Peritoneal washing cytology. How significant?
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Cytodiagnosis↗
Biomedical subjects
A P Soisson
Publications and source records attributed to A P Soisson.
Repair of transversely incised abdominal wall fascia in a rabbit model.
OBJECTIVE: To compare several commonly used methods of closing transversely incised anterior abdominal wall in order to determine which technique results in the strongest incisional tensile strength. METHODS: Thirty-six rabbits were randomized to receive either interrupted or continuous closure with 0-Vicryl. Within these groups, each animal was randomized to one of three different bite and interval techniques: 1-cm bites/0.5-cm intervals, 1-cm bites/1-cm intervals, and 2-cm bites/1-cm intervals. Each rabbit received three to four transverse abdominal wall incisions of approximately 3-8 cm in length. The incisions were excised en bloc and stored at -70C at postoperative week 1, 2, or 4 in a random fashion. Representative 1-cm strips were harvested from each incision after thawing. The Instron tensiometer was used to determine the maximum intrinsic tensile strength required to disrupt each tissue strip at the incision. Statistical analysis was performed using analysis of variance, two-sample t test, Scheffé multiple comparison, and Kruskal-Wallis test. RESULTS: Two hundred thirty-seven strips were analyzed. The mean maximum tensile strength of all of the interrupted and continuous suture repairs was 48 and 38 lb, respectively (P < .001). The maximum tensile strength for interrupted closures was achieved at week 1 and was similar at week 4. The continuous closure was weakest at week 1 and increased to a maximum value during week 4. There was no difference in maximum tensile strength between the interrupted and continuous closure groups at week 4. There was no significant difference in the maximum tensile strength of the three repair techniques. The mean maximum tensile strength of all specimens was significantly less among those harvested during weeks 1 and 2 compared with week 4 (P = .001). CONCLUSION: In this randomized study, the interrupted closure had a greater maximum tensile strength than the continuous closure in repair of transverse incisions during the first 2 postoperative weeks. Both repair methods were associated with a similar maximum tensile strength at 4 postoperative weeks. Repair techniques using different bite sizes and intervals resulted in similar maximum tensile strengths.
Abdominal Muscles↗
A new ureteral anastomotic device: the Unilink system. A pilot study using the porcine model.
OBJECTIVE: Ureteral injury is a complication of gynecologic surgery in approximately 1% of all cases. The anatomic site of the injury determines the type of operative repair. When an end-to-end ureteral anastomosis is required, interrupted sutures are usually used. A prospective, randomized animal study was performed to determine the efficacy of a new microvascular anastomotic device, the Unilink system, in repairing transected ureters. STUDY DESIGN: Nineteen pigs underwent randomized anastomosis with the Unilink system on one side and traditional anastomosis with suture on the contralateral side. A postoperative intravenous pyelogram was performed immediately and 2 weeks later, before the anastomotic site at a second laparotomy was harvested. Patency rates for each type of anastomosis were compared microscopically, and the degree of hydronephrosis was compared grossly and radiographically. RESULTS AND CONCLUSION: The anastomotic repair with the Unilink system did not significantly differ structurally or functionally from traditional suture repair.
Anastomosis, Surgical↗
An unusual cutaneous reaction to anticoagulant therapy.
Unusual complications of warfarin therapy include cutaneous necrosis and the "purple toe syndrome." The latter is more common in men and is not associated with vascular compromise; it usually occurs 3 to 8 weeks after warfarin therapy is begun and may persist for many months after the medication is discontinued. The following is a case of a 63-year-old woman who received warfarin therapy in conjunction with heparin for treatment of a left leg deep vein thrombosis. Approximately 8 hours after receiving her first dose of warfarin (15 mg), she developed acute pain, edema, and discoloration of the entire left leg to the mid-thigh, most prominent in the left great toe. After discontinuation of warfarin therapy, her symptoms completely resolved within 48 hours. This may be a report of a new cutaneous lesion associated with anticoagulant therapy.
Carcinoma, Squamous Cell↗
Rectus abdominis myocutaneous flap for primary vaginal reconstruction.
Reconstructive procedures are being performed with increasing frequency in conjunction with pelvic exenterations and other radical gynecologic surgeries. The most common reconstructive procedures include continent urinary diversion, rectosigmoid anastomosis, and vaginal reconstruction. Historically, the gracilis myocutaneous flap has been the procedure of choice for vaginal reconstruction. However, the gracilis myocutaneous flap has a history of partial to severe necrosis, a propensity to prolapse, and leaves ipsilateral donor scars on the thigh. In contrast, neovaginal reconstruction using a relatively new procedure, the distally based rectus abdominis myocutaneous flaps, has the advantage of using a large, single flap that can be incorporated into the primary incision. This flap is mobilized on a long vascular pedicle, the rectus muscle. In relation to the underlying rectus muscle, the orientation of the cutaneous portion of this flap may be customized to accommodate the pelvic defect or the surgeon's preference. Depending on their primary orientation, they are referred to as either a vertical or transverse rectus abdominis myocutaneous flap. The versatility and reliability of the rectus flap is demonstrated here through the presentation of a small pilot series of seven patients. The technique was used for vaginal reconstruction, primarily in conjunction with pelvic exenteration. The flaps were mobilized from the supraumbilical area and had a flap viability of 100% for the 2 years that they have been followed. There were no postoperative incisional or flap infections. There was one infraumbilical fascial dehiscence. The advantages of primary pelvic reconstruction along with the description of the operative techniques are presented.
Adult↗
Prevention of superficial wound separation with subcutaneous retention sutures.
The objective of this prospective study was to determine the efficacy of subcutaneous retention sutures in the prevention of superficial wound separation in obese women undergoing gynecologic surgery. From 1985 to 1990, 80 women with subcutaneous tissue of 5 cm or greater undergoing laparotomy were randomly assigned to either standard wound closure (37 patients) or closure including subcutaneous retention sutures (43 patients). We examined the relationship of the following factors to the development of superficial wound dehiscence: malnutrition (total protein < 6.0 mg/dl, albumin < 3.0 mg/dl), minidose heparin (5000 U subcutaneously every 8 hr for 5 days), diabetes mellitus, prolonged operative time (> 180 min), intraoperative spillage of enteral contents, and subcutaneous retention sutures. In a univariate analysis, malnutrition (P = 0.02), the use of heparin (P = 0.03), and the absence of retention sutures (P = 0.02) were associated with an increased risk of separation. In a multivariate analysis, malnutrition (P = 0.02), low-dose heparin (P = 0.03), and the absence of retention sutures (P = 0.04) retained their independent association with superficial wound separation. This study suggests that the use of subcutaneous retention sutures reduces the incidence of superficial wound separation in obese women undergoing gynecologic surgery.
Adult↗
Neovaginal reconstruction with a rectus abdominis myocutaneous flap.
BACKGROUND: Neovaginal reconstruction after pelvic exenteration has several advantages. Besides the obvious psychosocial benefit to the patient and her partner, the incorporation of viable tissue into the pelvic cavity decreases the incidence of infection and small-bowel complications. Several surgical techniques are available to the gynecologic oncologist for construction of a functional vagina. Recently, myocutaneous flaps incorporating the rectus abdominis and gracilis muscles have been used. Disadvantages of the gracilis myocutaneous flap are the 10-20% incidence of flap loss due to vascular compromise and the potential for prolapse. The rectus abdominis myocutaneous flap is a large flap with a reliable blood supply that allows mobilization without tension on the vascular pedicle, resulting in a much lower incidence of vascular compromise. CASE: We present two case reports, a review of the gynecologic and surgical literature, and the techniques for vaginal reconstruction using the rectus muscle as a myocutaneous flap. CONCLUSIONS: The outcome for both patients was a satisfactory functional vagina that was technically easy to construct. The rectus abdominis myocutaneous flap can provide an adequate neovagina with minimal morbidity.
Abdominal Muscles↗
Fibronectin is an immunosuppressive substance associated with epithelial ovarian cancer.
BACKGROUND: Although the ascites of patients with ovarian cancer has been reported to contain immunosuppressive factors, the identity and source of this activity has not been determined. Previously, the authors showed that conditioned media from two of four epithelial ovarian cancer cell lines inhibits proliferation of mitogen-stimulated human lymphocytes. The physical characteristics of the inhibitory substance are unlike those of peptide growth factors but closely resemble those of fibronectin. METHODS AND RESULTS: In the current study, it was found that the two ovarian cancer cell lines that produce the inhibitory substance have more fibronectin on the cell surface and secrete significantly more immunoreactive fibronectin into their culture media than the other two ovarian cancer cell lines. In addition, the immunosuppressive activity was bound to a gelatin-Sepharose affinity column, known to bind fibronectin. Finally, in ascites from 20 patients with advanced epithelial ovarian cancer, fibronectin levels correlated with the ability to inhibit proliferation of lectin-stimulated lymphocytes (P < 0.001). CONCLUSIONS: Fibronectin is produced by some ovarian cancer cell lines and acts to inhibit proliferation of mitogen-stimulated lymphocytes. Additional studies are needed to clarify the role of fibronectin in ovarian cancer.
Ascites↗
Radical hysterectomy in obese women.
OBJECTIVE: To determine whether there is a significant difference in treatment outcome and acute and chronic complications in obese compared with non-obese women having radical hysterectomy for early-stage cervical cancer. METHODS: From 1970-1985, 320 women underwent a class III radical hysterectomy and pelvic lymphadenectomy for stage IB-IIA invasive cervical cancer at Duke University Medical Center. Forty-three of these women weighed at least 80 kg and had a body weight greater than 25% above their ideal predicted weight. These women were compared to 277 patients with normal weight for height. RESULTS: The median age, incidence of diabetes mellitus and hypertension, number of nodes removed at lymphadenectomy, disease-free survival, length of hospital stay, and serious surgical or medical complications were the same in the two groups. However, obese patients had a significantly higher estimated blood loss, greater incidence of transfusion, and longer operative times. CONCLUSIONS: Survival is not compromised and the incidence of serious complications is not increased in obese patients treated with radical hysterectomy, but the operative technique is more difficult, the procedure lasts longer, and the surgery is associated with greater blood loss.
Adult↗
Stage I small cell carcinoma of the vulva treated with vulvectomy, lymphadenectomy, and adjuvant chemotherapy.
Neuroendocrine small cell carcinoma is a lethal, but rare, tumor that arises most frequently in the lung. Small cell cancer also rarely may occur in the female genital tract, usually in the cervix. This article concerns the fourth reported case of neuroendocrine small cell carcinoma of the vulva. Previously, small cell carcinoma of the vulva has been treated with regional therapy including surgery and radiation. Survival has been poor, however, due to the propensity of these tumors to metastasize early in the course of the disease. Recently, the median survival of patients with small cell carcinoma of the lung has been improved with the use of chemotherapy. The authors review the literature on the treatment of small cell carcinoma of the vulva and report on a patient who was treated successfully with vulvectomy and inguinal lymphadenectomy followed by adjuvant chemotherapy.
Adult↗
Preoperative evaluation of serum CA 125, TAG 72, and CA 15-3 in patients with endometrial carcinoma.
We evaluated 109 women with endometrial carcinoma to determine the accuracy of preoperative tumor-associated antigen levels (CA 125, CA 72, CA 15-3) for prediction of extrauterine disease and whether TAG 72, CA 15-3, or both would improve the predictive value of CA 125 alone. Eleven (12%) of 80 patients with disease confined to the uterus or positive cytologic findings had CA 125 values greater than 35 U/ml versus 12 (65%) of 20 patients with extrauterine metastasis. Therefore CA 125 values had sensitivity of 65% and specificity of 88%. The TAG 72 level was elevated (greater than 6 U/ml) in 4% of patients with localized disease and 30% with metastasis. CA 15-3 was elevated (greater than 30 U/ml) in 17% and 65% in these categories, respectively. TAG 72 or CA 15-3 levels did not improve the combination of sensitivity and specificity of CA 125 alone. In addition, only one of 10 patients with microscopic metastasis (three cases) or positive peritoneal cytology (seven) had elevation of any of these tumor-associated antigen levels. Failure to detect occult metastasis and a high false-positive rate limit the role of these tumor-associated antigen assays in the preoperative evaluation of patients with endometrial carcinoma.
Antigens, Neoplasm↗
Heterogeneity of antigen expression in advanced epithelial ovarian cancer.
Immunohistochemical techniques were used to evaluate the expression of six antigens (CA 125, TAG 72, CA 19-9, OVTL3, DF3, and transferrin receptor) in frozen sections from the primary tumor and metastases of 20 patients with epithelial ovarian cancer. Heterogeneous expression of most antigens was observed within a given tumor nodule, but in each patient the proportion of cells expressing an antigen was similar in the primary tumor and metastases. To explore the stability of the antigenic phenotype of individual cells, we studied CA 125 expression in an ovarian cancer cell line. Cells were separated into CA 125-positive and -negative groups using fluorescence-activated cell sorting. After the two groups of cells were recultured separately, only 38% of cells originally sorted as CA 125 positive still expressed CA 125, whereas 27% of cells sorted as CA 125 negative expressed CA 125. That cells may gain or lose CA 125 expression in culture suggests that expression of CA 125 by ovarian cancer cells is not a stable trait.
Adenocarcinoma↗
Adjuvant radiotherapy following radical hysterectomy for patients with stage IB and IIA cervical cancer.
From 1971 through 1984, 320 women underwent radical hysterectomy as primary therapy of stage IB and IIA cervical cancer. Two hundred forty-eight patients (78%) were treated with surgery alone and 72 patients (22%) received adjuvant postoperative external-beam radiotherapy. Presence of lymph node metastasis, large lesion (greater than 4 cm in diameter), histologic grade, race (noncaucasian), and age (greater than 40 years) were significant poor prognostic factors for the entire group of patients. Patients treated with surgery alone had a better disease-free survival than those who received combination therapy (P less than 0.001). However, patients receiving adjuvant radiation therapy had a higher incidence of lymphatic metastases, tumor involvement of the surgical margin, and large cervical lesions. Adjuvant pelvic radiation therapy did not improve the survival of patients with unilateral nodal metastases or those who had a large cervical lesion with free surgical margins and the absence of nodal involvement. Radiation therapy appears to reduce the incidence of pelvic recurrences. Unfortunately, 84% of patients who developed recurrent tumor after combination therapy had a component of distant failure. The incidence of severe gastrointestinal or genitourinary tract complications was not different in the two treatment groups. However, the incidence of lymphedema was increased in patients who received adjuvant radiation therapy. Although adjuvant radiation therapy appears to be tolerated without a significant increase in serious complications, the extent to which it may improve local control rates and survival in high-risk patients appears to be limited. In view of the high incidence of distant metastases in high-risk patients, consideration should be given to adjuvant systemic chemotherapy in addition to radiation therapy.
Adolescent↗
The role of peptide growth factors in epithelial ovarian cancer.
We studied the effect of epidermal growth factor, platelet-derived growth factor, fibroblast growth factor, and transforming growth factor-beta on proliferation of four epithelial ovarian cancer cell lines (OVCA 420, OVCA 429, OVCA 432, and OVCA 433). Epidermal growth factor stimulated growth of OVCA 429 cells (P = .0001) and OVCA 433 cells (P = .0002). Platelet-derived growth factor did not stimulate growth of any of the cell lines. Fibroblast growth factor stimulated growth of OVCA 420 cells (P = .003). Transforming growth factor-beta inhibited growth of OVCA 420 cells (P = .0001), OVCA 432 cells (P = .003), and OVCA 433 cells (P = .004). To detect production of known growth factors by the cancer cell lines, we tested the effect of cancer cell-conditioned media on proliferation of cell lines known to respond to growth factors. Only media exposed to OVCA 433 cells were found to contain activity that mimicked one of the known growth factors (transforming growth factor-beta). These results suggest that individual ovarian cancers vary widely in their response to and production of known peptide growth factors. Finally, we found that OVCA 429-conditioned medium significantly inhibited proliferation of mitogen-stimulated lymphocytes (P less than .0001). The characteristics of this immunosuppressive factor were distinct from those of transforming growth factor-beta. Production of this factor by an immortalized cell line provides a unique opportunity to identify an immunosuppressive substance associated with ovarian cancer.
Cell Division↗
A comparison of symptomatology, physical examination, and vaginal cytology in the detection of recurrent cervical carcinoma after radical hysterectomy.
To evaluate our surveillance program for recurrent cervical carcinoma, we reviewed patients who underwent radical hysterectomy for International Federation of Gynecology and Obstetrics (FIGO) stages IB and IIA cervical cancer. The study group consisted of 203 women followed at Duke University Medical Center exclusively who had at least 2 years of regular surveillance. Thirty-one (15%) developed recurrence. For the detection of recurrent tumor, vaginal cytology had a sensitivity and specificity of 13 and 100%, pelvic or general physical examination 58 and 96%, and the presence of suspicious symptoms 71 and 95%, respectively. Ninety-four percent of all patients with recurrent tumor had at least one abnormal surveillance index. Three of 31 patients (10%) with recurrent tumor were treated successfully with secondary therapy. Two recurrences were detected by vaginal cytology exclusively. Even though vaginal cytology is not sensitive and may not be cost-effective, we conclude that it is the technique most likely to detect recurrent tumor while it is localized and potentially curable.
Female↗
Immunohistochemical expression of CA 125 in endometrial adenocarcinoma: correlation of antigen expression with metastatic potential.
Immunohistochemical localization of CA 125 using murine monoclonal antibody OC 125 was performed on fresh frozen tissue from 44 endometrial adenocarcinomas and 26 benign endometria. Immunohistochemical evaluation incorporated both intensity and distribution of staining (CA 125 HSCORE). Thirty-seven cancers (84%) and 23 benign endometria (88%) expressed immunohistochemically detectable CA 125. Staining was confined to epithelial cells and was present both on the cell membrane and in the cytoplasm. Among the 44 endometrial cancers, CA 125 HSCORE did not correlate with histological grade, depth of myometrial invasion or estrogen/progesterone receptor levels. Following surgical staging, 13 patients (30%) were found to have extrauterine metastatic disease. The median CA 125 HSCORE of patients with metastatic disease (2.25) was significantly higher than that of patients with disease confined to the uterus (0.6) (P less than 0.001). In addition, high CA 125 HSCORE also correlated with the presence of lymph node metastasis (P less than 0.001). The results of this study suggest that high CA 125 expression by endometrial adenocarcinomas is associated with increased metastatic potential.
Adenocarcinoma↗
Epidermal growth factor receptor expression in normal and malignant endometrium.
Epidermal growth factor receptor expression in fresh-frozen uterine tissues was studied with the use of monoclonal antibody 528, which recognizes an epitope on the external domain of the epidermal growth factor receptor. Immunohistochemically detectable epidermal growth factor receptor was seen in all uterine cell types in 19 of 20 normal uteri. Staining of endometrial glands and endometrial stromal cells was consistently greater than that of myometrium, and no variation in intensity or distribution of staining was seen during the menstrual cycle. Immunohistochemically detectable epidermal growth factor receptor was found less frequently in endometrial adenocarcinomas than in normal endometrium (p less than 0.01). Thirteen of 40 endometrial adenocarcinomas (32.5%) did not express detectable receptor. Epidermal growth factor receptor expression did not correlate with histologic grade, depth of myometrial invasion, estrogen-progesterone receptor status, the presence of extrauterine metastases, or the development of recurrent disease.
Adenocarcinoma↗
Immunohistochemical expression of TAG-72 in normal and malignant endometrium: correlation of antigen expression with estrogen receptor and progesterone receptor levels.
TAG-72 is a tumor-associated antigen that is expressed by secretory endometrium and most endometrial adenocarcinomas. We used immunohistochemical techniques to quantitate expression of TAG-72, estrogen receptor, and progesterone receptor in 21 normal endometria and 44 endometrial adenocarcinomas. In normal cycling endometrial glands, TAG-72 expression was related inversely to expression of receptors for estrogen and progesterone. This suggests that TAG-72 expression in normal endometrium may be hormonally regulated. Ninety-one percent of endometrial adenocarcinomas expressed immunohistochemically detectable TAG-72. The magnitude of TAG-72 expression did not correlate with other known prognostic factors in endometrial cancer such as histologic grade, depth of myometrial invasion, surgical stage, or steroid receptor status. The production of TAG-72 by most endometrial adenocarcinomas may represent nonspecific expression by cells that have dedifferentiated.
Adult↗