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The cell-mediated immune response, as demonstrated by cutaneous delayed hypersensitivity, has been reported to correlate well with the clinical course in a variety of neoplastic diseases. To facilitate evaluation of cellular immunity in patients with gynecologic cancer, an immunologic index has been devised which incorporates the cutaneous reaction to standard antigens, 1-nitro,2,4-difluorobenzene, and croton oil. Thirty-six patients with invasive cervical cancer, 19 patients with cervical dysplasia or carcinoma in situ, and 77 patients with dermatologic disorders were tested. Results reported here indicate a highly significant relationship between host cellular immunity and the clinical course of the patient with a gynecologic neoplasm.

The cases of 16 patients treated for intestinal radiation injuries are reviewed. The conclusion is that in patients who have received radiation treatment earlier, it is never possible to rule out intestinal radiation injuries as the reason for abdominal complaints. The pathologic picture and the symptoms seem to be independent of the latency period and age. The possibilities for treatment are discussed, and it is concluded that only patients with slight injuries in whose cases cancer has been ruled out can be treated conservatively. For all other patients resection and perhaps closure of a fistula if it is possible should be done. This, however, was possible only in 25 per cent of our patients. In the rest of the patients operated on it was only possible to establish a colostomy.

A series of 42 cases of carcinoma in situ of the cervix during pregnancy is presented. Hysterectomy was the mode of treatment in 24, and 7 of these were cesarean hysterectomies. The use of cesarean hysterectomy in the treatment of carcinoma in situ of the cervix during pregnancy is discussed. A simple technique for performing this latter type of operation is described which allows complete removal of the cervix and helps to diminish complications. No complications were encountered in this series. This suggests that cesarean hysterectomy, performed by the technique described in this report, warrants more consideration as one of the methods of treating selected cases of carcinoma in situ of the cervix during pregnancy.

Coherent optical signal processing techniques applied to the screening of exfoliated cytologic cervical samples were evaluated. The two-dimensional Fourier spectrum of some 80 isolated cells was obtained from high resolution cell photographs and recorded. Quantitative spectrum data were collected on a training set consisting of 15 categorized malignant cells taken from slides diagnosed as malignant and 10 categorized normal cells taken from slides diagnosed as normal. A variety of transform parameters were measured and certain combinations of them were found which separated completely the normal from malignant cells. Certain parameters were shown to be functionally related to the cell diameter, nuclear diameter and nuclear density. Other parameters were found which appear to be related to other cell features such as clumping of nuclear deoxyribonucleic acid. When they were used in combination with the previous parameters, they greatly enhanced the discriminatory capabilities. Computer model studies formed the basis for our experimental design and parameter selection and have validated much of our experimental results. Although the sample size to date is admittedly small, our results have been very encouraging. The purpose of this paper is to report on the initial results obtained in a study to determine the effectiveness of coherent optical processing techniques when applied to the screening of’ exfoliated cervical cytologic samples for malignancy. These techniques rely on the diffraction properties of coherent light which are closely related to scattering techniques used by the groups at the Lawrence Livermore Laboratories and the Max-Planck Institute for cytologic screening and sample enrichment. The specific approach used in this investigation is concerned with the relationship the cell image has to its two-dimensional Fourier transform, which is generated optically by a well known method described below. The success of the screening approach depends upon the ability to measure and discriminate between the Fourier spectrum of malignant and Fourier spectrum of normal exfoliated cervical cells. In most instances the measured discriminating parameters can be functionally related to well known cytologic characteristics which are conventionally used to discriminate between malignant and normal exfoliated cervical cells.

A statistical model is developed that describes the population of women who are given a cytologic screening test for cervical cancer. The model is used to determine false positive and false negative rates as a function of (a) the proportion of "positive" cells in women free from cancer and in those with cancer, (b) the number of cells examined and (c) the minimal number of positive cells for a diagnosis of cancer. The model allows estimation of the minimal number of cells that must be examined in order to reduce both the false positive and the false negative rates below some predetermined levels. An expected cost equation is derived which combines the costs of examining each cell with the costs for false positives and false negatives. It is shown how cancer detection can be optimized through the use of this cost equation. The method determines both the maximal permissible cost for examining each cell and the optimal number of cells to examine in order to reduce the over-all expected cost below some predetermined level.

Between 1965 and 1967, Papanicolaou smears were obtained before admission in 2,409 women accepted for intrauterine contraceptive devices (IUD's) and 2,684 women for long-acting injectable progestogens (LAP) contraception (chlormadinone acetate and medroxyprogesterone acetate). These were repeated yearly since then, with accumulated woman years of 3,269 for the IUD group and 7,119 for the LAP group. Both groups were comparable in age distribution, previous pregnancies, and socioeconomic level. The diagnosis was based on repeated cytology, colpomicroscopy, and histology of the biopsy or conization. Statistical analysis shows that women who requested LAP had a significantly higher prevalence rate of histologically confirmed lesions than those applying for IUD's. However, the incidence rate of new lesions appearing during the use of these contraceptive methods was the same for both groups. It is concluded that the risk of developing cervical carcinoma in patients using LAP is not significantly different from women using IUD's.

A detailed account is given of the lymphographic appearances of the normal lumbar lymphatics based on an analysis of 126 normal bipedal lymphograms. The lymph vessels are shown to have a variable distribution, and a prominent vessel in the right chain is described as the “right lower lumbar bypass” vessel. The right and left lymph node chains are shown to be often asymmetrical in the level of opacification as well as in the numbers of nodes. The left chain usually contains more nodes and rises to a higher vertebral level than the right chain. A middle chain of nodes is present in 65% of lymphograms. The appearances of the “right lower lumbar gap” and the “left upper lumbar clump” are described and their normality is stressed. Normal lumbar nodes do not extend in a lateral direction beyond the tips of the transverse processes of the lumbar vertebrae. Fibrolipomatous infiltration of lumbar nodes is uncommon.

Lymphocytes from patients with bladder, renal or prostate carcinomas, or with non-malignant genito-urinary disorders, and from normal individuals, were tested in a microcytotoxicity test against cultured bladder cancer cells (T24) and other target cell types. Effector cells were titrated over a range of concentrations against target cells to achieve a quantitative measure of toxicity. Tests were shown to be reproducible by repeat tests of normal donors. Lymphocytes from patients with bladder cancer were more strongly cytotoxic to T24 than lymphocytes from normal healthy donors or from patients with renal or prostatic carcinomas. Cell-mediated cytotoxicity (CMC) by lymphocytes from bladder-cancer patients, however, was not significantly stronger than CMC by lymphocytes from patients with non-malignant GU disorders. Strength of CMC against T24 by lymphocytes from patients with bladder cancer correlated inversely with the extent of disease. Patients with superficial and locally invasive lesions showed strongest anti-T24 reactivity while patients with disseminated disease had CMC equivalent to normals. In tests against target cells derived from amnion of carcinomas of the breast, cervix and/or colon, CMC by lymphocytes from bladder-cancer patients was not significantly different from that of any other group. Lymphocytes from all donor groups were cytotoxic at some level to cells from cultures derived from bladder cancer and other tissues, although cell lines differed in apparent vulnerability in CMC tests.

In an attempt to increase survival in cervical malignancies, a study was started in 1950 with preoperative internal and external irradiation followed by radical operation. The study was made at Confederate Memorial Medical Center in Shreveport, Louisiana. Three previous reports seemed to indicate an advantage to this combined approach. This report deals with the current findings since the preliminary results were reported.

A prospective study of pelvic node involvement in 118 patients with Stage I cervical carcinoma was carried out. All patients were treated by full irradiation therapy (cesium or radium and external cobalt) before or after transperitoneal pelvic lymphadenectomy. Positive nodes were noted in 22.4 per cent of those operated on prior to radiation and 11.7 per cent of those undergoing lymphadenectomy 6 to 16 weeks after full irradiation. Over-all five-year survival was 81.4 per cent but in those with positive nodes survival was only 20 per cent. When nodes were negative, 93.9 per cent of patients survived five years. There were no operative deaths or operative injuries to the urinary tract in the series. Complications were not more frequent or more severe in the group undergoing surgery after radiation. The results suggest that radiation can eradicate metastatic carcinoma from lymph nodes in a portion of the cases and information regarding the presence or absence of nodal metastases is useful in planning therapy and predicting outcome.

Summary The frequency of thrombo-embolic complications as assessed by objective diagnostic techniques was investigated in 262 patients having major pelvic surgery. The lowest incidence of leg vein thrombosis (7 per cent) was found in patients undergoing vaginal hysterectomy. After abdominal hysterectomy for benign pathology the incidence was 13 per cent and after Wertheim's hysterectomy for carcinoma of the cervix 25 per cent. After operation, the highest incidence of leg vein thrombosis (45 per cent) was in patients having surgery for gynaecological carcinoma other than that of the cervix. Fatal pulmonary embolism occurred in two patients (0.7 per cent), one with advanced ovarian carcinoma and the other after surgery for carcinoma of the corpus uteri; non-fatal pulmonary embolism was diagnosed in six patients (2.2 per cent).

Tumor scanning with 57Co-bleomycin was carried out in 46 patients with an overall accuracy of G6% in malignant tumors. There were no genuine false positive results in four benign lesions. Since 57Co-bleomycin is excreted rapidly through the kidneys, a high tumor-to-blood ratio is obtained a short time after injection. Although its long physical half-life may restrict its routine use, 57Co-bleomycin might provide a valuable adjunct in the work-up of malignant tumors when used in properly selected patients.

Summary A comparison was made between colposcopy, scanning electron microscopy (SEM) and histology in 50 asymptomatic patients presenting with abnormal cervical cytology. Colposcopy was very accurate in predicting epithelial abnormalities. Using already established criteria, the SEM changes of carcinoma in situ were found to be reliable and reproducible and it was also found possible to predict whether or not invasion of the basement membrane had taken place.

Results are presented supporting the philosophy that malignancy can be detected by studying the size/density matrix of nuclei in cell populations to form the basis of an automated screening system. Some methods of cell dispersal and staining are briefly described. A preliminary assessment of the performance of the Cytoscreen is discussed.

A review of 21 papillary squamous tumors of the uterine cervix encountered over an 8-year period is presented. The lesions were grouped into three categories: Group A, condyloma acuminatum, 15 cases; Group B, true squamous papilloma, four cases; Group C, verrucous squamous-cell carcinoma, two cases. The clinical and pathologic features of these three groups of lesions are described. In 14 of the 15 cases the condylomas were typical. One, because of extensive involvement of the cervix, was clinically suggestive of carcinoma, but histologically on cone biopsy showed the usual features of condyloma acuminatum. All four squamous papillomas showed histologic features of severe squamous dysplasia and carcinoma in situ involving the papillomatous as well as the adjacent nonpapillomatous epithelium, indicating a high risk of malignant transformation in this group of tumors. Two of the cases represented the rare verrucous squamous-cell carcinoma. The literature on the subject of squamous-cell papillomas of the cervix is reviewed. Including the present series, there are approximately 254 reported cases of squamous papillary tumors of the uterine cervix. Of this total, only 13 are regarded as malignant, and none has had distant or lymph nodal metastases.

Small bowel complications developed in 9 patients 6-60 months following radiotherapy for carcinoma of the cervix. A phenotypic profile of unusual sensitivity was determined from analysis of patient characteristics. Four patients were diabetic, three were hypertensive and diabetic, five had Stage III disease, and all were either underweight or of normal weight. Only one had previous abdominal surgery. All received at least 4000 rads of external beam therapy. Complications developed in patients with one or two radioactive implants. Small bowel problems are particularly prone to develop in patients of small habitus with preexisting small vessel disease, especially as evidenced by hypertension and diabetes.

Summary The incident age distribution for Stage I, Stage II and Stage III carcinoma of the cervix in 12 regions in England and Wales between 1945 and 1969 was studied. For the various geographical areas considered during the same five-year period, the mean age points for a given stage of carcinoma of the cervix were usually tightly clustered. The highest mean ages for a given stage were usually found in the least industrialized areas and this was most noticeable for the period 1965 to 1969. The mean age for Stage I carcinoma of the cervix fell slightly between 1950 and 1969. No similar decrease occurred for Stages II and III.

Patients with Stages IIB and III carcinoma of the cervix were subjected to laparotomy with special attention directed to para-aortic lymph nodes. Of the patients with Stage IIB carcinoma of the cervix, 16.1 per cent had metastatic disease in the para-aortic lymph nodes. Of the patients with Stage III cervical carcinoma, 46.4 per cent had positive para-aortic lymph nodes. In addition, one patient with Stage III carcinoma of the cervix had metastatic disease to the small intestine and ascending colon. Thus, 50 per cent of the patients with Stage III carcinoma of the cervix had disease beyond the usual field of radiation therapy. It is suggested that these findings demand an alteration in the concept of treatment of Stage III carcinoma of the cervix.

1. 1. The objective of this investigation was to determine if certain marker enzymes were associated with either the exterior or interior aspect of the plasma membrane. 2. 2. Experimentally, the problem was approached by comparing enzymatic activity of intact cells with that of disrupted cells. Because isolated cells from dispersed guinea pig liver were found to be of limited value only, the investigation was pursued in varous cultured cell lines. Permeability of whole cells to substrate was excluded as a possible source of error. 3. 3. Most of the activities of non-specific Mg2+-ATPase and 5′-nucleotidase of several cell lines (i.e. HeLa; KB; human, mouse and guinea pig hepatocyte, mouse neuroblastoma) was the expression of ecto-enzymes. Phosphodiesterase I, p- nitrophenylphosphatase and leucyl-β-naphthylamidase also may occur preferentially as ecto-enzymes, though fewer cell lines were tested. 4. 4. Adenylate cyclase was clearly associated with the interior aspect of the plasma membrane. Nucleotidepyrophosphatase of isolated guinea pig hepatocytes had the characteristics of an ecto-enzyme but was associated with the inside of the plasma membrane in Chang hepatocytes and KB cells.

A pilot study has been conducted on 50 consecutive cases of carcinoma of the cervix Stage III and IV which were treated with 6,000 rads to the whole pelvis without the addition of radium. The first 25 patients were treated in air and the second 25 patients under HPO. The 5 year tumorfree survival rate of the air group was 16 per cent which is similar to other published series of patients treated with 6,000 rads without the addition of radium. The 44 per cent 5 year survival rate of the hyperbaric group compares favorably with, but is not greatly superior to, published reports of patients treated with external radiation followed by intracavitary radium. The serious bowel complication rate of 6 per cent in the air group and 17 per cent in the hyperbaric group supports previous animal studies which suggest that late bowel damage was increased by HPO.The study supports the theory that human tumors contain hypoxic areas which can be either reoxygenated when fractionated radiation is used with subsequent radium...

A summary of a 21 year experience with peritoneal cytology obtained by cul-de-sac and peritoneal lavage is presented. The interpretation of this type of cytology requires well-trained, experienced cytologists. Vaginal cul-de-sac lavage in asymptomatic patients has not proved effective in the early detection of ovarian cancer. Peritoneal cytology obtained at operation, on the other hand, has promise of considerable value. It was positive in 78 per cent of patients with ovarian cancer. Significantly, malignant tumors with an intact capsule shed malignant cells into the peritoneal cavity in 36 per cent of Stage I a patients. The over-all percentage of positive cytology for Stage I a, b, and c tumors was 45 per cent. There were 39 cases of Stage I endometrial carcinoma, of which 12.8 per cent had positive cytology. In patients with Stage III cervical carcinoma, who were explored as a part of their primary treatment, 14.7 per cent of those with negative nodes and 55.5 per cent of those with positive nodes had postive peritoneal cytology. Evidence is presented to prove that shed cancer cells are viable and capable of continued growth and that some form of adjunctive therapy should be considered.

An increasing amount of evidence now provides a firm basis for the concept that there is significant relationship between immunological capacity and human neoplastic disease. The presence of human tumor-associated antigens and the ability of the immunologically competent host to respond to them is well documented. Recent studies have indicated a correlation between the cell-mediated component of the immune system and clinical prognosis. Furthermore, the delayed cutaneous hypersensitivity reaction as demonstrated by reactivity to common skin antigens and contact allergens, has proved to be an excellent in vivo correlate of cell-mediated immunity. One hundred and twenty-five patients with various gynecologic cancers were studied using a battery of skin-test antigens and a contact allergen. It was found that those patients capable of displaying a normal delayed hypersensitivity reaction to standard skin test antigens and to DNFB (dinitrofluorobenzene) do indeed have a better prognosis, whereas, those who are anergic or who exhibit impaired reactivity experience a poor response to therapy, with an increased incidence of recurrent disease, metastasis, and eventual early death. This study suggests that, while derangement of the immunological defense system is not unequivocally necessary for a cancer to flourish, it does strongly imply a common framework for the progression of the neoplastic process. Thus, this study supports the concept that there is a highly significant relationship between host cellular immunity and clinical course in the patient with a gynecologic cancer.

That malignant disease of bone may be a late complication of radiotherapy is now well recognized. The first report in the literature appears to be that of Beck (1922), who described three cases of sarcoma following radiotherapy for tuberculous bone disease three to six years previously. Since this paper, many others on both clinical and experimental work have been written. The necessary criteria for diagnosing malignancy following irradiation were defined by Cahan et al. (1948), reiterated by Cruz, Coley and Stewart (1957) and by Arlen et al. (1971), all from the Memorial Centre for Cancer and Allied Diseases, New York. In these papers a total of 50 cases were reported. However, Cahan and his colleagues commented on the rarity of sarcoma of the pelvis following irradiation for carcinoma of the cervix and, despite many other papers on this subject, only six cases appear to have been described, with a further two cases following treatment of carcinoma of the body of the uterus. The following case is of inte...

The object of this study was to measure some of the differences between normal squamous epithelial cells and cells from invasive squamous carcinoma of the uterine cervix. A total of 107 patients were studied; only those specimens which when assessed by a histopathologist were thought to show classic normal features or undoubted invasive carcinoma were included in the quantitative analysis. In addition, any specimens which at the electron microscope level, showed faulty sampling or preparation were discarded, leaving us with 16 carcinoma and 15 normal specimens for detailed study. The nuclei of tumour cells had a greater area than those of normal cells; histograms of the size distribution of nuclei showed a distinctly different pattern in the 2 groups. Tumour cells had fewer ribosomes in each cubic micron of cytoplasm than had the normal cells and showed a reduction in the amount of intercellular space; in addition, the malignant cells had a smaller surface density and fewer tonofibrils in their cytoplasm. Some tumour cells had a smaller percentage of cell membrane specialized as desmosomes than the corresponding normal cells but all tumour cells had desmosomes of shorter length than normal. Discriminatory analysis, carried out with the help of a computer, allowed all of these variables to be assessed with respect to each other in order to arrive at a numerical score for each specimen. When expressed graphically, these scores showed that the populations of normal and carcinomatous cells fell into 2 separate groups. The significance of these results is discussed. ImagesFig. 3Fig. 4Fig. 1Fig. 2

A coordinated study of the effects of oral contraceptives (OC3) undertaken by 12 institutions from all over the country is presented. Women with stroke were matched with women in the hospital for other conditions and both groups were asked if they had taken OCs. Almost 40% of the women with thrombotic stroke had been using OCs whereas only 12% of the controls had used the method. Studies of a relationship between OC use and breast cancer or benign lesions indicate the evidence is unavailable to support such a relationship. While it is still unknown whether OC effects the incidence of cervical cancer patients who choose this method are more likely to have dysplasia on their initial visit to the clinic. OC use seems to affect changed in whites blood pressure various blood tests and psychologic changes. There is also an effect on the 1-hour glucose tolerance tests. Recent work implicating the steroids with fetal cardiac anomalies also stresses the need for an organized effort to study the effect of OC on progeny. Comments by the editor state that it is extremely important to continue to examine the physiologic and pathologic effects of OCs. The physician should be aware of all possible complications in order to aid the women in choosing a contraceptive best suited to their needsw.

Three hundred patients with carcinoma of the uterine cervix stages I and II were examined by foot lymphography and treated by radical hysterectomy with pelvic lymph node dissection 6 weeks after preoperative radium insertions. A total of 9187 lymph nodes were removed, of which 97 (1.1%) contained no contrast medium. All solitary metastases found were situated in regions ordinarily opacified. Of 209 lymph nodes containing metastases, 32 (15.3%) showed little or no contrast medium. The internal iliac (hypogastric) lymph nodes were visualized in 55% (gluteal nodes) and 41% (lateral sacral nodes) of the normal lymphograms.

The authors derived figures representing the biological effect of radiotherapy on normal tissues in cases of carcinoma of the cervix. The doses causing both early and late effects are calculated by using quantitative relationships determined from clinical considerations between physical factors (dose, time-dose rate, fraction dose and numbers of fractions) and the effects to calculate the combined effects of the two modalities of radiation at significant points in the pelvis. Sample calculations will be shown from techniques used at some major clinical centers.

5-Bromodeoxycytidine is phosphorylated to 5-bromodeoxycytidine 5′-monophosphate in extracts of cells infected with herpes simplex virus but not in extracts of uninfected cells. The conversion of 5-bromodeoxycytidine to nucleotides and its utilization for DNA synthesis in uninfected cells occurs by deamination of 5-bromodeoxycytidine to 5-bromodeoxyuridine followed by phosphorylation of 5-bromodeoxyuridine to 5-bromodeoxyuridine 5′-monophosphate. In contrast, in cells infected with herpes simplex virus, 5-bromodeoxycytidine is phosphorylated directly to 5-bromodeoxycytidine 5′-monophosphate, which can then be deaminated to 5-bromodeoxyuridine 5′-monophosphate and incorporated into DNA. These results indicate a difference in the substrate specificity of nucleoside kinases induced by herpes simplex virus and the enzymes present in uninfected cells. It is suggested that this difference in substrate specificity between virus-induced and host-cell enzymes may allow selective chemotherapy of herpes simplex infections with 5-bromo- or 5-iododeoxycytidine.

Nineteen patients with known or suspected neoplasms of the skull and/or brain were studied with 99mTc pertechnetate, 99mTc polyphosphate, and 67Ga citrate. Lesions of the calvaria were detected most accurately with 99mTc polyphosphate. In some cranial lesions, 67Ga citrate localized within the core, 99mTc polyphosphate outlined the periphery, and 99mTc pertechnetate demonstrated the entire affected area. In postcraniotomy patients, the combination of 67Ga citrate and 99mTc polyphosphate provided a basis for distinguishing the surgical scar from a recurrent intracranial tumor. Purely intracerebral lesions were generally poorly localized with 99mTc polyphosphate.

The epidemiological method and findings have identified and emphasized the research potential of studying migrants within the U.S., for specific causes of death. The study has demonstrated the marked differences in cancer mortality which become manifest for the nonwhite and native-born white when resident male and female deaths of a state are subclassified by region of birth and state of residence, which would not otherwise be apparent in the comparisons by broad classifications as currently coded in vital records. The age adjusted rates for all cancers (ages 35–69) for the nonwhite males born in the South were 363.67 vs 180.43 for those born in Ohio. The same ratio among the white males born in the South was 225.73, and for those born in Ohio, 197.14. For cancer of the lung and other specific cancer sites, the nonwhite males showed a higher rate for those born in the South compared to those born in Ohio. The excess for the white males was most notable for cancer of the lung. Statistical evidence is presented for the conclusion that the observed differences in cancer mortality among the nonwhite are not due to race per se . The importance of endemic factors associated with place of birth in the U.S. and the influences of the early years of life, particularly in the South in the development of social and biological imprints, and following migration the subsequent exposure to industrial environments, has been considered.

5 cases of carcinoma of the cervix complicated by a leaking or ruptu red pelvic abscess are reported. Cases were treated at the Baylor University College of Medicine in affiliated hospitals between 1965 and 1971. During this period 463 new cases of cervical carcinoma were treated. Case histories of each of the 5 patients are outlined. Treatment consisted of urgent surgery and irradiation with required individual variations. Prognosis appeared to be related primarily to the stage of the cervical cancer rather than to the coexistence of the severe adnexal infection. Accuracy of findings was difficult to assess with the extensive pelvic inflammation. There is no evidence that infection influences tumor growth or spread but acute infection complicates treatment especially surgery.

Investigating the geographic variation in the occurrence of cancer of the uterine corpus presents certain problems. Mortality rates are particularly unsuitable for this because of the large proportion of deaths from uterine cancer not specified as to whether they originated in the cervix or the corpus. Incidence rates, on the other hand, may be somewhat inflated if cytology screening is being extensively used in a population of women, but the designation between corpus and cervix is nearly complete. Incidence rates compiled by the International Union Against Cancer indicate considerable variation in the frequency of uterine corpus cancer among female populations throughout the world. There is a correlation between the frequency of this cancer and that of the ovary and breast, but not with cervical cancer. In the United States southern white women tend to have cancers of the uterine corpus, breast, and ovary less frequently and of the cervix more frequently than women of the north and west. American-born Japanese women are developing breast cancer nearly as frequently in California as white women. This may be true for ovarian cancer as well. Uterine corpus cancer may be increasing but the population is still too young to be sure, since this cancer reaches its highest rates at older ages. All these cancers are less frequent in Japan. The American-born Japanese will be followed with considerable epidemiological interest.

The term "pelvic vascular bed isolation" is given to our newly described type of cancer chemotherapy. The tissues underlying the bilateral vaginal mucosa are clamped for 4-6 hr. The hypogastric, superior gluteal, inferior gluteal, internal pudendal, obturator and ovarian arteries and veins are all ligated. MMC solution ranging from 50 to 80 mg is given into the hypogastric arteries. Pelvic isolation seldom caused prohibitive complications because the lumbar artery served as a collateral shunt by making its own way into the median sacral artery. We reported here controlling recurrent cervical cancer for about one and a half years in one case, and panhysterectomized radioresistant pelvic cancer for at least 3 mo in two cases with this type of cancer chemotherapy. Clinical benefit to these patients was also great.

A quantitative study of cell‐mediated immunological reactivity was made in patients with female genital tract cancer. Prinary reactivity was measured by contact sensitization to dinitrochlorobenzene (DNCB) and secondary reactivity by delayed cutaneous hypersensitivity to skin test antigens (STA). In general, there was an increased incidence of anergic and impaired reactivity in patients with cancer of the cervix, corpus uteri or ovary, compared with age‐matched controls; however, differences between patient‐groups, regarding organ or origin or histological type, were small and insignificant. There was a progressive increase in incidence of anergic and impaired reactivity with worsening of clinical staging of the tumour. Significant differences in reactivity were noted between patients who had remained free of disease and those who had progressive disease after 12 months of follow‐up. It is considered that impairment of cell‐mediated immunity is an unfavourable factor in host‐tumour interactions, and the possibility of augmenting immunological reactivity should be considered in management. Copyright

The use of a small-diameter, flexible endometrial cannula for aspirating endometrial cells is the most simple, safe, inexpensive, and reliable method for physicians to use in their offices to routinely screen asymptomatic women at high risk for endometrial cancer. Earlier detection of endometrial cancer will improve patient survival and the direct endometrial aspiration cytologic smear will enhance that goal.

An investigation into crossover of contrast medium from one side of the lumbar region to the other based on 83 normal unipedal lymphograms is described. Crossover and opacification of contralateral lumbar nodes was found in 45% of lymphograms, and right to left crossover occurred more often than left to right crossover in a ratio of 2:1. 56% of right sided lymphograms showed crossover to the left but only 32% of left sided ones showed crossover to the right. When crossover occurred, between 1 and 5 contralateral nodes opacified in 62% of lymphograms, and between 6 and 10 opacified in 48%. The anatomical level of contralateral node opacification was found to be significantly more cranial after right pedal lymphography than after left pedal lymphography. Reflux into contralateral pelvic lymphatics did not occur.

Until the Kinsey report there had been very little published concerning sexual activity in the aging woman. Since then other authors have stated that chronic illness or lack of a sexual partner rather than age have placed limitations on their sexual activity. This study reports the effect of different modes of therapy for invasive carcinoma of the cervix on subsequent sexual function, and also tries to establish a correlation with the type of changes of the vaginal anatomy. Radiotherapy alone had been performed on 28 patients, surgery alone on 32, and combined treatment on 15. All were clinically free of cancer for 1 year after treatment was completed. The youngest was aged 23 and the oldest 68. Of the 28 patients treated with radiotherapy alone 22 had developed shortening or narrowing of the vagina sufficient to interfere markedly with sexual function. Only 2 of the 32 surgically treated patients had such a sexual interference. With combined treatment 60% showed some vaginal alterations and 33% sexual dysfunction. Questioning of patients revealed the importance of sexual function in the lives of middle-aged women. Therefore preference is expressed for radical surgery in the treatment of early carcinoma of the cervix because this mode of therapy interfers minimally with the sexual function.

In cytology studies false negative smears range from 1.8% to 20% due to different levels of cytologic expertise and of material presented to the pathologist. Only 6% of in situ carcinomas of the cervix have an abnormal gross appearance so routine multiple biopsies are needed. Schiller's test, using a weak aqueous solution of iodine, leaves an area of carcinoma unstained but colors normal cervical epithelium a dark brown. However, not all areas which fail to stain represent foci of cancer. Multiple biopsies and endocervical curettage are required, particularly to detect lesions not involving the portio. Conization is the most accurate method for evaluating the suspicious cervix. 80 histo logic sections should be examined from each cervix specimen. Complicati ons of conization may be hemorrhage, cervical stenosis, uterine perforation, and pelvic infection. Only after 4-6 weeks does pelvic infection cease to be a significant risk. When done during pregnancy, conization may cause a fetal loss of 15%. Colposcopy has a low false-negative rate but cannot detect lesions inside the cervical canal. It is the best method of clinical evaluation of patients with abnormal cytological smears, particularly during pregnancy. A colposcopic diagnosis is based on an evaluation of vascular pattern, intercapillary distance, surface contour, color tone, and clarity of demarcation. Where colposcopic examination is unsatisfactory and cytology is positive, conization is indicated. The final diagnosis depends on the histology of the directed biopsy.

In recent years several methods have been described for the construction of indidividual field shaping devices in the mantle treatment of Hodgkin's disease (Douglas Jones, 1971; Edland and Hansen, 1969; Fordham and Hibbs, 1969; Maruyama et al., 1969; Maruyama and Khan, 1971; Hendee and Lindsey, 1972). When shielding large fields with lead blocks in radiation therapy, two main problems arise. The first is the accurate day-to-day reproducibility of irregular fields and therefore the precise positioning of lead shields in relation to the radiation beam and to the organs which are to be protected. The second problem concerns the shape and size of the lead blocks, according to the areas to be shielded, and the correction for the divergence of the beam. For 95–130 cm SSD, frequently employed with telecobalt units, the divergence of the beam must be evaluated to correct for over- or under-shielding of tumour-bearing areas (Edland and Hansen, 1969), otherwise increased rates of recurrence and of complication (i.e...

500 cases of vaginal hysterectomies were studied. Indications for vaginal hysterectomy were cervical carcinoma in situ (211), sterilization (210) and abnormal uterine bleeding (79). Blood loss was increased in those patients 35-44 years of age (mean of 331 ml) and was lowest in the 20-24 year age group (276 ml). Mean blood loss for all patients was 291 ml. Blood loss was significantly (p.01) increased in those patients with a secretory endometrium. Pelvic infection (cellulitis or abscess) was unrelated to absolute blood loss but was significantly increased (p.001) in those patients with pelvic hematomas. These finding suggest that vaginal hysterectomy performed on the perimenopausal patient with a secretory endometrium is most likely to be associated with increased blood loss. However, this increased blood loss does not cause a higher incidence of pelvic infection or prolonged postoperative hospital stay.

Several hypotheses have been posited on the observed association between herpesvirus type 2 (HSV-2) infection and squamous cell carcinoma of the cervix. One is covariability since attributes associated with sexual promiscuity are found more frequently among women who develop cervical cancer and among women infected by the virus. However a Houston study of a population with similar attributes assoicated with increased risk of developing cervical cancer and for becoming infected with a venereally transmitted agent shows that the association is not one of covariables of sexual promiscuity. Within each race studied (Negro and Caucasian) the sampled population was relatively homogeneous with respect to sexual and reproductive-associated factors. Another hypothesis is that malignant changes increase patient susceptibility to the viral infection and may precede the virus infection. However several studies show that infectivity with the virus can occur before the development of cervical cancer. The inability to demonstrate the difference in the occurrence of antibodies to HSV-2 between cases and controls in all geographic areas is the strongest evidence against the hypothesis that the virus is etiologically related to cervical neoplasia. Current serologic techniques for measuring HSV-2 antibodies do not accurately reflect the occurrence of past exposures to the virus infection. The observed geographic differences may also be attributed to differences in strains of HSV-2; or the HSV-2 may be etiologically related to only a portion of the cases of cervical cancer and the portion may vary in different social settings. Other viruses may also be carcinogenic like the cytomegalovirus which infects the uterine cervix and which is venereally transmitted under certain conditions. Overall available data are not sufficient to either refute or establish the etiologic role of HSV-2 in cervical cancer. The oncogenic potential of the virus has been demonstrated in hamsters and in the observation of a greater risk of developing cervical cancer among women infected with HSV-2 than among women with similar sexual and reproductive-associated factors but without a past HSV-2 infection. If the virus is etiologically related effective prevention programs should be designed.

Of 1,258 admissions of patients with invasive carcinoma of the cervix in 20 years, 87 (6.9 per cent) had adenocarcinoma of the cervix. The age and stage at admission were similar for adenocarcinoma patients and for all cervical carcinoma admissions. The pathologic diagnoses included: adenocarcinoma (78), mixed adenosquamous carcinoma (5), mesonephric carcinoma (2), medullary carcinoma (1), and clear cell carcinoma (1). Adenocarcinoma patients were treated by radiation only (69), operation (13), or both (5). The adenocarcinoma patients were matched with squamous cell carcinoma control patients, on the basis of age, stage, year of treatment, and treatment method; comparisons included crude survival rate, cumulative survival rate, and parity. Crude survival rate of 53 patients treated over 5 years previously was 54.7 ± 6.8 per cent in adenocarcinoma patients and 58.5 ± 6.8 per cent in squamous cell carcinoma patients. The cumulative 5 year survival rates for 87 patients in the adenocarcinoma group were 56.2 ± 5.8 per cent and 68.1 ± 5.4 in the control group. Mean parity of the adenocarcinoma group was 2.6, compared with 3.7 in the squamous cell control subjects. The improvement in recent years in treatment of and survival of patients with squamous cell carcinoma has not been reflected in survival of patients with adenocarcinoma.

Experimental evidence supporting the postulated analogy between myelin basic protein and a previously described common tumour specific antigen is summarized under antigenic cross-reactivity, subcellular localization, molecular size, basicity and proteolipid nature. A third protein antigen, present in all tissues, also shows strong similarities in all these respects.