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Biomedical subjects

James Fanning

Publications and source records attributed to James Fanning.

At least 19 recordsLinked to original sources
PubMed2005

Carboplatin and paclitaxel for the treatment of advanced or recurrent endometrial cancer.

OBJECTIVE: The purpose of this study was to determine the activity and toxicity of carboplatin and paclitaxel (taxol) in the treatment of advanced or recurrent endometrial cancer. STUDY DESIGN: This was a retrospective review of 18 consecutive patients with advanced (stage 4) or recurrent endometrial adenocarcinoma that had been treated with outpatient carboplatin and taxol. Taxol was delivered at 135 mg/m 2 over 3 hours, and carboplatin was delivery at an area under the curve of 5 over 1 hour. Cycles were repeated every 21 days. RESULTS: The overall response rate was 63% with 28% of patients who had a partial response and 35% of patients who had a complete response. Kaplan-Meier test was used to estimate the median survival time of 27 months and the median progression free survival time of 24 months. No patient had neutropenia, thrombocytopenia or grade 3 vomiting, neurosensory toxicity, or renal toxicity. CONCLUSION: Carboplatin and taxol for the treatment of advanced or recurrent endometrial cancer appear to be active regimens with minimal toxicity.

Adult↗
PubMed2004

Digital rectal fecal occult blood screening during gynecologic examination.

OBJECTIVE: The purpose of this study was to test the feasibility of digital rectal fecal occult blood screening during pelvic examination. STUDY DESIGN: We reviewed the data for 232 consecutive women who underwent digital rectal fecal occult blood screening during routine pelvic examination and who had had at least 1-year of follow-up visits: 59% of the women were followed for gynecologic cancer, and 41% of the women were followed for benign gynecologic disease. The median age was 62 years. Patients with positive digital rectal fecal occult blood screening were sent for gastroenterologic examination. RESULTS: Sixteen of 232 patients (7%) had a positive digital rectal fecal occult blood screening result. On gastroenterologic examination, 5 of the 16 patients (31%) were found to have disease (2 polyps, 1 diverticular disease, 2 radiation proctitis). At 1-year follow-up, no patient had colon cancer. CONCLUSION: Until better compliance can be obtained with home stool sample fecal occult blood testing, we recommend a larger study of digital rectal fecal occult blood screening during gynecologic examination to verify our results.

Aged↗
PubMed2004

Feasibility of laparoscopic debulking with electrosurgical loop excision procedure and argon beam coagulator at recurrence in patients with previous laparotomy debulking.

OBJECTIVES: Our purpose is to assess the feasibility and success of laparoscopic ovarian debulking with electrosurgical loop excision procedure (LEEP) and argon beam coagulator (ABC). METHODS: Thirty-six consecutive asymptomatic patients with chemosensitive stage III or IV ovarian cancer who had undergone prior laparotomy debulking and chemotherapy, underwent laparoscopic debulking at the time of elevated CA 125. Preoperative abdominal/pelvic computed tomography was negative. Operative laparoscopy was performed through an open technique in the left upper quadrant. Tumors were debulked laparoscopically by using the LEEP and the ABC. RESULTS: Of 36 patients, 34 (94%) underwent successful laparoscopic debulking without requiring laparotomy. Of 34 patients, 32 (94%) had all visible disease resected at laparoscopy; 6% had surgical complications. Median time for surgery was 2.6 hours, median blood loss 70 mL, and median hospital stay 1 day. Seventy-four percent had a complete response after laparoscopic debulking and chemotherapy with a median progression free survival of 1.1 years. CONCLUSION: We present the first report of laparoscopic ovarian debulking using LEEP and ABC after elevation of CA 125 in chemosensitive, asymptomatic patients who had undergone prior laparotomy debulking. Laparoscopic debulking appears feasible (94%), successful (94%), and safe (6% complications). Prospective randomized trials are needed to determine the optimal management of asymptomatic, chemosensitive patients with elevated CA 125.

Adult↗
PubMed2004

Cost-effectiveness analysis of the treatment for intermediate risk endometrial cancer: postoperative brachytherapy vs. observation.

OBJECTIVE: To compare the survival, morbidity, and cost of treating women with intermediate risk endometrial cancer with postoperative vaginal cuff brachytherapy versus observation followed by treatment for vaginal recurrence. METHODS: A cost-effectiveness analysis was performed comparing two treatment strategies for intermediate risk endometrial cancer (Stage IC, IG3, II-tumors limited to the uterus with greater than 50% myometrial invasion or poor differentiation or cervical metastasis). All patients undergo hysterectomy, oophorectomy, and lymphadenectomy: strategy 1-postoperative vaginal cuff brachytherapy, strategy 2-observation. Strategy 2 patients who develop vaginal recurrence undergo diagnostic work-up followed by teletherapy and brachytherapy. All six principles of cost-effectiveness analysis were employed. Importantly, actual payer costs were evaluated, not charges. RESULTS: Although the treatment for vaginal cuff recurrence is expensive, since only 8% of patients develop a vaginal recurrence, there was a 31% decreased cost by not treating patients with postoperative low-dose rate brachytherapy (strategy 2). Also, although the complication rate for teletherapy is greater than brachytherapy, since only 8% of patients develop a vaginal recurrence and require teletherapy, projected complication rates for the two strategies are similar. Survival would be decreased 3% by withholding postoperative brachytherapy (strategy 2). With postoperative high-dose rate brachytherapy (strategy 1), the cost per life saved would be 38,764 US dollars. CONCLUSION: Using a cost-effectiveness analysis, we have shown that withholding postoperative brachytherapy for patients with intermediate risk endometrial cancer results in a 31% decrease in cost, has a similar radiation complication rate, and results in a 3% decrease in survival.

Algorithms↗
PubMed2002

Detection of genomic alterations in human endometrial cancer by two-dimensional gel electrophoresis.

OBJECTIVE: The purpose of this study was to detect genomic alterations in human endometrial cancer by two-dimensional gel electrophoresis. STUDY DESIGN: With use of a newly developed two-dimensional gel electrophoresis assay, we scanned 19 high-risk DNA fragments for alterations in human endometrial hyperplasias and adenocarcinomas. This method includes cleaving of high-molecular-weight DNA, radioactive labeling, and separating DNA fragments by two-dimensional gel electrophoresis. By comparing the two-dimensional gel electrophoresis profile (spots) of neoplastic with normal endometrium, genetic alterations such as amplification, allelic loss, and hypermethylation or hypomethylation can be detected. RESULTS: Seven of 8 human endometrial adenocarcinoma (88%) and 1 of 2 hyperplasias (50%) revealed changes in spot density. The number of spots changed per specimen was 4. The median percentage of specimens with changes in an individual spot was 30%. Eleven spots had a reduction or loss of spot density, and 8 spots had an increase in spot density. CONCLUSION: By use of a novel two-dimensional gel electrophoresis assay, we identified genetic alterations in 50% of hyperplasias and 88% of endometrial adenocarcinomas.

Adenocarcinoma↗
PubMed2002

Cold knife conization vs. LEEP. Are they the same procedure?

OBJECTIVE: To prospectively evaluate the amount of tissue removed at loop electrosurgical excision procedure (LEEP) vs. cold knife conization. STUDY DESIGN: Forty consecutive LEEP or cold knife conization specimens were prospectively measured and weighed by a single pathology technician. Diameter, length and weight of the specimens were compared using Student's t test. RESULTS: Mean diameter of cold knife cone specimens was 2.6 vs. 2.2 cm for LEEP (P = .07). Mean length of cold knife cone specimens was 1.5 vs. 1.0 cm for LEEP (P = .001). Mean weight for cold knife cone specimens was 4.4 vs. 2.0 g for LEEP (P = .001). CONCLUSION: In a prospective evaluation, cold knife cone specimens were 50% longer and 100% heavier than LEEP specimens.

Adult↗
PubMed2002

Delay of hospital discharge secondary to postoperative fever--is it necessary?

Although postoperative fever is common after major gynecologic surgery, the majority of patients have no identifiable infectious or pathologic etiology. Traditional management has been to delay hospital discharge until the patient is afebrile. The authors evaluate the outcome of patients discharged with postoperative fever after major gynecologic surgery. In a retrospective review of 537 women undergoing major gynecologic surgery, 211 (39%) had postoperative fever. The authors identified all patients who were discharged despite having a temperature of 38 degrees C or higher (> or = 100.4 degrees F) in the preceding 12 hours. All outpatient and inpatient records for a period of 30 days were reviewed. Thirty-eight (18%) of 211 patients who were febrile postoperatively were discharged despite having a fever within the preceding 12 hours. One patient was lost to follow-up. Two (5%) of 37 patients had a documented infection (one urinary tract infection and one postoperative wound infection). Four (11%) were readmitted within 30 days for noninfectious causes. None of the patients discharged on oral antibiotics had an antibiotic-related complication. Eighty-four percent of patients discharged with a postoperative fever did not have a documented infectious or pathologic cause for the fever while at home.

Adult↗
PubMedDate not supplied

A laparoscopic bipolar cutting forceps can assist in a case of difficult vaginal hysterectomy.

A vaginal approach to hysterectomy can become challenging when visualization is limited by poor or absent uterine descent, obesity, or other factors that make an approach to the uterine pedicles difficult. When factors occur that make application or visualization of conventional vaginal instruments difficult, using an instrument designed for laparoscopic application, with its thin, elongated shape, may permit continuation of a vaginal approach. In such a case, a Gyrus bipolar laparoscopic cutting forceps was used for coagulation and transection of the uterine pedicles during a vaginal hysterectomy. This represents a way to expand on traditional techniques for completion of difficult vaginal hysterectomy, which may be used concurrently. Surgical techniques that more easily and safely permit completion of hysterectomy by the vaginal approach can improve outcomes for all.

Arteries↗
PubMedDate not supplied

Examining interactions between biomeds and caregivers.

Quality healthcare delivery is a team effort requiring trust, mutual respect and a little professional courtesy when stress levels are high and equipment problems arise. Trust and professional respect are best established through other means like committees or special projects done together rather than the heat of a crisis, yet bonds created during difficulties are some of the strongest. Biomedical technicians equipped with an attitude of patience and humility can contribute to a positive learning experience when the problem lies with the equipment operator.

Biomedical Engineering↗