Different antibody response against Candida albicans cell wall antigens in cervicovaginal secretions of patients with vulvovaginal candidiasis

Vaginal washings from 118 women were investigated by means of immunofluorescence for the presence of antibodies against Candida albicans. A significantly (p less than 0.02) higher antibody titer was found in the samples from patients with clinically evident vulvovaginal candidiasis. Vaginal secretions from those patients with a positive culture for C. albicans were assayed by means of Western blotting. A distinct band pattern was found in the group of patients with a positive culture and the classical clinical picture of C. albicans vulvovaginitis.     

Continuous postoperative epidural analgesia for gynecologic oncology patients

The efficacy of continuous postoperative epidural analgesia (CPEA) was assessed in 193 patients who collectively underwent 254 gynecologic oncology procedures. Seventy-five patients elected to receive CPEA; 118 did not. The CPEA patients received an epidural catheter the morning of surgery. Postoperatively, a bolus of meperidine was placed in each catheter. An IVAC pump continued to deliver meperidine at the rate of 14 to 20 mg per hour. The 193 patients also received a total of 655 postoperative intramuscular narcotic injections. CPEA patients were three times less likely to request injections, and those who did required an average of 6.58 compared with 12.42 for non-CPEA patients. The presence or absence of CPEA was the only significant variable. The use of CPEA led to no secondary complications, and it greatly enhanced mood and ability to participate in postoperative care. We conclude that CPEA provides excellent postoperative analgesia for such high-risk patients.     

Prolapsed fallopian tube masquerading as adenocarcinoma of the vagina in a postmenopausal woman

A postmenopausal patient with vaginal prolapse of the fallopian tube presented with an erroneous diagnosis of adenocarcinoma of the vaginal apex. Failure to consider fallopian tube prolapse in the differential diagnosis of vaginal adenocarcinoma led to an upper vaginectomy and subsequent complication of a ureterovaginal fistula. The differential diagnosis of adenocarcinoma of the vagina in the postmenopausal patient and the management of vaginal prolapse of the fallopian tube are discussed.     

Insulin-induced receptor regulation in early gestation and term human placental cell cultures

Human placentae of different gestational ages have been used to investigate the binding and degradation of insulin as well as the regulation of insulin membrane receptors. Bacitracin was found to be an effective inhibitor of insulin degradation in human early gestation and term placental cell cultures. In the presence of bacitracin, [125I]-insulin bound rapidly and reversibly: maximal binding occurred at 4 degrees C, with a sharp pH optimum at 7.5, and exhibited a high degree of specificity. The extent of binding was proportional to cell protein and [125I]-insulin concentrations. Term (38 to 41 weeks; n = 25) placental cell cultures possessed receptors for insulin that were increased three-fold compared to early gestation (8 to 18 weeks; n = 17). This was due to an increase in receptor number with no significant alteration in affinity. A decrease in insulin binding in both early gestation and term placental cells was related to both the insulin and bacitracin concentrations present during 12 to 20 h of preincubation at 37 degrees C. The receptor loss was due to a decrease in the number of receptors per mg cell protein with no apparent change in their affinity. We conclude that our in vitro system, which utilizes human placental cells in monolayer culture, will permit a more direct study of the metabolic effects of insulin in both early gestation and term placentae.     

Colposcopy is superior to cytology for the detection of early genital human papillomavirus infection

Of 2232 women with no cytologic evidence of intraepithelial neoplasia, 250 (11.2%) were positive for human papillomavirus deoxyribonucleic acid (DNA) by filter in situ hybridization. In 150 of those human papillomavirus-positive patients, an adequate colposcopic examination of the cervix was possible; human papillomavirus infection was diagnosed in 104 women (70%). Cervical cytology showed evidence of human papillomavirus infection in only 23 patients (15%). The following colposcopic features were most common: acetowhite epithelium (29%), punctuation (18%), acetowhite spikes (17%), and mosaicism (9%). Colposcopy was essentially normal in 27%. In 64 hysterectomized patients, vaginal colposcopy showed evidence of human papillomavirus infection in 38 women (59%). Vaginal cytology showed signs of human papillomavirus infection in only 9% (N = 6). Acetowhite spikes were seen in 52%, acetowhite epithelium in 5%, punctuation in 3%, and normal findings in 40%. Histologic examination of 25 biopsy specimens (cervical, N = 15; vaginal, N = 10) showed mainly a lack of glycogenation, acanthosis, and elongation of rete pegs. Koilocytosis and dyskeratosis were seen only in a few cases as rare foci, hence the negative cytology. We conclude that colposcopy is far more sensitive than cytology for the detection of cervical and vaginal human papillomavirus infection.     

Prevention of pelvic adhesion formation by different modalities of treatment

This prospective study was designed to investigate the effect of glucocorticoids, promethazine (Phenergan), hyskon, heparin, and Ringer's lactated solution in the prevention of pelvic adhesion formation after pelvic surgery. The patients were divided into two groups: The first consisted of 396 patients who had laparotomy for different types of pelvic surgery, and the second group consisted of 546 patients who had operative laparoscopy for different types of pelvic disease. Patients in these two major groups were divided prospectively into different subgroups with different modalities of adjuvant therapy to prevent postoperative pelvic adhesions. A second-look laparoscopy was performed for some of the patients who failed to conceive in each of these subgroups. Pregnancy rate and adhesion formation were compared between these subgroups with no statistical difference noted. It is concluded that glucocorticoids, promethazine, heparin, and hyskon have no therapeutic advantage over Ringer's lactated solution in the prevention of postoperative pelvic adhesion formation.     

Results of primary chemotherapy in 44 patients with advanced squamous cell carcinoma in the area of the head and neck

44 patients with advanced squamous cell carcinoma of the head and neck were randomized and treated preoperatively either with arm "A": cis-DDP (3 mg/kg iv day 1) and BLM (15-20 mg iv continuously day 2-6) or arm "B": MTX (30 mg/m2 iv day 1 + 6) and VDS (3 mg/m2 iv day 2 + 7). Treatment with arm "A" was superior producing 73% complete and partial remissions (CR + PR) compared to 40% for arm "B" (p = 0,05). The number of patients with CR could be increased from 2 to 26 by surgery and/or radiotherapy. The median survival for patients with chemotherapeutically induced CR and PR was 16 months but this did not differ significantly from the median survival (13 months) of non responders (p = 0.25). For patients with CR and PR achieved by surgery and/or x-ray therapy the median survival point has not yet been reached, and this is significant compared to the non responders (p = 0.001). Five of 26 patients with CR died after 39 months of observation and 6 are living with recurrence. In addition to clinical trials, chemotherapy is indicated for patients with inoperable tumours. The value of chemotherapy can only be answered by randomized trials comparing chemotherapy combined with standard procedures against surgery and radiotherapy alone.