Compliance to clinical guidelines for early-stage epithelial ovarian cancer in relation to patient outcome.

Objectives: To assess compliance to current surgical staging and adjuvant treatment guidelines for patients with early-stage epithelial ovarian carcinoma and its impact on overall survival.

Methods: Patients diagnosed between 1991 and 1997 with early-stage ovarian cancer were recruited from the Regional Cancer Registry of the central region in the Netherlands. Demographic data, tumour characteristics, surgical findings and therapeutic data were abstracted from medical records.

Repetitive phosphorus-32 peritoneal instillations in a patient with malignant ascites.

During the last decade, intraperitoneal injection of phosphorus-32 chromic phosphate (P-32 CP) has been used principally for its initial intended purpose, the palliative management of malignant ascites. The authors describe a patient with a stage IIIB well-differentiated extraovarian peritoneal serous papillary adenocarcinoma. As a palliative treatment for malignant ascites, P-32 CP was instilled intraabdominally eight times.

The pre-operative assessment of the adnexal mass: the accuracy of clinical estimates versus clinical prediction rules.

Objective: To evaluate the reproducibility of the clinical judgement of gynaecologists, gynaecologists in training and gynaecologic oncologists and to compare the predictive performance of the offhand assessment with the predictive performance of existing mathematical models for the pre-operative assessment of the adnexal mass.

Design: Questionnaire with paper cases of women operated on for an adnexal mass.

Setting: Gynaecological unit in a teaching hospital in the South of The Netherlands.

Treatment of metastatic invasive moles in two husband-side sisters-in-law. Case reports and review of literature.

Purpose Of Investigation: The treatment of "high risk" persistent trophoblastic disease (PTD) consists of poly-chemotherapy. This policy probably will lead to overtreatment of some patients. Also, familiar molar pregnancies through the paternal line are unknown in the literature up till now.

Is platinum-based chemotherapy with paclitaxel effective in optimally debulked patients with advanced ovarian cancer?

Objective: Suboptimally debulked patients with advanced ovarian cancer who are treated with a combination of cisplatin plus paclitaxel (TP therapy) have a better survival as compared to patients treated with a combination of cisplatin plus cyclophosphamide (CP therapy), but this advantage has not been demonstrated in optimally debulked patients. We performed a retrospective study to compare the effectiveness of TP therapy and CP therapy in optimally debulked patients.

Study Design: From 1991 to 1996, 87 consecutive patients with advanced ovarian cancer treated in the University Hospital Utrecht and the St.

Distinguishing the benign and malignant adnexal mass: an external validation of prognostic models.

Objective: Because external validation of the present models has not been reported, the purpose of the present study was to assess existing diagnostic models that are used to distinguish malignant from benign masses.

Methods: We tested the performance of existing models in a prospectively assembled data set of 170 patients with an adnexal mass. Twenty-one models that have been reported previously were assessed.

Second-look and second surgery: second chance or second best?

About 40 years ago, second-look laparotomy (SLL) was introduced to evaluate, surgically and pathologically, primary treatment in case a clinical complete remission was obtained in ovarian cancer patients. But does SLL increase the disease-free or overall survival? Important technical aspects of the procedure as: how many biopsies should be taken, can laparoscopy be replaced by laparotomy and should complete lymphadnectomy be performed at SLL, are still not clarified. This and maybe even more important issues, are disputed in literature: for instance, should a SLL be done at all, or should a SLL be performed in order to do a secondary cytoreduction in case tumour is found at the operation.

Identification of sentinel lymph nodes in vulvar carcinoma patients with the aid of a patent blue V injection: a multicenter study.

Background: The aim of this multicenter study was to investigate the feasibility and negative predictive value of sentinel lymph node detection with blue dye in vulvar carcinoma patients.

Methods: In patients with squamous cell carcinoma of the vulva without suspicious groin lymph nodes, patent blue V was injected intradermally shortly before surgery. Routine groin lymph node dissection and radical vulvectomy were performed.

The validity of screening for small-for-gestational-age and low-weight-for-length infants by Doppler ultrasound.

A prospective blind study assessed the efficacy of Doppler examination of the umbilical arteries (pulsatility index) as a screening procedure for predicting small-for-gestational-age and low-weight-for-length (low ponderal index) infants. Birthweight below the 2.3rd and 10th centile and ponderal index below the 3rd and 10th centile were chosen as 'cut-off' levels.

Clinical value of screening for fetal growth retardation by Doppler ultrasound.

A representative sample of 405 pregnant women from one university hospital population was examined by Doppler ultrasound of the umbilical arteries to evaluate the validity of this method as a screening procedure for fetal growth retardation (IUGR) in the 28th and 34th week of pregnancy. Birthweight percentile and ponderal index were used as standards for fetal growth. The sensitivity of predicting impaired fetal growth varied between 17% and 33%, depending on the week of pregnancy and the standards used to define growth retardation.

The performance of a simple scoring system screening for low birthweight infants for gestation in an unselected pregnant population.

Identification of poor fetal growth is an important objective of antenatal care. We evaluated the validity of the Wennergren score to predict small for gestational age and/or underweight for length infants (low ponderal index). To 405 randomly chosen pregnant women from our university hospital population, this numerical scoring system was applied at 28 and 34 weeks of gestation.

Intrauterine growth retardation: prediction of perinatal distress by Doppler ultrasound.

To investigate the ability of umbilical artery Doppler findings to identify true cases at risk of fetal distress among 51 pregnancies clinically judged to be compromised by intrauterine growth retardation (IUGR) Doppler data were related to pregnancy outcome, which was classified into three groups-group 1, healthy babies with normal placental function (16 fetuses), group 2, fetuses with definite signs of placental failure (30), and group 3, non-classifiable pregnancies (5). Group 2 was subdivided into 2A, placental failure with manifest perinatal distress (19), and 2B, placental failure without perinatal distress (11). All 19 compromised and distressed fetuses (group 2A) had extremely pathological Doppler findings, even several weeks before fetal distress became apparent by cardiotocography.