Clinical significance of hysterography in the diagnosis of choriocarcinoma and invasive mole

From 1963 through 1988, a total of 194 hysterographies were performed for 111 patients. Three types of abnormalities were observed on the hysterogram: filling defect, intramural invasion of the uterine wall by the contrast medium; and intravasation of the contrast medium into the pelvic veins. The pathology and clinical significance of three types of abnormalities were studied. The results showed that hysterography demonstrated better images than pelvic arteriography and B-scan for the diagnosis of choriocarcinoma and invasive mole, especially when combined with B-scan/or pelvic arteriography, a greater accuracy was achieved.

[Ion-paired high performance liquid chromatographic determination of mitoxantrone hydrochloride injection]

Mitoxantrone (DHAQ) is a new anti-cancer agent. The ion-pair HPLC method to determine mitoxantrone hydrochloride injection was proposed. Mitoxantrone can be separated on Zorbax-ODS column with methanol-water-formic acid (450:50:1.5) containing 3.605g SDS as mobile phase. The pH of mobile phase was adjusted to 2.7. The flow rate was 1.0 ml/min and detection was at wavelength of 254 nm, providing a detection limit of 1ng (r/n, 3:1) of DHAQ. DHAQ was determined by peak area measurement with ametantrone as internal standard. The rectilinear calibration graph in the range of 1-10 micrograms of DHAQ was obtained (r = 0.999 2). The average recovery was 99.62 +/- 2.36% (n = 10), and the results were not interfered by the other ingredients in the injection.

Gestational trophoblastic disease: a case-control study from the People's Republic of China

A case-control study involving 331 patients with complete hydatidiform mole and 662 community controls matched to the cases on age and timing of pregnancy was conducted in Beijing, China. A history of a term birth was associated with reduced risk (odds ratio = 0.6, 95% confidence interval 0.4 to 0.9), with some evidence of further decrease with multiple births. Previous spontaneous abortions were not related to risk, although those with a prior induced abortion were at elevated risk, particularly if two or more abortions were involved (odds ratio = 2.8, 95% confidence interval 1.4 to 5.7). A history of having sought medical advice for infertility was associated with reduced risk (odds ratio = 0.5, 95% confidence interval 0.2 to 0.8), but those who reported use of herbal medicines during a first trimester of a previous pregnancy were at excess risk (odds ratio = 2.2, 95% confidence interval 1.3 to 3.6). In addition, a statistically significant trend in risk was observed with years of oral contraceptive use (odds ratio = 2.6, 95% confidence interval 0.9 to 6.9 for greater than or equal to 4 years of use). Dietary habits and family histories of cancer or trophoblastic disease were not related to risk in this study.

Pregnancy outcomes after successful chemotherapy for choriocarcinoma and invasive mole: long-term follow-up

In order to preserve the fertility of young patients with choriocarcinoma and invasive mole, chemotherapy alone was given without hysterectomy in 265 cases from 1959 through 1980. By the end of 1985, 205 patients had become pregnant after recovery, with a total of 355 pregnancies. Among these, 23 were terminated by induced abortions, 26 as miscarriages, two as ectopic gestations, two as intrauterine deaths, and three as stillbirths. Among 303 livebirths (including four sets of twins), six infants died neonatally, three of whom were found to have congenital anomalies incompatible with life, and two died during infancy. All the remaining 295 children had normal growth and development, the oldest now being 25 years of age. The rates of fetal wastage, malformations, twin pregnancies, and neonatal and infantile deaths did not deviate from the normal. Cytogenetic study of the peripheral lymphocytes of 94 of the children revealed no increase of chromosomal aberrations. The rates of recurrence of disease and of death caused by recurrence of disease in these were not increased in comparison with those in patients who underwent hysterectomy. These data indicate that treatment of malignant trophoblastic neoplasms with chemotherapy alone is compatible with the preservation of fertility in most women.

Hydatidiform mole in China: a preliminary survey of incidence on more than three million women

A nationwide retrospective survey to determine the incidence of hydatidiform mole has been conducted in China since 1979 by inquiring into the history of past pregnancies. Up to the end of 1983, a total of 3 089 399 women with 10 929 354 pregnancies from 26 provinces, special municipalities and autonomous regions had been investigated. The overall incidence was one mole in 1238 pregnancies (0.81 per 1000 pregnancies). The incidence was higher in five provinces of south-east China than in other parts of the country and higher among the coastal people than inlanders. Ethnic comparisons were made between the major Han and three main minority groups. The incidence was higher among the Zhuang in Guangxi and the Mongolians in Inner Mongolia than among the Han living in the same areas. However, in Ningxia, the incidence among the Hui (Muslims) was almost the same as that of the Han. There was no significant difference in the incidence of hydatidiform mole between urban and rural residents.The traditional view that hydatidiform mole occurs much more frequently among women in China and other Asian countries has to be revised. The present study shows that the incidence in China is higher than that among Caucasian women in some European countries, but it is by no means as high as previously believed.

Resection of pulmonary metastatic choriocarcinoma in 43 drug-resistant patients

A regimen of multiple intermittent intensive doses of chemotherapy (chiefly 5-fluorouracil) was used in a series of 806 women with choriocarcinoma and malignant mole. The rate of complete remission of choriocarcinoma was 78.6%, and approximately 85% of the patients survived for more than 5 years. From 1962 through 1982, pulmonary metastatic choriocarcinoma was found to be resistant to chemotherapeutic agents in 43 of these patients; they subsequently underwent lung resection. There were no postoperative deaths, and the 5-year survival was 50%. These are relatively good results for patients with long-standing and widely disseminated choriocarcinoma. Human chorionic gonadotropin titer in urine and blood and variations of lung shadows are important criteria in selecting candidates for lung resection. For preservation of lung function, simple lobectomy is the first choice. Better long-term survival was obtained in patients who had a solitary lung lesion on admission without other major organ metastases and in those in whom the lung lesion was well encapsulated and became necrotic after chemotherapy.