We report our experience using intravesical 0.5% bupivacaine as a topical anesthetic along with intravenous fentanyl and midazolam sedation to perform a variety of transurethral procedures in 78 patients. We achieved adequate pain control in all patients and observed no anesthetic complications. Use of this combination of intravesical topical anesthesia and intravenous sedation provided safe, adequate anesthesia to our patients undergoing various transurethral procedures in an outpatient clinic setting.

From the Department of Kadiology, University Hospitats K.U. Leuven, Herestraat 49, B-3000 Leuven, Belgium.

A 19-year-old woman was born with a cloacal malformation and a common urogenital sinus. We describe a method of urethral and vaginal reconstruction to correct these anomalous problems. A neourethra was constructed from tubularized anterior vaginal epithelium. A perineal artery based axial flap was used to cover the neourethra plus widen the vaginal orifice.

Seven patients with superficially invasive vulvar cancer and lymph node metastases are reported. Histology of the primary tumor does not seem to correlate reliably with its metastatic potential in any individual case, though "spray," pseudoglandular, and small cell carcinomas may be particularly aggressive lesions. While wide local excision seems to be adequate treatment for the primary lesion, it is recommended that for lesions with greater than 1 mm of stromal invasion, bilateral inguinal-femoral lymphadenectomy should be performed for midline lesions, and at least ipsilateral inguinal-femoral lymphadenectomy should be performed for lateralized lesions.

The experience of the Southern California Cancer Center with carcinoma in situ of the vagina has been analyzed. Thirty-five patients were treated over 22 years. Patients with carcinoma in situ of the vagina are usually asymptomatic and most often have no visible or palpable lesions; diagnosis therefore depends upon directed biopsy in patients with abnormal routine vaginal cytology. Local radium application was the most frequent modality of treatment in this study group of patients, and excellent results were obtained. The need for cytologic evaluation after hysterectomy is emphasized. Colposcopy is a valuable aid in the diagnosis and follow-up of these patients.

Forty-five cases of Stage II endometrial cancer are analyzed with regard to histologic grade, therapy, site of recurrence, survival, and cause of death. This group represents 5 per cent of all endometrial cancer patients registered at the Southern California Cancer Center from 1954 to 1974. Thirty-two (71.2 per cent) were classified as poorly differentiated tumors. A significant analysis of survival data comparing the 26 patients treated by RT alone, and 17 patients managed by surgery and RT, could not be obtained because of the small number of patients. However, the frequency of residual tumor in the uterus and intraperitoneal recurrence in the RT only group suggests that RT plus surgery should provide a better survival than RT alone.

A retrospective analysis was made of 94 patients, 39 years of age or younger, who were treated for Stage I carcinoma of the uterine cervix from 1942 through 1972 at the Los Angeles Tumor Institute and the Southern California Cancer Center. Comparisons were made between the frequency of Stage I and other stages of carcinoma of the uterine cervix, as well as the frequency of Stage I carcinoma in young and older individuals. Survival rates for the younger group were compared to those for the same stage of disease for all ages of patients. There is discussion of the treatment modalities used in light of recommendations for future plans of therapy for these young patients. Tumor recurrences are discussed, with special reference to 43 patients who survived over 10 years. Eight of these patients were found to show new or recurrent tumors after this period of time. The importance of careful, long-term follow-up and early secondary treatment for recurrent lesions is emphasized, since subsequent radical surgery may salvage a number of these individuals.

The possible benefits of preoperative radiation therapy on patients with operable carcinoma of the uterine corpus are examined. The clinical sample studied included only patients adequately treated in essentially the same environment over a 15 year period. It included 111 patients subjected to immediate operation and 124 patients who received preoperative radiation therapy. Analysis of the patient material in the two series, according to various biologic characteristics, showed only minor variations. Investigation of the results of treatment from survival statistics showed a more favorable result in patients receiving preliminary radiation. This was most apparent when results in patients with anaplastic lesions or large uteri were compared.

A study of patients with Stage II and Stage III carcinoma of the uterine cervix treated with CO60 plus radium was carried out. The late results of treatment were compared to similar groups treated in the immediately previous years with 450 kv. x-rays plus radium. In general, the CO60 plus radium series showed superior end results as in a similar study of Stage I patients. However, the techniques of treatment varied during the years of collection of the patient material. It was considered that the improved results were mediated through improved technical application of the therapy which, in turn, were attributable to some extent to the superior physical characteristics of the external radiation phase of the combined therapy.

A study has been made of the clinical course in cases classified as Stage I (localized) carcinoma of the uterine corpus in which the primary treatment failed. The relation of these failures to measurable biologic characteristics of the tumor and the type of treatment applied was analyzed. When failures which might be attributed to undertreatment or misclassification are excluded, a small group of cases remains for detailed study. The predictability of failure and its possible avoidance in this group is discussed.