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[Studies on pregnancy after CO2 laser conization for cervical intraepithelial neoplasia].

One hundred and sixteen patients with cervical intraepithelial neoplasia were treated by CO2 laser excisional conization, from 1985 to 1987. All operations in this series were performed in the outpatient unit. 1) In this series, 83.6% (97 out of 116) were patients with CIN and 44.0% (51 out of 116) were patients under the age 39 who can be pregnant. 2) There was no remaining in the 16 materials out of 44 obtained by hysterectomy due to cervical dysplasia and carcinoma in situ (CIS). 3) In our series, 10.3% (6 out of 58) of the women with dysplasia or CIS (surgical margin negative) required two treatments respectively to eradicate their disease from 9 months to 16 months after laser conization. 4) None of 72 women developed postoperative cervical stenosis and cervical infection. 5) Much of the epithelial cover, although originating from columnar cells, became squamous epithelium by 28 days. 6) There were 5 pregnancies in 72 patients, from 5 months to 13 after laser conization. From our studies, a CO2 laser conization for treating CIN preserved the architecture of the cervix, permitting adequate colposcopic and cytological follow-up, and preserved cervical function, so that fertility is not affected and so that there is no interference with pregnancy.

Adult↗

[Diagnosis and follow-up of ovarian cancer by a combination assay of serum sialyl SSEA-1 antigen and CA125 levels].

We used a combination assay of serum sialyl SSEA-1 antigen (SLX) and CA125 levels, and evaluated the clinical usefulness of this technique for a diagnosis of ovarian cancer and follow-up of the patient with ovarian cancer. In 28 patients with ovarian tumors, the sera of 8 (66.7%) of 12 with ovarian cancer and 5 (71.4%) of the 7 with endometriosis (endometrial cyst) were positive for both SLX and CA125, but serum SLX level was 50 U/ml or less in all these 5 SLX-and-CA125 positive patients with endometriosis. The sera of all 9 patients with benign ovarian tumor were negative for both tumor markers. No patient with endometriosis was negative for both markers. The diagnostic accuracy (true positive rate X true negative rate) of the combination assay for ovarian cancer was 50.3% when the cut-off value of the serum SLX was 38 U/ml but improved to 81.8% when the value was set at 50 U/ml. From the above observations, a combination assay of serum SLX and CA125 is promising method for the differential diagnosis of malignant and benign ovarian tumors. Our results also suggest that to improve the diagnostic accuracy, the cut-off value of the serum SLX level should be 50 U/ml for ovarian tumors alone. We found following-up two cases of ovarian cancer that the serum SLX level is not affected by the ascites and inflammation. We expect that this combination assay of serum SLX and serum CA125 will be beneficial for diagnosis and follow-up of ovarian cancer.

Antigens, Tumor-Associated, Carbohydrate↗

[Effects and side effects of hypertensive intra-arterial chemotherapy (CDDP, PEP) in advanced cancer of the uterine cervix].

UNLABELLED: We have been treating advanced cancer of the uterine cervix with intra-arterial cisplatin (CDDP) and pepleomycin (PEP) (injected into the bilateral internal iliac artery), combined with radiotherapy and hysterectomy. Concomitant angiotensin II (AT II) administered by intravenous drip infusion was double the tumoral blood flow and thereby enhanced the efficiency of the intra-arterial chemotherapeutic regimen. But CDDP runs the risk of renal and myelotoxicity, so we studied renal dysfunction after treatment by examining serum and urinary beta 2-microglobulin (beta 2-m), and RBC, Hb, WBC, lymphocyte, and PLT. RESULTS: At 1 week after the treatment, evaluation of the histological effects showed, Grade IIb: 72.7% (8/11 cases). Serum beta 2-m was within normal limit and not changed. Urinary beta 2-m levels increased to abnormal levels at 1 and 2 weeks after treatment, and fell to normal levels at 3 weeks after treatment. RBC, Hb, WBC, lymphocyte, and PLT fell most at 3 weeks after treatment and then increased slowly. This suggests that hypertensive intra-arterial chemotherapy (CDDP) impaired kidney and bone marrow, mildly and reversibly, and its appropriate interval is about 4 weeks.

Adult↗

[A case of advanced uterine cervical cancer responsive to continuous intra-arterial chemotherapy using an implanted drug delivery system].

Selective intra arterial hypertensive infusion of CDDP (100 mg) and PEP (40 mg) with angiotensin II was performed in a 64 year-old housewife with inoperable uterine cervical cancer stage IVa and transitional cell cancer of bladder (grade 1-2). PEP at 5 mg/day was also administered for 20 days (total 100 mg) using an implanted Drug Delivery System through the left internal iliac artery combined with irradiation therapy. There were hardly any side effects due to this treatment except for a slight upper digestive tract disturbance and bone marrow suppression, and the cancerous lesion gradually regressed following this treatment. This case suggested the efficacy of intra-arterial infusion using an implanted Drug Delivery System for advanced uterine cervical cancer. There has been no sign of recurrence six months after this treatment.

Angiotensin II↗

[A comparison between CO2 laser conization and cold knife conization in clinical diagnosis of cervical intraepithelial neoplasia].

Intraoperative and postoperative complications related to CO2 laser conization and cold knife conization were compared. From 1980 to 1984 66 patients were hospitalized for cold knife conization, the mean operative time was 28.1 minutes, all patients had epidural anesthesia, and the mean time of admission was 6.8 days. Three percent of cases had infections, the mean intraoperative hemorrhage was 75 ml, and the rate of remaining foci of neoplasia was 18.2%. Meanwhile there were 116 patients hospitalized for CO2 laser conization from 1985 to 1987. The mean operative time was 15.6 minutes, 15.5% of cases had local anesthesia, the mean time of admission was 0.6 days. Zero percent of cases had infections, 0% of cases had postoperative cervical stenosis, the mean intraoperative hemorrhage was 75 ml, and 29.5% of cases had remaining foci of neoplasia. There was no significant difference in hemorrhage amounts at hysterectomy following conization either method. Thus, in our experience, CO2 laser conization is more effective for clinical diagnosis and treating of cervical intraepithelial neoplasia.

Adult↗

[Studies of intra-arterial hypertensive chemotherapy with cisplatin and peplomycin in advanced cancer of the uterine cervix--suitable dose of angiotensin II determined by intra-arterial digital subtraction angiography].

UNLABELLED: We have been treating advanced cancer of the cervix uteri with intra-arterial cisplatin (CDDP) and peplomycin (PEP) (injected into the bilateral internal iliac artery), combined with radiotherapy and hysterectomy. Concomitant angiotensin II (ATII) administered by intravenous drip infusion was found to double tumoral blood flow and thereby to enhance the efficiency of the intra-arterial chemotherapeutic regimen. In the present study, hypertensive intra-arterial chemotherapy utilizing ATII was administered to a small group of patients with advanced cancer of the cervix uteri while ascertaining the increase in intratumoral blood flow by intra-arterial digital subtraction angiography. The subjects were 10 patients with stage IIb or more advanced cancer of the cervix uteri. RESULTS: A 2-fold or greater increase in tumoral blood flow was attained in those patients who showed concurrently a 1.5 fold or greater increase in mean blood pressure and an increase in mean blood pressure to 150mmHg or higher. In 2 patients, ATII infusion failed to raise blood pressure to a therapeutically adequate level. At 1 week after the treatment in question histological evidence indicated unequivocal degenerative changes and necrotic changes in tumor cells. Many plasma cells, lymphocytes + and granulocytes appeared around necrosis changed carcinoma nests.

Adult↗

Detection of a new TIGR gene mutation in a Japanese family with primary open angle glaucoma.

PURPOSE: To describe a new mutation of the trabecular meshwork-inducible glucocorticoid response protein (TIGR) gene in a Japanese patient with familial primary open angle glaucoma (POAG). METHODS: Standard ocular examinations were performed on the 44-year-old patient, his sister, and mother. DNA sequencing was used to identify the mutation. We also developed a DNA diagnostic method for detecting this missense mutation by polymerase chain reaction-induced mutation restriction analysis (PCR-IMRA). RESULTS: The patient, father, and sister had been diagnosed as having POAG. The patient and his sister had a Thr448Pro mutation (C-->A transition at the nucleotide number 1419) in exon 3. This mutation has not been reported before. CONCLUSIONS: Gene analysis is promising for an early diagnosis among the family members of familial POAG patients and will contribute to early therapy before an occurrence of irreversible visual impairment.

Aged↗