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Biomedical subjects

B U Sevin

Publications and source records attributed to B U Sevin.

At least 109 records · Page 6Linked to original sources
PubMed1989

Intraoperative staging in ovarian cancer.

In patients with early Stage I or II ovarian cancer a meticulous staging laparotomy is required; this should include omentectomy, pelvic and paraaortic lymphadenectomy, multiple peritoneal biopsies and diaphragmatic biopsies. Adjunctive therapy is based on these surgical-pathological findings. In patients with advanced disease (Stages III and IV) it has been demonstrated that optimal tumour reduction enhances the length of survival. A complete resection of all gross disease in the abdominal cavity is the goal. If this goal can be achieved, a pelvic and para-aortic lymph node dissection should be included. Postoperative adjunctive therapy should be based on the surgical pathologic findings. The planning of adjunctive therapy starts in the operating room, appropriate tissue specimens should be submitted for special studies, such as for receptor status. Intravenous and intraperitoneal access catheters should be placed during surgery for appropriate postoperative treatment. In spite of all the advances in the surgical management and adjunctive treatment for ovarian cancer, improvement in long-term survival is still missing. Each patient poses a different set of circumstances. Each patient needs individualized care, and surgical staging is the first and may be the most important step towards the development of an optimal comprehensive treatment plan.

Biopsy↗
PubMed1988

Comparative effectiveness and safety of cefotetan and cefoxitin as prophylactic agents in patients undergoing abdominal or vaginal hysterectomy.

In a multicenter, randomized clinical trial, 282 women who underwent abdominal or vaginal hysterectomy were given a single preoperative 2 g dose of cefotetan (171 evaluable patients) or three perioperative 2 g doses of cefoxitin (84 evaluable patients) as antibiotic prophylaxis. A successful clinical response occurred in 92 percent of those receiving cefotetan and 90 percent of those receiving cefoxitin who underwent abdominal hysterectomy, and in 94 percent of those receiving cefotetan and 93 percent of those receiving cefoxitin who underwent vaginal hysterectomy. The incidence of vaginal cuff cellulitis was 3.4 percent and 5 percent for cefotetan and cefoxitin patients, respectively, who underwent abdominal hysterectomy, and 4.8 percent and 4.5 percent, respectively, for those who underwent vaginal hysterectomy. The incidence of major wound infection was 3.4 percent and 2.5 percent for cefotetan and cefoxitin, respectively, in the abdominal hysterectomy group. Postoperative changes in oral body temperature, duration of hospitalization, and postoperative grading of surgical wounds were similar. Both drugs were well tolerated. These results suggest that a single dose of cefotetan is equally effective and as safe as multiple-dose cefoxitin for prophylaxis in patients undergoing hysterectomy.

Adult↗
PubMed1988

Application of an ATP-bioluminescence assay in human tumor chemosensitivity testing.

Intracellular adenosine triphosphate (ATP) is the primary energy unit of living cells, and can be quantitated by measuring the light generated with luciferase-luciferin reagent in a luminometer. The use of an ATP-bioluminescence assay, to determine tumor cell viability after exposure to chemotherapeutic agents, has been adapted to test tumor chemosensitivity in vitro. This presentation will illustrate the method of the ATP-chemosensitivity assay (ATP-CSA) using an ovarian cancer cell line NIHL:OVCAR-3 as an example and present preliminary data on 54/56 successful in vitro ATP-CSA's from 46 patients with pelvic malignancies. Fresh human tumor specimens were generally tested for single and combined drug effects at two drug concentrations (0.2 X and 1 X peak plasma concentrations). Correlation of in vitro drug sensitivity and in vivo patient response was obtained for 23 treatment regimens in 22 patients with ovarian carcinoma. The true positive rate was 100% and the true negative rate 66.7%. Our data demonstrate (a) that the ATP-CSA, measuring total cell viability, is a feasible in vitro assay for human tumor drug testing and (b) that specific criteria of in vitro chemosensitivity for this assay need to be defined by further studies, for single and combined drug exposure at different concentrations, to permit a meaningful correlation with in vivo clinical response.

Adenosine Triphosphate↗
PubMed1988

Comparison of cefotetan and cefoxitin prophylaxis for abdominal and vaginal hysterectomy.

The safety and efficacy of parenteral prophylaxis with either cefotetan or cefoxitin were evaluated in a prospective, randomized study of 355 subjects undergoing abdominal or vaginal hysterectomy. Each subject received either a single 1 gm dose of cefotetan intravenously 30 to 60 minutes before operation or three 2 gm doses of cefoxitin, the first 30 to 60 minutes before operation and subsequent doses 6 and 12 hours later. Prophylaxis was successful in 69 of 70 (98.6%) receiving cefotetan and 32 of 33 (97.0%) receiving cefoxitin who underwent vaginal hysterectomy. Prophylaxis was successful in 160 of 169 (94.7%) receiving cefotetan and in 79 of 83 (95.2%) receiving cefoxitin who underwent abdominal hysterectomy. Both drugs were well tolerated and without serious side effects or complications. On the basis of these findings, we conclude that a single 1 gm dose of cefotetan given before operation is as safe and effective as a multiple-dosing regimen of cefoxitin in subjects undergoing vaginal hysterectomy and in those undergoing abdominal hysterectomy at institutions where prophylaxis is indicated.

Abdomen↗
PubMed1988

Staging laparotomy and radical hysterectomy for cancer of the cervix.

Clinical staging does not define the true extent of disease in approximately one-third of the patients with early cervical cancer. Unless clear nodular tumour extension into the parametria is palpable a patient should be considered for surgical therapy. This involves a thorough staging laparotomy, including the exploration of the pelvic retroperitoneal spaces and para-aortic node dissection. If the disease appears to be confined to the cervix a radical hysterectomy and pelvic lymphadenectomy is performed. If gross tumour invasion into the parametria, the bladder, or rectum muscularis is documented, the patient is treated with pelvic radiation. If microscopic distant metastases to the para-aortic nodes are found, extended field radiation and possible chemotherapy is the treatment of choice. Survival is determined mostly by the extent of disease at the time of treatment. Therapy has to encompass the whole region affected by disease in order to provide the patient with a chance of cure. For disease beyond the cervix, regional radiation makes more sense. Just as in the study published by Zander's group (Zander et al, 1980), we add radiation if microscopic disease beyond the cervix is found after a radical hysterectomy. However, additional radiation adds morbidity, length of therapy, and cost. Unless there is clear proof that adequate primary radiation is inferior to surgery and postoperative radiation we recommend radiation for cancer of the cervix with proven Stages IIb and above. The benefit of systemic chemotherapy as an alternative to postoperative radiation needs to be evaluated.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1987

Surgical staging of gynecologic malignancies.

The role of surgical staging in gynecologic malignancies has not been precisely defined at this time despite the conventional employment of this modality in the initial staging of ovarian neoplasms. Major discrepancies have been documented between clinical and surgical estimates of disease extent in cervical, endometrial, and vulvar carcinomas. We recently reviewed our experience with patients who were found to have positive periaortic nodes after surgical exploration for clinical Stage IB and Stage IIA cervical cancer. Postoperative extended field radiotherapy was employed with minimum complications and the 5-year actuarial survival rate was 50% with a median survival time of 29 months. In order to justify the utilization of surgical staging for gynecologic neoplasms, it is necessary to demonstrate a survival advantage in patients where the precise extent of disease has been established and subsequent therapy tailored accordingly. In addition, it must be shown that surgical staging does not increase complications or decrease the efficacy of subsequent therapeutic interventions.

Female↗
PubMed1987

In vivo cell kinetic effects of cis-platinum on human ovarian cancer xenografts measured by dual parameter flow cytometry.

Dual parameter flow cytometry, measuring DNA and nuclear protein of individual cell nuclei simultaneously, makes it possible to follow cell kinetic perturbations in six distinct compartments of the cell cycle following chemotherapy in vivo. Human ovarian cancer xenografts in nude mice from a primary and recurrent tumor of the same patient were studied. The response to intraperitoneal application of cis-platinum was assessed by tumor volume measurements, changes in labeling indices by autoradiography, and dual parameter flow cytometry. Sequential tissue samples were taken from each tumor using fine needle aspirations as a microbiopsy method. Pretherapy samples were compared to multiple specimens collected up to 18 days after therapy. Morphologic changes of each specimen were also assessed. Cis-platinum affects malignant cells in the G1B, S, G2A, and G2B compartments with various intensities and different time frames, depending on the drug sensitivity of each individual tumor.

Animals↗
PubMed1987

Gastrointestinal surgery in gynecologic oncology: evaluation of surgical techniques.

In recent years, the use of surgical staples has become popular in all subspecialties of surgery. The advantages proposed have been a decrease in operative time and morbidity. This paper reviews the University of Miami/Jackson Memorial Medical Center, Division of Gynecologic Oncology experience with the use of surgical staples in gastrointestinal surgery on patients with a diagnosis of a gynecologic malignancy. Between January 1, 1979 and July 1, 1985, a total of 152 procedures were done, 81 by stapler and 71 by suture anastomosis. Ninety-one patients had received previous radiation or chemotherapy. The average age of the patients was 52 years. The results show a decrease in operating time, blood loss, and postoperative hospital stay in those patients where the stapler anastomosis was used. The postoperative morbidity and mortality were not increased. Twenty-seven total pelvic exenterations were performed during the period of study and they were evaluated separately. The hospital stay and blood loss as well as the operative time were significantly less using staplers. This report includes a detailed evaluation of the results. From this study, we concluded that surgical staples are a safe alternative in gastrointestinal surgery in patients with a gynecologic malignancy.

Adult↗
PubMed1986

In vivo chemosensitivity testing in patients with gynecologic malignancies and nude mouse xenografts by monitoring cell kinetic parameters and DNA distribution patterns: a preliminary report.

Using flow cytometry (FCM) and autoradiography we have evaluated changes in DNA-ploidy patterns as well as cell-cycle perturbations after chemotherapy in 12 patients with accessible tumors and 22 nude mice xenografts. Gynecologic malignancies growing as nude mouse xenografts serve as an experimental model to study the effect of chemotherapy at the cellular level. Excellent correlation was found between fine needle aspiration (FNA) and biopsy material for either FCM or autoradiography. It now appears possible to study the effects of chemotherapy in the patient as well as the animal model using serial FNAs as a microsampling technique.

Adenocarcinoma↗
PubMed1986

Small bowel complications after supravesical urinary diversion in pelvic exenteration.

Between June, 1966, and June, 1984, 102 pelvic exenterations were performed at Jackson Memorial Hospital/University of Miami Medical Center and all patients had some type of supravesical urinary diversion. Of these patients, 23 were reexplored for a gastrointestinal complication and 15 of those had a small bowel complication. Small bowel fistula occurred in 15 instances and 9 patients were reexplored. The fistula associated mortality was 53.3%. All the fistulas occurred in previously radiated patients who had undergone an enteroenteroanastomosis. The recent use of enterocolostomies after the construction of an ileal conduit in 21 patients has not produced any postoperative small bowel fistula, while in 43 patients who underwent enteroenterostomies, 13 fistulas occurred (P less than 0.01). Patients who did not undergo pelvic floor closure had a higher incidence of fistula and small bowel obstruction, while there were no fistulas in patients with previous enterocolostomies, regardless of the pelvic closure.

Colon, Sigmoid↗
PubMed1986

Ovarian adenocarcinoma complicated by malignant pericarditis.

Neoplastic pericarditis is a rare complication of gynecologic malignancies. However, as illustrated in the case presented, the physician involved in the care of patients with cancer should be aware of this possible life-threatening complication. The case report is followed by a brief review of the pertinent clinical, pathophysiologic, and therapeutic aspects of this condition.

Adenocarcinoma↗
PubMed1986

Major surgical procedures for gynecologic malignancy in elderly women.

We review 89 patients more than 75 years old who had major operations for various gynecologic malignancies. The recent routine use of perioperative intensive care decreased hospital mortality from 8.9% to 3.2%, and helped in decreasing and anticipating intraoperative and postoperative cardiorespiratory complications. Availability of visiting nurses since 1980 decreased the mean hospital stay from 30.2 to 24.4 days in patients who had radical vulvectomy. There were no deaths among 11 patients who subsequently had surgical reexploration for recurrent or new disease. Fifty-two of the 89 patients survived more than three years with no limitations resulting from the operations. When indicated, major surgical procedures for gynecologic malignancy in elderly women can be done safely, especially when the patient is evaluated and managed in a well staffed surgical intensive care unit.

Aged↗
PubMed1986

Neoplastic pericarditis and gynecologic malignancies--a review of the literature.

Neoplastic involvement of the heart/pericardium is not a common complication of gynecologic malignancies. However, as its occurrence can represent a substantial risk for the patient, it is important for the clinician to understand the pathophysiology, diagnosis, and treatment of this complication. An attempt, therefore, is made to review the pertinent clinical aspects of this condition with emphasis on the treatment options available.

Antineoplastic Agents↗
PubMed1986

[Vulvar cancer].

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Combined Modality Therapy↗