Cytogenetic observations of a human ovarian carcinoma clinically resistant to therapy

Citations from the Lifetatute CastratIon at Mrtb Ckorge S 26 Ince Road, Walton on Thames, Surrey KT12 .rsJ; UK British Medical JoumaI/297/6659 (1313-1314)/1988/ A great variety of injuries to bone and soft tissue have been attributed to the trauma of manipulation during vaginal breech delivery, especially during breech extraction. To my knowledge castration has not been reported before. A generous right posterolateral episiotomy was performed quickly as the patient was pushing and the breech was distending the perineum. Soon afterwards a pearly greyish pink spherical structure about 1.5 cm in diameter fell out of the vagina into the obstetrician’s hand. The patient kept pushing, and another similar structure was passed out. There was no undue bleeding. In this case episiotomy was performed as an urgent procedure because the perineum was overstretched and likely to tear. Unfortunately, despite 30 years’ experience, the obstetrician protected the genitals rather quickly and seemingly inadequately. This possible complication should be emphasised so that it will not happen again. The obstetrician should always protect the genitals with one hand as a barrier and make sure that they are not caught between the hand and the perineum while the episiotomy is performed.

ONCOLOGY oral contr8coptIveWC and Ina@m&a of the genw tract. RemIts from TLC Roy8l Colkge of General Praetitlouers’ Oral Coutracqtttoa Study BernIV; Hannaford P; Kay C Epidemiological Monitoring Unit, London School of Hygiene and Tropical Medicine, London WClE 7HT; UK Lancet/2/8624(1331-1335)/1988/ Of 47,000 women followed since 1%8, those who had used oral contraceptives (ever-users) had a significantly higher incidence rate of cervical cancer than never-users. After standardisation of rates by age, parity, smoking, social class, number of previously normal cervical smears, and history of sexually transmitted disease. the excess was 41 per 100,080 womanyears for carcinoma-in-sity and 8 per 100,000 woman-years for invasive cervical cancer. Incidence increased with increasing duration of use: the standardised incidence rate for cervical cancer in women who had taken the pill for more than 10 years was four times that in never-users. Ever-users had a lower incidence of other uterine cancers (deficit 5 per 100,000 woman-years); a lower incidence of ovarian cancer was also found (deficit 4 per lOO,ooO), but was not statistically significant. Overall, ever-users bad an excess incidence for genital tract cancers of 37 per 100,000 woman-years. This excess was mainly from carcinoma-in-situ of the cervix; the excess incidence of invasive cervical cancer was offset by the deficits in other uterine and ovarian cancers. Standardised mortality rates from genital cancer were similar in ever-users and never-users. Of relevance to clinical practice is the substantially different distribution of primary cancer sites; cervical cancer accounted

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for 75% of the invasive genital cancers and 74% of deaths from genital cancer in ever-users. but only 3 1% of the invasive cancers and 30% of deaths in never-users. Cytogeuetk obsewatlons of a human ovrrlrn carcinoma cbdcauy mistalIt to uler8pY Rotmensch J; Turkula TE; Weischselbaum RR; Schwartz JL Division of Gynecologic Oncology, &pattment of Obstetrics and Gynecology, Pritzket SchooI of Medicine, The University of Chicago, Chicago, IL 60637; USA American Journal of Obstetrics and Gynecology/l59/5 (1099-1103/1988/ Resistance of a cancer cell to therapy represents an important problem in tumor biology. Hypotheses concerning the mechanism of resistance have included genetic instability, gene amplification, aneuploidy, and altered ceU growth kinetics. Cytogenetic assays ahow for the analysis of each of them parameters and provide important information concerning tumor heterogeneity. In using cytogenetic analysis, we have analyzed a human ovarian carcinoma clinically resistant to therapy. The ovarian carcinoma had a complex but stable karyotype with a mean chromosome number of 61.7 chromosomes/ceJI. Approximately 50% of the metaphase preparations examined had double-minute chromosomes, which have sometimes been associated with gene amplification. The frequency of double minutes varied from one pair to hundreds of pairs per cell. Cell cycle kinetic analysis revealed an average generation time of 38 hours. The cells were relatively resistant to doxorubicin in vitro, and the baseline sister chromatid exchange frequency, a measure of genetic instability, was elevated. These results suggest that cytogenetic assay have potential as predictive assays of tumor chemoresistance and may provide information regarding the biologic aggressiveness encountered clinically. RefPmlra after negative second-look lqarotomy for ovarian cancer: Anrlysls of rinkfactors Rubin SC; Hoskins WJ; Hakes TB; Markman M; Cain JM; Lewis JL Jr Depttment of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021; USA American Journal of Obstetrics and Gynecology/l59/5 (1094 -1098)/1988/ To determine the long-term rate of recurrence and define risk factors for recurrence, we have analyzed clinical information on 83 patients followed up for a minimum of 4 years (median, 69 months) after negative second-look laparotomy. Overall, 21 of 83 patients (25.3%) had a recurrence. Median interval to recurrence was 14 months. Stage, grade and type of chemotherapy were significantly related to risk of recurrence. In patients with stage I disease only one of 27 (3.7%) had a recurrence. Patients with stage I disease were not included in further analysis of risk factors. In stages II, III and IV, 20 of 56 patients (35.7%) had a recurrence. Recurrence rates by grade (excluding stage I) are as follows: grade 1, three of 21 (14.3%); grade 2, six of 17 (35.5%), and grade 3, 11 of 17 (64.7%). Platinum-treated patients in stages II, III and IV had a 5Oqo (12/ 24) recurrence rate compared with 25% in nonplatinum-treated patients (8/32) @ = 0.05). Differences in disease-free survival Int J Gynecol Obstet 29