Worldwide survey of the results of treating gestational trophoblastic disease.

Objective: To determine factors influencing outcome for patients with gestational trophoblastic disease (GTD) from throughout the world.

Study Design: Physicians known to treat GTD were sent a questionnaire.

Results: There were 32 responses from 17 countries, totaling 26,153 patients.

Uracil mustard and 5-fluorouracil combination chemotherapy: a historic record.

Background: Uracil mustard and 5-fluorouracil (UM-FU) combination chemotherapy was used as one of the earliest combination chemotherapies in ovarian carcinoma from 1964 to 1971 at Yale New Haven Medical Center.

Methods: UM-FU was offered to patients with stage III and IV, histologically verified, ovarian carcinoma. Uracyl mustard was administered orally--1 mg/ kg, daily.

Imaging practices in the diagnosis and management of gestational trophoblastic disease: an assessment.

This article discusses several of the problems associated with imaging in gestational trophoblastic disease based on critical assessment of the literature. (1) Ultrasound scanning has revolutionized the diagnosis of abnormalities of the first trimester of pregnancy. Fetal death can now be diagnosed as early as 6 weeks of gestation, resulting in uterine evacuation.

Neoadjuvant and adjuvant chemotherapy of cervical cancer: mature results of the phase 2 PBM-PFU protocol.

Objective: The mature results of the neoadjuvant and adjuvant chemotherapy arms of the nonrandomized, phase 2 Yale University cisplatin, bleomycin, methotrexate, and 5-FU protocol are presented.

Methods: Sixty-seven patients were prospectively accrued with a median follow-up of 5.4 years, and standard parameters of toxicity and efficacy were studied.

John McLean Morris: a career in surgery, gynecology and reproductive physiology.

This biographical sketch of the professional life of Dr. John McLean Morris is presented as part of the history of the Department of Obstetrics and Gynecology of Yale University School of Medicine.

Evolution of the human brain, chorionic gonadotropin and hemochorial implantation of the placenta: insights into origins of pregnancy failures, preeclampsia and choriocarcinoma.

Hyperglycosylated chorionic gonadotropin (CG-H) signals placental cytotrophoblast cell growth and invasion, and chorionic gonadotropin (CG) promotes uterine vascularization. A hypothesis is presented relating the evolution of these molecules to the evolution of human hemochorial implantation and that of the human brain. Deep placental invasion, vascularization and hemochorial placentation, under the influence of CG and CG-H, are a critical part of the nutrition and energy-generating mechanisms needed for human brain development and thus for the evolution of humans.

The need for an hCG assay that appropriately detects trophoblastic disease and other hCG-producing cancers.

This report was conceived at the 13th World Congress of Gestational Trophoblastic Disease after multiple presentations indicated widespread discrepancies in human chorionic gonadotropin (hCG) use and results. There appears to be a need for a discussion to describe the advantages and limitations of commonly used hCG tests in the management of gestational trophoblastic disease, and to monitor testicular, germ cell and other hCG-producing malignancies. In most countries hCG tests are certified only for pregnancy testing.

Gestational trophoblastic diseases: 1. Pathophysiology of hyperglycosylated hCG.

Objective: Hyperglycosylated hCG (hCG-H) is a glycosylation variant of hCG produced by cytotrophoblast cells at implantation of pregnancy and in choriocarcinoma. We investigated the biological function of hCG-H in invasion in vitro and in vivo and the use of hCG-H antibodies in blocking tumorigenesis and cancer growth in vivo.

Methods And Results: hCG-H accounts for 43% to 100% of total hCG immunoreactivity in the culture fluid of choriocarcinoma cell lines and 100% in primary cultures of pregnancy cytotrophoblast cells.

Gestational trophoblastic diseases: 2. Hyperglycosylated hCG as a reliable marker of active neoplasia.

Objectives: To determine whether circulating hyperglycosylated human chorionic gonadotropin (hCG-H), a promoter of choriocarcinoma growth and tumorigenesis, is a reliable marker of active gestational trophoblastic neoplasia (GTN) or choriocarcinoma, and whether hCG-H can consistently discriminate quiescent gestational trophoblastic disease (GTD) from neoplasia.

Methods: Patients were those referred to the USA hCG Reference Service for consultation. These included a total of 82 women with GTN, including 30 with histologic choriocarcinoma.

Assessing sexual function and dyspareunia with the Female Sexual Function Index (FSFI) in women with vulvodynia.

Using the Female Sexual Function Index (FSFI; Rosen et al., 2000), we assessed forty-two women with vulvodynia. Internal consistency was high (Cronbach's alphas = 0.

How ultrasound first came to new England.

Diagnostic ultrasound came to Yale in the 1960s and was first developed in Glasgow and London. This story tells us that ultrasound was well-established in the Department of Obstetrics and Gynecology at Yale University School of Medicine in the Yale-New Haven Hospital by 1970. By then it had caught up with the pioneers in New York, Denver, and even Glasgow.

What we know about low-level hCG: definition, classification and management.

Objective: To critically assess the literature on the syndrome of low-level "real" human chorionic gonadotropin (hCG), to add new cases from our practice, to enumerate the investigations that are essential in the management of these patients and to offer a working classificationfor use by physicians encountering the condition.

Study Design: We report our experience with 9 patients with low-level hCG treated at the Yale Trophoblast Center and discuss London and Sheffield patients as well as reports from the USA hCG Reference Service.

Results: One of the 9 Yale patients had developed placental site trophoblastic tumor metastatic to the lung.

A survey of the complications of vaginal prolapse surgery performed by members of the Society Of Gynecologic Surgeons.

This study aimed to examine the frequency and nature of complications of vaginal prolapse surgery performed by members of SGS over a year and to determine the feasibility and the problems associated with prospective, multicentered collaborative data acquisition. A survey form, which included demographics, surgical indications, colpopexy type, concomitant procedures, technique, estimated blood loss (EBL), OR time, and intra/postoperative complications, was distributed to society members. The nature, extent, and solution of the complications were examined.

Negotiating a staging and risk factor scoring system for gestational trophoblastic neoplasia. A progress report.

Objective: To discuss the current problems in establishing a unified staging and risk factor scoring system for trophoblastic disease under the auspices of the International Federation of Gynecology and Obstetrics (FIGO).

Study Design: To present a history of the classifications of trophoblastic disease and compare these with the proposals presented to FIGO by the International Society for the Study of Trophoblastic Disease, the International Gynecologic Cancer Society and the Society of Gynecologic Oncologists.

Results: The situation concerning the proposed 2000 FIGO trophoblast classification was resolved by FIGO's acceptance of the recommendations outlined in this paper.

Gestational trophoblastic neoplasia and evidence-based medicine.

Objective: To determine whether protocols for the management of gestational trophoblastic neoplasia conform to the principles of evidence-based medicine.

Study Design: Protocols for the management of low- and high-risk gestational trophoblastic neoplasia were examined to determine to what extent they conformed to the principles of evidence-based medicine.

Results: Nearly all current chemotherapy regimens for gestational trophoblastic neoplasia are based on the experience of management of various risk groups, variously defined.

Persistent low-level "real" human chorionic gonadotropin: a clinical challenge and a therapeutic dilemma.

Objective: The finding of persistent low-level human chorionic gonadotropin (hCG) with or without a preceding pregnancy event presents a rare but clinically important challenge and a therapeutic dilemma. These are patients with "real" hCG shown by the positive test in both serum and urine or by specialized testing. The problems associated with "phantom" hCG have been recognized and should now be clinically resolvable.