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Biomedical subjects

V Friedberg

Publications and source records attributed to V Friedberg.

At least 19 recordsLinked to original sources
PubMed1989

Ileocecal vaginal construction.

In 10 patients, six with previously failed vaginal reconstruction of Mayer-Rokitansky syndrome, two with male pseudohermaphroditism, one with a history of Wertheim-Meigs operation followed by irradiation of the true pelvis, and one with vaginectomy caused by trauma, a neovagina was created out of cecal or ileocecal segments. Advantages of this technique are the excellent blood supply to the ileocecal region and the long vascular pedicle. The supplemental application of terminal ileum for prolongation of the cecal vaginoplasty allows for tensionless anastomosis between the neovagina and the vulva, even in patients with difficult anatomic conditions. A detailed description of the operative technique and indications for ileocecal and cecal vaginoplasty are presented, and the techniques in current use for vaginal replacement are reviewed and discussed.

Adolescent↗
PubMed1989

[Results of surgical treatment of stage IIb cervix cancer].

A total of 506 cases of cervix cancer, Stage Ib and IIb, operated according to Wertheim-Meigs were retrospectively (1972-1986) evaluated with their clinical and morphological aspects. After 1978 a more intensive histological evaluation of the specimen was performed, resulting in the examination of a large number of pelvic lymph nodes. The amount of lymph nodes infiltrated depends on tumour stage, invasion depth, regional lymphovascular invasion of the tumour edge and parametria, and on haemangiosis carcinomatosa. Stage pT2b cervical cancers survived five years in 81% of cases, when lymph nodes were not involved--in 69% (1-3 infiltrated l.n.) and 64% (3 infiltrated l.n.) of cases with positive lymph nodes. The five-year survival rates were further determined by the parametrial infiltration and the number of positive pelvic lymph nodes. If neither the parametria nor the lymph nodes are infiltrated by the tumor the survival rate is 96% whereas in cases of lymphovascular invasion of the parametria without infiltrated lymph nodes the rate decreases to 79%; in cases in tumor infiltration of both lymph nodes and parametria the cure rates are worst (62%). The operation of cervical cancer of Stages Ib and IIb with a thorough histological evaluation of the excised tissue therefore has a high prognostic value, but it also probably has better cure rates than is the case with radiological treatment.

Adult↗
PubMed1989

[Results of 108 exenteration operations in advanced gynecologic cancers].

We can now say that in our opinion exenteration is not an operation that is dangerous to life, if the conditions that will be described below are observed and if the indication is interpreted sufficiently narrowly, although during the first few years results had been moderate indeed. Exenteration has since developed so positively that it is now increasingly possible to consider the aspect of preserving the function of the adjacent organs, so that the disadvantages resulting for the patient's own body image and her self-concept and self-appraisal are now relatively acceptable compared to what had been possible previously. Indication for exenteration results from the situation, the ideas and the motivation of the patient, mainly, however, against the background of the characteristic features of the operation described here. Today we can say that even these extensive operations are firmly established in gynaecological oncology if there are extended carcinomas and recurring carcinomas. Hence, I believe it is advisable--at least in central recurring carcinomas--to refer such patients to competent surgical oncological centres before attempting to irradiate (or to irradiate again) the recurring tumour.

Colostomy↗
PubMed1989

[A new experimental method for the treatment of pelvic wall recurrencies of gynecological malignancies].

Pelvic side wall recurrences of gynecological malignancies subsequent to primary or adjuvant radiation therapy have a bad prognosis, although in almost half of the cases, distant metastases are not present at the time of diagnosis of the local tumor progression. A radical operative resection of the pelvic wall recurrence is rarely possible and a second conventional percutaneous or intracavitary irradiation with a tumoricidal dose is no longer feasible, because of the limited radiation tolerance of the surrounding pelvic tissue. The different forms of chemotherapy applied at present are not curative. Based on considerations of tumor and radiation biology, we propose a new experimental treatment mode after subtotal tumor resection. Intraoperatively, guiding tubes for afterloading HDR brachytherapy are fixed equidistantly on the tumor bed resp. residual tumor at the pelvic side wall. Coverage of this area by a rectus abdominis muscle flap or de-epithelialized myocutaneous flap improves fixation and creates a protective distance between radiosensitive pelvic structures and the radioactive source inserted postoperatively. In addition, improved vascularization by the flap might reduce the potential of hypoxia induced radioresistance of the residual tumor. Under these circumstances it appears possible, to deliver a second tumoricidal radiation dose of a small volume to a precisely defined area of the pelvic side wall.

Abdominal Muscles↗
PubMed1988

Operative therapy for stage IIb cervical cancer.

A total of 506 cases of cervical cancer, Stages Ib and IIb, operated on according to Wertheim and Meigs, were retrospectively (1972-1985) evaluated with respect to their clinical and morphological aspects. After 1978 a more intensive histological evaluation of the specimen was performed, resulting in the examination of a larger number of pelvic lymph nodes. The number of lymph nodes infiltrated depends on tumour stage, invasion depth, regional lymphovascular invasion of the tumour edge and parametria, and on haemangiosis carcinomatosa. The five-year survival rates were determined by the parametrial infiltration and by the number of positive pelvic lymph nodes. If neither the parametria nor the lymph nodes were infiltrated by the tumour the survival rate was 69%, whereas in cases of lymphovascular invasion of the parametria without infiltrated lymph nodes the rate decreases to 80%; in cases of tumour infiltration of both lymph nodes and parametria the cure rates are worst (62%). The operation on cervical cancer of Stages Ib and IIb with a thorough histological evaluation of the excised tissue therefore has a high prognostic value, but it also probably has better cure rates than is the case with radiological treatment.

Female↗
PubMed1988

[Preoperative localization of pathologic findings in mammography].

Pre-operative localization of abnormal findings during mammography makes it easier to find the lesions if they are not palpable. Our study is based on 373 procedures, using a "harpoon" needle. Radiographs of the operative specimen showed that 66% of the lesions had been completely removed, 15% had been partially removed and 19% could not be identified unequivocally. 172 patients had subsequent mammograms. Amongst these, the lesion had been completely removed in 70%, partially removed in 14% and in 10% it was still present. In 62% dense scar formation made it impossible to be certain whether excision had been complete.

Biopsy, Needle↗
PubMed1987

[The ileocecal vagina].

In 3 patients with vaginal aplasia respectively traumatic vaginal loss a neovagina was created out of the separated ileocecal segment. Advantages of this technique are the excellent blood supply of the ileocecal region and the long vascular pedicle. The additional application of terminal ileum for prolongation of the cecal vaginoplasty allows the tensionless anastomosis between neovagina and vulva even in patients with difficult anatomical conditions. The present paper gives a detailed description of the operative technique and the indications of the ileocecal vaginoplasty. Furthermore the common techniques for vaginal replacement are reviewed and discussed.

Adolescent↗