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Biomedical subjects

R E Hempling

Publications and source records attributed to R E Hempling.

At least 55 records · Page 3Linked to original sources
PubMed1993

Survival in patients with paraaortic lymph node metastases from endometrial adenocarcinoma clinically limited to the uterus.

PURPOSE: The purpose of this study was (a) to evaluate the incidence of paraaortic lymph node metastasis from adenocarcinoma of the endometrium clinically limited to the uterus (1971 FIGO Stages I and II) and (b) to report the 5 year disease-free survival of patients with histologically documented paraaortic lymph node metastasis from endometrial adenocarcinoma clinically limited to the uterus treated on two separate protocols. METHODS AND MATERIALS: From June 1979 to June 1990, 109 patients underwent staging paraaortic lymphadenectomy or paraaortic lymph node biopsy at the time of total abdominal hysterectomy and bilateral salpingo-oophorectomy for adenocarcinoma of the endometrium clinically limited to the uterus. Patients with histologically documented paraaortic lymph node metastasis were treated on two protocols: (a) pelvic radiation (5,040 cGy) plus progestins or (b) pelvic radiation therapy (5,040 cGy) plus paraaortic radiation (4,500 cGy). RESULTS: Paraaortic lymph node metastases was primarily associated with grade 3 tumors (34.4%) and deep myometrial invasion (42%) and was present in 17.4% (19) of 109 patients. None of the women treated with pelvic radiation therapy and progestins survived five years disease-free. In contrast, the 5 year disease-free survival was 27% for patients treated by pelvic and paraaortic radiation. CONCLUSIONS: Since all patients with macroscopic metastases to the paraaortic lymph nodes developed recurrent cancer and only a small percentage of those with microscopic metastases to the paraaortic lymph nodes survived disease-free at 5 years, improved survival for patients with paraaortic lymph node metastases will necessitate the addition of effective cytotoxic chemotherapy to pelvic and paraaortic radiation.

Adenocarcinoma↗
PubMed1993

A phase II study of weekly cisplatin followed by cisplatin and ifosfamide in advanced or recurrent cervical carcinoma.

BACKGROUND: Ifosfamide is an active agent in cisplatin-resistant cervical cancer. To determine the response rate of the combination of cisplatin and ifosfamide, a Phase II study was conducted of the administration of the combination after weekly cisplatin induction therapy. METHODS: Forty-seven patients with advanced or recurrent cervical carcinoma were treated with 1 mg/kg of cisplatin weekly for six courses, followed by 20 mg/m2 of cisplatin and 1.2 g/m2 of ifosfamide daily for 3 days every 28 days. RESULTS: Objective responses were seen in 11 of 40 (27.5%) assessable patients (complete response, 20%; partial response, 7.5%). The duration of response ranged from 3 months to 26+ months (median, 9+ months). All of the patients who responded to the cisplatin-ifosfamide combination initially responded to weekly cisplatin induction therapy. None of the four patients who had previously received chemotherapy responded. Grade 3 or 4 hematologic toxic effects occurred in 17 of 43 patients (39%). Neurologic and urologic toxic effects were infrequent. The current response rates are not better than the prior experience of the authors with other cisplatin combinations. CONCLUSIONS: These results do not confirm the favorable reports of other authors with cisplatin-ifosfamide regimens in cervical carcinoma. The results of ongoing Phase III studies comparing cisplatin-ifosfamide with cisplatin alone in cervical carcinoma are awaited.

Adult↗
PubMed1993

Predictive value of serum CA125 following optimal cytoreductive surgery during weekly cisplatin induction therapy for advanced ovarian cancer.

One hundred seventy-one patients with epithelial ovarian cancer were treated on a prospective protocol of weekly cisplatin induction (1 mg/kg weekly for four courses) followed by monthly cisplatin (50 mg/m2), Adriamycin (50 mg/m2), and cyclophosphamide (750 mg/m2). Seventy-five patients with FIGO stage III or IV disease who underwent optimal cytoreductive surgery (<2 cm residual disease) were treated on this protocol and had weekly as well as monthly serum CA125 levels measured. A retrospective analysis was performed in order to determine if a > or = 50% fall in elevated serum CA125 levels during weekly cisplatin induction therapy would be predictive of findings at second look operation, normalization of serum CA125 levels (< 35 u/ml) immediately prior to the third course of multiagent chemotherapy, and to determine the impact of such a decline on median progression-free interval. Positive predictive values for this parameter with respect to findings at second look operation ranged between 38% and 50% (P > 0.05). Positive predictive values for this parameter with respect to normalization of serum CA125 levels immediately prior to the third course of multiagent chemotherapy ranged between 64.2% and 89.6% (P > 0.05). Logistic regression analysis demonstrated that a > or = 50% fall observed in CA125 levels during four weekly courses of chemotherapy served as an independent predictor of normalization of serum CA125 levels (<35 u/ml) following two courses of multiagent chemotherapy (P = 0.009) and improved median progression-free interval (P = 0.04). Eighteen patients demonstrated a rise in serum CA125 levels during weekly induction cisplatin chemotherapy. Only one of these patients (5.5%) demonstrated a surgical complete response at the end of standard therapy.

Adult↗
PubMed1993

Vulvar carcinoma with 0.5 mm of invasion and associated inguinal lymph node metastasis.

A case of vulvar carcinoma with 0.5 mm of invasion treated by radical wide local excision only, which later developed ipsilateral inguinal lymph node recurrence, is presented. This represents the least amount of invasion reported resulting in inguinal lymph node metastasis. Review of the literature of stage I vulvar carcinoma with less than 1 mm of invasion indicates that this phenomenon occurs in only 1.6% of all patients who have undergone inguinal lymphadenectomy. Although this represents the second report of ipsilateral inguinal nodal metastasis associated with less than 1 mm of invasion, we continue to perform radical wide local excision without ipsilateral inguinal lymphadenectomy until more cases demonstrate a higher incidence of lymph node involvement.

Aged↗
PubMed1993

Intraoperative orthovoltage radiation therapy in the treatment of recurrent gynecologic malignancies.

A Phase I/II study was initiated to evaluate complications of orthovoltage intraoperative radiation therapy utilized in the treatment of patients with incompletely resected recurrent gynecologic malignancies. There were no osseous, vascular, neurologic, or ureteral complications. Of the 23 treated patients, 2 patients (8.7%) had complications outside the treated area. Survival of patients treated with intraoperative radiation therapy was highest among patients treated to a field of < or = 3 cm in greatest diameter and a tumor thickness of < or = 1 mm. A subgroup of patients (5) with microscopically positive margins following total pelvic exenteration demonstrated an absence of recurrence in the treated field. The role of intraoperative radiation therapy (IORT) in the treatment of recurrent and incompletely resectable gynecologic malignancies remains investigational.

Brachytherapy↗
PubMed1993

Response to Taxol chemotherapy in resistant ovarian carcinoma.

Taxol was administered to 25 patients with progressive ovarian cancer who had failed three or more lines of chemotherapy. A response rate of 27% was noted in 22 evaluable patients (5 partial responders; 1 complete responder). Median duration of response was only eight weeks. The impact of Taxol's use in this disease awaits the result of trials in which it is administered as first line therapy.

Adult↗
PubMed1993

The addition of etoposide and ifosfamide to cisplatin as second line therapy in ovarian carcinoma.

Forty-five patients with progressive or recurrent ovarian carcinoma received cisplatin, etoposide, and ifosfamide as salvage chemotherapy. The primary purpose of this trial was to evaluate if etoposide and ifosfamide added to cisplatin was effective second line therapy in the 20 patients with progressive or recurrent ovarian cancer after first line cisplatin-based chemotherapy. The overall response in the 20 patients was 20%, all of which were complete responses. However, responses were seen only in patients who had previously responded to first line cisplatin-based chemotherapy and then developed recurrent cancer, whereas none of the patients whose cancer progressed during first line cisplatin-based chemotherapy responded. The addition of etoposide and ifosfamide to cisplatin as second line therapy does not potentiate cisplatin in patients demonstrating first line cisplatin resistance and most likely does not contribute to the second line responses in those patients who demonstrated first line cisplatin sensitivity. This combination is also ineffective as third, forth, fifth or sixth line salvage chemotherapy with a response rate of only 8%.

Adult↗
PubMed1992

A prospective trial of progesterone therapy for malignant peritoneal cytology in patients with endometrial carcinoma.

From February 1982 to February 1991, 45 patients with endometrial carcinoma confined to the uterus except for malignant peritoneal cytology were treated with 1 year of progesterone therapy. Thirty-six patients have undergone planned second-look laparoscopy with repeat peritoneal washings and the remaining 9 patients either refused second-look laparoscopy or the procedure was medically contraindicated. Of the 36 who underwent second-look laparoscopy, 34 (94.5%) were NED (no evidence of disease) and had negative repeat peritoneal cytology and 2 (5.5%) had persistent malignant cytology. The latter two patients, after an additional year of progesterone therapy, were found to be NED and had negative peritoneal cytology at third-look laparoscopy. Of the 45 women enrolled in this protocol, no patient has developed recurrent endometrial cancer, and the expected 5-year disease-free survival was 88.6%.

Adenocarcinoma↗
PubMed1992

Leukemia following cisplatin-based chemotherapy for ovarian carcinoma at Roswell Park.

Three cases of leukemia following cisplatin-based chemotherapy are reported. All three patients received cyclophosphamide, a known leukemogen. In two cases, the leukemia was diagnosed after second line chemotherapy with intraperitoneal cisplatin and cytarabine, one of which is the first report of a chronic granulocytic leukemia as a result of cytotoxic chemotherapy.

Adult↗
PubMed1990

A prospective trial of postoperative vaginal radium/cesium for grade 1-2 less than 50% myometrial invasion and pelvic radiation therapy for grade 3 or deep myometrial invasion in surgical stage I endometrial adenocarcinoma.

A prospective trial was performed to evaluate the recurrence rate and 5-year disease-free survival rate in patients with surgical Stage I endometrial adenocarcinoma. Patients with Stage I, Grade 1 or 2 disease, less than 50% myometrial invasion, and no evidence of disease outside the corpus of the uterus were treated by hysterectomy and bilateral salpingo-oophorectomy and postoperative vaginal radium/cesium (Group 1). Patients with surgical Stage I, Grade 3 disease or deep myometrial invasion, and histologically negative paraaortic lymph nodes were treated with postoperative pelvic radiation therapy (5000-5040 cGY) (Group 2). Patients with malignant peritoneal cytologic findings also received progesterone therapy. Of the 92 Group 1 patients, there have been no recurrences and the 5-year estimated disease-free survival rate was 99%. Of the 41 Group 2 patients, there have been four (9.7%) recurrences but only one (2.4%) within the treated field (pelvis), and the 5-year estimated disease-free survival rate was 88%. Of the 133 patients, the 5-year estimated disease-free survival rate was 96%, and only one patient (0.7%) had a local pelvic recurrence. Of the 16 patients with malignant peritoneal cytologic findings who were treated with progesterone therapy, none has had a recurrence.

Adenocarcinoma↗
PubMed1990

Cisplatin-based chemotherapy for stage II ovarian adenocarcinoma: a preliminary report.

We have performed three sequential trials in patients with FIGO stage II ovarian cancer in an attempt to improve long-term survival. The first trial utilized whole-abdomen radiation and a pelvic boost and the second study utilized pelvic radiation plus melphalan chemotherapy. These trials resulted in estimated 5-year survivals of 40 and 50%, respectively (Gynecol. Oncol. 23, 168-175, 1986). In the current study, 20 patients were treated with 6 months of adjuvant cisplatin-based chemotherapy. The estimated progression-free survival was only 45%. However, by tailoring salvage therapy to the findings at second-look laparotomy, the estimated 5-year survival was 77%. Notwithstanding the latter result of 77%, improved therapy is still required for the relatively rare patient who has stage II ovarian cancer.

Adenocarcinoma↗
PubMed1989

Rectal J pouch reservoir to decrease the frequency of tenesmus and defecation in low coloproctostomy.

Low anterior resection of the colon with very low coloproctostomy is a procedure occasionally required in the surgical management of the patient with gynecologic malignancy. Very low end-to-end anastomosis of the colon to rectum has been associated with fecal frequency and tenesmus in up to 70% of cases. The construction of a rectal J-pouch low-pressure reservoir has been reported to have a salutary effect upon these symptoms. Between March 1987 and January 1988 a pilot study was carried out in which six patients with primary or recurrent gynecologic malignancy who underwent low anterior resection of the colon requiring very low coloproctostomy (below 6 cm) had construction of a rectal J-pouch reservoir with a Strasbourg-Baker end-to-side coloproctostomy. No postoperative complications were noted in this small series of patients. No patient has had more than three stools per day since surgery. Antidiarrheal medication was not required. All patients denied tenesmus. It was concluded that the rectal J-pouch reservoir offered a surgical technique for avoiding tenesmus and fecal frequency in very low end-to-end anastomosis of colon to rectum.

Anastomosis, Surgical↗
PubMed1989

Rectal J-pouch reservoir to decrease the frequency of tenesmus and defecation in low coloproctostomy.

Low anterior resection of the colon with very low coloproctostomy is a procedure occasionally required in the surgical management of the patient with gynecologic malignancy. Very low end-to-end anastomosis of the colon to the rectum has been associated with fecal frequency and tenesmus in up to 70% of cases. The construction of a rectal J-pouch low-pressure reservoir has been reported to have a salutary effect on these symptoms. Between March 1987 and April 1988, a pilot study was carried out in which 11 patients with primary or recurrent gynecologic malignancy who underwent low anterior resection of the colon requiring very low coloproctostomy (below 6 cm) had construction of a rectal J-pouch reservoir with a Strasbourg-Baker end-to-side coloproctostomy. No postoperative complications were noted in this small series of patients. No patient has had more than three stools per day since surgery. Antidiarrheal medication was not required. All patients denied tenesmus. It was concluded that the rectal J-pouch reservoir offered a surgical technique for avoiding tenesmus and fecal frequency in very low end-to-end anastomosis of colon to rectum.

Adult↗
PubMed1989

Neoplasms.

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Antigens, Tumor-Associated, Carbohydrate↗
PubMed1985

Pregnancy-associated group B streptococcal endocarditis: a report of two fatal cases.

Group B streptococci commonly colonize parturient women, yet pregnancy-associated endocarditis due to this organism is rare. Most reports of group B streptococcal endocarditis are from the preantibiotic era and occurred in women with rheumatic mitral valve disease. Reported herein are two cases of fatal group B streptococcal endocarditis involving the aortic valve of women with no preexisting heart disease. One had undergone a second-trimester abortion and the other had a normal pregnancy and uncomplicated vaginal delivery.

Abortion, Induced↗
PubMed1981

Antibiotic therapy for the Bacteroidaceae in post-cesarean section infections.

One hundred patients were treated for postpartum endometritis with ampicillin and clindamycin. Fifty patients were analyzed retrospectively and 50 prospectively for therapeutic response and development of late infectious sequelae. Seventy-eight patients exhibited an acceptable clinical response. One patient developed a wound infection from Staphylococcus aureus, which responded to drainage. The remaining 21 patients responded to the addition of an aminoglycoside. No patient developed a pelvic abscess or septic thrombophlebitis. The therapeutic response of the 2 groups treated with ampicillin and clindamycin is contrasted with the results derived from the traditional antibiotic regimen of a penicillin and an aminoglycoside.

Ampicillin↗
PubMedDate not supplied

Improvements in pelvic exenteration: factors responsible for reducing morbidity and mortality.

BACKGROUND: Since pelvic exenteration for the treatment of recurrent gynecologic malignancy first was described, reported rates of morbidity and mortality have declined steadily. However, the factors responsible for this decline have never been clearly delineated. METHODS: We reviewed the charts of 154 patients who underwent pelvic exenteration for gynecologic malignancy between 1954 and 1994. Charts were abstracted for details of the surgical procedure, pathologic findings, postoperative management, short- and long-term complications, time to recurrence, and overall survival. RESULTS: Seventy-two patients (47%) experienced 95 identifiable postoperative complications, resulting in death in 22 patients (14%). The rate of infectious complications declined to a statistically significant degree between the first two decades and latter two decades of the study (odds ratio [OR] 0.28. 95% CI 0.11-0.69). The use of routine prophylactic antibiotics was associated with this decline in infectious complications (OR 0.25, 95% CI 0.07-0.83). The use of preoperative subcutaneous heparin was associated with a reduction in thrombotic complications from 5 of 100 patients to 0 of 54 patients (P = .11), as well as a significant reduction in overall risk of complications (OR 0.53, 95% CI 0.33-0.85) and risk of postoperative mortality (OR 0.19, 95% CI 0.05-0.80). There was a significant reduction in overall risk of postoperative complications with both intensive care unit monitoring postoperatively (OR 0.65, 95% CI 0.43-0.99) and routine postoperative monitoring with a pulmonary artery catheter (OR 0.61, 95% CI 0.38-0.98). CONCLUSIONS: Routine use of prophylactic antibiotics, prophylactic subcutaneous heparin, and intensive postoperative monitoring appear to have reduced morbidity from pelvic exenteration.

Adult↗