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Biomedical subjects

R A Lee

Publications and source records attributed to R A Lee.

At least 19 recordsLinked to original sources
PubMed1990

Anatomy of anal sphincters and related structures in continent women studied with magnetic resonance imaging.

Five anally continent nulliparas of reproductive age were studied with magnetic resonance imaging. The internal and external anal sphincters could be easily delineated, as could the intervening longitudinal musculature, puborectalis muscle, anococcygeal raphe, anorectal lumen, vagina, uterus, bladder, urethra, coccyx, and pubis. The shape of the sphincters was nearly cylindrical, with an anterior component averaging 18.3 mm thick and 28.0 mm long. Fifty-four percent of this anterior thickness was attributable to the internal sphincter. The anorectal angle varied considerably, with a mean of 86.8 +/- 19.1 degrees (range 60-112). The angle between the portion of the rectal lumen supported by the anococcygeal raphe, or levator plate, and the plane of the puborectalis muscle was consistent at 149.0 +/- 6.3 degrees (138-154). The finding of anterior anal sphincters with substantial thickness and length contrasts markedly with a view often pictured in the literature of a female anal sphincter that narrows anteriorly to half its posterior length and forms a small bundle of muscle rather than a broad band. Knowledge of these relationships is important in primary repair of obstetric sphincter lacerations as well as in surgical correction of anal incontinence.

Adult↗
PubMed1989

McIndoe procedure for vaginal agenesis: results and complications.

During the 10-year interval from 1976 through 1985, 50 patients with congenital absence of the vagina underwent McIndoe vaginoplasty at our institution. The medical records of these patients were retrospectively reviewed, and additional information was obtained through a survey of the patients. The mean duration of follow-up was 6.5 years. Two rectovaginal fistulas and one graft failure were among the complications that occurred. Five patients required additional reconstructive vaginal operations. Operative vaginoplasty was considered functionally successful by 40 of the 47 patients (85%) who responded to the survey, yet only 36 of these 40 (90%) had remained coitally active by the time of the survey. Recognizing the potential for complications, the need for long-term follow-up and care of the neovagina, and the less-than-perfect results achieved, we continue to consider the McIndoe operation as the procedure of choice for most patients with vaginal agenesis.

Adolescent↗
PubMed1988

Recurrent disease after negative second-look laparotomy in stages III and IV ovarian carcinoma.

Between 1977 and 1984, second-look laparotomy to evaluate disease status after adjuvant chemotherapy was performed in 134 patients originally presenting with advanced epithelial ovarian carcinoma. Surgical and histologic assessment did not detect persistent disease in 50 patients (37%). Recurrent carcinoma was subsequently documented in 15 patients (30%), all failures occurring within the abdominal cavity or the retroperitoneal space. Several patient subgroups at high risk for recurrence after negative second-look laparotomy are identified that might benefit from additional adjunctive therapy. Because of different treatment-associated morbidities, the corresponding sensitivities and specificities of the high-risk groups may assist subsequent treatment selection.

Adult↗
PubMed1988

Current status of genitourinary fistula.

From 1970-1985, 303 women with genitourinary fistulas were seen at the Mayo Clinic. The fistula formed after treatment for benign conditions in 74% of the patients and malignant conditions in 14%; in 12%, we were unable to establish the nature of the condition. Gynecologic surgery was responsible for 82% of the fistulas, obstetric procedures for 8%, various forms of irradiation for 6%, and trauma or fulguration for 4%. In the nonirradiated patient, the ideal time for operative repair was eight to 12 weeks after fistula formation or failed repair. With ureterovaginal fistulas, the patient's general condition and the degree of obstruction of the ureter influenced the time and method of repair. We used a vaginal approach for urethral fistulas and an abdominal one for ureteral repairs. Because of difficulty with adequate exposure and the proximity of the ureter, an abdominal approach was used in 20% of the patients with vesicovaginal fistulas; the remaining 80% were approached vaginally, regardless of size, number, or history of previous repairs. Ninety-two percent of the urethrovaginal fistulas were corrected on the first attempt; the four failures were managed successfully at the second attempt. Ninety-eight percent of the vesicovaginal fistulas were corrected on the first attempt when approached vaginally, and all were managed successfully when approached abdominally, regardless of the number, size, or previous operative attempts.

Female↗
PubMed1988

Endometriosis of the sciatic nerve: a report of two cases and a review of the literature.

Endometriosis of the sciatic nerve is rare but must be included in the differential diagnosis of sciatic pain. Patients present with typical signs and symptoms of sciatica, which are cyclic in nature. Electromyography and computed tomographic scanning are useful in diagnosis. At laparoscopy or laparotomy, a characteristic "pocket sign" is frequently seen, and may be the only clue to the presence of endometriosis. The patient often requires definitive surgery with total abdominal hysterectomy and bilateral salpingo-oophorectomy. However, conservative surgery with excision of the endometriosis from the nerve can be successful in selected patients who wish to preserve reproductive function.

Adult↗
PubMed1988

Ovarian remnant syndrome: diagnostic dilemma and surgical challenge.

The ovarian remnant syndrome, an unusual complication of bilateral oophorectomy, usually presents with pelvic pain with or without a mass. From 1980-1985, 31 patients were seen with this diagnosis, which was confirmed by excision of ovarian tissue. Various adhesion-producing conditions leading to retention of ovarian tissue, such as endometriosis, pelvic inflammatory disease, or inflammatory bowel disease, were present at the original procedure. The increase in diagnosis of this condition during the past five years may represent a greater awareness of the potential condition, combined with wider use of ultrasonography and computed tomography scanning. Twenty of the 31 patients were found to have a tender palpable mass of thickening. In 11 patients, a mass was found only on ultrasonography. Surgical correction required dissection and mobilization of the ureter throughout its entire pelvic course to facilitate resection of the specimen. The complications were minor, and symptoms were relieved.

Adult↗
PubMed1988

Presacral tumors in the female: clinical presentation, surgical management, and results.

A relatively infrequent and heterogeneous group of tumors with similar clinical presentation may arise in the presacral space. From 1965-1980, 70 female patients with primary presacral tumors underwent surgical management at the Mayo Clinic. Twenty-three percent had no symptoms, and their tumors were found on routine pelvic examination. Most of the symptoms resulted from compression or obstruction of adjacent organs or from pressure on pelvic nerves or bone. A palpable tumor was found in 65 (93%) of the patients. Computed tomography scan has proved valuable in determining the extent and degree of tumor invasion. The abdominal approach was selected in 39 (56%), transsacral in 20 (28%), abdominal/perineal in six (9%), and transperineal in five (7%). Complications occurred in 22 patients (31%). However, there were no operative deaths. Seventy percent of the tumors were benign, and 30% were malignant. The prognosis for patients with benign tumors was excellent and their symptoms were relieved. All 21 patients with malignant tumors died between three months and four years after surgery. Survival was not prolonged by the use of radiation or chemotherapy.

Adolescent↗
PubMed1987

Sequential torsion of the uterine adnexa.

Sequential bilateral torsion of the uterine adnexa in a young girl led to right and, subsequently, left salpingo-oophorectomy. Acute lower abdominal pain in a young female patient, especially one who has had previous similar episodes, should alert the physician to the possible presence of adnexal torsion. If possible, surgical management of this condition should be conservative--that is, the blood supply should be restored to the adnexa and a viable tube or ovary should be preserved. Contralateral adnexal suspension should always be done, in an effort to prevent bilateral adnexal torsion and to preserve the reproductive potential in these young patients.

Abdomen↗
PubMed1987

Ovarian dysgerminoma: a retrospective analysis of results of treatment, sites of treatment failure, and radiosensitivity.

Thirty-five patients with a diagnosis of pure ovarian dysgerminoma underwent assessment at our institution between 1950 and 1984. The median age of these patients was 21 years (range, 8 to 41 years). The surgical pathologic stages of the tumors were as follows: stage IA1 in 18 patients, stage IA2 in 2, stage IB1 in 2, stage IC in 1, stage IIB in 2, stage III in 9, and stage IV in 1. The overall survival at 5, 10, and 20 years was 94.3%, 82.9%, and 82.9%, respectively, for all 35 patients and 100%, 83.9%, and 83.9%, respectively, for the 18 patients with stage IA1 lesions. The maximum interval from diagnosis to relapse was 3.7 years. All patients were under surveillance for a minimum of 2 years (median follow-up, 15.9 years). Of the 18 patients with stage IA1 disease, 16 did not receive prophylactic radiation therapy to the para-aortic lymph nodes, and in 6 of the 16 (38%) recurrent disease developed in this region. Five of these patients were salvaged with radiation therapy and one with radiation therapy and subsequent chemotherapy. No definite correlation was noted between the size or mass of the resected unilateral encapsulated tumor and the risk of development of recurrent disease. For patients with stage IA1 dysgerminoma who have undergone unilateral oophorectomy, two treatment options seem reasonable: (1) observation, with radiation therapy reserved for subsequent recurrence, or (2) prophylactic radiation therapy (2,000 cGy) to para-aortic and ipsilateral common iliac lymph nodes, which would preserve fertility.

Adolescent↗
PubMed1986

Urinary diversion with use of ileal and sigmoid conduits.

Two hundred eighteen patients underwent urinary diversion: 156 with ileal and 62 with sigmoid conduits. There were no significant differences between the two groups regarding frequency of conduit morbidity or patient survival. The ileal conduit is preferred for urinary diversion with anterior exenteration, whereas the sigmoid conduit is preferable for urinary diversion with total exenteration.

Adolescent↗
PubMed1979

Surgical complications and results of modified Marshall-Marchetti-Krantz procedure for urinary incontinence.

At the Mayo Clinic from January 1960 through December 1975, 673 patients underwent a modification of the Marshall-Marchetti-Krantz operation as a primary or secondary procedure for recurrent stress incontinence. There were 96 patients (14%) lost to follow-up, and 28 patients have died; 549 patients have been followed for 2-16 years. Of the 549 patients, 227 underwent the procedure as a primary operative effort; 91% of these were cured or much improved from socially disabling stress urinary incontinence, 7% were unchanged, and 2% became worse. There were 322 patients who underwent surgery for persistent or recurrent stress incontinence. This group had had a total of 740 previous unsuccessful operations (an average of 2.3 per patient) specifically for stress incontinence; 90% of these patients were cured or much improved, 5.3% were unchanged, and 4.7% became worse. The Marshall-Marchetti-Krantz operation is an effective and safe procedure associated with minimal morbidity and no mortality.

Follow-Up Studies↗
PubMed1977

An evaluation of early or delayed adjuvant chemotherapy in premenopausal patients with advanced breast cancer undergoing oophorectomy.

We treated randomly 75 premenopausal patients with advanced breast cancer with combination chemotherapy (5-fluorouracil, cyclophosphamide and prednisone), either as an early adjunct to oophorectomy or as a delayed treatment upon appearance of progressive metastatic disease after operation. The group receiving early systemic chemotherapy enjoyed an improved response rate, an improved survival rate and, most importantly, an improved progression-free interval (median of 53 versus 17 weeks). With the exclusion of the group with early (within three weeks after oophorectomy) progression, the progression-free intervals had a median duration of 77 weeks in the early-treatment group versus 33 weeks in the control group. The early-progression group did exceedingly poorly, although systemic chemotherapy was employed at that juncture, having a median survival of 22 weeks as compared to 144 weeks in the immediate-treatment group and 105 weeks in the control group.

Adult↗