摘要:

A retrospective review of 194 patients with stage IB cervical carcinoma treated with radical hysterectomy between January 1977 and December 1984 revealed 30 patients (15%) with pelvic node metastases. Twenty patients with pelvic node metastases received postoperative radiotherapy and ten patients did not. Five of 20 patients who received adjuvant radiotherapy had recurrence, compared with five of ten patients who did not receive radiotherapy. No pelvic recurrences occurred in the adjuvant radiotherapy group compared with two in the no radiotherapy group. Only one serious complication occurred in a patient receiving radiotherapy. Adjuvant postoperative radiotherapy may reduce pelvic recurrences and improve survival in patients with pelvic node metastases treated with radical hysterectomy and pelvic lymphadenectomy.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

We reviewed the cases of 31 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB cervical carcinoma who developed recurrent disease after radical hysterectomy and pelvic lymphadenectomy between 1961 and 1982. The overall incidence of recurrence was 11.3%. Recurrence was significantly more common in patients with adenocarcinoma or adenosquamous carcinoma (17.4%) than in those with pure squamous tumors (9.2%). The median time from operation to recurrence was eight months. The median survival of patients dying of disease was 18 months. Sites of recurrence were categorized as central pelvic in 35% of cases, pelvic sidewall in 39%, and distant in 26%. Patients treated with postoperative pelvic radiotherapy for positive pelvic nodes or surgical margin involvement were more likely to develop distant recurrence. Various therapeutic modalities were used to treat recurrent disease. Twenty-two of 23 patients with central pelvic or sidewall recurrence failed radiation therapy. None of four patients with central recurrence treated by pelvic exentera-tion survived. No patient treated with chemotherapy survived. Overall survival for patients with recurrence was 3.2%. The dismal prognosis for this group of patients warrants evaluation of alternative treatment modalities.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Hysterectomy is the most common major operative procedure in the United States. The present review of 291 women with primary ovarian cancer of the epithelial cell type from the metropolitan Washington, D.C. area reveals 41 (14%) had a prior hysterectomy. The hysterectomies were performed abdominally in 80% of women at an average age of 41 years and vaginally in 20% at an average age of 46 years. The interval between hysterectomy and discovery of ovarian cancer was ten years in the vaginal group and 18 years in the abdominal group. Women who had their ovaries retained at hysterectomy and later developed invasive ovarian cancer had approximately an 80% mortality.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

This report reviews the results of therapy in 93 patients with metastatic gestational trophoblastic tumor treated from 1965–1985. Complete remission was achieved in all 42 patients with low-risk metastatic disease and in 34 of 51 patients (67%) with high-risk metastatic disease. Singleagent chemotherapy induced complete remission in 38 of 42 patients (91%) with low-risk metastatic disease. Survival of high-risk patients has improved markedly over the past two decades; complete remission was attained in 13 of 24 highrisk patients (54%) from 1965–1975, and in 21 of 27 (78%) from 1976–1985. Survival correlated with the number of high-risk factors, the prognostic score, and the type of treatment. From 1965–1975, 54% (13 of 24) of high-risk patients were treated with single-agent chemotherapy alone, while in the last decade only 7% (two of 27) were so treated. Twenty-one patients with traditional high-risk factors had a prognostic score of 7 or less, and all achieved remission, with 67% (14 of 21) treated with primary single-agent chemotherapy. The prognostic scoring system was more effective than traditional high-risk criteria at predicting which patients require intensive combination chemotherapy to attain remission.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The role of appendectomy in the management of epithelial ovarian cancer is unknown as a staging and cytoreductive procedure. In this series, the appendix was found to have metastatic disease in 40 of 78 patients (51%) and in 40 of 57 patients (70%) with advanced disease (stage III/IV). Occult or microscopic disease was found only in two patients (5%) with grossly normal appearing appendices. The appendix as a site of metastatic ovarian cancer is common with advanced stages (stage III/IV) and rare with early disease.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Eighty-six patients with preoperative and postoperative urodynamic studies who underwent modified Burch colposuspensions were divided into two groups, one with a urethral closure pressure of 20 cm H2O or lower, and one with a pressure over 20 cm H2O. The two groups were comparable except for a difference in age (53.3 versus 46.6 years; P <.01). There were significant differences between the two groups in both preoperative and postoperative functional lengths and closure pressures (P <.01). The low-urethral-pressure group had a 54% failure rate, compared with 18% in the group with urethral closure pressures above 20 cm H2O (P <.0005). Low urethral pressure was found to be a significant independent risk factor for patients under the age of 50, but not independent of age in women over 50 years old. Patients under the age of 50 who have urethral closure pressures of 20 cm H2O or lower are at high risk of surgical failure when undergoing a modified Burch colposuspension (P <.0002). These patients should not be considered appropriate candidates for this procedure.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Sixteen women with endometriosis were treated with daily subcutaneous injections of a potent agonist of gonadotro-pin-releasing hormone (GnRH) for six months. Ovarian estrogen secretion was reduced to castrate levels during most of the course of treatment. Blinded evaluation of laparoscopic photographs confirmed marked suppression of visually apparent disease, but biopsy specimens showed occult, inactive endometriosis in most cases. Marked pain relief was noted by all patients. As a result of this “medical oophorectomy,” the women experienced severe hot flashes, and many had insomnia and emotional disturbances. Vaginal cytology showed menopausal changes but related symptoms were generally mild. Calcium excretion rose to menopausal levels. High-density lipoprotein and total cholesterol remained unchanged. These results indicate that GnRH agonist administration has impressive effects on endometriotic implants, and these actions may be enhanced with longer therapy. Further development of this new form of therapy should involve either use of lesser degrees of ovarian suppression or adjunctive therapy to counter the side effects of “medical oophorectomy.”

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Although numerous etiologies for endometriosis have been proposed, it is clear that retrograde menstruation and cellmediated lymphocytotoxicity each play a significant role in the disease's development. A comprehensive theory of pathogenesis of endometriosis holds that development of the disorder depends upon amount of retrograde menstruation and the ability of the immune response to remove the debris. To test this theory, 64 women with mullerian anomalies and intra-abdominal surgery were evaluated for the presence or absence of endometriosis, patency of tubes, hematocolpos or hematometra, and outflow obstruction. Results demonstrated that endometriosis was present in ten of 13 women with functioning endometrium, patent tubes, and outflow obstruction, whereas it could be identified in only 16 of 43 women with no obstruction (77 versus 37%, P <.01). Similarly, eight of nine women with hematocolpos or hematometra had endometriosis, while only 18 of 47 with functioning endometrium but no hematometra/hematocolpos had it (89 versus 38%, P <.01). None of the eight women without endometrium had endometriosis. These data support the concept that an increase in retrograde menstruation will increase the likelihood of endometriosis.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

This study compared peritoneal fluid volume, marcophage count, and macrophage concentration by diagnosis and cycle week of 426 patients undergoing laparoscopy. Patient diagnosis and cycle week had no significant interaction. Peritoneal fluid volume was dependent upon cycle week and diagnostic group, but macrophage count depended only upon diagnostic group. Endometriosis was associated with a significantly elevated total number of macrophages. Postovulatory peritoneal fluid volumes were significantly higher than preovulatory values. Cyclic and postovulatory differences in peritoneal fluid volume support proposed pathophysiologic roles.

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0029-7844    

出版商:OVID    

年代:1987

数据来源: OVID