摘要:

Thirty patients found to have residual epithelial ovarian cancer at second-look laparotomy were treated with whole abdominal radiation as salvage therapy. Dosage fractions were 120 rad per day until 3000 rad were delivered, then the pelvis was boosted to 5000 rad at 180 rad per day. Fourteen patients (47%) completed therapy without interruption and seven (23%) completed therapy with interruptions due to myelosuppression ranging from one to four weeks. Therapy was not completed in nine patients (30%). Four of 16 patients (25%) with microscopic residual disease before radiation remain alive and free of disease at 22 to 41 months. Two of six (33%) patients with minimal (≤ 5 mm) residual disease remain alive and free of disease 19 to 40 months after radiation treatment. Patients with residual nodules greater than 5 mm uniformly did poorly. Patients who progressed on primary chemotherapy had a median survival of seven months, compared with more than 38 months for chemotherapy responders. Chronic bowel morbidity was a significant problem, with 30% of patients surviving at least four months from completion of radiation requiring laparotomy for small bowel obstruction. These preliminary results suggest that whole abdominal radiation may be useful in the management of patients who have responded to primary chemotherapy, but the benefit is confined to those patients who have minimal or microscopic disease at second-look laparotomy.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Fine-needle aspiration for suspicious extrapelvic lesions is documented in 82 specimens from patients with known pelvic malignancy. Specimens were obtained from lung (39%), supraclavicular lymph nodes (24%), paraaortic lymph nodes (11%), liver (7%), and other sites. Three of 32 (9.4%) patients with transthoracic aspirates experienced pneumothoraces requiring chest tube placement, and three others had smaller pneumothoraces that resolved spontaneously. Fifty-nine (72%) specimens were positive for malignancy. There were no known false positives. Of six negative aspirates that had follow-up histology, there were two false negatives. When the subsequent course was used as an indication of accuracy, specificity was 100%, and sensitivity was 91%. Fifty-eight (71%) patients had therapeutic alterations as a direct result of aspiration diagnosis. Thirty-nine major operative procedures and 28 open biopsies were spared. Fine-needle aspiration is a reliable and cost-effective diagnostic method that should become an increasingly routine component of the diagnostic armamentarium and may have broader roles defined through continuing study.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The diagnostic value of computed tomography for detecting metastatic tumor in common iliac and/or paraaortic lymph nodes among 44 patients with cervical carcinoma was analyzed. Pathologic confirmation of nodal status was obtained in 33 patients with primary disease and 11 patients with recurrent disease, either by staging laparotomy (82%) or fine needle aspiration (18%). Nodal metastases were detected in 12 patients. Fine needle aspiration of nodes 1.5 cm or greater in size detected 67% of metastatic nodes. The sensitivity of computed tomography for detection of metastatic nodes was 75%, specificity 91%, negative predictive value 91%, and positive predictive value 75%. There appears to be a role for computed tomography and fine needle aspiration of enlarged nodes in patients with advanced or recurrent cervical carcinoma.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The relationship between involvement of the cervical cone margins by cervical intraepithelial neoplasia (CIN) and the presence or absence of CIN as determined by subsequent hysterectomy or cytology follow-up was studied in 522 cervical cones. Hysterectomy was performed in 161 patients, 54% of which were done within six weeks after conization. The remaining patients were followed up with cytology. In 136 women, cone margins were involved by CIN. Twelve of these patients were lost to follow-up. Forty of the 73 (54.8%) patients who underwent hysterectomy had CIN in the uterus. One of 51 (1.9%) patients followed up with cytology developed cytologic evidence of CIN. In 60% of the patients with CIN III and involved margins, in whom hysterectomy was delayed for more than six weeks, there was at least one interval of cytology positive for CIN. All these patients had CIN at the time of hysterectomy. In contrast, CIN was not present in patients with negative follow-up cytology. None of the 107 patients with CIN III and free margins had CIN at hysterectomy or during follow-up. However, of the 249 women with CIN I to II and free margins, six had CIN at hysterectomy. In none of the cases was the residual disease worse than CIN. Although it is impossible to predict the presence or absence of residual CIN based on the appearance of the cone margins, it is important to report the status of the margins. Free margins indicate removal of the CIN in a majority of cases, or reassures that invasive cancer is not present. When CIN is present at the margins the possibility of more advanced disease in the uterus cannot be excluded.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Seventy-three patients with adenocarcinoma of the cervix were seen between 1969 and 1983. This represented 8.1% of all carcinoma of cervix seen during that period. Survival rates in stage Ib were significantly worse for those with poorly differentiated lesions and for those with involved pelvic lymph nodes. Age at presentation appeared to decline over the period of the study. When the patients with stage Ib lesions were compared with a group of stage Ib squamous carcinomas treated in the same unit, there was no difference in age at presentation, node metastasis rates, or survival. Four patients had cervical intraepithelial neoplasia (CIN) in addition to adenocarcinoma.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Twelve of 304 patients (4%) treated with surgery and adjuvant irradiation for endometrial carcinoma experienced a serious complication. The complication rate for patients whose irradiation consisted of an implant alone was only 1% (two of 199), if the implant was preoperative, but was 12% (three of 26) if the implant was postoperative. For patients who received external pelvic irradiation as part of their adjuvant therapy, the incidence of complications was 8.8% (seven of 79) and the timing (preoperative versus postoperative) had no effect. There was, however, a significant correlation of the complication rate with an increasing dose of external irradiation to the whole pelvis: For doses of 3000 rad or less, it was 2% (five of 264) but was 18% (seven of 40) for doses in excess of 3000 rad. These data suggest that the safest form of adjuvant irradiation for adenocarcinoma of the endometrium is a preoperative implant, and that adding external pelvic irradiation to the preoperative implant will significantly increase the complication rate if the external dose to the central pelvis exceeds 3000 rad.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Excised tubal segments from 42 women with uterotubal junction obstruction were studied histologically to evaluate the pathologic spectrum of disease and correlate this with clinical data. The most frequent lesion encountered was obliterative fibrosis (38.1%), confirmed by connective tissue stains, which was not associated with cornual nodularity. Other pathologic entities included salpingitis isthtmica nodosa (23.8%), intramucosal endometriosis (14.3%), and chronic tubal inflammation (21.4%). Intramucosal endometriosis was distinguishable from salpingitis isthmica nodosa by virtue of its unique stroma confirmed by connective tissue staining. Women with previous pregnancies were included in all the groups. In all instances, the obstruction was present in the transmural portion of the tube and extended a variable distance into the isthmic segment. These observations on uterotubal junction obstruction demonstrate that: 1) There are multiple distinct histologic patterns, 2) Intraabdominal findings do not predict the histology of the uterotubal junction pathology, 3) Any histologic pattern can be associated with a previous intrauterine or ectopic pregnancy, and 4) The obstruction begins within the transmural portion of the oviduct, extends a variable distance into the isthmic segment, but does not obstruct the ampullary segment. These data suggest that the initiating process originates within the uterus and that fibrosis may represent a nonspecific response to chronic injury of the transmural and isthmic segments of the oviduct.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Incremental infusion cystometry and continuous infusion urethrocystometry were performed on sequential days in 52 patients with an unstable detrusor. Bladder compliance was the same in both techniques. However, continuous infusion urethrocystometry demonstrated involuntary detrusor contractions in three times as many patients as incremental infusion cystometry. It is concluded that in the supine position, medium rate continuous infusion urethrocystometry is more discriminating than rapid rate incremental infusion cystometry with a Lewis recording cystometer in the demonstration of involuntary detrusor contractions.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Alpha-tocopherol (vitamin E) has been used to treat patients with benign breast disease. To evaluate the efficacy of this treatment, a randomized, double-blind placebo-controlled study was performed on 128 women with confirmed mammary dysplasia. Patients were treated with placebo or 150, 300, or 600 IU of d, 1 α-tocopherol per day for two months; breast examinations, sonography, and thermography were performed in the midluteal phase of the menstrual cycle before and after treatment. No significant objective effects to treatment were noted in any of the parameters monitored. In addition, serum concentrations of estradiol, progesterone, dehydroepiandrosterone sulfate, and testosterone were measured before and after treatment. There were no significant effects on concentrations of these hormones. From this study, d, 1 α-tocopherol does not seem to be beneficial in the treatment of patients with mammary dysplasia.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

A prospective study was performed on 26 preeclamptic patients and 17 pregnant control subjects relating the platelet count to in vivo platelet function as assessed by the bleeding time and in vitro platelet function as assessed by collagen-stimulated thromboxane B2biosynthesis. The results of these tests were normal in all control subjects. Nine of the 26 preeclamptic patients (34%) showed thrombocytopenia, and five of these patients had a prolonged bleeding time. Four of the 16 nonthrombocytopenic patients also had a prolonged bleeding time. Eleven patients had impaired thromboxane B2biosynthesis, and seven of these had a prolonged bleeding time. In all patients, the bleeding time returned to normal, and in most the platelet count returned to normal within five days or after delivery. A significant proportion of patients with preeclampsia develop an acquired defect of platelet function that could contribute to bleeding.

ISSN:0029-7844    

出版商:OVID    

年代:1985

数据来源: OVID