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Biomedical subjects

R A Lee

Publications and source records attributed to R A Lee.

At least 55 records · Page 3Linked to original sources
PubMed1982

Factitious illness in gynecology.

Factitious or self-induced illness has rarely been mentioned in gynecologic literature. Described herein are 4 nonpregnant women, 3 of whom had vaginal bleeding of unknown origin and 1 who had recurrent fevers and an acute abdomen. In gynecologic practice, factitious illness should be suspected whenever a patient presents with a protracted illness that has eluded diagnosis. Furthermore, the index of suspicion for factitious illness should be high whenever a patient has an abnormal psychiatric history or has worked in a paramedical field.

Abdomen, Acute↗
PubMed1982

Multilocular cysts of the peritoneum.

Multilocular cysts of the peritoneum diagnosed at the Mayo Clinic from 1907 through 1981 were examined and divided, on the basis of their light microscopic features, into two groups--cystic mesotheliomas and cystic lymphangiomas. There are apparent clinical differences between the two groups. Cystic mesotheliomas tend to occur in adult females and often recur. Cystic lymphangiomas occur most often in males, often develop in children, and rarely recur, if at all. The distinguishing histologic features are the cytologic characteristics of the cells lining the cysts and the presence or absence of smooth muscle in the wall of the cysts.

Adolescent↗
PubMed1981

Posthysterectomy enterocele and vaginal vault prolapse.

Of 421 patients with posthysterectomy enterocele and vault prolapse, 190 cases are reported for the first time. These 190 patients had 197 operations, 90% were vaginal procedures and 10% were abdominal-presacral suspension procedures; 88% of the operations provided good vaginal support and a satisfactory result. A vaginal repair is advocated for this condition because it provides an excellent result with minimal exposure of the frequently elderly patient to serious risk or disability. An abdominal-presacral suspension is advised only for those patients who are anxious to preserve vaginal function, in whom there is an inversion of an already much-operated-on, snug vagina.

Adult↗
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↗
PubMed1976

Recurrent stress incontinence of urine: preoperative assessment and surgical management.

Surgical correction of stress incontinence in the female remains a complex and distressing problem. Just as there is no single etiologic factor present in all patients with stress incontinence, so ther is no single uniformly corrective operative procedure, as attested by the continued reports of new operative techniques or malfunctions of old procedures. Every therapeutic effort for stress incontinence, whether by means of medication, exercise, plication, suspension, sling, or some combination of these, effectively increases urethral resistance by tightening the musculofasical planes and supporting the urethra. Regrettably, none of these methods can be 100% effective. The patient who does not have good urethral smooth muscle, qualitatively and quantitatively, will remain incontinent. Regardless of its length, caliber, angle, or axis, a fixed, fibrotic, noncontractile urethra will not provide urinary control. I prefer to use the Marshall-Marchetti-Krantz procedure in patients who had previous operatons and have persistent or recurrent incontinence.

Female↗
PubMed1976

Recurrent carcinoma in situ of the vagina in patients previously treated for in situ carcinoma of the cervix.

Sixty-six patients were seen at the Mayo Clinic from 1950 through 1974 with in situ carcinoma of the vagina following various forms of treatment for a similar lesion of the cervix. Sixty-three patients have remained free of recurrent disease. One patient has been lost to followup, 1 patient required a second local excision, and 1 patient had recurrent carcinoma that progressed to invasive vaginal malignant disease. The recurrent malignant disease was usually asymptomatic; its presence was suggested by an abnormal Papanicolaou smear and confirmed by Schiller stain or colposcopically directed biopsy. Colposcopic examination of the vagina has greatly facilitated delineation of the lesion; this may allow relatively simple definitive therapy in some instances--that is, local excision or partial vaginectomy. Total vaginectomy, with or without skin graft vaginal reconstruction, must be carried out in patients who have multicentric lesions. The use of vaginal radium or external beam therapy should be limited to the elderly patients or those to whom a functional vagina is unimportant.

Adult↗
PubMed1975

Ovarian surgery in pregnancy.

A series of 57 cases of ovarian disease during pregnancy is presented; 10 of the patients were referred to the Mayo Clinic for treatment. During the 17 year period under investigation (1955 through 1971), there were 25,189 deliveries in Rochester, Minnesota. Thus, the corrected incidence of operable ovarian disease in pregnancy was one case in every 536 deliveries. Simple ovarian cysts were the most common lesions found (38 of 57 cases). The over-all abortion rate was about 25 per cent (14 of 57 patients); six of the patients were threatening to abort prior to surgery. Therefore, the incidence of spontaneous abortion after surgery was 16 per cent (eight of 51 patients). Progestational agents given before and after operation did not affect the abortion rate.

Abortion, Spontaneous↗
PubMed1975

Repeat Marshall-Marchetti procedure for recurrent stress urinary incontinence.

Thirty-six patients with recurrent stress incontinence had undergone a total of 109 previous procedures, at least one of which had been a Marshall-Marchetti-Krantz (MMK) operation. At the time of operative dissection, it was apparent that most of these patients had had an "alleged" MMK operation with no evidence of adhesion or scarring in the periurethral and vesical neck regions. With the transvesical approach, accurate assessment of the tone and quality of the bladder neck and the proximal urethra is possible. This approach also provides an opportunity to "see and feel" the effect of the properly placed periurethral and suspending suture. Thirty-two of 36 patients are continent after repeated suspension augmented by plication and bladder revision

Evaluation Studies as Topic↗
PubMed1975

Prophylactic use of hydroxyprogesterone caproate in abdominal surgery during pregnancy. A retrospective evaluation.

Abdominal surgery (unrelated to delivery) during pregnancy is not common. Review of a recent 17-year experience at our institution revealed 112 surgical procedures among 25,189 deliveries--an incidence of 0.44% (1 case for every 225 deliveries). Progestational agents have been used prophylactically in such procedures, but few studies have adequately assessed the effectiveness of these drugs to prevent onset of premature labor. The present study involved 35 gravid patients who had been treated with various doses of hydroxyprogesterone caproate before and after operations unrelated to delivery. These 35 patients were matched with 35 gravid control patients who had undergone similar operations but who had not received progestational compounds. Analysis revealed no significant difference in the abortion rate between these two groups.

Abortion, Spontaneous↗
PubMed1975

Cholecystectomy in pregnancy.

During the 17 years 1955 through 1971, 20 gravid patients underwent cholecystectomy. This represented 1 case for every 1259 deliveries (0.079% of 25,189 deliveries). The primary indication for surgery was repeated attacks of gallbladder colic. Generally, surgery was performed between the 10th and the 20th week of gestation. There was one spontaneous abortion; this occurred at 10 weeks of gestation, 42 days after surgery.

Abortion, Spontaneous↗