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Background Genital warts (GW) are a common sexually transmissible infection (STI) among young adults and are associated with poor quality of life (QoL). We investigated the functional and psychosocial effect of GW on Singaporean patients and evaluated for any variations in QoL between genders. Methods: Patients with GW completed a standard questionnaire containing the Short Form-36 (SF-36) health survey and the Cuestionario Específico para Condiloma Acuminado in a cross-sectional survey. QoL deficits were determined by comparing the SF-36 scores with local population norms. Variations in SF-36 (norm-based) scores among patients with different characteristics were examined using multiple linear regressions. All data analyses were performed for male and female patients separately. Results: The mean age of male (n = 100) and female patients (n = 80) was 31 years. The typical patient profile was male, ethnic Chinese, single, tertiary education level and presenting with recurrent warts and a history of prior STIs. Compared with the general population, male patients had similar or better functioning and wellbeing, whereas female patients had lower levels of productivity, mental health and general health. Among male patients, individuals afflicted with their first episode of GW and currently with a partner had better QoL. In contrast, for females, tertiary education, older age and being a nonsmoker were positively associated with better QoL. Conclusions: Patients with GW have a significant psychosocial burden, with differences in certain aspects of QoL between genders. We hope that with active intervention, we will be able to mitigate the associated negative impact to QoL.

Gestational trophoblastic diseases are a heterogenous group of conditions ranging from the benign hydatidiform mole to the malignant choriocarcinoma. Optimal therapy in this group of diseases rest in the correct diagnosis, assessing their risk for malignant behavior using prognostic scoring systems and administering appropriate treatment. Their rarity makes it imperative that these patients are treated in special centres by experts. Benign moles are treated surgically with evacuation of the uterus or hysterectomy. In malignant gestational trophoblastic disease, chemotherapy is the treatment of choice; single agent for non-metastatic and low-risk metastatic disease and combination chemotherapy for high-risk metastatic disease. Judicious use of surgery and radiotherapy in these cases will improve the survival rate. With appropriate treatment, the cure rates approach 100% in the low-risk group and 80% to 85% in the high risk group.

Raman spectroscopy is a unique optical technique that can probe the changes of vibrational modes of biomolecules associated with tissue premalignant transformation. This study evaluates the clinical utility of confocal Raman spectroscopy over near-infrared (NIR) autofluorescence (AF) spectroscopy and composite NIR AF/Raman spectroscopy for improving early diagnosis of cervical precancer in vivo at colposcopy. A rapid NIR Raman system coupled with a ball-lens fiber-optic confocal Raman probe was utilized for in vivo NIR AF/Raman spectral measurements of the cervix. A total of 1240 in vivo Raman spectra [normal (n=993), dysplasia (n=247)] were acquired from 84 cervical patients. Principal components analysis (PCA) and linear discriminant analysis (LDA) together with a leave-one-patient-out, cross-validation method were used to extract the diagnostic information associated with distinctive spectroscopic modalities. The diagnostic ability of confocal Raman spectroscopy was evaluated using the PCA-LDA model developed from the significant principal components (PCs) [i.e., PC4, 0.0023%; PC5, 0.00095%; PC8, 0.00022%, (p

This study aimed to evaluate the clinical utility of applying near-infrared (NIR) Raman spectroscopy and genetic algorithm-partial least squares-discriminant analysis (GA-PLS-DA) to identify biomolecular changes of cervical tissues associated with dysplastic transformation during colposcopic examination. A total of 105 in vivo Raman spectra were measured from 57 cervical sites (35 normal and 22 precancer sites) of 29 patients recruited, in which 65 spectra were from normal sites, while 40 spectra were from cervical precancerous lesions (i.e., 7 low-grade CIN and 33 high-grade CIN). The GA feature selection technique incorporated with PLS was utilized to study the significant biochemical Raman bands for differentiation between normal and precancer cervical tissues. The GA-PLS-DA algorithm with double cross-validation (dCV) identified seven diagnostically significant Raman bands in the ranges of 925-935, 979-999, 1080-1090, 1240-1260, 1320-1340, 1400-1420, and 1625-1645 cm(-1) related to proteins, nucleic acids and lipids in tissue, and yielded a diagnostic accuracy of 82.9% (sensitivity of 72.5% (29/40) and specificity of 89.2% (58/65)) for precancer detection. The results of this exploratory study suggest that Raman spectroscopy in conjunction with GA-PLS-DA and dCV methods has the potential to provide clinically significant discrimination between normal and precancer cervical tissues at the molecular level.

The levels of prostaglandin F2 alpha metabolites (PGFM) in the peripheral blood were measured during third stage in a group of patients not given any oxytocic and this was compared with the levels produced in other groups given different oxytocics. There was a significant rise in PGFM within 5 min of delivery in all groups but there was no statistical difference in the serum concentrations of PGFM between the different groups. This suggests that oxytocics given during third stage do not act through release of prostaglandins.

The efficacy and side effects of a new synthetic compound, 16-phenoxy-W-17, 18, 19, 20-tetranor prostaglandin E2 methylsulfonylamide, for menstrual induction. The study was conducted in an outpatient clinic in 240 patients with a delay in menstruation of 6-14 days. In 206 patients (86%) the immunologic pregnancy test was positive before prostaglandin administration. Most of the remaining 34 (14%) patients with a negative pregnancy test had symptoms suggestive of pregnancy. Whenever there was doubt that amenorrhea was due to reasons other than pregnancy, the patients were not treated with prostaglandins. The patients' age range was 16-32 years; the parity range was 0-6. The treatment was successful in 228 patients (95%), i.e., there was uterine bleeding after prostaglandin administration followed by a negative pregnancy test within 14 days. In 6 patients with failed treatment, there was uterine bleeding after prostaglandin administration lasting for 2-13 days but the pregnancy remained positive. Prostaglandin failed to induce bleeding in 4 patients. In 3 of the patients the pregnancy test was positive before and 14 days after prostaglandin administration. The uterus was evacuated by vacuum aspiration in 9 patients. In 1 patient who had no uterine bleeding, pregnancy test was negative both before and 2 weeks after prostaglandin administration. 2 patients were admitted to the hospital the day after prostaglandin treatment for excessive bleeding. Curettage was carried out in both these patients and the bleeding stopped. 1 patient was readmitted to the hospital 8 hours after prostaglandin administration with severe pain in the lower abdominal region. On further examination a tubal pregnancy was diagnosed and confirmed by laparotomy. 2 patients were successfully treated for pelvic infection with antibiotics 7-10 days after prostaglandin administration. All patients experienced mild uterine pain a few minutes after prostaglandin administration. 16 patients required analgesics. The majority of the patients described the bleeding as heavier and longer in duration than their normal menstrual period. The average length of bleeding was 7.3 days with a range of 2-13 days. Side effects included 1 or 2 episodes of vomiting in 13 patients and headache in 9 patients.

A prospective randomized study is presented of 161 patients with cervical intraepithelial neoplasia (CIN) comparing treatment either by "cold" coagulation or cryotherapy. Following colposcopy with directed biopsy confirmation of CIN, patients were randomized on the basis of their medical record numbers and received outpatient therapy. Seven patients were excluded from analysis of final cure rates. The follow-up period ranged from 3 months to 4 years, with 81% of subjects being followed for longer than 1 year. Of 154 patients assessable for cure following single or repeat treatment using the same modality, 89 had received cold coagulation and 65 cryotherapy. Final cure rates using cold coagulation were for CIN I 95.3%, CIN II 100%, and CIN III 92.6%; the overall cure rate for the three grades combined was 95.5%. In the 65 patients treated with cryotherapy, the final cure rates for CIN I, II, and III were 96.7%, 100%, and 84.2%, respectively, and overall, for the three grades combined, it was 93.8%...

Metastatic gestational trophoblastic disease poses problems in diagnosis and management and has a poorer prognosis than the non-metastatic variant. The lung is the most common site of metastases. This paper reviews 97 patients with pulmonary metastasis developing after gestational trophoblastic disease who were seen at one centre over 26 years. Most patients had an antecedent molar pregnancy but an associated choriocarcinomatous lesion in the uterus was absent in the majority. In many patients the pulmonary lesion was asymptomatic. Whilst chemotherapy was the treatment of choice, selective thoracotomy in cases with solitary lung nodules reduced the treatment time and need for aggressive multi-drug combination regimens. The overall survival rate at 2 years after diagnosis was 65%. A higher mortality was found when the antecedent pregnancy ended at term, when the time interval between the preceding pregnancy and diagnosis of pulmonary metastases was greater than 1 year, when multiple pulmonary secondaries were present or when cerebral metastases occurred. The main causes of death were cerebral haemorrhage, respiratory failure and pulmonary embolism.

Molar pregnancy should always be considered as a possible diagnosis in any pregnancy that does not conform to the normal. The practice of subjecting all pregnant women to ultrasound B-scan at their first visit in some centres is commendable, but unfortunately not possible in the areas of high incidence, owing to lack of facilities. Close, regular and meticulous follow-up with facilities for radio-immunoassay of HCG is a necessity after a mole has been treated. Early detection of lesions and individualized treatment of patients, with close monitoring of progress, are essential. Where necessary, enlightened use of drugs with adjuvant surgery and occasionally radiotherapy will give the optimum chance of recovery. To achieve complete eradication of the tumour, treatment may be required even after the HCG test appears to be negative.

Multiple primary cancers account for only 0.38% of all cases in the Singapore Cancer Registry. The close temporal association of nasopharyngeal carcinoma (NPC) in three Chinese women with uterine cervical adenocarcinoma was observed in our department within a 3-month period; one other case was extracted from the local literature. Although NPC is a common neoplasm in local Chinese women, uterine cervical adenocarcinomas comprise only 8% of cervical cancers locally. The close occurrence of these cancers does not seem to be related to the therapy used for cervical cancer and suggests that an association of the Epstein-Barr virus (EBV) with uterine cervical adenocarcinoma should be further investigated.

Molar pregnancy should always be considered as a possible diagnosis in any pregnancy that does not conform to the normal. The practice of subjecting all pregnant women to ultrasound B-scan at their first visit in some centres is commendable, but unfortunately not possible in the areas of high incidence, owing to lack of facilities. Close, regular and meticulous follow-up with facilities for radio-immunoassay of HCG is a necessity after a mole has been treated. Early detection of lesions and individualized treatment of patients, with close monitoring of progress, are essential. Where necessary, enlightened use of drugs with adjuvant surgery and occasionally radiotherapy will give the optimum chance of recovery. To achieve complete eradication of the tumour, treatment may be required even after the HCG test appears to be negative.

The term gestational trophoblastic disease encompasses a wide spectrum of disorders ranging from the benign hydatidiform mole to the malignant choriocarcinoma and placental site trophoblastic tumor. Recent advances in cytogenetics and pathological criteria have brought to light the occurrence of the partial mole, which is probably more common than the complete mole. The World Health Organisation has proposed a classification to rectify the current confusion that exists with clinical and pathological terms. Evacuation of the uterus followed by meticulous followup with sensitive beta subunit Human Chorionic Gonadotropin assay remain the cornerstone of management of molar pregnancy. Prompt chemotherapy is the most important aspect in managing malignant sequelae. Newer chemotherapy regimes have helped to salvage failures from the usual drugs. Judicial use of surgery in metastatic trophoblastic disease can reduce the duration and toxicity of chemotherapy. All patients with gestational trophoblastic disease should be managed in a tertiary care centre with the expertise and facilities easily available to manage these cases.

Pelvic lymphocysts occur infrequently after radical surgery for cervical cancer. The problem is one of recognition. In a retrospective analysis of patients seen over 10 years in this department, the incidence was 25.3%. All were diagnosed by bimanual, clinical examination only. The only factor that appears to relate to the formation of lymphocysts is the presence of poorly differentiated tumors; 70.8% of patients developing lymphocysts had poorly differentiated tumors. All the lymphocysts in this series resolved spontaneously and did not produce any major complications.

Prostaglandin E2 administered orally and combined with amniotomy was used for induction of labour at or near term in 1533 patients. The study was carried out as a collaborative project between the University Departments of Obstetrics and Gynaecology in Singapore, Medan (Indonesia) and Kuala Lumpur (Malaysia). The overall success rates for Medan, Kuala Lumpur and Singapore were 95.6%, 88.1% and 84.7% respectively.

Metastatic choriocarcinoma can present in bizarre fashions. Two cases with primary neurological presentations are reviewed. Cerebral metastases in choriocarcinoma generally denote a poor prognosis. However, in solitary metastases in the brain, craniotomy and excision followed by chemotherapy may be curative as illustrated by the following two cases. The first patient was diagnosed to have brain metastases 112 years after an evacuation of her molar pregnancy while the other patient developed cerebral choriocarcinoma 5 months following a spontaneous first trimester abortion. Both presented with neurological symptoms. Both patients are alive and well now, 9 and 5 years respectively after craniotomy and chemotherapy. A brief review of current considerations in the management of cerebral metastases in gestational trophoblastic disease is presented.

Ogilvie's syndrome of colonic pseudo-obstruction has been reported in a wide variety of systemic disorders including blunt and surgical trauma but apparently not as a complication of radical hysterectomy with pelvic and paraaortic lymphadenectomy. Its occurrence following extensive paraaortic dissection in this case but no report so far of its occurrence after routine radical hysterectomy supports the most commonly proposed etiology of disturbed splanchnic nerve supply to the colon as a cause. Colonic pseudo-obstruction following radical hysterectomy with pelvic and paraaortic lymphadenectomy is reported and the etiology, diagnosis, and management are discussed to highlight the condition so that possible associated morbidity/mortality may be avoided.

What was once an almost uniformly fatal disease has now become highly curable, with survival rates of 100% being reported for the early stages of the disease. This is the direct result of improved techniques of diagnosis, recognition of high risk groups, effective and intensive chemotherapy, adjunctive surgery in selected cases and most important of all, a close follow-up of all patients with monitoring of the tumour marker, human chorionic gonadotrophin (hCG). This review will highlight the advances made in these areas and how these have helped in reducing morbidity and mortality from gestational trophoblastic disease (GTD).