[Primary malignant neoplasms of the female genitalia]

A patient with synchronous multiple malignant neoplasms of the female genital tract, involving the ovary, the cervix and the endometrium is described. A 49-year-old patient, presenting pelvic pain and menometrorrhagia over the last six months. An abdominal and speculum examination revealed an abnormal mass occupying the entire left lower quadrant and a vegetating tumor of the cervix, respectively. Microscopic examination of the uterus and ovary revealed a cystadenocarcinoma of the ovary and an adenosquamous carcinoma of the cervix and an endometrioid carcinoma of the endometrium. The data suggests this is a multiple mullerian tumor. Due to treatment and prognostic implications, in the presence of a patient with a tumor involving different organs, we must not overlook differential diagnosis between primary and metastatic tumor.

[The quality of life after tubal ligation]

OBJECTIVE

To analyse the attitude, physical and psychological repercussions of sterilisation on Portuguese women in order to determine their quality of life.

PROJECT

Retrospective study of women submitted to sterilisation between 1988 and 1991, by means of a questionnaire mailed in June 1992.

LOCATION

Family planning clinic, S. Francisco Xavier Hospital, Lisbon.

POPULATION

Between 1988 and 1991, 540 women were sterilised at the Gynaecology/Obstetrics Department of S. Francisco Xavier, 308 of which were included in the study (women who were sterilised with a pathology which might interfere with the results and those who were sterilised during a caesarean section, post partum or post abortion were excluded). MAIN DETERMINATIONS: Descriptive and demographic data taken from the clinical files and the results of a mailed questionnaire with eleven groups of questions on their attitudes, opinions and behaviour as well as gynaecological and sexual complaints, all with regard to sterilisation.

RESULTS

106 women (34.5%) replied to the mailed questionnaire. An overwhelming majority felt satisfied (97.1%) and well informed (98%) regarding sterilisation. Sexual satisfaction and coital frequency improved or remained the same in 92.1% of the women and a slightly lower number (85.3%) stated that their sexual interest had improved or remained the same. All the women stated that the sexual interest of their partners had not diminished. The symptoms which were most frequently referred to as being worse or which had recurred were alterations in the menstrual cycle (43.1%), dysmenorrhea (16.7%) and mastodynia (16.7%).

CONCLUSION

The majority of women (3/4) presented good or very good results in terms of quality of life.

Modification of the fetal reactivity by an intravenous glucose load to the mother

The effect of an intravenous maternal glucose load upon fetal activity and FHR was studied 51 times in 48 pregnancies at 34 or more weeks, in which the fetuses were classified as non-reactive during the NST. The initiation of fetal muscular activity was observed in 44 instances (41 fetuses) approximately 6 minutes after a 6 grams glucose load to the mother, which lead to the diagnosis of a state of fetal well-being without the need of a CST. In the 7 cases which were not responsive to the load, CSTs were performed; of these, 5 were positive, 1 negative and 1 suspicious. These pregnancies resulted in one fetal death during the 12 hours following CST and 5 newborns showed an APGAR Score less than 4 at one minute, with 2 neo-natal deaths. The reason for the negative glucose load test with negative CST was probably related to hemodynamic changes induced by intra-amniotic bleeding following a bloody amniocentesis, and not to the lack of fetal energy substate. The proposed method may constitute a screening possibility for the clinical management and prognosis of the hypoactive fetus, because the glucose load to the mother may release the somatic activity of the non-hypoxemic fetus. A fetus unable to show any significant increase in glucose uptake, even with increasing maternal-fetal gradients, could be identified by the negative response to the test.