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Biomedical subjects
Publications and source records attributed to F Flam.
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The prognosis in patients with placental tumours, invasive mole or choriocarcinoma, is excellent. Chemotherapy offers, in the majority of cases, complete cure with preservation of fertility. However, surgery still plays a role in this group of diseases. Elective surgery aiming at curing the patient plays a minor but definitive role in selected patients. This study discusses emergency surgical procedures. In 92 patients treated because of gestational trophoblastic neoplasia at one institution 10 patients (11%) were subjected to invasive surgery, for the most part because of life threatening haemorrhage.
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A case of primary carcinoid of the ovary in association with an imitation of appendix vermicularis is presented. These elements were thus parts of a mature teratoma. In the other ovary a granulosa cell tumour with a similar morphology was found. Following surgery no additional treatment was administered and the patient is well 13 years after the diagnosis.
Although choriocarcinoma is a gynaecologic malignancy, it may well present with nongynaecologic symptoms. We present such a case with metastases to the lungs and brain. The malignancy had arisen in a full-term pregnancy ending nine months prior to admission. In female patients presenting with cerebral metastases, a pregnancy test will either confirm or dismiss the possibility of choriocarcinoma.
Twenty-five consecutive patients referred to the Department of Gynecology and Obstetrics, Karolinska Hospital, Stockholm, because of gestational trophoblastic neoplasia (GTN) had colour flow Doppler performed. The examinations were performed transabdominally in the initial ten patients and transvaginally thereafter. Tumour vessels within the uterus were detected in eighteen patients (72%). A negative colour Doppler finding in patients with persistent disease could imply a diagnosis of choriocarcinoma rather than invasive mole, but all five patients belonging to this group responded promptly to chemotherapy. There seems to be a rough correlation between extent of uterine disease, as judged by colour flow Doppler, and response to chemotherapy.
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