-two years' experience

One hundred seventy-eight patients who had radical hysterectomy performed for management of invasive carcinoma of the cervix over 22 year period at the Medical University of South Carolina were critically analyzed. The degree of differentiation of the malignancy appeared to be of more significance than tumor size in Stage 1 lesions. With proper patient selection and excellent operative technique, survival rates well over 90% with minimal complications can be obtained. The radical hysterectomy should never be used in association with irradiation.

Carcinoma of the endometrium: Radiation followed immediately by operation☆

A prospective study was established in August, 1967, to treat all adenocarcinomas of the endometrium by protocols of preoperative radiation followed immediately by operation. Two hundred and ninety-five women have been treated, 220 of whom had Stage I disease. In these cases, factors known to be associated with survival were studied, and their influence upon survival was noted. Preoperative radium followed immediately by operation was the primary method of therapy. Life tables demonstrated a five-year survival rate of 91 per cent with a low complication rate in patients with Stage I disease. Cell type, degree of differentiation, and depth of myomentrial invasion were the primary factors influencing survival.

Primary invasive vaginal carcinoma

A review of primary vaginal carcinoma treated at the Medical University of South Carolina from January 1970 through December 1989 included 76 squamous carcinomas, 12 adenocarcinomas, and 3 undifferentiated carcinomas. Staging was done according to the system of the International Federal of Gynecology and Obstetrics as modified by Perez et al. Stages I, II, III, and IV included 25, 39, 15, and 12 patients, respectively. Corrected 5-year survival rates were 73% for stage I, 39% for stage II, 38% for stage III, and 25% for stage IV. Sixteen percent of patients had received prior pelvic radiation. Invasive cervical cancer preceded vaginal cancer in 21% of patients. Detection of cancer was accomplished by routine cytologic testing in 17% of patients, palpation of an asymptomatic mass in 10% of patients, or palpation of a symptomatic mass in 72% of patients. Eighty-seven percent of patients were treated with radiation therapy. Survival curves of patients grouped by stage and other potential prognostic factors were compared. Lower stage (p less than 0.01), younger age (p less than 0.02), and no symptoms at detection (p less than 0.01) were statistically significant favorable prognostic factors. Histologic type, extent of vaginal involvement, vaginal location, prior radiation therapy, prior cervical cancer, and prior hysterectomy are factors that did not significantly affect survival.

Metastatic placental tumors: Report of three cases

THE SPREAD OF CANCER in man to distant sites is nothing new to the medical community; however, metastasis to the placenta of a gravid woman stirs the interest of most physicians. A review of the medical literature reveals only 36 such case reports which are dominated by metastatic melanoma, breast cancer, and the leukemic-Iymphoma groups. The purpose of this paper is to cite three case histories with placental metastasis encountered since 1968 in the Department of Obstetrics and Gynecology at the Medical University of South Carolina.

Endometrial carcinoma: A new method of classification of therapeutic and prognostic significance

Abstract A retrospective study has been performed on 120 patients with Stage I carcinoma of the endometrium searching for a prognostic index based on histological evaluation of cell type, grade of differentiation, and depth of myometrial invasion measured from the serosal surface in millimeters. A program of therapy is outlined as well as a method of treating the pathological specimen so that this prognostic index can be systematically applied to all patients with this disease. From this study, patients who have disease with 5 mm of the serosal surface of the uterus are believed to be candidates for more extensive methods of treatment than generally applied to Stage I disease of the uterus.

Adenocarcinoma of the endometrium: Role of preoperative radiation in stage I disease

Abstract A prospective study was reported evaluating the effectiveness of preoperative radiation focused on the vaginal apex followed immediately by abdominal hysterectomy and bilateral salpingo-oophorectomy as a means of therapy for Stage I adenocarcinoma of the endometrium. Eighty-three consecutive patients over a 53/4-yr span of time were studied. This technique resulted in a predicted 5-yr survival of 91.8%. Complications were low and patient acceptance excellent. The precise dosages and schedules were discussed in detail.

Cryosurgery. Its use for the abnormal Pap smear

During a two‐and‐one‐half year period, 317 women were seen in the Colposcopy Clinic for evaluation of an abnormal Pap smear. Seventy‐four (23%) desired to maintain their childbearing potential and were treated conservatively. Ten (14%) had inadequate colposcopy and underwent cold knife conization of the cervix. The remaining 64 were treated by adequate colposcopy, combined with cryosurgery; they are discussed in detail. All were managed economically as outpatients without anesthesia and no serious complications occurred. To date, only four have recurrent abnormal cervical cytology and several have delivered children. Adequate colposcopic examination combined with biopsies must proceed all cryosurgical procedures performed for abnormal cervical cytology.

Gonadoblastoma: Clinicopathologic correlation in six patients

Six patients with a total of nine gonadoblastomas are presented; three--and possibly a fourth--had dysgerminomatous overgrowth which was massive in two patients. Calcification detected by abdominal films was present in three sufficient for preoperative diagnosis. All patients were found to have a Y stem line on peripheral leukocyte chromosome cultures except one patient, who had a 46 XX/45 XO karyotype. She was found to have Y chromatin bodies in the germ cells of her tumor which was in a normal ovary found at exploration for an ectopic pregnancy. Three were found in virilized phenotypic females investigated for amenorrhea, and two for therapy of pelvic masses due to dysgerminomatous overgrowth. Y chromatin studies are reported on gonadal tissue.