Search PubMed⌕ Search

Biomedical subjects

N Kadar

Publications and source records attributed to N Kadar.

At least 55 records · Page 3Linked to original sources
PubMed1992

Selective pelvic and periaortic lymphadenectomy does not increase morbidity in surgical staging of endometrial carcinoma.

OBJECTIVE: The objective of this study was to retrospectively assess whether there was increased morbidity associated with the addition of selective pelvic and periaortic lymphadenectomy to hysterectomy in patients with endometrial carcinoma. STUDY DESIGN: From 1977 through 1988, 196 patients undergoing selective pelvic and periaortic lymphadenectomy plus hysterectomy were compared with 104 patients who underwent hysterectomy alone for endometrial adenocarcinoma. RESULTS: Only after adjusting for covariates was selective pelvic and periaortic lymphadenectomy associated with a higher estimated blood loss, which increased linearly with weight and was higher for black than for white women. The transfusion rate was similar for the two groups (selective pelvic and periaortic lymphadenectomy 6%, hysterectomy 10%). The mean blood loss was significantly different among the four gynecologic oncology surgeons (range 343 to 652 ml). The operating time primarily depended on patient weight and race, surgeon, and estimated blood loss. Postoperative hospital stay increased significantly with age, surgeon, wound infections, thrombotic events, and serious complications. Selective pelvic and periaortic lymphadenectomy had no effect on wound infections, which were directly related to operating time. Seventy-five (38%) of the selective pelvic and periaortic lymphadenectomy group and 19 (18%) of the hysterectomy group (p < 0.01) received whole-pelvic radiation with no difference in bowel complications (selective pelvic and periaortic lymphadenectomy 2/75, hysterectomy 1/19). The risk of serious complications was associated only with increasing age. CONCLUSION: Selective pelvic and periaortic lymphadenectomy in patients with endometrial carcinoma does not significantly add to morbidity from hysterectomy, which is related primarily to other factors such as patient weight, age, and race; operating time; and surgeon.

Adenocarcinoma↗
PubMed1992

Determinants of survival of surgically staged patients with endometrial carcinoma histologically confined to the uterus: implications for therapy.

OBJECTIVE: To determine the factors that influence the survival of patients with endometrial carcinoma histologically confined to the uterus. METHODS: Retrospective analysis was conducted of 262 surgically staged cases using multiple regression (Cox proportional hazards model). RESULTS: After excluding patients with clear-cell and serous tumors, which were adverse prognostic factors unrelated to any other variables, we found that survival was adversely affected by increasing stage, tumor grade and depth of myometrial invasion, cervical stromal and vascular space invasion by tumor, and increasing age. Tumor grade, myometrial invasion, and cervical involvement by tumor exerted their effects on survival as dichotomous rather than as ordinal variables. The greatest effect on survival was obtained by dichotomizing grade as grade 3 versus grade 1 or 2, myometrial invasion as invasion of more versus less than the inner third of the myometrium, and cervical spread as the presence versus absence of stromal invasion. The joint effect of the tumor-related prognostic factors was best expressed by constructing three risk groups consisting of patients with zero or one, two, and three or four risk factors. These risk groups were associated with 5-year survival rates of 97, 66, and 17%, respectively. After adjustment for risk factors, pelvic radiation did not affect survival significantly, although there was a trend toward improved survival of subjects with two risk factors who received pelvic radiation (70 versus 50% survival at 5 years). CONCLUSIONS: The number of tumor-related risk factors present is the best predictor of survival of patients with endometrial carcinoma confined to the uterus, and may provide the optimal basis for individualization of treatment.

Endometrial Neoplasms↗
PubMed1990

Further observations on the doubling time of human chorionic gonadotropin in early asymptomatic pregnancies.

The doubling time (DT) of human chorionic gonadotropin (hCG) in serum was investigated retrospectively using serial serum hCG values that had been obtained from asymptomatic pregnant women with a prior history of infertility. The DT of hCG did not increase significantly as pregnancy advanced during the period in gestation when the serum hCG concentration was less than 10,000 mIU/mL (International Reference Preparation). Serum hCG concentrations increased subnormally in 2 of 60 women with normal intrauterine pregnancies, 5 of 8 women with asymptomatic ectopic pregnancies (EPs), and in 2 of 8 asymptomatic women who subsequently aborted their pregnancies. Neither the sensitivity nor the specificity of serial hCG testing for EP was enhanced by adopting different test criteria at different serum hCG concentrations.

Chorionic Gonadotropin↗
PubMed1990

Early recourse to laparoscopy in the management of suspected ectopic pregnancy. Accuracy and morbidity.

Ninety-nine patients with suspected ectopic pregnancy (EP) who were subjected to laparoscopy/laparotomy over an 18-month period at Greenwich District Hospital, London, were audited. A third (32/99) of the cases had an EP, and 67 potentially avoidable laparoscopies were performed. A potentially avoidable laparoscopy was followed by a laparotomy in 27% of cases (18/67), and at least 13 of those laparotomies were unnecessary. In addition, two false-positive diagnoses of EP were made at laparoscopy, resulting in the avoidable loss of part or all of a single remaining fallopian tube. With the use of sensitive pregnancy testing at least 62 laparoscopies, 13 laparotomies and 1 case of pulmonary embolus might have been avoided in these patients and up to 195 days' hospitalization saved.

Female↗
PubMed1990

The influence of nipple stimulation at term on the duration of pregnancy.

The influence of nipple stimulation (NS) at term on the duration of pregnancy was investigated among low-risk gravidas in a randomized prospective study. A significant inverse relationship was found between the duration of pregnancy and both gestational age at recruitment and cervical (Bishop) score, although the influence of cervical score was quantitatively small. Nipple stimulation did not influence either the duration of pregnancy or the probability of having a cesarean section or an instrumental delivery. Patient compliance was, however, poor, which may in part account for these findings, as there was an inverse trend between the daily average duration of NS and the duration of pregnancy.

Adult↗
PubMed1988

The value of adnexal sonographic findings in the diagnosis of ectopic pregnancy.

A prospective study of 383 patients with suspected ectopic pregnancy was carried out at Yale-New Haven Hospital to determine the value of adnexal sonographic findings in the diagnosis of ectopic pregnancy. In patients with adnexal sonographic results and human chorionic gonadotropin titers less than 6000 mIU/ml (n = 220), the presence of a noncystic mass had a positive predictive value of 83%, and the presence of a cystic mass had a positive predictive value of 35%. The combination of a noncystic mass and fluid in the cul-de-sac (found in 22% of all patients with ectopic gestations) was the best predictor of an ectopic pregnancy with a 94% positive predictive value. It is suggested that the demonstration of a non-cystic mass, alone or in the presence of fluid in the cul-de-sac, be used as an indication for diagnostic laparoscopy.

Abortion, Spontaneous↗
PubMed1988

Further observations on serial human chorionic gonadotropin patterns in ectopic pregnancies and spontaneous abortions.

The half-life of hCG was measured retrospectively in paired blood samples from 108 pregnancies with falling hCG levels. hCG levels fell significantly more slowly in women who had an ectopic pregnancy (41 cases) than in women who had spontaneous abortions (67 cases). When the hCG half-life was greater than or equal to 7 days, 86% of cases had ectopic pregnancies, a third of which had ruptured. By contrast, when the hCG half-life was less than 1.4 days, only 7.6% (2/26) of cases had an ectopic pregnancy (both of which were unruptured), and villi were identified in only 10% of curettage specimens from (presumed) cases of spontaneous abortion. When the half-life of hCG was between 1.4 and 6.9 days, 34% of the cases had ectopic pregnancies, 14% of which had ruptured: chorionic villi were recovered from 76% of the women who had a curettage, and failure to detect villi was more than 80% predictive of an ectopic pregnancy.

Abortion, Spontaneous↗
PubMed1988

The value of bladder filling in the clinical detection of urine loss and selection of patients for urodynamic testing.

Bladder filling was used to enhance the clinical detection of urine loss in 37 women who attended a general gynaecological outpatient clinic with lower urinary tract symptoms and incontinence. Videocystourethrography was performed subsequently in all women, and the clinical and fluoroscopic detection of urine loss compared. The two methods of detecting urine loss agreed in all but four women with very slight genuine stress urinary incontinence, two being detected by one but not by the other of the two tests. In only 5 of 25 patients was incontinence demonstrable clinically without bladder filling, and in only 13 of 25 was it demonstrable in the supine position. These proportions were 5 of 21 and 10 of 21, respectively, for those with genuine stress incontinence, with or without coexistent detrusor instability. Bladder filling provoked uncontrollable voiding in five women, two had detrusor instability on cystometry, and two had low peak urinary flow rates on uroflowmetry. The significance of these findings is discussed in the context of selecting patients for urodynamic testing.

Adult↗
PubMed1987

Proliferative index in breast carcinoma determined in situ by Ki67 immunostaining and its relationship to clinical and pathological variables.

Sixty cases of primary breast carcinoma have been studied using a monoclonal antibody, Ki67, which recognizes an antigen expressed by cells in G1, S, G2, and M phases of the cell cycle but not Go. A Ki67 score (positive cells/total tumour cells) was determined, and possible relationships between this index of cellular proliferation and a number of clinical and pathological parameters were investigated. There was a strong positive correlation between the Ki67 score and mitotic index (p less than 0.001), a weak negative correlation with age (p less than 0.02), and weak positive correlations with histological tumour grade (p less than 0.03), tumour necrosis (p less than 0.01), and cellular reaction (p less than 0.01). No relationship was noted between the Ki67 score and tumour size, nodal status, tumour oestrogen receptor levels, or menopausal status. The Ki67 score may prove to be an objective indicator of biological behaviour and thus be of clinical significance, particularly since it is not strongly related to other clinical and pathological parameters used in predicting outcome in breast carcinoma.

Adult↗