Lower urinary tract resection as part of cytoreductive surgery for ovarian cancer.
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Female↗
Biomedical subjects
N F Hacker
Publications and source records attributed to N F Hacker.
Management of postexenteration perineal hernias by myocutaneous axial flaps.
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Adult↗
Positive peritoneal cytology in corpus carcinoma. Report of a fatal outcome.
A 64-year-old patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy in October, 1978 for a Stage IA, grade 2 papillary adenocarcinoma of the endometrium. Peritoneal washings contained numerous malignant cells, although the tumor invaded the myometrium only superficially. Two weeks after operation, 12 mCi of P32 were instilled into the peritoneal cavity. In May, 1979, laparotomy was performed for clinical obstruction of the small intestine and revealed diffuse peritoneal, omental, and hepatic metastases. Radiation changes involved the terminal ileum, ascending and sigmoid colon; an ileorectal fistula was also identified. The factors that might cause malignant cells to be present in the peritoneal cavity and the ideal treatment of such patients have yet to be determined. THe risk of intraperitoneal P32 might outweigh its benefits.
Adenocarcinoma, Papillary↗
Nd: YAG laser therapy of rectosigmoid bleeding due to radiation injury.
The Nd:YAG laser was used to treat a patient bleeding from the rectosigmoid as a result of radiation injury related to therapy for cervical carcinoma. Successful laser therapy was performed after a diverting colostomy failed to control persistent bleeding. Further surgical procedures were not required. Characteristics of Nd:YAG laser as compared with those of the carbon dioxide and argon lasers are considered.
Carcinoma, Squamous Cell↗
Levator ani transposition for anal incompetence secondary to sphincter damage.
An operative procedure is described in which the levator ani muscles are used to correct anal incompetence secondary to sphincter damage. The relevant pelvic anatomy and operative procedure are described in detail. Four patients in whom sphincter damage occurred during surgery for posterior vulvar carcinoma underwent the procedure; in 3, good sphincter function was attained. Morbidity was minimal. The transposition of the levator ani muscle to replace partially obliterated anal sphincter muscles is a suitable procedure for patients who have insufficient sphincter tissue for simpler repairs.
Adult↗
Carcinoma of the cervix associated with pregnancy.
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Adolescent↗
Primary carcinoma of the Bartholin gland: a report of 14 cases and review of the literature.
Fourteen cases of primary carcinoma of the Bartholin gland were treated between 1955 and 1980. Follow-up information was available on all patients. Ten patients have survived free of disease for 5 or more years. Three patients with positive inguinal lymph nodes have survived 5 years. Histological patterns and lymph node involvement are analyzed. The authors' data and a review of the literature support the concept that radical vulvectomy with bilateral inguinal-femoral lymphadenectomy is required for all histologic types of Bartholin gland carcinoma. Routine pelvic lymph node dissection is not necessary when the inguinal-femoral nodes are negative for metastases.
Adenocarcinoma↗
Recent progress in the treatment of epithelial ovarian malignancy.
Improved surgical and chemotherapeutic management has ensured that more than half the patients with advanced ovarian cancer will be clinically free of disease shortly after treatment begins. Aggressive cytoreductive surgical treatment and combination cytotoxic chemotherapy have appreciably prolonged survival and have induced cures in some women with metastatic disease. An increasing number of women are being seen with small residual disease at second-look laparotomy, and intraperitoneal administration of chemotherapeutic and immunotherapeutic agents is being investigated for these patients. Specific immunotherapies, including monoclonal antibodies raised against patients' own tumor cells, are also being investigated. During the next five years we may see significant improvement in the cure rate for this disease.
Female↗
Adenocarcinoma of the uterine cervix.
One hundred patients with primary adenocarcinoma of the uterine cervix were evaluated. Of the 48 Stage I patients, 13 were treated with radical surgery, 16 with radiation alone, and 19 with combination therapy. Life table analysis of Stage I patients showed no significant difference in survival for those treated with radical surgery or combination therapy. Both groups had a greater five-year survival (P less than 0.05) than those treated with radiation. Recurrences in Stage I were more frequent with primary radiation alone, both locally and at distant sites (P less than 0.01). Greater tumor size was related to poorer survival, and failures in patients with larger lesions were more common in those treated with radiation therapy. Survival for the 32 Stage II patients was greater for those treated with combination therapy. Higher tumor grade was associated with poorer survival for each stage, regardless of treatment. More complications were associated with radiation therapy than with radical surgery. Radiation therapy alone is not sufficient for patients with Stage I and II disease, and radical surgery may be appropriate treatment for Stage I disease.
Adenocarcinoma↗
Radical vulvectomy and bilateral inguinal lymphadenectomy through separate groin incisions.
One hundred patients underwent radical vulvectomy and bilateral inguinal lymphadenectomy using separate groin incisions. Forty-nine had stage I disease, 37 stage II, and 14 stage III. Corrected actuarial 5-year survival for each stage was 97.4, 86, and 49.2%, respectively. Inguinal lymph nodes were positive in 25% of cases: 10.2% of stage I, 27% of stage II, and 71.4% of stage III cases. Major complications occurred in 21 patients, including major groin breakdown in 14. Thirty patients experienced no acute postoperative morbidity. The mean postoperative hospital stay was 19 days, and mean operative blood loss was 620 ml. No patients developed isolated metastases in either the groin or the inguinal skin bridge, but 2 stage III patients developed simultaneous metastases in the skin bridge and elsewhere. For appropriately selected patients, separate groin incisions for inguinal lymphadenectomy appear to result in lower morbidity than traditional methods, without compromising survival.
Adenocarcinoma↗
Postcoital posthysterectomy vaginal vault disruption with haemorrhagic shock.
Two cases of haemorrhagic shock secondary to partial disruption of the vaginal vault of sexual intercourse occurring 2 and 8 weeks after abdominal hysterectomy are presented. One patient required bilateral hypogastric, bilateral ovarian, and unilateral uterine artery ligation to control the bleeding, and is believed to be the first such case reported.
Adult↗
Blood pressure changes when uterine stimulants are used after normal delivery.
Use of an automatic sphygmomanometer showed that intravenous ergometrine given immediately after delivery caused significant elevation of diastolic blood pressure in all 10 normotensive women studied. Blood pressure was also raised in some patients following the use of intramuscular oxytocin and ergometrine (Syntometrine). Uterine stimulants for use after delivery must be chosen with care.
Blood Pressure↗
Spontaneous bowel haematoma with anticoagulant therapy.
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Anti-Bacterial Agents↗
Current management of epithelial ovarian carcinoma: a review.
Epithelial carcinoma of the ovary is the most lethal of gynaecological malignancies and it affects about one in 70 women in developed countries. Over 75% of women with the disease have tumour spread beyond the pelvis at the time of diagnosis, and their treatment requires the appropriate use of surgery and chemotherapy. The strategies used in the treatment of ovarian cancer are constantly evolving. An overview of current treatment regimens and their evolution is provided, with particular emphasis on the interdependence of surgery and chemotherapy in the optimal management of the disease.
Antineoplastic Combined Chemotherapy Protocols↗
Lymphatic ascites following lymphadenectomy for gynecological malignancy.
Seven patients seen between January 1995 and December 1998 developed symptomatic lymphatic ascites following either pelvic or para-aortic lymph node dissection. The incidence of symptomatic lymphatic ascites during this 4-year period was 2.7% (7 of 263 cases). The accumulation of ascites postoperatively was associated with a prolonged postoperative ileus, abdominal pain, and extended postoperative hospitalization. Once the condition was recognized, abdominal paracentesis resulted in rapid improvement of symptoms in two patients but repeated paracenteses were required for a further two patients who had significant complications as a result of these procedures. Two patients improved following spontaneous drainage of a large amount of ascites per vagina and did not require further intervention. The final patient settled with observation only. This condition can be difficult to recognize and is a potential cause of significant postoperative morbidity.
Ascites↗
Sexual functioning in patients following radical hysterectomy for stage IB cancer of the cervix.
Despite extensive research on sexual dysfunction after gynecological cancer, uncertainty remains regarding the nature and extent of sexual problems following surgery for early cervical cancer. This study investigated whether radical hysterectomy for stage IB cancer of the cervix without adjuvant treatment entails short- or long-term sexual difficulties. Twenty patients with stage IB cervical cancer undergoing radical hysterectomy (CG), 18 women treated with hysterectomy for a benign gynecological condition (BG), and 20 gynecologically healthy women (HG) were studied. At 0, 4, and 8 months postoperatively, data were prospectively gathered using standardized questionnaires and specifically developed scales. Sexual functioning was covered in 15 specifically designed items and analyzed using Fisher's exact tests. For all other variables, group comparisons were computed using analysis of variance (ANOVA) or nonparametric statistical equivalents. Nonsignificant trends, consistent across time and groups, resulted for most of the sexual variables. Preoperatively, cancer patients exhibited slightly better sexual functioning than the other two groups, but over time this decreased slightly. Conversely, sexual functioning among the patients with benign disease showed steady improvement. These results indicate that radical hysterectomy for stage IB cervical cancer does not entail major sexual sequelae. Because of the limited sample size of our study, conclusions must be drawn cautiously.
Adult↗
Malignant perivascular epithelioid cell tumor (PEComa) arising in the broad ligament.
Malignant perivascular epithelioid cell tumor (PEComa) is an extremely rare mesenchymal neoplasm mostly composed of HMB-45-positive epithelioid cells with clear-to-eosinophilic cytoplasm, a propensity for perivascular distribution and a coexpression of smooth muscle markers. The uterus seems to be one of the most prevalent sites of involvement, although only 14 cases of uterine PEComa have been described. We report the case of a 51-year-old woman with a PEComa arising in the broad ligament. She was treated with total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and pelvic radiation, and remains without evidence of disease 15 months after diagnosis. This is, to the best of our knowledge, the first report of a malignant PEComa arising in the broad ligament. To correctly diagnose PEComa, an extensive immunohistochemical panel is essential. As PEComas can behave in an aggressive manner, careful follow-up is warranted.
Broad Ligament↗