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Biomedical subjects

J L Powell

Publications and source records attributed to J L Powell.

At least 37 records · Page 2Linked to original sources
PubMed1998

Uterine and ovarian conservation in advanced small cell carcinoma of the ovary.

BACKGROUND: The decision to recommend removal or conservation of a normal ovary and uterus in a young woman with advanced ovarian cancer is difficult and controversial. CASE: A 21-year-old patient with a large-cell variant of small-cell carcinoma of the ovary stage IIIc underwent optimal debulking surgery with preservation of the normal appearing uterus and opposite adnexa followed by aggressive multi-agent chemotherapy. She is menstruating normally and is free of disease, more than 2 years since completion of chemotherapy. CONCLUSION: In selected cases, conservation of the uninvolved ovary and uterus in patients with advanced-stage, small-cell carcinoma of the ovary may not compromise survival.

Adult↗
PubMed1998

Serous psammocarcinoma of the ovary.

We present the case of a 59-year-old woman with an International Federation of Gynecology and Obstetrics stage IIIB serous psammocarcinoma. Only 12 cases of this rare ovarian neoplasm have been reported previously. These tumors act like borderline tumors and, therefore, do not usually require chemotherapy or radiation therapy after appropriate surgical debulking and staging.

Cystadenocarcinoma, Serous↗
PubMed1997

Management of advanced juvenile granulosa cell tumor of the ovary.

Juvenile granulosa cell tumors (JGCTs) of the ovary are rare. They usually present in children and adolescents. About 90% are diagnosed in early stage (FIGO I) with a favorable prognosis. More advanced stages (FIGO II-IV) have a poor clinical outcome. We report two cases of short-term, disease-free survival of teenagers with Stage III JGCTs treated with aggressive debulking and thorough staging but conservative surgery relative to the uterus and contralateral tube and ovary plus carboplatin and etoposide chemotherapy. These results are encouraging, but the best treatment for extensive and recurrent disease has yet to be determined.

Adolescent↗
PubMed1997

Release of tumor necrosis factor alpha in response to Vibrio vulnificus capsular polysaccharide in in vivo and in vitro models.

Vibrio vulnificus produces a severe septic shock syndrome in susceptible individuals. Virulence of the bacterium has been closely linked to the presence of a surface-exposed acidic capsular polysaccharide (CPS). To investigate whether CPS plays an additional role in pathogenesis by modulating inflammatory-associated cytokine production, studies were initiated in a mouse model and followed by investigations of cytokine release from human peripheral blood mononuclear cells (PBMCs). Mouse tumor necrosis factor alpha (TNF-alpha) could be detected in serum up to 12 h postinoculation in animals challenged with the encapsulated parent strain MO6-24/O. The unencapsulated strain CVD752 was quickly eliminated by the animals, thus preventing a direct association between serum TNF-alpha levels and the presence or absence of the CPS. Purified CPS from MO6-24/O when injected into D-galactosamine-sensitized mice was a more immediate inducer of TNF-alpha than an equivalent quantity of MO6-24/O lipopolysaccharide (LPS). Both V. vulnificus CPS and V. vulnificus LPS induced inflammation-associated cytokine responses from primary human PBMCs in vitro. CPS elicited TNF-alpha from PBMCs in a dose-dependent manner, with maximal induction at 6 to 10 h, and was not inhibited by polymyxin B. Expression of interleukin-6 (IL-6) mRNAs was also induced in the presence of CPS. Interestingly, while adherent PBMCs secreted high levels of TNF-alpha after stimulation with LPS, they secreted little TNF-alpha in response to CPS. These studies provide evidence that V. vulnificus CPS directly stimulates the expression and secretion of proinflammatory cytokines by murine and human cells and suggest that CPS activation of PBMCs operates through a cellular mechanism distinct from that of LPS.

Animals↗
PubMed1996

Treatment of refractory ovarian cancer with 5-fluorouracil and leucovorin.

The objective of this study was to evaluate the activity of the combination of 5-fluorouracil (5-FU) and leucovorin in women with platinum-resistant recurrent or advanced ovarian cancer. A retrospective study was conducted of consecutive patients treated with weekly intravenous 5-FU and leucovorin, both at 500 mg/m2. Sixty-one cycles were administered to 28 women between 1989 and 1995. The median age of the patients was 58 years and median number of previous chemotherapy regimens was 2. No patient had a complete response. There was 1 partial response (PR) among 8 patients with measurable disease, and 4 PR among 20 women with evaluable disease; 2 had stable disease and 21 progressed on treatment for a response rate of 18% (95% confidence interval, 3-33%). Duration of response was 2 to 14 months, median 5 months. Survival from the start of 5-FU/leucovorin ranged from 1 to 78 months, median 5.5 months, and a mean of 10 +/- 15 months (mean +/- SD). The combination of 5-FU/leucovorin had minimal activity in this patient population. Only 2 women achieved resolution of their ascites and experienced a significant palliation.

Adult↗
PubMed1996

Preclinical immunoprophylactic and immunotherapeutic efficacy of antisera to capsular polysaccharide-tetanus toxoid conjugate vaccines of Vibrio vulnificus.

Vibrio vulnificus is an oyster-associated bacterial pathogen that causes life-threatening fulminating septicemia and necrotizing wound infections in humans. The capsular polysaccharide of V. vulnificus (VvPS) is critical for virulence. Previously we showed that active immunization of mice with a VvPS-tetanus toxoid (VvPS-TTa) conjugate vaccine conferred significantly higher protection against subsequent lethal challenge than immunization with VvPS alone. In the current study, we examined the utility of immunoprophylaxis or immunotherapy with hyperimmune antisera elicited by VvPS-TTa and VvPS-TTb conjugate vaccines prepared by different synthetic schemes. First we demonstrated that the Ribi adjuvant significantly enhanced the murine antibody response (P < or = 0.02) to both conjugates. Subsequently, high-titered polyclonal antisera were raised to VvPS-TTa and VvPS-TTb conjugate vaccines by using Ribi adjuvant or Freund's adjuvants. Antisera were observed to have protective effects when administered before and after acute lethal infection. All animals receiving prophylactic antisera intraperitoneally 24 h before lethal challenge with homologous carbotype 1 were protected, while 73 to 100% of control mice succumbed. Immunotherapy was also effective, with survival rates of 60 to 73% seen among mice when antisera were administered 2 h after bacterial challenge, at a time when symptoms of infection were already apparent. The protective effect of capsular antiserum appeared to be serotype specific. Antisera to the, carbotype 1 VvPS-TTa vaccine did not confer cross-protection against lethal challenge with carbotype 2 V. vulnificus despite partial structural similarity and a weak serological cross-reaction between the two carbotypes. Immune globulins induced by a potential multivalent VvPS conjugate vaccine composed of clinically prevalent carbotypes may have utility in the management of V. vulnificus infections and deserve further evaluation.

Animals↗
PubMed1996

Impact of the loop electrosurgical excision procedure on future fertility.

OBJECTIVE: The loop electrosurgical excision procedure (LEEP) is a popular and effective method of conservatively treating premalignant lesions of the cervix in reproductive-age women. While the safety and effectiveness of LEEP has been documented, few data have been collected on the long-term effect of LEEP of the cervix on subsequent fertility. The purpose of this study was to determine that effect. STUDY DESIGN: A retrospective, cohort study with chart review and telephone or mail-in survey. One hundred fifty-eight women seen in the colposcopy clinic at New Hanover Regional Medical Center for abnormal cervical cytologic smears from January 1991 through December 1992 were surveyed concerning their reproductive history since undergoing colposcopy. The study group consisted of 79 women who had been treated with LEEP after demonstrating abnormalities on colposcopically directed cervical biopsy. The control group consisted of 79 women who underwent colposcopy and cervical biopsy without subsequent LEEP of the cervix. RESULTS: One hundred eleven women responded to the survey. In this study group, 11 of the 12 women who desired pregnancy actually became pregnant in the in interval between treatment and completion of the survey. All 17 patients in the control group who desired pregnancy became pregnant. CONCLUSION: In our patient population there appeared to be no significant detrimental effect of LEEP on future fertility. These preliminary findings are reassuring, however, due to the small sample size, the study lacked sufficient power for us to draw definitive conclusions.

Adult↗
PubMed1994

Nd:YAG laser excision of a giant gingival pyogenic granuloma of pregnancy.

A 19-year-old Hispanic nullipara experienced the rapid growth of an oral lesion on the right lower gingiva which she had first noticed at 29 weeks gestation. The lesion interfered with oral hygiene and eating. At surgery, the lesion measured 3.5 x 2.5 x 2.0 cm. Biopsy confirmed a pyogenic granuloma ("granuloma gravidarum"). Panorex films showed no bony invasion. The lesion was excised using the Nd:YAG laser under general anesthesia when the patient had reached 36 3/7 weeks gestation. We chose the Nd:YAG laser over the CO2 laser for the removal of this very vascular lesion, because of its superior coagulation characteristics. This technique results in removal of the lesion with less danger of bleeding than with any other surgical technique. The patient did well postoperatively, delivered a healthy 3,884 g infant at 40 6/7 weeks gestation, and has had no recurrence after 15 months of follow-up.

Adult↗
PubMed1994

The safety and efficacy of extensive abdominal panniculectomy at the time of pelvic surgery.

Nine massively obese patients underwent excision of a large abdominal panniculus in conjunction with pelvic surgery. The most frequent indication for surgery was endometrial cancer. The charts of the patients were reviewed with careful attention to the outcome of the operation and the postoperative course. Comparison was made to previously reported data. The patients ranged in age from 48 to 72 years (mean 56). Weight range was 216 to 325 pounds (mean 261) and averaged more than twice ideal body weight. The weight of the resected abdominal wall was 3900 to 11,000 grams (mean 6247). Hospital stay ranged from 6 to 18 days (mean 8.2). Postoperative complications were chiefly those associated with the dead space created by the large resection without flap undermining (seromas in 2 and wound infections in 3). Four patients required prolonged wound drainage as outpatients. The average length of time to complete wound healing was 40.3 days (range 10 to 65). There were no dehiscences, pulmonary emboli, or operative mortalities. No patients required reoperation. Our study demonstrates that it is possible to safely combine plastic and gynecologic surgery without significantly increasing operative time, blood loss, postoperative complications, or hospital stay.

Abdomen↗
PubMed1994

Reproducibility of tumor measurements in ovarian cancer: a study of interobserver variability.

We evaluated the accuracy and interobserver variability of intraoperative tumor measurements in ovarian cancer. Thirty-four obstetrician-gynecologists, 26 gynecologic oncologists, and 12 residents estimated the size of a primary ovarian cancer and four metastases in a simulated patient at laparotomy. The validity of the model was rated from 1 (poor) to 10 (excellent) as 6.9 +/- 1.3 (range 4-10). Actual diameters and range of estimates were, respectively, primary ovarian tumor, 13 cm and 4 to 20 cm; plaque right pelvic sidewall, 8.5 cm and 0 to 12 cm; paraaortic nodes, 2 cm and 0 to 5 cm; right hemidiaphragm, 1 cm and 0.3 to 3 cm; and left hemidiaphragm, 5 cm and 2 to 7 cm. There was no significant difference in measurements between the three groups of surgeons. More surgeons underestimated than overestimated tumor diameters. Tumor measurements in individual patients are highly variable; interpretation of the surgical literature and ovarian cancer treatment protocols based on tumor volume are subject to significant measurement error.

Analysis of Variance↗
PubMed1994

Cytoreductive surgery for ovarian cancer with the Cavitron Ultrasonic Surgical Aspirator and the development of disseminated intravascular coagulation.

OBJECTIVE: To explore the association between the use of the Cavitron Ultrasonic Surgical Aspirator for cytoreduction of ovarian cancer and the intraoperative development of disseminated intravascular coagulation (DIC). METHODS: A retrospective chart review was performed of all patients undergoing surgery for ovarian cancer from September 1991 to February 1993. Data were extracted to correlate clinical and hematologic evidence of DIC with and without intraoperative use of the Cavitron Ultrasonic Surgical Aspirator. Statistical analyses were done by chi 2 and analysis of variance. RESULTS: Fifty-one patients underwent surgery for ovarian cancer; 33 had stage IIIB, IIIC, IV, or recurrent disease and could be evaluated for this study. Nineteen patients were treated with the surgical aspirator, five of whom developed an intraoperative coagulopathy, as compared to none of 14 patients treated with conventional cytoreduction (P < .04, chi 2). The duration of use of the surgical aspirator correlated with the risk of coagulopathy (P < .001, analysis of variance). CONCLUSION: These data suggest a potential risk of developing DIC after extended use of the Cavitron Ultrasonic Surgical Aspirator for cytoreduction of ovarian cancer.

Disseminated Intravascular Coagulation↗
PubMed1994

Gynecologic and dermatologic electrosurgical units: a comparative review.

Electrosurgery is a popular surgical technique in which high-frequency, low-voltage electrical energy produced by an electrosurgical unit is used to excise abnormal tissue with hemostasis. In this study, electrosurgical units were critically evaluated for safety, electrical specifications, design, and performance characteristics. Quantitative electrical specification and histologic thermal artifact measurements and qualitative observations were recorded for 13 electrosurgical units representing 11 manufacturers. The Aspen Sabre 180 and Laerscope e10 were considered exemplary units based on safety criteria alone. Cut-mode thermal artifact was less than 10 microns for the Cooper Leep 6000, Laserscope e10, and Utah Finesse. A maximum fulguration distance of greater than 0.5 mm was demonstrated by the Gyne-Tech Autolepe 2000 and 4000, Laserscope e10, and the Elmed ESU 30. For gynecologic electrosurgery, the Aspen Sabre 180 and Laserscope e10 were rated best, followed closely by the Utah Finesse and Finesse II and the Gyne-Tech Autolepe 4000. Dermatologic electrosurgery may be well accomplished with many of the electrosurgical units, except as noted.

Ambulatory Surgical Procedures↗
PubMed1993

Management of advanced juvenile granulosa cell tumor of the ovary.

Juvenile granulosa cell tumor of the ovary occurs most frequently in young women and children. Ten percent of cases present during pregnancy. The majority of tumors are in FIGO Stage I and have a favorable prognosis. The prognosis of higher stage tumors, however, is generally less favorable. We report the long-term, disease-free survival of a patient with FIGO Stage III juvenile granulosa cell tumor of the ovary. We believe this to be the first report of a successful pregnancy following "MAC" chemotherapy for this particular malignancy.

Adolescent↗
PubMed1993

Cushing's syndrome secondary to malignant lipoid cell tumor of the ovary.

Malignant lipoid cell tumors of the ovary are rare lesions that are frequently associated with endocrinologic abnormalities. A case of a woman with this lesion who developed Cushing's syndrome with progression of tumor is presented. Neither aggressive medical therapy with ketoconazole nor multiagent chemotherapy was beneficial in controlling tumor growth or physical and biochemical manifestations of Cushing's syndrome.

Aged↗
PubMed1993

Primary breast cancer of the vulva.

Supernumerary breasts on the vulva are a rare occurrence. There have been 26 cases previously reported and only 4 case reports of primary mammary carcinoma of the vulva. This is the fifth case report of mammary carcinoma of the vulva and the second report using tamoxifen for adjuvant treatment.

Aged↗
PubMed1993

Outpatients' attitudes and understanding regarding living wills.

OBJECTIVE: To assess outpatients' attitudes toward and understanding of a standard living will. DESIGN: Survey using a self-administered questionnaire that patients completed after they had read a sample living will. SETTING: General medicine clinic of a Department of Veterans Affairs medical center. PATIENTS: Two hundred fourteen patients (85% of those approached) attending a continuity care clinic appointment. Eighty-seven percent were men; mean age was 60 years. MEASUREMENTS AND MAIN RESULTS: Patients' attitudes toward living wills, understanding of the terminology contained in living wills, desire to discuss living wills with their doctors, and desire to prepare a living will. RESULTS: Seventy-two percent of the patients had prior knowledge of living wills, though only 53% had discussed the topic with family members and only 14% with physicians. Half felt that the living will terminology should be simplified, and 55% were unable to identify the correct definition for at least one commonly used term. Desire to prepare a living will was positively associated with better understanding of the sample document and previous knowledge of and exposure to living wills, and was negatively associated with concern about its use and revocability (all p < 0.001). Patients who reported poor understanding of the living will were more likely to want to discuss the topic with a physician (p < 0.01). CONCLUSIONS: In this ambulatory patient population attitudes toward living wills were influenced by knowledge and understanding of these documents. Primary care physicians and institutions should develop patient education strategies that enhance understanding of advance directives.

Attitude to Death↗