Preservation Of Ovarian Function Research Articles

Preserving ovarian function in the treatment of epithelial and special (other) malignant ovarian tumors

About 90% of malignant tumors of the ovary in Scandinavia develop from the germinal epithelium. There are great differences in the incidence rates between countries in the Western world and in Africa and Asia. The WHO classification of ovarian malignancies is generally used. The epithelial tumors comprise the serous, mucinous, endometrioid, clear cell, undifferentiated and mixed true carcinomas. In addition, borderline lesions of especially the serous and mucinous types are of interest when the question of preservation of ovarian function comes into notice. Conservative surgery, which means removal of only the afflicted ovary should be restricted to young women of the childbearing age who want to preserve the possibility of becoming pregnant. However, certain prerequisites must be fulfilled. The tumor must be located to one ovary only (Stage Ia) and must be either a borderline lesion or a Grade 1 true carcinoma of either the serous, mucinous or endometrioid type. There must be no ascites and peritoneal washings must be negative for cancer cells. Germ cell tumors are usually found in young women. Only the dysgerminomas are regularly bilateral in 10-15% of the cases. All other germ cell tumors are rarely bilateral. But both in borderline lesions, Grade 1 true carcinomas, and in germ cell tumors, a biopsy of the normal looking contralateral ovary should always be performed. Endodermal sinus tumors and immature teratomas may well be treated conservatively by surgery, but modern triple chemotherapy (VAC, PVB) must be added. Granulosa theca cell tumors are bilateral in only about 5% of the cases.(ABSTRACT TRUNCATED AT 250 WORDS)

The preservation of ovarian function in young women undergoing pelvic radiation therapy

Because cervical carcinoma rarely metastasizes to the ovaries, it became logical to preserve ovarian function by the method of lateral ovarian transposition as part of the management of young women with this disease. This technique prevents castration should subsequent radiation therapy be planned or become necessary. Forty patients with carcinoma of the cervix or vagina underwent unilateral or bilateral ovarian transposition. Eighteen patients received radiation therapy. Of these, 16 had gonadotropin measurements and only 6 (37%) had levels elevated to the postmenopausal range. If patients whose ovaries were not shielded or who received paraaortic radiotherapy are excluded, then only two (17%) had elevated gonadotropin values. It is concluded that, if properly performed, lateral ovarian transposition and ovarian shielding will protect ovarian function in patients receiving pelvic radiotherapy.

ENDOMETRIOSIS I. CONSERVATIVE OPERATIONS

Significant endometriosis was found in 17.1 per cent of 1,565 patients who had abdominal gynecologic operations. Seventy-seven patients had resection of endometriosis with preservation of reproductive function; 70 were married; and 42 (60 per cent) conceived. Twenty-two of these couples had other infertility problems or were using contraception. Among 48 married patients with endometriosis, with fertile husbands, who did not use contraception, 42 (87.5 per cent) conceived and were delivered of 68 term babies after resection of endometriosis. Only 6 of this group did not conceive. Among 129 somewhat older patients who had hysterectomies and resection of endometriosis with preservation of ovarian hormonal function, only 6 required exogenous hormones within 5 years after the operation; 4 others, within the first 10 years postoperatively.

Endometriosis: I. Conservative operations

Significant endometriosis was found in 17.1 per cent of 1,565 patients who had abdominal gynecologic operations. Seventy-seven patients had resection of endometriosis with preservation of reproductive function; 70 were married; and 42 (60 per cent) conceived. Twenty-two of these couples had other infertility problems or were using contraception. Among 48 married patients with endometriosis, with fertile husbands, who did not use contraception, 42 (87.5 per cent) conceived and were delivered of 68 term babies after resection of endometriosis. Only 6 of this group did not conceive. Among 129 somewhat older patients who had hysterectomies and resection of endometriosis with preservation of ovarian hormonal function, only 6 required exogenous hormones within 5 years after the operation; 4 others, within the first 10 years postoperatively.

Preservation of ovarian function in pelvic radiation for Hodgkin's disease.

With the advent of the use of large-dose (4,000 rads) radiotherapy to involved nodes, Hodgkin's disease has become a highly curable entity. 1 The key to cure depends on the accurate knowledge of the nodes involved. Lymphangiograms are very useful in determining subdiaphragmatic involvement, but, unfortunately, about one third of them are equivocal. Beginning three years ago, exploratory laparotomy was carried out on those equivocal cases for more accurate staging. The findings from these early cases revealed a large number of cases of unsuspected or misdiagnosed spleen and liver involvement. 2 This has led to the adoption of laparotomy with node biopsy, liver biopsy, and splenectomy in all new cases of Hodgkin's seen at the Stanford Medical Center. 3 In the past, 100% of all premenopausal women receiving pelvic irradiation for Hodgkin's disease have become amenorrheic. Since the advent of the use of exploratory laparotomy for staging in many cases

Successful pregnancy after radiation therapy for carcinoma of the cervix

Radiosensitivity of the ovary is considered, and the possibility of recovery of ovarian function following pelvic radiotherapy is evaluated with reference to previously reported cases and a new case. In the standard radiation program of combined Ra and x-ray therapy currently employed for the control of carcinoma of the cervix, thc amount of radiation delivered to the gonads makes preservation of ovarian function nearly impossible. Even after Ra therapy alone for cervical cancer, continued ovarian activity as evidenced by regular menstruation is infrequent, and successful pregnancy after Ra treatment for a malignant growth on the cervix is an extremely rare occurrence. Data are tabulated for nine previous cases in which pregnancy occurred after radiotherapy for cervical carcinoma. In the present case, a 21-yr-old women was treated with 5000 mg-hr and became pregnant twice, four and six yrs later. No external x-ray therapy was given. The patient experienced vaginal bleeding consistent with a menstrual period in each of the first two months after Ra insertion but had total amenorrhea for the next year. Rectal bleeding and diarrhea six months later because of radiation proctitis. A cervical biopsy performed three yr later showed a severe radiation reaction. Regular menses commenced four monthsmore » after this procedure. Both pregnancies terminated prematurely but in both instances an apparently normal infant was born, and no subsequent abnormalities in their growth, development, or behaviour were noted. In the reviewed group of cases, preservation of ovarian function was attributed in great measure to the increased distance of the ovaries from the Ra source because of an intrauterine gestation (five cases), recent parturition (one case), recent miscarriage (one case), and a large exophytic tumor (one case). The existence of an amenorrheic state for nine months in one earlier case and for 12 months in the present case indicates that the radiosensitive gonads were significantly affected by the action of radiation. The relative youth of these two patients may have played a role in the capacity of their ovaries to reestablish ovulation. The effect of radiation on the function of cervical dilatation in parturition was also discussed after a study of these cases. Because of radioinduced scarring of the cervix, cesarean section is usually necessary for delivery in such cases. Among the 10 children who were born of these mothers whose ovaries had received a subliminal castration dose of radiation there was no evidence of any gross congenital defect, but the follow-up on all of these children is incomplete and the possibility of a genetic defect in a future generation cannot be ruled out if children should be born to any of these individuals.« less

Surgery of endometrioma of the ileum and colon

1. 1. The subject of endometrioma of the small and large intestine associated with intestinal obstruction is reviewed. 2. 2. The clinical manifestations, the treatment and the associated pathology are presented pertinent to ten patients with involvement of the intestine by isolated endometrioma. Range in age of these ten patients was thirty-three to forty-eight years. 3. 3. A solitary endometrioma of long-standing may involve the ileum and sigmoid or rectosigmoid colon to such an extent that gastrointestinal symptoms and signs of partial or complete intestinal obstruction may appear. 4. 4. The occurrence of obstructive symptoms, accentuated preceding or during the menstrual period, should suggest endometrioma of the small or large intestine in the differential diagnosis of intestinal obstruction. 5. 5. An endometrioma of the small or large intestine may be diagnosed on an awareness of the possibility of the disease, a complete history, and a combined rectovaginal examination coupled with the findings of the proctoscopic and barium enema examinations. 6. 6. The symptomatology and the gross appearance of an endometrioma and carcinoma of the colon are so similar that it is often difficult to distinguish these lesions even at operation. Anterior resection of the colon is recommended if any doubt exists. 7. 7. The management of patients with a solitary endometrioma or multiple endometrial implants affecting the small or large intestine should be individualized. The choice of treatment depends upon the age of the patient, the evaluation of the severity of symptoms, and the extent of the involvement of the intestine and pelvic organs. 8. 8. The recommended treatment of an acute obstruction of the ileum and sigmoid or rectosigmoid colon by an endometrioma is resection with end to end anastomosis, whenever possible. A Mikulicz procedure or lateral anastomosis may be indicated in patients who are poor risks. 9. 9. When chronic or recurring symptoms of low-grade intestinal obstruction are present, segmental resection of the colon may be contemplated. Local excisions of small isolated endometriomas may be adequate treatment in certain instances. 10. 10. In the surgical management of these patients, the preservation of ovarian function is advocated whenever possible.

Preservation of ovary by means of intrauterine transplantation in radical operations for adnexal disease

The type of cases which come to the service of Cook County Hospital makes “a follow-up” exceedingly difficult for a period sufficiently long. Frequency of syphilis makes the possibility of pregnancy rather remote. Of sixteen cases of transplantation all resumed menstrual function from three weeks to three months after the operation. Slight dysmenorrhea was the only complication noted in some of the cases. Out of a group of five cases of transplantation with preservation of the pedicle, all menstruated and one became pregnant six months later, but aborted at two months. The effect of operation upon the health and the psychic states of the women was most gratifying. My experience coincides with that of Estes and Tuffier. Preservation of ovarian function in these cases is a distinct advance over the older castrating procedures.