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At least 217 records · Page 12Linked to original sources
PubMed1993

[Radical hysterectomy. Operative complications].

The Authors carried out a retrospective examination of data relating to 241 patients undergoing radical hysterectomy with pelvic lymphadenectomy between 1970 and 1991. The basic aim of the study was to identify and quantify complications correlated to radical hysterectomy using the Wertheim-Meigs method. Surgery was performed in 223 cases due to cervical cancer, in 13 cases due to endometrial cancer, in 3 cases due to vaginal cancer and in 2 due to ovarian cancer with secondary extension to the uterus. Complications were subdivided into intraoperative and postoperative. Intraoperative complications involved the urinary tract in 4.5% and other apparatus (intestinal and nervous lesions, hemorrhage due to vascular damage) in 8.7% of cases. Postoperative complications were classified as follows: 35.2% involving the urinary tract (fistula 20.3% and vesical dysfunction 14.9%) and 8% involving other organs or systems (infections, neuropathy, pelvic lymphocele, pathologies of intestinal canalization, etc.). Lastly, the Authors examined the individual complications of radical hysterectomy, focusing attention in particular on vesicourethral dyskinesia, in the light of the physiopathological mechanisms reported in the literature. The mean rate of complications in the series examined here was substantially comparable to that reported by other Authors.

Adult↗
PubMed1991

Clear cell adenocarcinoma of the vagina: a second primary in a diethylstilbestrol-exposed woman?

A clear cell adenocarcinoma of the vaginal remnant in a diethylstilbestrol (DES)-exposed woman developed 20 years after anterior exenteration for a histologically similar stage II vaginal cancer. Arguments favoring a new primary cancer over a late recurrence are presented. This case probably represents the first report of a second primary vaginal clear cell cancer after DES exposure in utero. The implications of a second vaginal primary and the need for long-term surveillance in DES-exposed women are discussed.

Adenocarcinoma↗
PubMed1995

Risk of lung cancer in pre- and post-menopausal women with ano-genital malignancies.

Women diagnosed during the period 1943-1990 and reported to the Danish Cancer Registry with invasive squamous-cell carcinomas of the uterine cervix, vulva, vagina or anus, together with those having pre-cancerous lesions (CIN III or carcinoma in situ) of the uterine cervix diagnosed in the period 1958-1990, were followed for the occurrence of subsequent lung cancer over 762,000 person-years. Overall, these patients developed 2 to 2 1/2 times more lung cancers than women in the general Danish population. Women in whom cervical cancer was diagnosed recently, and before the age of 45 years, had a 4.6 times elevated risk of developing lung cancer, while young women with vulvar or vaginal cancer were at a 4.0-fold elevated risk. Similarly, women in whom anal cancer was diagnosed before the age of 60 years were at a 3.5-fold increased risk of developing lung cancer. The present study supports the hypothesis that smoking is involved in the aetiology of ano-genital malignancies. The particularly high risk of developing subsequent lung cancers seen in women who were pre-menopausal (< 45 years) at the time of the ano-genital cancer diagnosis suggests that the effect of smoking in ano-genital carcinogenesis might be partly mediated through alterations in oestrogen metabolism. Alternatively, patients who developed their initial ano-genital cancer at a young age might harbour some genetic susceptibility which could explain their excess lung-cancer risk.

Adult↗
PubMed1997

A new technique for performing Syed-Neblett template interstitial implants for gynecologic malignancies using transrectal-ultrasound guidance.

PURPOSE: Interstitial brachytherapy plays an important role in the treatment of advanced and recurrent gynecologic malignancies. Unfortunately, the inability to visualize the tumor and surrounding normal structures during the implant has hampered the accuracy and safety of the implant. Transrectal ultrasound guided Syed-Neblett template implantation is a new technique for performing interstitial implants under direct visualization. The details of the technique are presented to demonstrate the ability to accurately guide needle placement into tumor and avoid needle insertion into critical surrounding normal structures. METHODS AND MATERIALS: The transrectal ultrasound is positioned so that it can visualize the tumor, and normal surrounding structures in both transverse and longitudinal planes. The Syed-Neblett template is positioned and sutured into the perineum. Needles are inserted into the target area under direct visualization through transverse imaging. The bladder and rectum can be directly imaged and thus avoided. Longitudinal imaging is then used to guide the needles to the appropriate depth. In addition, it can be used to assess the length of the target volume and aid in determining the active length of the sources. RESULTS: A total of 12 procedures have been performed on seven patients from August 30, 1995 to April 12, 1996. The presenting diseases included: Stage IIIb cervical cancer in four cases, recurrent endometrial cancer in two cases, and Stage III vaginal cancer in one case. The total length of time for implantation of the needles ranged from 45 to 165 min (median--130 min). CONCLUSION: Transrectal ultrasound guidance provides real-time visualization of the target volume and normal tissues during interstitial implantation of gynecologic malignancies and allows for accurate needle placement.

Aged↗
PubMed1998

Use of saline-filled tissue expanders to protect the small bowel from radiation.

Over the past 7 years, 58 saline-filled tissues expanders (TEs) have been temporarily placed in 57 patients. The indications for TE placement were: small bowel exclusion from external-beam radiation therapy (N = 25), interstitial RT (N = 16), or both (N = 13) when there was insufficient omentum to provide adequate exclusion. Of the 57 patients, 24 had primary tumors (4 colon, 4 endometrial, and 11 rectal cancer; 3 sarcomas, 1 schwannoma; and 1 vaginal cancer). The remaining 33 patients (58%) had recurrent cancers (3 anal, 8 colon, and 16 rectal cancers; and 6 sarcomas), of whom 26 (79%) had received prior RT. Of the 58 TEs, 15 were placed superior to the iliac vessels and 43 were placed in the pelvis. Complications included post-withdrawal enterocutaneous fistulae in four patients, TE deflation in three patients, and TE extrusion in one patient. Improvements in TE design and removal techniques have reduced the incidence of these complications. When no native tissue is available for small bowel exclusion, the saline-filled TE is a safe, effective substitute.

Colorectal Neoplasms↗
PubMedDate not supplied

Detection of sentinel nodes by lymphoscintigraphy and gamma probe guided surgery in vulvar neoplasia.

BACKGROUND: Pathologic lymph node status is the most important prognostic factor in vulvar cancer; however, complete inguinofemoral node dissection is associated with significant morbidity. Intraoperative lymphoscintigraphy associated with gamma detecting probe-guided surgery has proved to be reliable in the detection of sentinel node (SN) involvement in melanoma and breast cancer patients. The present study evaluates the feasibility of the surgical identification of inguinal sentinel nodes using lymphoscintigraphy and a gamma detecting probe in patients with early vulvar cancer. METHODS: Technetium-99-labeled colloid human albumin was administered perilesionally in 44 patients. Twenty patients had T1 and 23 had T2 invasive epidermoid vulvar cancer; one patient had a lower-third vaginal cancer. An intraoperative gamma detecting probe was used to identify SNs during surgery. Complete inguinofemoral node dissection was subsequently performed. SNs underwent separate pathologic evaluation. RESULTS: A total of 77 groins were dissected in 44 patients. SNs were identified in all the studied groins. Thirteen cases had positive nodes: the SN was positive in all of them; in 10 cases the SN was the only positive node. Thirty-one patients showed negative SNs: all of them were negative for lymph node metastasis. CONCLUSIONS: Lymphoscintigraphy and SN biopsy under gamma detecting probe guidance proved to be an easy and reliable method for detection of SNs in early vulvar cancer. If these preliminary data will be confirmed, the technique would represent a real progress towards less aggressive treatment in patients with vulvar cancer.

Adult↗
PubMed1991

[Endorectal ultrasonography].

Endorectal ultrasound examination is a valuable method for detection and monitoring of pelvic diseases. The authors record their clinical experience in endorectal ultrasonography with Bruel & Kjaer ultrasound scanner. One hundred patients with diseases of the pelvic organs were examined, mainly before and after operation of ano-rectal cancer. There were 59 patients with rectal cancer, 8 patients with relapse after rectal resection, 3 patients with anal cancer, 2 patients with insufficiency of the anastomoses after rectal resection with formation of pelvic abscesses, 2 patients with metastases of bladder cancer, 2 patients with rectal cancer invading the prostate gland, 1 patient with vaginal cancer invading the rectum, 1 patient with rectal cancer invading the bladder and both ureters leading to bilateral hydronephrosis and 2 patients with extrauterine pregnancy. Another group of 20 patients was examined for detecting early postoperative recurrences. EU is an obligatory method of diagnosis of rectal cancer. It is part of the complex approach to the choice of operative method and helps to make short- and long-term prognosis after the operation. The method is also essential for the diagnosis of inflammatory processes in the pelvis and in-lying organs.

Anus Neoplasms↗
PubMed1988

Nonsquamous cancer of the vagina.

This report retrospectively analyzes 48 cases of primary vaginal cancer treated at Walter Reed Army Medical Center and the Naval Hospital, Bethesda, from 1962 through 1983. There was an unusually high number of uncommon histologic types. Nine patients had an adenocarcinoma, 5 had a sarcoma, 3 had a melanoma, 2 had an adenosquamous carcinoma, 1 had a lymphoma, and 1 had a carcinoid tumor. The remaining 27 patients had a squamous cell carcinoma. This represents a 43% prevalence of nonsquamous lesions. Nonsquamous cancer of the vagina occurred in patients at an earlier age than squamous cell carcinoma. Presenting symptoms, the location of the tumor within the vagina, and survival rates were similar for both groups. The clinical characteristics and treatment of the patients with nonsquamous tumors are discussed.

Adenocarcinoma↗
PubMed2002

The role of radiation therapy in early endometrial cancer.

Few randomized studies have addressed the best choice of adjuvant radiation therapy after surgery for stage I endometrial cancer. Although whole pelvic radiation decreases the incidence of pelvic and vaginal cancer recurrence, there is no convincing evidence that it improves survival in women who have been completely staged. Several studies have indicated that women with high-risk stage I endometrial adenocarcinoma are treated adequately with extended surgical staging and vaginal cuff radiation. In the absence of randomized trials suggesting that whole pelvic radiation improves survival, it should be limited only to the highest risk stage I subgroups. Vaginal cuff brachytherapy appears to provide excellent local control of disease with minimal morbidity.

Brachytherapy↗
PubMed1995

A 30-year experience in the management of primary carcinoma of the vagina: analysis of prognostic factors and treatment modalities.

This retrospective study of 100 cases of primary carcinoma of the vagina treated at Magee-Women's Hospital of the University of Pittsburgh from 1962 to 1992 analyzes disease and treatment-related prognostic factors and treatment results. Fifty percent of patients had previous hysterectomies prior to the diagnosis of vaginal cancer. The tumor was limited to one-third of the vaginal canal in 64 patients, but involved more than one-third of the canal in 36 patients. Treatment consisted of surgery in 40 patients, radiation therapy in 47 patients, and surgery plus radiation therapy in 13 patients. With a median follow-up of 11.2 years, the 5-year actuarial disease-free survival (DFS) was 67% for Stage I (23 patients), 53% for Stage II (58 patients), 0% for Stage III (9 patients), and 15% for Stage IV (10 patients). Using univariate and multivariate analysis, treatment with surgery, disease limited to one-third of the vaginal canal, and FIGO Stage I and II disease were significantly favorable prognostic factors for DFS. Treatment with surgery was superior to radiation therapy alone in Stage II patients (P = 0.00004). There appeared to be a selection bias in Stage II patients, as the more unfavorable cases were treated with radiation therapy. Although radiation therapy will often be the treatment of choice, excellent results and limited morbidity accompany selected cases surgically resected.

Adolescent↗
PubMed2003

[Laparoscopic-vaginal radical hysterectomy in surgical treatment of cervical cancer].

Radical vaginal hysterectomy has been performed in surgical treatment of cervical cancer for over one hundred years. After the term of decrease of popularity of this operation, nowadays we can observe gradual come back to the idea of radical vaginal hysterectomy. Possibility of association of advanced laparoscopic techniques/lymphadenectomy/with vaginal operation have changed the approach to the surgical treatment of cervical cancer. The aim of the study is to present the method of laparoscopic-vaginal radical hysterectomy based on Schauta-Amreich technique. The 51 year old women was admitted to the hospital and cervical cancer FIGO stage IIA was diagnosed according to clinical and histopathological examination. We performed laparoscopic-vaginal radical hysterectomy in general anaesthesia. First after cutting of ligamentum teres uteri and infundibulo-pelvicum, laparoscopic pelvic lymphadenectomy was done. Subsequently vaginal stage of operation was performed. Then we did laparoscopy and controlled operation field again. Combining Schauta operation with laparoscopy allows us to estimate lymph nodes as well as make vaginal phase of operation easier because of mobilization of uterus. We consider that laparoscopic-vaginal radical hysterectomy could be a valuable element in broadening the spectrum of many kinds of operations used in treatment of cervical cancer.

Carcinoma, Squamous Cell↗
PubMed1985

Recurrent carcinoma of the vagina following Okabayashi's radical hysterectomy for cervical carcinoma.

Between 1962 and 1976, 1847 cases of cervical cancer were treated by Okabayashi's radical hysterectomy. Of these, 42 cases developed vaginal invasive carcinoma and 5 developed vaginal intraepithelial carcinoma thereafter, giving a recurrence rate of 2.5%. The vaginal recurrence rate declined annually during the period 1962-1976, and was thought to be due to the efficacy of routinization of postoperative vaginal cuff irradiation. Of the 47 recurrent cases 33 were discovered within 2 years following the operation. Seventy-two percent of the recurrent cases were asymptomatic. The importance of close follow-up of the patients during the first 2 postoperative years was denoted. The incidence of developing a secondary vaginal cancer in the cases of cervical adenocarcinoma was 10.0%, higher than the 2.2% for squamous cell carcinoma. All the recurrent cases were treated with vaginal cuff irradiation, either alone or with external irradiation and/or chemotherapy. The 3-year survival rate of the patients who had vaginal recurrence alone was 40.0%, better than that of the cases accompanied with recurrence at the other sites.

Adenocarcinoma↗
PubMed1993

Replacing diagnostic curettage by vaginal ultrasound.

Dilatation and curettage has for many years been the method of choice for diagnosing endometrial cancer in postmenopausal women. However, less than 10% of women with postmenopausal bleeding have an endometrial cancer. Vaginal sonography for measuring endometrial thickness, has in several studies proved to be a sensitive diagnostic method for diagnosing endometrial pathology. Our studies as well as others have shown that an endometrial thickness of 4 mm or less (including both endometrial layers) indicates a very low risk for endometrial carcinoma as well as any other major endometrial pathology in women with postmenopausal bleeding. Since vaginal sonography is such a simple and a non-invasive diagnostic method, it thus seems reasonable that vaginal sonographic assessment of the endometrium should be the primary method for excluding any endometrial abnormality in a woman with postmenopausal bleeding.

Aged↗