Hemorheological parameters in patients with gynecologic malignancies

Citations from the Literature aromatase activity may become useful in selecting ovarian cancer patients for endocrine therapy. Serum CA 125 kvds and surgical findings in prtkmts undergoing secondary operations for epitbelial ovarlaa cancer Rubin SC; Hoskins WJ; Hakes TB; Markman M; Reichman BS; Chapman D; Lewis JL Jr Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; USA American Journal of Obstetrics and Gynecology/l60/3 (667671)/1989/ Serum CA 125 levels and surgical findings were prospectively compared in % secondary laparotomies performed on patients with epithelial ovarian cancer. All patients had documentation of an elevated CA 125 level (> 35 U/ml) at a time when ovarian cancer was present, and thus the tumors were known to be ‘marker positive’. Operation was performed in 45 patients who were clinically free of disease and in 51 patients in whom there was clinical evidence of disease. At the time of operation, 29 patients had normal CA 125 levels; persistent disease was documented in 18 (62%) of these. Of the patients with normal CA 125 levels at the time of operation, those with persistent disease had a significantly higher mean CA 125 level (16.9) than those with no disease detected (8.8, p = 0.001). At exploration, cancer was found in 84 patients. There was a correlation between the maximum diameter of the largest residual tumor mass and the accuracy of the CA 125 level as follows: microscopic to 1 cm disease, 55% accuracy; > 1 to 5 cm disease, 80010accuracy; >5 cm disease, 92% accuracy (p = 0.013). There was no correlation of CA 125 accuracy with the patient’s age, number of months from initial diagnosis, tumor stage, grade, or cell type, or the highest-ever level of CA 125. Of the 84 patients with tumor found at exploration, 66 had elevated CA 125 levels, yielding a sensitivity of 78.5%. There were 12 patients with no tumor found at exploration; 11 of these had normal CA 125 levels. The one patient who had an elevated CA 125 level subsequently had a recurrence; the corrected specificity is thus 100%. An elevated CA 125 level is an accurate predictor of persistent disease. Most of these patients will have gross tumor present. The accuracy of the CA 125 level in detecting disease is related to the amount of tumor present. In our population, the predictive value of an elevated CA 125 level was 100070;the predictive value of a normal CA 125 level was 38%. The role of postoperative alkylating agent therapy in earlystage epithelid ovarian cancer Mackintosh J; Buckley CH; Tindall VR; Lind MJ; Anderson H; Crowther D Department of Medical Oncology, Christie Hospital, Manchester; United Kingdom British Journal of Obstetrics and Gynaecology/96/3 (353357)/1989/ Forty-six patients with early (Stage I and II) ovarian cancer referred as free of residual disease after primary surgery, selected for high-risk features, were treated with adjuvant single-agent alkylating therapy comprising either intravenous cyclophosphamide (1 g/m*) in 36 patients, or oral melphalan

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(0.2 mg/kg daily for 5 days) in eight. Cyclophosphamide was repeated every 3 weeks for 10 cycles and melphalan every 6 weeks for 12 cycles. With a median follow-up of 36 + months, 18 patients have relapsed. The actuarial 5-year relapse-free survival was 48% and the overall 5-year survival was 54%; median survival was 84 months. Pretreatment FIGG stage was the single most important predictor of relapse-free and overall survival duration. For patients with Stage IA and IB tumours the 5-year acturial relapse-free survival was 89vo’r;for patients with stage IC and II (all substages) the 5-year relapse-free survival was 24% (P = 0.001). For this latter group adjuvant single alkylating agent therapy was not adequate and alternative therapeutic regimens are required. The problem of suboptimal primary surgical staging is also addressed. Hemorbeological parameters in patients with gynecologic malignancies Miller B; Heilmann L Department of Obstetrics and Gynecology, University Hospital, University of Essen, l&en; Germany Federal Republic Gynecologic Ontology/33/2 (177--181)/1989/ Thromboembolic events account for a significant number of complications during surgical and chemotherapeutic treatment for gynecologic malignancies. Besides changes in the hemostatic system, changes in hemorheological parameters faclliate initiation and promotion of thrombotic disease. We used a rheoaggregometer to determine erythrocyte aggregation and a capillary viscosimeter to evaluate plasma viscosity in patients with gynecologic malignancies at the time of primary diagnosis and during follow-up and compared the results to those for a normal control group. We found a significant elevation in plasma viscosity and erythrocyte aggregation as well as in fibrinogen and globulin concentrations in cancer patients. The extent of this rise was related to the tumor volume. Treatment with cisplatin, doxorubicin, and cyclophosphamide resulted in a further rise in erythrocyte aggregation which is attributed to a direct effect on the membrane. Thus, additional factors contributing to the risk of thrombosis in these patients were defined. Additional administration of rheologically active agents might improve the results of thrombsis prophylaxis. Diagnosis and resection of an oral contraceptive-suppressible Sertoli-Leydig cell tumor with preservation of fertility and a 7year follow-up Haning RV Jr; Loughlin J; Shapiro SS Department of Obstetrics and Gynecology, Brown University, Providence, RI; USA Obstetrics and Gynecology/7316 II SUPPL. (901-905)/1989/ A 2l-year-old white woman presented with virilization, hirsutism, and acne of 1.5 years’ duration. Endocrine testing demonstrated complete suppression of serum testosterone, from 5.3 to 0.6 ng/mL, and serum androstenedione, from 4.7 to 1.7 ng/mL, after oral administration of 50 pg of mestranol and 1 mg of norethindrone for 21 days. No suppression of either steroid was produced by dexamethasone, whereas serum dehydroepiandrosterone sulfate was suppressed from 5.2 to 1.9 pg/mL. A left salpingo-oophorectomy was performed for a 3 x 4-cm Sertoli-Leydig cell tumor of intermediIn! J Gynecol Obstet 30