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Biomedical subjects

N F Hacker

Publications and source records attributed to N F Hacker.

At least 91 records · Page 5Linked to original sources
PubMed1984

Second-look laparotomy in stage III epithelial ovarian cancer: clinical variables associated with disease status.

Variables associated with a negative second-look laparotomy in patients with stage III epithelial ovarian carcinoma are analyzed. Fifty-six patients were clinically free of disease after systemic chemotherapy and were subjected to second-look laparotomy to assess tumor status. Eighteen of these patients (32.1%) had no evidence of malignancy. Eight (14.3%) additional patients with no gross evidence of disease at laparotomy had microscopic persistence; five of these had disease documented in the pelvic or para-aortic lymph nodes. Significant variables associated with a histologically and cytologically negative second-look operation were low tumor grade (P less than .01), the use of cis-platinum containing combination chemotherapy (P less than .01), patient age less than or equal to 50 years (P less than .02), small residual tumor (less than 0.5 cm) before chemotherapy (P less than .05), and metastatic tumor less than or equal to 10 cm before initial cytoreduction (P less than .05). Patients treated with six to nine cycles of combination chemotherapy had the same probability of a negative second-look laparotomy as those treated with ten to 12 cycles. Multivariate discriminate analysis indicated that patients with low tumor grade, those receiving cis-platinum containing combination chemotherapy, and those with minimal residual tumors (less than 0.5 cm) after primary cytoreductive surgery correctly classify second-look status in 78.6% of patients. Until a nonsurgical method of monitoring subclinical disease is available, a through second-look laparotomy, including a pelvic and para-aortic lymphadenectomy, should be performed.

Adult↗
PubMed1984

Individualization of treatment for stage I squamous cell vulvar carcinoma.

Of 177 cases of invasive squamous cell vulvar cancer seen at the University of California at Los Angeles and the City of Hope National Medical Center from 1957 to 1980, 84 (47.5%) had stage I disease. Seventy-seven patients with stage I disease (91.7%) had stromal invasion of 5 mm or less. Correlation between lymph node status and depth of invasion was as follows: 1 mm or less, none of 34 (0%); 1.1 to 2 mm, two of 19 (10.5%); 2.1 to 3 mm, two of 17 (11.8%); 3 to 5 mm, one of seven (14.3%); more than 5 mm, three of seven (42.9%). Fifty-six patients had radical vulvectomy for the primary lesion, and 28 had more conservative excision, but the incidence of local invasive recurrence (4%) was the same in each group. None of 58 patients treated with inguinal-femoral lymphadenectomy developed a groin recurrence, but three of 26 patients (11.5%) who had omission or modification of inguinal-femoral lymphadenectomy died with groin recurrence within 12 months. These data suggest that although some modification of the standard radical vulvectomy is appropriate for the primary lesion in patients with stage I disease, patients with greater than 1 mm of stromal invasion require at least an ipsilateral inguinal-femoral lymphadenectomy.

Adult↗
PubMed1984

Vaginal reconstruction performed simultaneously with pelvic exenteration.

Twenty-eight patients underwent vaginal reconstruction simultaneously with pelvic exenteration performed for recurrent pelvic malignancy. A satisfactory neovagina was created in 24 (86%) patients. Successful bilateral grafting was accomplished in 18 of 21 (86%) patients using gracilis myocutaneous grafts. Seven patients had a split-thickness skin graft, most of which was combined with an omental pedicle graft; six of these patients had a satisfactory neovagina. None of the patients developed herniation of the bowel through the reconstructed pelvic floor, or fistulas in the absence of recurrent malignancy. The gracilis myocutaneous graft is most feasible in patients in whom total pelvic exenteration is performed, whereas a split-thickness graft is preferable in those patients who undergo anterior exenteration or who have rectosigmoid reconstruction using low colon reanastomosis.

Adult↗
PubMed1984

Immunotherapy with biochemically dissociated fractions of Propionibacterium acnes in a murine ovarian cancer model.

The antitumor effect of two strains of Propionibacterium acnes (PAI and PAII) and chemically derived fractions from the whole bacterial cell were studied using a murine ovarian teratocarcinoma (MOT) model. When injected i.p. in high doses (700 to 1400 micrograms/mouse), both strains produce survival of a significant proportion of tumor-bearing mice (30 to 90%). On a weight to weight basis, however, PAI was significantly more effective than PAII. PAI and PAII were extracted using pyridine, which yielded four fractions, i.e., pyridine-extracted strains PAI and PAII (PA-PEI and PA-PEII, respectively) which are composed of the cell wall material extracted by pyridine, and the residues of PA-PEI and PA-PEII (PA-RI and PA-RII, respectively) which are composed of the residue material following the chemical extraction. The chemical composition of PA-PEI was different from that of PA-PEII (the latter had proportionately three times as many carbohydrates and one-third of the protein content of the former) and so were their antitumor properties in the MOT model. PA-PEI had markedly reduced antitumor effect when compared to the untreated cell on a per weight basis. Furthermore, curability was only seen when using a high dose (1400 micrograms/mouse). By contrast, the cell wall components extracted by pyridine from PAII (PA-PEII) had powerful antitumor effects, i.e., greater than 50% of mice given 1400-micrograms injections survived. The material contained in PA-PEII was further fractionated on the basis of its organic solubility in chloroform:methanol solvent. The water-soluble and solvent-insoluble fractions retained most of the antitumor effects of PA-PEII, while the water-insoluble and solvent-soluble fractions were only moderately effective, suggesting that the active moiety(ies) was associated with the nonlipid components of this fraction. Both residue fractions (PA-RI and PA-RII) were as effective on a per weight basis in controlling the growth of 10(5) tumor inoculum as were whole untreated cells. However, periodate oxidation of PA-RI resulted in complete loss of its antitumor effects. When surviving mice that had no evidence of tumor persistence following a tumor challenge (10(5) MOT cells) and i.p. treatment with PA were subsequently rechallenged with 10(4) tumor cells, survival was significantly prolonged, as compared to tumor-challenged (10(4) MOT) naive mice. In addition, 10 to 20% of these rechallenged mice had complete eradication of the tumor inoculum (no evidence of disease for greater than 120 days).(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1983

Estrogen and progesterone receptors in ovarian neoplasms.

The cytoplasmic receptors for 17 beta-estradiol (ER) and progesterone (PR) were measured in 39 malignant and 15 benign ovarian neoplasms. All eight endometroid carcinomas had positive ER sites, one-half contained PR. The number of ER binding sites decreased as tumor grade increased. Conversely, none of the 11 mucinous tumors contained either ER or PR receptors. One-half of the well-differentiated serous tumors had ER (57 +/- 23 fmole/mg protein) while none of the poorly differentiated tumors had measurable binding. In serous carcinomas, PR was only detected in well-differentiated lesions (447 +/- 240 fmole/mg protein). Only one of 15 benign neoplasms contained ER and PR receptors. Correlation of tumor grade and type may help to plan hormonal therapies in advanced ovarian malignancies.

Adolescent↗
PubMed1983

Estrogen and progesterone receptor sites in malignancies of the uterine cervix, vagina, and vulva.

Cytoplasmic receptors for 17 beta-estradiol (ER) and progesterone (PR) were measured in uterine cervical, vaginal, and vulvar carcinomas by the dextran-coated charcoal (DCC) technique. Tissues from 30 patients with cervical carcinoma were examined. Thirteen percent (2 of 16) of well-differentiated squamous carcinomas had positive ER, and 19% (3 of 19) had positive PR. None of the three patients with moderately well-differentiated disease have positive ER or PR, while two of five patients with poorly differentiated lesions contained measurable ER and PR. In contrast, all four of the well-differentiated adenocarcinomas of the cervix had detectable ER, and three of four for PR. Neither of the two patients with poorly differentiated adenocarcinoma had either ER or PR. None of the five vulvar and seven vaginal epidermoid carcinomas studied had ER or PR activity. Hormonal therapies may be useful in the treatment of adenocarcinoma of the cervix.

Adenocarcinoma↗
PubMed1983

Superficially invasive vulvar cancer with nodal metastases.

Seven patients with superficially invasive vulvar cancer and lymph node metastases are reported. Histology of the primary tumor does not seem to correlate reliably with its metastatic potential in any individual case, though "spray," pseudoglandular, and small cell carcinomas may be particularly aggressive lesions. While wide local excision seems to be adequate treatment for the primary lesion, it is recommended that for lesions with greater than 1 mm of stromal invasion, bilateral inguinal-femoral lymphadenectomy should be performed for midline lesions, and at least ipsilateral inguinal-femoral lymphadenectomy should be performed for lateralized lesions.

Adult↗
PubMed1983

Laparoscopy in the management of patients with ovarian carcinoma.

Since operative evaluations of patients undergoing therapy for ovarian cancer are necessary, the laparoscope will continue to play a role in the management of these patients. However, the sensitivity of the laparoscope for detecting disease either prior to or at the completion of chemotherapy is significantly less than that of laparotomy, and therefore its utility must be more narrowly defined. The morbidity of laparoscopy is low when performed correctly and utilizing techniques to avoid bowel perforation. Most patients require only a brief hospitalization, and those who cannot medically tolerate an extensive laparotomy might be able to undergo a laparoscopy. The major limitations of laparoscopy are the inability to adequately inspect the peritoneal cavity and pelvis in at least one-quarter of patients because of extensive adhesions, to assess retroperitoneal lymph nodes in all patients, and to resect tumour masses necessary to cytoreduce the tumour prior to therapy. The successful performance of interval laparoscopy, however, is predictive of survival and can select a group of patients whose likelihood of recurrence is relatively low (30 per cent) after more than three years. The observation that the majority of patients who have a negative laparoscopy following six months of chemotherapy remain free of disease for several years, suggests that sensitive tumours are most likely to respond during the initial courses of chemotherapy, and that consideration should be given to briefer and more intensive courses of therapy prior to operative evaluation of the patients.

Biopsy↗
PubMed1983

Pharmacokinetics of Ip cisplatin in refractory ovarian carcinoma.

Four patients with small residual ovarian carcinoma following treatment with cisplatin, doxorubicin, and cyclophosphamide have subsequently received 57 courses of ip cisplatin. Cisplatin (120-270 mg in 2 L of Ringer's lactate) was administered via Tenckhoff catheter, with a dwell time of 15-20 mins. Courses were given weekly for 12 weeks, with response documented by laparoscopy or laparotomy prior to and following the trial. With a dwell time of 20 mins, 75% +/- 5% (mean +/- SD) of platinum was recovered. With 120 mg of cisplatin and a dwell time of 20 mins, total plasma platinum peaked at 1.23 +/- 0.42 microgram/ml and by 8 hrs decreased to 0.67 +/- 0.12 microgram/ml. Filterable (non-protein-bound) platinum peaked at 0.73 +/- 0.21 microgram/ml and by 8 hrs fell to 0.03 microgram/ml. Excretion rate paralleled the filterable plasma curve, peaking at 40 mins; 30% +/- 7% of absorbed drug was recovered in urine within 24 hrs. Renal clearance of filterable platinum was 106 +/- 20 ml/min. Creatinine clearance was 76 +/- 7 ml/min. Three responses, one complete and two partial, were noted. Zero to two episodes of vomiting occurred in each course. One patient had a creatinine clearance decrease to 40 ml/min, one had two episodes of thrombocytopenia, and one had mild abdominal pain with a cisplatin dose of greater than or equal to 210 mg. No neurotoxicity, catheter infection, or peritonitis was encountered.

Adult↗
PubMed1983

Psychosexual adjustment following pelvic exenteration.

Fifteen pelvic exenteration patients from 2 institutions participated in semistructured interviews and objective assessment to examine postoperative psychologic, social, and sexual functioning. Analyses of variance indicated significant differences between the sexually active and nonactive patients and the patients with a neovagina and those with no vaginal capacity only in the area of sexual functioning, not in psychologic or social adjustment. Descriptive statistics for the entire group of patients provide a view of psychosocial adjustment for the average pelvic exenteration patient. Long after such patients are asymptomatic and clinically free of disease, they appear mildly distressed and depressed. However, these women report active and satisfactory levels of social and free-time activities. Sexual functioning continues as the area of greatest disruption for these patients and, as a group, they resemble severely sexually dysfunctional healthy women. This investigation provides a substantive look at the post-treatment life circumstances of these patients and offers a data base for future investigations.

Adaptation, Psychological↗
PubMed1983

Intraperitoneal immunotherapy of human ovarian carcinoma with Corynebacterium parvum.

Corynebacterium parvum has been administered i.p. to 14 patients with advanced ovarian cancer. Two patients had responded completely to cytoreductive surgery and combination chemotherapy prior to immunotherapy, and one patient with residual disease had received only a single course of C. parvum due to i.p. catheter malfunction. Among the 11 patients with residual disease evaluable for response, from three to eight i.p. treatments with C. parvum produced surgically confirmed tumor regression in five patients (45%) with three partial responses and two complete responses of 5 and 12 months duration. All responders had (a) multiple tumor nodules less than 0.5 cm at the initiation of immunotherapy, and (b) severe abdominal pain and fever after C. parvum injection. Overall, 58 courses of immunotherapy were associated with abdominal pain (91%), fever (67%), nausea (52%), vomiting (31%), and hypotension that responded promptly to i.v. infusion of fluids (10%). Use of i.p. cathethers was associated with two episodes each of infection and intraabdominal bleeding. Administration of C. parvum i.p. has augmented the ability of human peritoneal cells to lyse human ovarian carcinoma cell lines in the presence of specific rabbit heteroantiserum. C. parvum administered i.p. has inhibited the growth of human ovarian carcinoma and may prove useful for modulating the activity of human effectors for antibody-dependent cell-mediated cytotoxicity.

Adult↗
PubMed1983

Management of regional lymph nodes and their prognostic influence in vulvar cancer.

One hundred thirteen patients with invasive carcinoma of the vulva underwent radical vulvectomy and bilateral inguinal-femoral lymphadenectomy between 1957 and 1978. Eighteen had unilateral pelvic lymphadenectomy. Thirty-one patients (27.4%) had positive lymph nodes. The corrected actuarial five-year survival for patients with negative nodes was 96%, whereas it was 94% for patients with one positive node, 80% for those with two positive nodes, and 12% for those with three or more positive nodes. All patients with positive pelvic nodes or pelvic recurrence had three or more positive unilateral groin nodes, and all had palpably suspicious groin nodes preoperatively. Groin and systemic recurrences occurred in 2.9 and 3.8%, respectively, of patients with fewer than three positive unilateral inguinal-femoral nodes, as compared to 33 and 66%, respectively, of patients with three or more positive nodes. These data do not support routine pelvic lymphadenectomy in patients who have no clinically suspicious groin nodes and fewer than three positive nodes on histologic examination.

Adult↗
PubMed1983

Primary cytoreductive surgery for epithelial ovarian cancer.

Forty-seven patients with stage III or IV invasive epithelial carcinoma of the ovary underwent primary cytoreductive surgery at UCLA during the five-year period 1974 to 1979. Optimal cytoreduction (defined as largest residual tumor mass 1.5 cm or less in diameter) was achieved in 31 patients (66%), including ten of 14 (71%) who underwent laparotomy and biopsy before referral. Median survival for the suboptimal group was six months, compared with 18 months for patients whose largest residual disease was 0.5 to 1.5 cm, and 40 months if residual nodules were less than 0.5 cm (P less than .001). All patients in the suboptimal group died of disease from 22 months to seven years and four months postoperatively. Given the limited ability of chemotherapy to cure ovarian cancer, and the acceptable morbidity of extended operation, the availability of ideal initial surgical effort for patients with advanced stage disease may be the most important variable in current ovarian cancer care. Optimal cytoreduction is most effective in prolonging survival in patients first seen without clinical ascites or large metastatic disease.

Adult↗
PubMed1983

Delayed vaginal reconstruction in the fibrotic pelvis following radiation or previous reconstruction.

Vaginal reconstruction was performed in 14 patients who had developed vaginal stenosis secondary to extensive pelvic fibrosis after pelvic radiation therapy (12 patients) or prior vaginal reconstruction (2 patients). Sixteen procedures were performed using a split-thickness skin graft. All patients had satisfactory vaginal restoration, and 12 patients reported good vaginal function. No fistula developed as a result of the operative procedure, but one patient later developed a rectovaginal fistula resulting from tumor recurrence. Successful vaginal reconstruction can be achieved even years after initial therapy in patients who develop an obliterated vagina from previous radiation or surgery.

Adult↗
PubMed1983

Psychosexual adjustment after vulvar surgery.

Fifteen patients treated surgically for vulvar cancer from two institutions participated in semistructured interviews and objective assessment to examine postoperative psychologic, social, marital, and sexual adjustment. Descriptive statistics indicate that after vulvar surgery patients report mild distress, but they report reasonable levels of and satisfaction with their free-time and social activities. Mild levels of marital distress may exist. Sexual functioning and body image appear to undergo major disruption despite the fact that intercourse remains possible. Women reported levels of sexual arousal at the eighth percentile and body image at the fourth percentile. Although replication of these findings is clearly necessary, this investigation provides the first substantive look at the posttreatment life circumstances for these patients and offers a data base for future investigation.

Adaptation, Psychological↗