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Biomedical subjects

R C Park

Publications and source records attributed to R C Park.

At least 55 records · Page 3Linked to original sources
PubMed1984

The second-look surgical reassessment for epithelial ovarian carcinoma.

The second-look surgical reassessment is currently being performed on most patients with epithelial ovarian carcinoma after first-line chemotherapy if they are clinically free of disease. Ninety-six patients who underwent such procedures at Walter Reed Army Medical Center and the Naval Hospital, Bethesda, from January 1974 through May 1982 are reviewed. The grade of tumor, stage of disease, and amount of residual tumor remaining after initial surgery are predictive of the findings of the surgical reassessment. While a surgical reassessment is beneficial in evaluating response to therapeutic modalities under protocol investigation, its use should be individualized.

Carcinoma↗
PubMed1984

Repair of urinary tract fistulas with bulbocavernosus myocutaneous flaps.

Urinary tract fistulas resulting from severe trauma or pelvic irradiation are often associated with extensive tissue loss, scar formation, and fibrosis. Two cases, one with a urethro-vaginal fistula secondary to trauma and one with a vesico-vaginal fistula secondary to irradiation, are presented. In neither case could the bladder, urethra, or vagina be repaired primarily. Using a bulbocavernosus myocutaneous "island" flap, the fistulas were successfully repaired. The anatomy of the graft and the operative procedure are described. This new procedure should be considered in urinary tract fistulas in which there is extensive tissue loss and scarring.

Adult↗
PubMed1981

Cervical carcinoma in pregnancy.

Forty-one cases of invasive carcinoma of the cervix associated with pregnancy that were treated at the Walter Reed Army Medical Center from January 1961 through April 1979 were reviewed. Postpartum patients were included in the study if the diagnosis of cancer was made within 6 months of delivery. Three cases of clinical stage IA disease treated by Wertheim-Taussig hysterectomy had a 5-year survival rate of 100%. There were 22 cases of stage IB disease with a 5-year actuarial survival rate of 90%. Four patients with stage IB were treated by radiotherapy, 17 by Wertheim-Taussig hysterectomy, and 1 by a combination of pelvic irradiation, cesium application, and simple extrafascial total abdominal hysterectomy and bilateral salpingo-oophorectomy for a barrel-shaped cervix. Twelve cases of stage II disease treated by radiotherapy had a 5-year actuarial survival rate of 24%. There were no survivors in 2 cases of stages III and IV disease. The 5-year actuarial survival rate of patients with stage I carcinoma of the cervix associated with pregnancy is not statistically different from that of nonpregnant patients, regardless of the method of treatment.

Adult↗
PubMed1980

The role of adjuvant therapy in Stage I ovarian cancer.

Women with Stage I epithelial carcinoma of the ovary were initially treated by an extirpative operation and were subsequently randomized to either no further treatment, radiotherapy, or chemotherapy. Only two patients (6%) treated with chemotherapy developed recurrence, compared to five (17%) and seven (30%) patients in the no-treatment and radiotherapy regimens, respectively (P < 0.05). All patients, with the possible exception of those with Stage IA(1)g1, appeared to benefit from adjuvant chemotherapy compared to no treatment or radiotherapy.

Adenocarcinoma↗
PubMed1980

Treatment of women with disseminated or recurrent advanced ovarian cancer with melphalan alone in combination with 5-fluorouracil and dactinomycin or with the combination of cytoxan, 5-fluorouracil and dactinomycin.

The purpose of this study was to determine the efficacy of single and multiple drug chemotherapeutic regimens in the treatment of patients with advanced or recurrent, Stage III and IV, ovarian epithelial carcinoma. Patients were randomly assigned to one of four treatment regimens postoperatively, or at the time of recurrence: Regimen I--Melphalan (MEL) 0.2 mg/kg/day for five days every four weeks; regimen II--MEL as in Regimen I plus 5-fluorouracil (FU) 15 mg/kg/day for five days every four weeks; regimen III--MEL and FU as in regimen II plus dactinomycin (AC) 0.5 mg daily for five days every four weeks; and regimen IV--Cytoxan (CY) 7 mg/kg/day, FU 8 mg/kg/day and AC 0.5 mg/day for five days every four weeks. Four hundred and twenty-seven patients were in the study, 314 of whom are evaluable for progression-free interval (PFI), survival, and toxicity: 102 in regimen I, 80 in regimen II, 83 in regimen III, and 49 in regimen IV. Of these, 293 were considered evaluable for response. Because of excessive toxicity, entry of patients to regimen IV was discontinued midway through the study. The overall toxicity was quite high but was most severe in regimen II and IV where 16 toxicity deaths were recorded. The complete and partial response rate with Melphalan alone was 29.2%. This response rate was not enhanced by the addition of FU or FU and AC and not substantially different than the response rate of AC, FU, and CY.

Cyclophosphamide↗
PubMed1980

Antibiotic prophylaxis in vaginal hysterectomy: a review.

Recent experimental studies in laboratory animals have elucidated the pathogenesis of operative site infections and have defined the mechanism by which prophylactic antibiotics enhance host defenses against infection. On the basis of these experimental observations, several investigators have conducted well-designed studies to evaluate the effectiveness of prophylactic antibiotics in reducing the risk of infection associated with vaginal hysterectomy. Without exception, these studies have demonstrated a dramatic decrease in the incidence of pelvic infections when antimicrobial agents are administered for a limited time in the perioperative period. To date, short courses of prophylactic antibiotics have not been shown to create selective pressures for the emergence of drug-resistant organisms or to lead to the development of more serious superinfections.

Animals↗
PubMed1978

Treatment of malignant ovarian germ cell tumors: response to vincristine, dactinomycin, and cyclophosphamide (preliminary report).

From November 1971 to November 1975, 27 patients with malignant germ cell tumors of the ovary (excluding pure dysgerminoma and tumors containing trophoblastic elements) were treated with vincristine, dactinomycin, and cyclophosphamide; 12 patients received other therapy. Fourteen tumors were pure endodermal sinus tumors, two were embryonal carcinomas, 11 were mixed germ cell tumors and 12 were immature teratomas. Of 23 patients with surgically resected disease (Stages I-IIA) only seven have failed. Median follow-up for 16 patients remaining free of disease is 24.5 months. Restaging (second-look) laparotomies were done in 15 patients. Eight were negative. Fifteen of the patients had tumors with endodermal sinus elements. Six of these have failed. Of 16 patients with advanced disease (Stage IIB, III and recurrent), eight have responded to chemotherapy, eight have failed. Median follow-up period for those remaining free of disease is 26.5 months. Six have had negative second-look surgery and one had mature teratoma. Four of eight cases which contained endodermal sinus elements responded to chemotherapy and remain disease-free. Grade 3 hematologic toxicity was seen in eight patients, dose-limiting gastrointestinal toxicity in five patients, dose-limiting neurotoxicity in five patients.

Adolescent↗
PubMed1976

Microinvasive carcinoma of the cervix.

The clinical and pathologic features of 51 cases of microinvasive carcinoma of the cervix treated by radical hysterectomy and pelvic lymphadenectomy are presented. Microinvasion was defined as stromal penetration by carcinoma not exceeding a depth of 5 mm from the surface at the point of origin. Patients with confluent patterns and lymphatic invasion were not excluded. Lymphatic invasion was demonstrated in 24% of the patients, but none of the resected lymph nodes from the entire series contained metastatic tumor. Residual invasive disease was present in 9 of 47 patients who underwent conization including 1 in which the residual tumor invaded to 8 mm, although the depth of invasion in the cone biopsy was only 2.5 mm. Factors related to the presence of residual invasive disease included the pattern and extent of invasion and involvement of the cone margin. There were no surgery-related deaths or fistulae in this series; the actuarial survival rate at 5 years was 100%. Simple hysterectomy seems justified if the cone margin is free of tumor since none of these patients has residual disease. In contrast, radical hysterectomy may be indicated if the cone margins are involved in view of high frequency of residual tumor (39%) and the possibility of invasion in the cervix exceeding 5 mm.

Adult↗
PubMed1975

Prospects for para-aortic irradiation in treatment of cancer of the cervix.

The incidence of para-aortic node metastasis in cancer of the cervix ranges from 5%to 50% in clinical Stages i-iv. Extended field irradiation is being administered more frequently because of high incidence of extrapelvic disease. The cancer of the cervix material at Walter Reed General Hospital has been analyzed as to site and time of failure to determine who might have benefited from extended field irradiation. Of patients who fail, the majority will have uncontrolled pelvic disease regardless of other involvement. Diagnostic procedures including staging laparotomy are unable to predict pelvic failure or the presence of occult distant disease in lung and bone. The maximum number of patients who could benefit from pari-aortic irradiation is lessthan 3% of a total series. It is concluded that the salvage of patients with para-aortic metastasis will be small, but for those few long-term survivors, the benefit will be great.

Adult↗
PubMed1975

Diagnostic outpatient aspiration curettage.

Outpatient uterine curettage has proved to be an effective diagnostic tool and could replace the need for many hospital curettages. The materials needed to perform an outpatient curettage are described. The method was evaluated on 300 patients who underwent conventional hospital curettage under anesthesia 24 hours after the outpatient curettage. The outpatient curettage was evaluated for safety, reliability, economy, effectiveness, and patient acceptance. The results of the two methods compared favorably.

Adult↗