[Unnecessary delay in vulvar carcinoma].
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Biomedical subjects
Publications and source records attributed to F B Lammes.
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In two pregnant women the diagnosis fetal triploidy was made by transabdominal villous biopsy at 20 and 21 weeks. Chromosomal analysis revealed a 69, XXX respectively 69, XXY karyotype. The diagnosis was suspected because of fetal growth retardation and a large vesicular placenta on sonographic examination. One patient had bilateral multilocular ovarian cysts. She had an eclamptic seizure at 22 weeks. In both patients labour was induced by intravenous prostaglandins. One fetus had a small spina bifida, the other fetus had no congenital malformations. Microscopy of both placentas showed a partial mole. A short description is given of the abnormalities associated with triploidy.
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In the diary of Mary and Vincent Novello it is mentioned that Constanze Mozart has told that the Quartet in D Minor (K 421/417 b) was written by Mozart during her delivery. The evidence for this information is discussed.
The role of CA 125 determination in diagnosing progression of ovarian cancer was evaluated in 98 patients of whom forty-nine had progressive disease. An elevated CA 125 level at the time of progression was found in 36 (73%) patients. In 31 (63%) patients CA 125 increase preceded clinical progression for a median time lag of 4.5 months (range 0.5-29.5 months). The combination of serum CA 125, gynecological and general physical examination detected progression in 45 (92%) patients. The additional contribution of second-look surgery, CTscan, chest X-ray and routine laboratory tests was minimal.
Ovaries are seldom subject to metastases and therefore their preservation is possible in radical cervical cancer surgery. However, with postoperative radiotherapy they cannot be preserved unless they are placed outside the radiation field. The practicality of this transposition was analysed in a series of 126 patients with cervical cancer. The ovaries were transposed intraperitoneally in a lateral and cranial direction in 44 of the 64 women under the age of 50 years. In 16 of these 44 women, only one ovary could be preserved and transposed. A critical analysis was performed of the ovaries' new location by plotting their position, marked by 2 clips each, in a single pelvis. In 68% of the women at least one ovary was placed outside the radiation field. However, because of scattered radiation, i.e. 5% of the total radiation dose at a distance of 4 cm outside the radiation field, a substantial loss of ovarian function may occur. In 32% of the women at least one ovary received less than this 5%. Optimal transposition may be achieved after extension of the abdominal incision. However, this will be unnecessary in most cases, since postoperative radiotherapy will be indicated in only approximately 15% of the women.
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Eighty-five patients with epithelial ovarian cancer were studied to assess the prognostic value of the prechemotherapy serum concentration of CA125 and its half-life during induction therapy. The endpoints of the analysis were progression rate and time to progression. The prechemotherapy CA125 level had no prognostic value (P = 0.36) if the patients were stratified for tumor size. The half-life of CA125, however, was an independent prognostic variable (P = 0.01). Patients with a half-life of 20 days and more had a 3.2 times higher progression rate and a significantly shorter median time to progression of only 11 months, as compared to 43 months for patients with a half-life of less than 20 days.
The use of cryopreserved semen offers the possibility of home insemination by the instructed partner. A comparative study was designed whereby participants were randomly allocated to use home or clinic insemination for six cycles. If no pregnancy had occurred after six cycles, the site of insemination was switched to the opposite location for a maximum of six further cycles. Fifty-three women with primary infertility fulfilling all entry criteria entered the study. In the first 6 cycles out of 29 home starters, 13 pregnancies were conceived, whereas in 24 clinic starters 11 pregnancies occurred, yielding no statistical difference in pregnancy rate. Of 138 couples who did not meet the criteria in the same period, 45 opted for home insemination, resulting in 20 home-inseminated pregnancies. Again, for comparable subgroups no statistical difference in pregnancy rate between home and clinic insemination was found.
As a gynaecologist-oncologist one will quite often have been confronted with patients who have informed one of fairly impressive results of methods of alternative medicine. These convincing stories must have been impressive. Very often one may wonder about these 'cures'. There are, however, patients who give quite accurate and detailed reports, thereby surprising one that such cures were achieved by non-regular treatment. Because of such stories, one will probably start wondering what there is between heaven and earth that conventional medical science does not know of. Now we should certainly not preclude that there may be therapeutic possibilities that are not yet rationally explicable; on the other hand one should be armed when forming an opinion. It is necessary to realise that there may be quite different explanations for miraculous results that alternative therapies may have in cures.
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