Vaginal laser surgery.

Vaginal epithelial lesions including endometriosis, cysts, septae, human papillomavirus (HPV) disease, and vaginal intraepithelial neoplasia (VaIN) can be successfully treated by laser surgery. The carbon dioxide laser with a wavelength of 10,600 nm is the ideal laser for these clinical applications. Pretreatment evaluation using colposcopically directed biopsies is mandatory.

Cryotherapy and laser treatment for intraepithelial neoplasia of the cervix, vagina, and vulva.

Over the past 20 years, the incidence of invasive genital neoplasia has decreased, while the incidence of preinvasive, or intraepithelial, neoplasia has increased. These trends are the result of increased cancer screening women and the widespread application of improved diagnostic techniques by physicians. The rapid increase in genital human papillomavirus infections over the past 10 years may also be a factor influencing the increased incidence of intraepithelial neoplasia.

Neoadjuvant therapy for advanced squamous cell carcinoma of the cervix: cisplatin followed by radiation therapy--a pilot study of the Gynecologic Oncology Group.

Eleven patients with untreated advanced squamous cell carcinoma of the cervix (FIGO Stage IIIB and IVA, or positive paraaortic nodes) were treated with cisplatin 50 mg/m2 every 3 weeks for six courses prior to irradiation therapy (RT). Six patients completed six courses of cisplatin prior to RT with one complete and two partial responses (PR). Five other patients did not complete cisplatin therapy; two progressed after two and three courses, one had a PR after three courses and refused further therapy, one refused treatment after two courses and one elected to begin RT after one course.

Vincristine infusion in refractory gynecologic malignancies.

Prolonged intravenous infusion of vincristine was evaluated in 26 patients with advanced, refractory gynecologic malignancies. Most patients (88%) had progressive disease following treatment with one or more chemotherapeutic agents. Treatment consisted of a 0.

Evaluating the acquisition of colposcopy skills in an obstetric-gynecologic residency program.

Instruction in colposcopic technique is now an integral component of residency training in obstetrics and gynecology. No statistical method for assessing colposcopy skills has been reported on before. The statistical calculations of sensitivity, specificity and kappa were applied to determine if there was any progressive acquisition of colposcopy skills by the colposcopy trainee during the four-year residency program.

Use of the human tumor stem cell assay to study chemotherapy sensitivity in cancer of the cervix.

Two questions concerning chemotherapy of cervical cancers are addressed in this study. 1) Can the human tumor stem cell assay identify active chemotherapeutic agents?; and 2) Can the human tumor stem cell assay predict which patient's tumors will demonstrate clinical responsiveness to chemotherapy? Sixty-seven of 76 cervical cancer specimens (88.2%) were grown in the human tumor stem cell assay, resulting in 159 separate drug assays.

Chemotherapy of advanced squamous carcinoma of the cervix: a phase I-II study of high-dose cisplatin and cyclophosphamide. A pilot study of the Gynecologic Oncology Group.

Sixteen patients with recurrent squamous cell carcinoma of the cervix were treated with a combination of cyclophosphamide and cisplatin to determine a tolerable dose schedule, major adverse effects, and a general estimate of response rate and duration. Toxicity was substantial with a dose of cyclophosphamide 1000 mg/m2 and cisplatin 100 mg/m2 given intravenously every 3 weeks. Renal, hematologic, and gastrointestinal toxicities were severe.

Use of colposcopically directed, four-quadrant cervical biopsy by the colposcopy trainee.

Colposcopically directed cervical biopsies performed by experienced colposcopists have greatly reduced the need for conization of the cervix to evaluate patients with cervical intraepithelial neoplasia (CIN). Because of the subjectivity of the colposcopic technique and variable time required to become skilled, continued reliance on cervical conization is often recommended to validate colposcopic findings for novice colposcopists . We assessed the colposcopic skill of residents in training in obstetrics and gynecology who had received 9-12 months of instruction in colposcopic techniques.

Treatment of advanced ovarian malignancy with chemoimmunotherapy using autologous tumor and Corynebacterium parvum.

Fourteen patients with advanced ovarian epithelial carcinoma were treated with a combination of chemotherapy and immunotherapy. The chemotherapy consisted of either melphalan or a combination of adriamycin, cytoxan, and cisplatin. The immunotherapy consisted of the injection of autologous radiation-attenuated tumor and Corynebacterium parvum.

In vitro chemotherapy testing of gynecologic tumors: basis for planning therapy?

The human tumor stem cell assay (HTSCA) has broad research applications in the field of cell biology as well as in clinical chemotherapy. This report examines the applicability of the HTSCA to patient treatment planning, asking: (1) How often will gynecologic tumors grow in the assay? (2) What kinds of therapeutically useful information can be gained from the assay? (3) What are the correlations between in vitro results and patient treatment responses? Tumor specimens from 207 patients having ovarian, cervical, or endometrial carcinomas have been studied with the HTSCA, 183 of which have grown in vitro. Of 103 ovarian cancer specimens which grew in culture, 564 separate drug assays have been done, looking for patterns of sensitivity among "first line" drugs as well as drugs used for relapsing patients.

Endometrial carcinoma diagnosed by examination of peritoneal dialysate.

Well-differentiated adenocarcinoma of the endometrium was diagnosed by cytologic examination of peritoneal dialysate during continuous ambulatory peritoneal dialysis in a 70-year-old woman. The patient had undergone estrogen therapy for 16 years. The carcinoma was localized, noninvasive, and apparently at an early stage of development.

Treatment of vaginal intraepithelial neoplasia with the carbon dioxide laser.

The carbon dioxide laser was used to treat vaginal intraepithelial neoplasia in 24 patients. Initially, partial or complete ablation of vaginal epithelium was performed, the extent of the procedure depending upon the distribution of disease. Later in the series complete ablation was performed routinely because of recurrences among patients treated with only partial ablation.

Tubal microsurgery with the carbon dioxide laser.

Thirty New Zealand White female rabbits underwent tubal resection and reanastomosis for comparison of conventional microsurgery and laser microsurgical techniques. The rabbits were divided into three groups. The first group of 10 rabbits had 3 cm of tissue resected by knife from each uterine horn; the cut ends were then reanastomosed in one layer with 8-0 Vicryl sutures with the use of the operating microscope.

Advanced and recurrent carcinoma of the ovary treated with a combination of cyclophosphamide, doxorubicin, and cytosine arabinoside.

Twenty-six patients with advanced or recurrent epithelial ovarian carcinoma, FIGO Stages III and IV, were treated with combination chemotherapy using cyclophosphamide, doxorubicin, and cytosine arabinoside (CARA). In 17 cases, CARA was initiated following failure to single-agent chemotherapy, in all cases, melphalan. Nine patients with advanced cancer received CARA as their primary chemotherapy after maximum cytoreductive surgery.

Intravenous vincristine infusion: phase I trial.

In an attempt to sustain potentially cytotoxic concentrations of vincristine in man, a five-day continuous infusion of vincristine after an initial intravenous bolus injection was administered to 30 patients with refractory malignancies. Three dosage levels were explored (0.5 mg/m2, 0.

Single dose carbenicillin versus T-tube drainage in patients undergoing vaginal hysterectomy.

In this study, a prospective, randomized, non-blinded report, single dose carbenicillin prophylaxis preoperatively is compared with T-tube suction drainage postoperatively in 50 patients undergoing vaginal hysterectomy. A higher incidence of febrile morbidity, fever index units, cellulitis of the vaginal cuff and prolonged hospitalization postoperatively was experienced by the group patients with T-tube suction drainage, P less than 0.05.

Cervical intraepithelial neoplasia.

Proper technique and competent cytopathology are important in obtaining and evaluating the Pap smear. Colposcopy and directed biopsies, combined with endocervical curettage, will permit outpatient diagnosis in about 85 percent of patients with cervical intraepithelial neoplasia. Other patients will require knife conization for diagnosis.

Autoimmune hemolytic anemia and ovarian dermoid cysts: case report and review of the literature.

A case of autoimmune hemolytic anemia (AIHA) associated with an ovarian dermoid cyst is presented. Early recognition and specific therapy for this entity is stressed for optimal results since conventional forms of therapy of AIHA are ineffectual. Unusual features of the case are discussed.