ISSN:1077-2847    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1077-2847    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

ObjectiveThe objectives of the report are to show the intrinsic biases that exist in fixed end-point (5-year and 10-year survival rates) when related to the TNM staging system. The biases are reduced when survival data are reported as forces of mortality. These biases yield false expectations and prednispose to tort claims.ResultsThe intrinsic biases in comparing the benefit of cancer control strategies by TNM stage specific fixed end-point (i.e., 5-year and 10-year) survival rates predisposes treating physicians to tort claims. How variable growth rates and variable biologic propensity to metastasize introduce both length bias and lead time bias is presented. Effective cancer control is documented only when the population based age specific mortality rate declines, or when the treated patients exhibit a decrease in the force of mortality associated with individual cancer co-mortality variables. Only when the force of mortality associated with invasive breast cancer is brought to parallel the expected mortality, can a statistical cure be concluded. No study has ever confirmed that a statistical cure for invasive breast cancer has been attained. Breast cancer is used as a model but the principles apply to many other forms of cancer.

ISSN:1077-2847    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

ObjectiveTo compare high uterosacral fixation to sacrospinous ligament fixation, with traditional techniques for cuff support.Study DesignUterosacral ligaments were identified and dissected in cadavers to compare relationships of the cervix, ureters, and sacrum. Patients with uterine prolapse were prospectively evaluated postoperatively for vaginal length and sexual function. High uterosacral fixation was compared to sacrospinous fixation and traditional cuff closure methods (incorporation of immediately adjacent cardinal and uterosacral ligaments into the vaginal cuff) after surgery in 31 patients.ResultsAnatomic measurements in fresh cadavers showed greater downward displacement of the vagina in sacrospinous ligament fixation than in high McCall culdoplasties. Furthermore, lateral displacement of the vagina seen with sacrospinous fixation is not seen with the high McCall culdeplasty. Finally, the length of the uterosacral ligament on the back of the cervix averaged 1 cm. At the base of the cervix, the uterosacral ligaments were only 1.4 cm from the ureter. However, when plicating sutures begin on the back of the cervix and continue serially into the pelvis, the deepest sutures placed are an average of 8.1 cm back from the vaginal cuff in the cadaver. The deepest sutures placed in the pelvis averaged 4.4 cm from the ureter on the lateral pelvic sidewall. In postoperative patients, vaginal length measured an average of 10.2 cm in 10 patients with uterosacral ligament fixation, 8.3 cm in 14 patients with sacrospinous ligament fixation, and 7.7 cm in 11 patients with traditional vaginal cuff closure techniques.ConclusionsAnatomic and clinical studies show that high uterosacral ligament fixation is as helpful as sacrospinous ligament fixation in the surgical correction of uterine prolapse and/or uterovaginal eversion.

ISSN:1077-2847    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

ObjectiveTo observe the functional and anatomic results in 50 patients undergoing abdominal sacrocolpopexy in the management of posthysterectomy vaginal vault prolapse.Study DesignIn 50 patients undergoing an abdominal sacrocolpopexy who had been followed for a median of greater than 5 years. A follow-up assessment reviewed their anatomic and functional status.ResultsIn 46 patients eligible for examination, a recurrent enterocele developed in 1 patient, and 2 patients experienced mesh-related morbidity. Durable vault support was afforted in 39 patients with 5 patients having minimal relaxation, which did not require therapy. Persistent urinary incontinence was noted in 5 patients.ConclusionSatisfactory long-term results can be obtained by the use of abdominal sacrocolpopexy in those patients in whom a vaginal procedure is less than satisfactory. Mesh-related complications are few. However, persistent urinary incontinence may be significant, albeit infrequent.

ISSN:1077-2847    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

ObjectivesThe objective of this study was to evaluate wound strength in abdominal wall closure in rats treated with glucocorticoid during the perioperative period. A second objective was to determine if timing of glucocorticoid administration alters wound strength.Study DesignIn this study, 102 male Sprague Dawley rats were randomized into four treatment groups. In the preoperative group, each rat received a daily injection of methylpred-nisolone 2 days before surgery, as well as on the day of surgery. In the postoperative group, each rat received a daily injection of methylprednisolone on the day of surgery and the first two postoperative days. In the perioperative group, each rat received a daily injection of methylprednisolone on the 2 days before surgery, on the day of surgery, and on the first two postoperative days. In the control group, each rat received a daily injection of 0.9% saline on the 2 days before surgery, on the day of surgery, and on the first two postoperative days. A midline laparotomy was performed on each animal, and the incision was repaired using a continuous mass closure. On the seventh postoperative day, wound strength was assessed by determining the abdominal pressure required to burst the incision.ResultsThe postoperative group and the perioperative group had statistically significant reductions in the mean abdominal pressure required to burst the incision, when compared to the control group. There was no difference in mean abdominal pressure required to burst the incision when the preoperative group was compared to the control group.ConclusionsWhen glucocorticoid is administered in the first few postoperative days, wound strength is reduced. Administration of glucocorticoid during the immediate preoperative period does not seem to affect wound strength.

ISSN:1077-2847    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Objectives1) To assess local practice standards for closure of ovarian defects. 2) In the rabbit model, assess adhesion formation after closure of ovarian defects by the prevalent community standard approach compared to electrocautery hemostasis, without suturing.Study Design1) Five faculty gynecology attendings and five community gynecologists were surveyed as to the preferred technique for ovarian closure. 2) Twenty-four female rabbits and 1 sham operated male rabbit were used. The left ovaries were incised and closed with a Buxton closure using 3–0 polyglycolic suture while the right ovaries were similarly incised and complete hemostasis achieved through electrocautery. The number of adhesions were determined 21–24 days after surgical intervention, and adhesion formation was scored by an observer blinded to the animal group.Results1) A Buxton type closure with polyglycolic suture was the standard of care. 2) Only one ovary in each group showed no adhesion formation. Ninety-two percent of sutured ovaries showed dense adhesions, whereas this number was 38% in the cauterized ovaries.ConclusionsBoth methods of handling ovarian incisions were associated with adhesion formation. Use of a Buxton closure and suture material was more adhesiogenic than simple hemostasis through electrocautery.

ISSN:1077-2847    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

BackgroundA retrospective study was performed of all patients undergoing attempted primary cytoreductive surgery for Stage IIIc serous cystadenocarcinoma of the ovary from 1981 through 1989.MethodsNo patients in whom Stage IIIc serous cystadenocarcinoma had been diagnosed between January 1981 and December 1989 were knowingly excluded from the study. All patients underwent analysis for histology, stage, grade, level of cytoreduction, and survival.ResultsOne hundred forty-eight patients who fit the above description were identified. Ninety patients were younger than 65 years old, and 58 patients were 65 years or older. Of the patients who were 65 years or older, 32 underwent optimal cytoreductive surgery, whereas 26 were unable to have optimal cytoreduction. The 32 patients who were 65 years or older who underwent maximal cytoreductive surgery had a mean survival of 30.9 months, whereas the 26 patients who were unable to have optimal cytoreduction of their tumor had a mean survival of 12.5 months (P = 0.005). Regardless of age, patients who underwent optimal cytoreduction (mean survival, 36.0 months) survived longer than patients who were unable to have optimal cytoreduction of their tumor (mean survival, 21.5 months; P = 0.024). Although there was no difference in the survival of patients who were able to have optimal cytoreduction of their tumor regarding age, patients who were 65 years or older and unable to have optimal cytoreduction (mean, 12.5 months) survived a significantly shorter time than their younger counterparts (mean, 29.6 months; P = 0.047)ConclusionsIn our study population, optimal cytoreduction of tumor bulk was important both in patients who were younger than 65 years old, and patients who were 65 years or older with Stage IIIc serous cystadenocarcinoma of the ovary.

ISSN:1077-2847    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1077-2847    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1077-2847    

出版商:OVID    

年代:1995

数据来源: OVID