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There is significant morbidity associated with inguinofemoral lymphadenectomy in the surgical treatment of vulval cancer, but surgical removal of all involved lymph nodes is integral to the treatment of the disease. In order to examine the feasibility of limiting the surgical dissection of the groin without compromising the removal of all lymph nodes, a study was undertaken to determine the exact location of the inguinal lymph nodes. Bilateral lower limb lymphangiograms from 73 patients were analyzed to determine the location of the most laterally occurring lymph node relative to the anterior superior iliac spine (ASIS) and the most medial node relative to the pubic tubercle (PT). By conserving the lateral 15% of fibro-fatty tissue overlying the right inguinal ligament and the lateral 20% over the left inguinal ligament, there is statistically a greater than 99.8% chance of complete nodal clearance. The anatomical basis for a more conservative inguinofemoral dissection is provided that may decrease surgical morbidity without compromising survival.

The estrogen sulfotransferase activity of high-speed supernatants of mouse placenta and uterus behaves on conventional and high-performance liquid chromatographic gel filtration as an enzyme species with a molecular weight of the order of 30 000. This is so whether the cytosols are freshly prepared or have been stored at -20 degrees C before chromatography. The presence of thiol groups or EDTA has no effect on the elution pattern. The partially purified enzyme is extremely unstable and is poorly recovered by (NH4)2SO4 fractionation. Some stabilization can be achieved in the presence of 0.1 microM estradiol. Chromatofocusing of cytosols results in the elution of one or two sulfotransferase peaks, depending upon experimental conditions such as the presence or absence of thiol groups. These peaks act upon both estrone and estradiol as substrates. Chromatofocusing by fast protein liquid chromatography (FPLC) in the absence of thiol groups results in the elution of one sulfotransferase peak whose activity can be detected only when thiol groups are present during enzyme assay.