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Biomedical subjects

L McGowan

Publications and source records attributed to L McGowan.

At least 37 records · Page 2Linked to original sources
PubMed1993

Patterns of care in carcinoma of the ovary.

BACKGROUND: During an epidemiologic study of women with ovarian cancer, the type of incision, intraoperative evaluation of the extent of disease, frequency of mistaken diagnosis, and ovarian cancer occurring in women who had a prior hysterectomy were reviewed. METHODS: The thoroughness of intraoperative evaluation of the extent of disease as well as the type of incision in 291 women with ovarian cancer was investigated. Within this group 41 women had undergone hysterectomy with retention of one or both ovaries before the diagnosis of ovarian cancer. An additional 43 women were discovered not to have primary carcinoma of the ovary. RESULTS: Seventy-one percent of the women with transverse incisions had incomplete intraoperative evaluations of the extent of disease compared with 42% of the vertical incision group. Medical record documentation revealed that 97% of the cases operated on by gynecologic oncologist had complete staging evaluations performed, but only 52% and 35% of cases operated on by obstetricians/gynecologists and general surgeons, respectively, were evaluated adequately. Of the 43 women discovered not to have primary carcinoma of the ovary, 5% had benign ovarian tumors, 3% had primary carcinoma of the peritoneum, and 5% had primary carcinoma of the intestines. Women who had their ovaries retained at hysterectomy and later had invasive ovarian cancer had approximately an 80% mortality. CONCLUSIONS: The mistaken diagnosis of carcinoma of the ovary can be reduced if surgeons and pathologists improve communications between themselves. The greater use of preoperative second opinions by gynecologic oncologists in women suspected of ovarian cancer should enhance quality of care.

Adult↗
PubMed1991

Pathology of the ovary.

Recent medical articles on pathology of the ovary have contributed to a better understanding of ovarian cancer. Postmenopausal women with ovarian neoplasms, especially bilateral ones, are at great risk that they are malignant. Methods for histologic and frozen-section sampling of ovarian neoplasms may vary from one pathology laboratory to another. Primary peritoneal cancer is a distinct clinical entity and all physicians operating on women with pelvic cancers should be alert for its presence. Serum CA 125 analysis may be of value in determining whether to carry out a second-look operation in women with epithelial ovarian cancer. The influence of rupture of the capsule of epithelial ovarian tumors, hydronephrosis, and disease limited to the ovaries and survival are discussed.

Antigens, Tumor-Associated, Carbohydrate↗
PubMed1991

The mistaken diagnosis of carcinoma of the ovary.

The primary site of carcinoma was investigated in 339 women diagnosed as having carcinoma of the ovary. After a review of medical records and microscopic slides, 43 women were discovered not to have a primary carcinoma of the ovary. Of these 43 women, 15 had benign ovarian tumors, 13 had primary carcinoma of the peritoneum and 15 had primary carcinoma of the intestines. Review of the medical records of 15 women found to have benign ovarian tumors disclosed the original pathologic interpretation of cancer was not supported by clinical or operative observations and no second opinion pathologic review was noted in the records. Until our review, 13 women who were diagnosed as having carcinoma of the ovary had primary peritoneal tumors. Nine of these women either had normal ovaries removed previously or had normal results of biopsies of the ovary done intraoperatively. Of those women entering the study with a diagnosis of carcinoma of the ovary, but in whom our review noted carcinoma of the intestines, 14 of 15 had intestinal complaints before operation. More than one-half of the patients did not have the intestine studied preoperatively, most had diffuse disease at operation and almost one-half of the women had normal sized ovaries at operation. By not performing gastrointestinal roentgenographic studies and suspecting the possibility of metastasis and by misleading the pathologist by presenting the specimen as an ovarian tumor, patients were erroneously diagnosed as having primary carcinoma of the ovary.

Adult↗
PubMed1989

A case-control study of epithelial ovarian cancer.

With data from a study of 296 patients with primary epithelial ovarian cancer and 343 patients hospitalized because of other conditions, we estimated ovarian cancer risk in accordance with reproductive and other factors. Risk was greatest among women of lower parity, especially among women who said they planned to have children but could not. The protective effect of oral contraceptives seen in other studies was observed only in subgroups of our study population. Women who had breastfed their children had decreased risk, but the number of months of breastfeeding was not related to risk. Incomplete pregnancies did not provide the protection seen for live births. A family history of ovarian cancer and a medical history of breast cancer were both strong risk factors. None of the nonreproductive factors that we examined, including childhood illnesses, tobacco and alcohol consumption, obesity, and selected adult diseases, was convincingly associated with risk.

Adult↗
PubMed1989

Epidemiology of ovarian cancer.

What factors influence a woman's chances of developing or avoiding ovarian cancer? Because early diagnosis is so difficult and this disease is usually diagnosed only in the late stages where treatment usually fails, physicians and women are becoming increasingly interested in answering this question. As a result of two studies conducted over the last fifteen years, certain risk factors have been identified, showing that a woman has a greater chance of developing ovarian cancer if she is white, married, has a family history of the disease, has no children or has a history of difficulty in conceiving, and has menopausal hot flashes. Chances of developing the disease are also greater in women who have a primary breast or colon tumor. Clinical conditions were utilization of these risk factors may contribute to the reduction of morbidity and mortality of ovarian cancer are suggested.

Adult↗
PubMed1988

Menopause and ovarian cancer.

Using data from a study of 296 patients diagnosed in greater Washington, D.C., from 1978 to 1981 with primary epithelial ovarian cancer and 343 patients hospitalized for other conditions, the authors estimated the rate ratios according to various characteristics of the menopause. Menopause induced by hysterectomy with preservation of both ovaries was associated with a 30 per cent reduction in risk of later development of ovarian cancer. Age at natural menopause was not consistently related to risk. Women who used menopausal estrogens showed a 40 per cent decreased risk.

Actuarial Analysis↗
PubMed1988

Risk factors in ovarian cancer.

For 50 years, the three- and five-year survival rates of under 40% for invasive ovarian cancer in the USA have not significantly changed. Identifying those women who have a greater probability of developing the disease should contribute to improving survival. Our 3-year case-control study of 298 women from the metropolitan Washington, DC, area with primary epithelial ovarian cancer revealed a woman is at greater risk of developing ovarian cancer if she has a family history of the disease, experiences difficulty becoming pregnant, and has a normal menopause with hot flashes. Her risk for the disease is diminished with multiparity, a history of dysmenorrhea, and hysterectomy. Physicians should consider these risk factors when performing pelvic examinations in women and coordinate them with known changes in ovarian size and procedures to view the ovaries which may permit earlier recognition of ovarian cancer.

Adult↗
PubMed1987

Paraaortic lymph node irradiation in cervical carcinoma without prior lymphadenectomy.

A study of complications associated with paraaortic irradiation was undertaken in patients with uterine cervical cancer who had not undergone prior lymphadenectomy. Between 1975 and 1984, 29 highly selected patients received paraaortic irradiation as part of their definitive treatment for cervical carcinoma. Paraaortic fields were irradiated to a total dose of 4,200-5,000 rad (42-50 Gy), in fractions of 150-180 rad (1.5-1.8 Gy). An anteroposterior-posteroanterior technique was generally used. All fields were treated every day. There were no instances of small-bowel obstruction or other major complications, surgical procedures, or deaths caused by paraaortic irradiation. Eleven patients (38%) have no evidence of recurrent disease 23-120 months after completion of therapy. Paraaortic irradiation was well tolerated in this patient group without prior staging lymphadenectomy. Thus, in selected patients and with appropriate techniques, paraaortic irradiation for cervical carcinoma may be used with relative safety.

Aorta, Abdominal↗
PubMed1987

Ovarian cancer after hysterectomy.

Hysterectomy is the most common major operative procedure in the United States. The present review of 291 women with primary ovarian cancer of the epithelial cell type from the metropolitan Washington, D.C. area reveals 41 (14%) had a prior hysterectomy. The hysterectomies were performed abdominally in 80% of women at an average age of 41 years and vaginally in 20% at an average age of 46 years. The interval between hysterectomy and discovery of ovarian cancer was ten years in the vaginal group and 18 years in the abdominal group. Women who had their ovaries retained at hysterectomy and later developed invasive ovarian cancer had approximately an 80% mortality.

Female↗
PubMed1986

Abdominal incisions and staging in ovarian cancer.

The type of abdominal incision--transverse or vertical--in 291 women with ovarian cancer and completeness of intraoperative evaluation of the extent of disease were investigated. Fourteen percent of woman had transverse incisions, 69% of which were the Pfannenstiel type. Half of the women who had transverse incisions and ovarian cancer were aged 50 years or older. A preoperative diagnosis presumptive of ovarian cancer was made in 93% of women; 71% of the transverse incision group had incomplete intraoperative evaluations of the extent of disease compared with 42% of the vertical incision group. A transverse incision should never be performed in women who are suspected to have ovarian cancer or in women who have ovarian or adnexal tumors and are over 30 years of age.

Adult↗
PubMed1985

Effects of anesthetics on regional hemodynamics in normovolemic and hemorrhaged rats.

Twenty-nine male Sprague-Dawley rats were divided into four groups based on anesthetic exposure, i.e., awake animals and those receiving anesthesia produced by chloralose-urethan, pentobarbital, or by midcollicular brain stem transsection. Before and after hemorrhage (30% of the estimated blood volume), cardiac output (CO) and regional blood flows were measured by the microsphere method. Arterial blood gases and lactate (L) and pyruvate (P) were also determined. CO and regional blood flows were greatest and the L/P ratio was least in awake animals both before and after hemorrhage. In normovolemic rats, the frequency of altered values (as compared with those in awake animals) was similar for all anesthetic techniques, whereas the CO and regional blood flow responses to hemorrhage were altered less frequently in decerebrated animals. Decerebration may be the preferable procedure if the intent is to produce responses in anesthetized animals similar to those in awake rats. If the intent is to study hemodynamics in a specific organ, the selection of an anesthetic technique should be guided by the individual anesthetic effects on that particular tissue.

Anesthesia, General↗
PubMed1985

Misstaging of ovarian cancer.

The thoroughness of intraoperative evaluation of the extent of disease in 291 women with primary ovarian cancer was investigated. Notable differences among physician specialties but not types of hospitals where initial surgery was performed were observed. A review of medical record documentation revealed that 97% of the cases operated on by gynecologic oncologists had complete staging evaluations performed intraoperatively, but only 52 and 35% of cases operated on by obstetricians/gynecologists and general surgeons, respectfully, were adequately evaluated. Roughly one-half of the cases diagnosed in community hospitals and in hospitals with teaching affiliations were found to be completely studied, and 66% of those operated on in university hospitals received complete intraoperative evaluations.

Diagnostic Errors↗
PubMed1985

A study of the effect of meptazinol on fetal heart rate patterns.

A study was carried out in 40 women undergoing labour to investigate the effect of 100 to 150 mg meptazinol intramuscularly, given alone for the relief of labour pain, on fetal heart rate patterns. Patients were monitored continuously using a fetal scalp electrode attached to a fetal monitor, and fetal heart rate patterns recorded on the cardiotocograph. Traces were interpreted for 2 hours preceding and 2 hours after administration of meptazinol using a 12-point scoring system to quantify the variables of baseline rate and variability and the presence or absence of variable or late decelerations. All babies were born live and, except for 1 delivered by emergency caesaraen section under general anaesthesia, none had an Apgar score less than 8 at 1 minute. Analysis of the cardiotocograph traces showed that adverse changes, such as loss of variability, were not significantly associated with the use of meptazinol.

Adult↗