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Biomedical subjects

D C Figge

Publications and source records attributed to D C Figge.

At least 37 records · Page 2Linked to original sources
PubMed1989

Fetal and maternal considerations in the management of stage I-B cervical cancer during pregnancy.

The timing of treatment for stage I-B cervical carcinoma diagnosed during pregnancy is complicated by conflicting concerns for fetal survival and control of malignancy. There were 11 pregnant women with stage I-B cervical carcinoma diagnosed prior to fetal viability since 1969. Six patients were managed with termination of pregnancy and radical hysterectomy with pelvic lymphadenectomy. In 5 patients, treatment was delayed for 6 to 17 weeks and then delivery was accomplished by cesarean section followed directly by radical hysterectomy and pelvic lymphadenectomy. Two of the infants experienced complicated neonatal courses and would have benefited from additional delay. Benefits that could be achieved by delaying delivery for the fetus were calculated from a review of 600 inborn infants without congenital anomalies admitted to the neonatal intensive care (NICU) during 1984 and 1985. Neonatal mortality decreased from 32.8% at 26-27 weeks to 2.7% at 34-35 weeks gestation. Similar improvements in neonatal morbidity were demonstrated. Although adverse maternal outcomes were not associated with delay, an evaluation of risk cannot be derived from this series. Significant fetal benefit can accrue from relatively short delays in planned delivery dates. When stage I-B cervical carcinoma is diagnosed during pregnancy and when fetal survival is desired, delivery should be delayed to achieve fetal maturity, rather than only potential viability.

Adult↗
PubMed1989

The morbidity and benefits of concurrent gracilis myocutaneous graft with pelvic exenteration.

This study was undertaken to evaluate the morbidity and potential benefits of concurrent gracilis myocutaneous graft with exenteration. All patients undergoing exenteration from 1962-1986 were reviewed, of whom 24 had concurrent grafts. The mean operative time, blood loss, and hospital stay were not different in patients with versus without grafts. The rate of fistula formation in the hospital was less in the graft group (P = .004) but was not different when compared with contemporary patients only. The total infection rate (wound and pelvic) was decreased in the graft group (P = .04) when graft infections were excluded. The major problem with the graft was significant necrosis of the flap(s) in nine of the 24 patients. There were no life-threatening complications attributed to concurrent placement of gracilis myocutaneous flaps. Experience with the technique is improving the cosmetic and functional outcome of the neovagina formed with the graft. Patients most likely to benefit from this procedure include those requiring immediate reconstruction or those with potentially poor healing due to high-dose pelvic radiation, including intraoperative radiation.

Female↗
PubMed1988

Whole abdomen radiation for minimal residual epithelial ovarian carcinoma after surgical resection and maximal first-line chemotherapy.

Ten patients with Stage III epithelial ovarian received whole abdomen radiation therapy after extensive courses of chemotherapy and second or third laparotomies. All patients had less than 2-mm diameter residual disease. The major side effect was bone marrow suppression which led to decreased dose or field size in four patients. Five patients have recurred and three of these have died. Further treatment after recurrence was compromised by bone marrow suppression. While 40-50% of selected patients may respond to this approach, numerous alternatives are being explored that would not handicap further treatment to the same degree and may have equal response rates.

Abdomen↗
PubMed1988

Glassy cell carcinoma of the cervix redefined.

Glassy cell carcinoma of the cervix has been classically regarded as a poorly differentiated adenosquamous carcinoma, infrequently diagnosed and associated with a poor outcome regardless of the modality of therapy. The histologic characteristics associated with this lesion are also frequently encountered among undifferentiated large-cell, nonkeratinizing cervical carcinomas. In a review of all undifferentiated large-cell carcinomas of the cervix encountered at the University Hospital in Seattle, Washington, over an eight-year period, 29 cases appeared to display the characteristic histologic criteria described as typical for glassy cell carcinoma. All cases were stage Ib lesions, and 28 were treated by radical hysterectomy. The mean age was ten years younger than that of the usual patient treated at this institution with stage I carcinoma. Fourteen of these patients (45%) have developed recurrent carcinoma, and in all but one, the interval to recurrence was less than eight months. Only two have survived after second-line salvage therapy. The current survival rate among the 29 women is 55%. These observations suggest that the poor prognosis ascribed to the classically defined glassy cell carcinoma also holds true for this extended group of large-cell, undifferentiated cervical cancers that display similar histologic features and pursue a similarly aggressive clinical course.

Adenocarcinoma↗
PubMed1987

Adjunctive hysterectomy following radiation therapy for bulky carcinoma of the uterine cervix: prognostic implications of tumor persistence.

Twenty-five patients underwent adjunctive extrafascial hysterectomy 14-60 days following completion of external and intracavitary irradiation for bulky carcinoma of the uterine cervix. Review of the operative histopathology and correlation with subsequent patient outcomes suggests that morphologically persistent cancer is prognostically ominous and that cancer near the surgical margin is viable in the majority of instances.

Adenocarcinoma↗
PubMed1987

Radical reirradiation for recurrent or second primary carcinoma of the female reproductive tract.

Twenty-five women have been treated with a second course of irradiation for recurrent cancer or a second primary carcinoma arising within a previously irradiated pelvic volume. Fourteen patients have been rendered cancer-free (56%) with follow-up ranging from 10 to 61 months. Three of these patients have died of intercurrent disease. Seven of these patients have experienced major complications (50%), necessitating surgical intervention in three cases. The rationale for reirradiation and techniques of retreatment are discussed. Prognostic factors are analyzed and criteria for patient selection are identified.

Adult↗
PubMed1987

High dose para-aortic lymph node irradiation for gynecologic cancer: technique, toxicity, and results.

A technique for high dose (5600-6100 cGy) extended field irradiation to the para-aortic lymph nodes is described. Fourteen patients have been treated with this technique, of whom 10 have had histologic confirmation of para-aortic node metastases. With follow-up ranging from 11 to 78 months, 7 of 14 patients are alive and clinically cancer-free. Acute effects of extended field treatment on patient weight and circulating blood counts are analyzed, and late treatment morbidity assessed. The findings suggest that such treatment, executed with modern equipment and appropriate technique, is not significantly more hazardous than pelvic irradiation, and can result in a substantial probability of disease-free survival.

Adult↗
PubMed1987

Malignant melanoma of the vulva: a case report of distal recurrence in a patient with a superficially invasive primary lesion.

Malignant melanoma of the vulva is a rare but highly lethal disease traditionally treated by radical surgery. Recently, data has been presented suggesting that less aggressive surgical management for superficially invasive lesions results in low levels of local recurrence and metastatic disease. We present a patient with a Clark level II superficial spreading melanoma of the vulva that developed distal recurrence after wide local excision.

Adult↗
PubMed1985

Lymphatic spread in carcinoma of the vulva.

A study of 153 patients with squamous cell carcinoma of the vulva is reviewed. Regional node metastases were present in 20%, and lymphatic spread proved the single most significant prognostic factor in this disease. Recurrent carcinoma developed in 47% of cases with nodal metastases. Lymph node metastases were directly related to stage of disease, tumor differentiation, lesion size, and depth of invasion. Sixty percent of nodal disease was not suspected by clinical examination. No patient developing recurrent disease after identification of positive nodes survived the disease. Surgical staging based only upon size of lesion and presence of nodal metastases appears to offer a clearer prognostic profile than conventional clinical staging. The pattern and frequency of nodal spread suggest that in selected instances modifications of the standard surgical treatment of vulvar cancer may be appropriate.

Adult↗
PubMed1984

Adjuvant postoperative pelvic radiation for carcinoma of the uterine cervix: pattern of cancer recurrence in patients undergoing elective radiation following radical hysterectomy and pelvic lymphadenectomy.

Thirty-seven patients with invasive cervical cancer have been referred to the Department of Radiation Oncology at the University of Washington following radical hysterectomy and pelvic lymphadenectomy. Patients at high-risk for tumor recurrence were selected for adjuvant pelvic irradiation because of adverse risk factors identified on pathological study of the hysterectomy specimen. All patients were treated because of possible residual, microscopic carcinoma. Fourteen patients (38%) developed recurrent cancer, of whom 10 (27%) manifested initial failure within the irradiated volume. Possible explanations for this observation are discussed.

Brachytherapy↗
PubMed1984

Osteomyelitis pubis after radical gynecologic operations.

The clinical and microbiologic features of five cases of osteomyelitis of the pubis after radical gynecologic and exenterative pelvic surgery are reported. Pain and tenderness over the pubic symphysis and difficulty with ambulation were common features. The interval between surgery and diagnosis ranged from eight to 17 weeks (average, 13.6 weeks). Erythrocyte sedimentation rate and alkaline phosphatase level were often abnormal, and x-rays, bone scan, and gallium scan were useful diagnostic tests. Osteomyelitis of the pubis contributed to an increased hospital stay of 5.6 weeks (mean) for patients undergoing radical vulvectomy and ten to 24 weeks for patients undergoing total pelvic exenteration. Intravenous antibiotic therapy followed by long-term oral administration may provide effective therapy, but the presence of necrotic bone requires surgical excision of necrotic and infected tissue.

Adult↗
PubMed1983

Treatment variables in the management of endometrial cancer.

A review was made of 240 women with endometrial carcinoma who were treated at the University Hospital in Seattle, Washington, between 1961 and 1979. The most common predisposing factor was a history of exogenous hormones, elicited in 46.7%. As predicted, such patients exhibited a more favorable outcome. Twelve percent of patients developed recurrent disease, and the vagina was the most common site of recurrence. However, 85% of patients with vaginal recurrence had received preoperative radiation therapy. Nodal sampling was a phase of the primary surgical treatment of the disease in 41 of the 240 patients. An effort to focus on this issue was made by including in a separate review 26 additional patients similarly managed in 1980 and 1981, thereby raising to 67 the total number of patients with nodal sampling. Fifty-nine of these patients had Stage I endometrial cancer. In these patients, histologic grade of tumor and depth of invasion determined at the time of operation appear to serve as reasonable predictors of nodal involvement.

Adult↗
PubMed1983

Dermatofibrosarcoma protuberans of the vulva.

An unusual case of vulvar sarcoma, histologically identified as dermatofibrosarcoma protuberans, is presented together with a summary of current information regarding this lesion.

Female↗
PubMed1983

Cryotherapy in the treatment of cervical intraepithelial neoplasia.

More than ten years of experience has now accumulated relating to the treatment of cervical intraepithelial neoplasia (CIN) by cryocautery. Cryotherapy has been established as an acceptable and effective therapeutic approach to CIN. Careful safeguards must be defined and respected to avoid the failure of diagnosing invasive carcinoma at the outset and to detect and manage persistent disease during follow-up. A treatment failure rate must be anticipated, but this failure rate does not appear excessive and is indeed comparable to that realized with other conservative forms of therapy. Presently, there appears to be no valid reason for proscribing or limiting the use of cryocautery in the treatment of CIN.

Cryosurgery↗
PubMed1982

Stage I vulvar cancer: criteria for microinvasion.

Thirty-eight women with stage I epidermoid carcinoma of the vulva were studied retrospectively in an attempt to define the criteria for conservative therapy in early invasive vulvar cancer. Among the 38 women, 23 met the 6 criteria established for early invasive carcinoma of the vulva. In those 23 women, there were no nodal metastases. Depth of stromal invasion correlated strongly with the degree of tumor differentiation and the presence of carcinoma in situ (CIS). Stromal invasion less than 3 mm and presence of CIS were predictive of no involvement of the lymph nodes or endothelial-like space.

Aged↗
PubMed1981

Adenocarcinoma of the uterine tube: potential for lymph node metastases.

A clinicopathologic study of 15 cases of primary adenocarcinoma of the uterine tube occurring over a 12-year period is presented. The mean age of the patients was 54.8 years. Predominant symptoms were abnormal bleeding, abnormal vaginal discharge, and pelvic pain. Abnormal vaginal cytology was noted in two instances (13%). A pelvis mass was detected in two thirds of patients. The neoplasm was bilateral in three instances (20%). Lymph nodes were involved in eight cases (53%), and metastatic spread to the para-aortic nodes was present in five (33%). The most common primary treatment was total abdominal hysterectomy and bilateral salpingo-oophorectomy. Various combinations of adjuvant radiation therapy and chemotherapy were also employed. Six patients (40%) are alive without evidence of recurrent cancer. It is concluded that lymphatic spread, especially to the para-aortic nodes, is a major pattern of disseminaton for adenocarcinoma of the uterine tube. The presence of tumor in capillary-like spaces bears a strong relationship to lymph node metastases, and the para-aortic nodes are a frequent site of involvement even when the disease is apparently limited to the tube.

Adenocarcinoma↗