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Biomedical subjects

F B Stehman

Publications and source records attributed to F B Stehman.

At least 73 records · Page 4Linked to original sources
PubMed1986

Estrogen and progesterone receptors in uterine sarcomas.

Estrogen and progesterone receptors were measured in tissues from 43 patients with various uterine sarcomas using the dextran-coated charcoal assay. Estrogen receptor was present in 55.5% and progesterone receptor in 55.8% of samples, at median estrogen and progesterone receptor concentrations of 10.7 and 15.8 fmol/mg cytosol protein, respectively. These median values are much lower than those in 30 consecutive endometrial adenocarcinomas and 50 breast carcinomas assayed in our laboratory. Progesterone receptor status correlated strongly with estrogen receptor status in uterine sarcomas (P = .001). Estrogen and progesterone receptor levels were not influenced by stage, grade, or mitotic count. Patients 50 years of age or less had significantly higher progesterone receptor than those over 50. No such age effect was seen for estrogen receptor. Endometrial stromal sarcoma had higher estrogen and progesterone receptor levels than other histologic types. Low-grade endometrial stromal sarcomas had higher median estrogen receptors (238.9 fmol/mg) and better survival (all patients alive at 6-12 months) than did high grade (N = 7) endometrial stromal sarcomas (median ER = 6.6 fmol/mg, all dead of disease at 8-27 months). For all histologic types, evaluable patients with stage I or II disease (N = 16) were more likely to survive longer than one year than those with stage III or IV disease (N = 13, P = .003). Evaluable patients with estrogen receptor-positive sarcomas were more likely to survive longer than one year than those with estrogen receptor-negative tumors (P = .006). With one exception, an endometrial stromal sarcoma, hormonal therapy exerted no beneficial effect.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Second-look laparotomy after chemotherapy in the management of ovarian malignancy.

Eighty-eight patients with ovarian malignancy underwent second-look laparotomy as part of their plan of management at Indiana University Hospital. Thirty-five patients (39.8%) were found to have no gross or microscopic evidence of persistent neoplasm, and an additional 16 (18.2%) had only microscopic tumor. Patients with initial Stage III or IV disease were less likely to have negative findings at laparotomy than were patients with Stage I or II disease. A complete initial cytoreductive operation (residual disease = 0 cm) correlated positively with negative findings at laparotomy. Endometrioid histologic findings were associated with a favorable condition at the second look, but tumor grade was associated with superior survival only for patients with grade 0 disease. Eight of 30 patients (26.7%) with invasive carcinoma and negative findings at second-look laparotomy have had tumor recurrence (2 to 63 months), and five of eight have died. Intraperitoneal chromic phosphorus salvage therapy for patients with microscopic disease was promising, with eight of 15 treated patients (53.3%) alive after therapy, with no evidence of disease from 16 to 56 months after the second look. Second-look laparotomy has been the major determinant of continued or alternative therapy for patients with ovarian malignancy. Second-look laparotomy has been incorporated into the standard management plan without a formal clinical trial. The need for a second look may be reduced by identifying patients who do not benefit from the procedure. Patients with persistent disease confirmed by noninvasive means can continue therapy without laparotomy. There is also a subgroup of patients with a favorable prognosis whose therapy could be safely discontinued without laparotomy.

Adenocarcinoma↗
PubMed1985

Lymphangiosarcoma of the edematous thigh after radiation therapy for carcinoma of the vulva.

A 66-year-old patient was treated with external radiation therapy for an advanced carcinoma of the vulva. Seven years later, a lymphangiosarcoma developed in her edematous lower extremity. Lymphangiosarcomas have been reported to occur in postmastectomy patients; however, this is only the third case in a patient with a gynecologic primary malignancy. In anticipation of possible increased use of radiation therapy in vulvar carcinoma, gynecologists should be aware of this rare, highly aggressive neoplasm.

Aged↗
PubMed1985

Cisplatin, vinblastine, and bleomycin as second-trial therapy in ovarian carcinoma. A pilot study of the Gynecologic Oncology Group.

Ten patients with ovarian carcinoma whose tumors had progressed on first-trial chemotherapy were treated with cisplatin, vinblastine, and bleomycin (PVB) to determine the efficacy, dose range, and toxicity of this combination. Two dose levels of vinblastine were used. Objective responses occurred in 5/10 patients (3 CR, 2 PR), with a median response duration of 17.0 weeks. Toxicity was appreciable. One patient expired of bleomycin-induced pulmonary fibrosis. With the higher dose of vinblastine, four patients had grade III and three patients had grade IV hematologic toxicity. At the lower dose, two patients had grade II and one patient had grade III hematologic toxicity. PVB has activity in second-trial therapy of ovarian carcinoma at the dose and schedule tested, but the role of this regimen in the future treatment of this disease remains to be determined.

Adenocarcinoma↗
PubMed1985

Randomized trial of three cisplatin dose schedules in squamous-cell carcinoma of the cervix: a Gynecologic Oncology Group study.

The Gynecologic Oncology Group has conducted a randomized prospective trial comparing cisplatin 50 mg/m2 every 21 days (regimen 1), 100 mg/m2 every 21 days (regimen 2), and cisplatin 20 mg/m2 for five consecutive days repeated every 21 days (regimen 3). Four hundred ninety-seven evaluable patients have been accrued on this study. The response rates were 20.7%, 31.4%, and 25.0%, for regimens 1, 2, and 3, respectively; the complete remission rates were 10.0%, 12.7%, and 8.6% for regimens 1, 2, and 3, respectively. The median duration of response ranged from 3.9 to 4.8 months, the median progression-free interval from 3.7 to 4.6 months, and the median survival time from 6.1 to 7.1 months. The difference in response rates for regimens 1 and 2 is statistically significant (P = .015) but less than the magnitude originally considered clinically significant. The differences in complete remission rates, response duration, progression-free interval, and survival times are not statistically significant. The following types of toxicity were observed: serum creatinine level greater than 2 mg/dL and/or BUN level greater than 40 mg/dL was 7%, 14%, and 17% on regimens 1, 2, and 3, respectively; leukocyte count less than 4,000/microL was 27%, 44%, and 41% on regimens 1, 2, and 3, respectively. Nausea and vomiting occurred in 74 patients (83%). The regimen consisting of a 100-mg/m2 single dose has produced a statistically significant higher response rate than the 50 mg/m2 regimen while producing no appreciable differences in complete remission rate, response duration, progression-free interval, or survival. In addition, the higher dose regimen was associated with greater myelosuppression and nephrotoxicity.

Adult↗
PubMed1984

Secondary ovarian neoplasia. A clinicopathologic study of 35 cases.

The authors reviewed the clinical and pathologic features of 35 cases of secondary ovarian neoplasms in which the clinical presentation was that of a primary ovarian tumor. The most common secondary neoplasms to mimic an ovarian tumor were colonic adenocarcinoma, breast carcinoma, lymphoma, carcinoid, and gastric adenocarcinoma. It was found that a classification based on gross appearance was useful in evaluating these neoplasms. Solid neoplasms with either a diffuse or nodular gross appearance had distinct histologies so that accurate diagnosis was possible. Cystic neoplasms, especially colon adenocarcinomas, were deceptive and frequently misclassified as primary ovarian adenocarcinoma. Since all of the metastatic colonic carcinomas had mucus-containing cells, the main differential diagnosis was between metastatic colonic carcinoma and primary mucinous carcinoma of the ovary. The absence of a mucus-cell predominant pattern and the lack of transition from benign-appearing epithelium to malignant epithelium are two useful criteria in making this important distinction. Other features may also prove helpful.

Adolescent↗
PubMed1984

Phase II evaluation of dianhydrogalactitol in the treatment of advanced non-squamous cervical carcinoma. A Gynecologic Oncology Group study.

In an on-going Phase II evaluation, dianhydrogalactitol (NSC 132313) was administered intravenously to 28 patients with advanced or recurrent non-squamous cell carcinoma of the cervix. The initial dosage was 60 mg/m2/wk with escalation to 75 mg/m2/wk if there were no adverse effects. Twenty-seven patients were evaluable for toxicity and response. There was one complete response and one partial response. Adverse effects were not infrequent but tolerable.

Adult↗
PubMed1984

Peritoneo-cystic shunt for malignant ascites.

Peritoneo-venous shunting has been used extensively in the treatment of benign ascites and, to a limited extent, in the palliative management of malignant ascites. Acceptance of this therapy for malignant ascites has been slow because of concern over intravascular dissemination of disease. Recently a patient with advanced drug-resistant ovarian carcinoma was treated with peritoneo-cystic shunt. This patient's tumor had progressed on multiple chemotherapeutic agents. She continued to work 40 hr per week but her activity was limited by massive ascites. The Denver Shunt (Storz) was selected in preference to the strut-type shunt. The Denver Shunt has a miter valve which is less likely to become occluded by fibrinous and cellular debris, and manual compression of the pumping chamber allows flushing and control of flow. This patient's shunt remained patent for 5 months, until her death, documented by urine cytology and cystoscopy. Initial control of ascites was only fair, probably due to the virtual absence of a pressure gradient between the peritoneal cavity and the bladder. Without a pressure gradient, spontaneous flow would be expected to be nil. Though feasible and well tolerated, this technique is probably not useful in the management of malignant ascites. If modifications of the device could be made to increase the manual flow rate, then this technique might be acceptable.

Ascites↗
PubMed1984

Failure of hexamethylmelamine as salvage therapy in ovarian epithelial adenocarcinoma resistant to combination chemotherapy.

Favorable responses to hexamethylmelamine (HMM) have been documented in untreated as well as in alkylating agent-resistant ovarian epithelial adenocarcinoma (OvCa). Platinum-based combination therapy for OvCa has been used since 1976. Eighteen patients with OvCa were treated with HMM as salvage therapy between February 1979 and October 1981. All patients had histologically confirmed OvCa. Eleven tumors were grade III/III and seven tumors were grade II/III. Sixteen patients had received cisplatin-based combination therapy, whereas two had received doxorubicin/cyclophosphamide because of other medical conditions. HMM was used alone in 16 patients and in combination with other drugs in two patients. The initial dose of HMM was 300 mg/m2/day X 14 days when used alone and 130 mg/m2/day X 14 days when used in combination with other drugs. Six patients were treated at a reduced initial dose because of prior marrow toxicity. Adverse effects were tolerable, with 14 patients experiencing hematologic toxicity (5 mild, 5 moderate, 3 severe, 1 life threatening) and 15 patients experiencing GI toxicity (5 mild, 7 moderate, 3 severe). Only 2 patients experienced no toxicity. No objective tumor responses were observed. Four patients had progression of tumor within 4 weeks of starting therapy and 14 patients had stable disease with a mean progression-free interval of 21 weeks. Although HMM is an active drug in untreated and alkylating agent-resistant OvCa, experience suggests that HMM at the dose and schedule tested has insignificant activity in patients who have failed cisplatin-based combination therapy.

Adenocarcinoma↗
PubMed1984

A phase II study of PALA (NSC 224131) in patients with advanced ovarian carcinoma. A Gynecologic Oncology Group study.

Pala, 5G /M2 i.v. every 3 weeks was given to 32 evaluable patients with ovarian carcinoma (31 previously treated). No complete or partial responses were noted. Ten patients had stable disease for a median progression-free interval of 4.7+ months, while the remainder had progression of disease from the start of therapy. The major toxicity was dermatologic, and five patients had severe skin rash with desquamation or ulceration. There was no substantial hematologic or gastrointestinal toxicity. PALA displays no useful activity in previously-treated patients with ovarian cancer.

Adult↗
PubMed1984

PALA (NSC-224131) in advanced carcinoma of the cervix. A phase II study of the Gynecologic Oncology Group.

Thirty-six patients with advanced carcinoma of the cervix received PALA at a dosage of 5 gm/m2 every three weeks. Thirty-three patients had received prior irradiation therapy and chemotherapy. No complete or partial responses were seen. The major toxicity was dermatologic and occurred in 16/36 (44%) of patients. Three patients experienced dose limiting disorientation or confusion. PALA was not associated with any antitumor activity in patients with advanced carcinoma of the cervix who had received prior chemotherapy. The results of this study indicate that PALA has no substantial activity in patients with advanced squamous carcinoma of the cervix who have previously received chemotherapy.

Adult↗
PubMed1984

Assessment of primary gynecologic malignancies: comparison of 0.15-T resistive MRI with CT.

Thirty-eight patients with gynecologic malignancies (ovarian, cervical, and endometrial carcinoma) underwent computed tomography (CT) and magnetic resonance imaging (MRI) of the abdomen and pelvis. Results of these studies were compared with each other as well as with clinical staging and surgical findings when possible. CT and MRI correctly staged 64% (nine of 14) of patients with cervical carcinoma. In patients suspected of residual or recurrent disease, CT and MRI were each correct in 75% (15 of 20), four of the errors being due to inability to distinguish inflammation or radiation changes from recurrent tumor. CT and 0.15-T resistive MRI are of equal value in screening for residual or recurrent disease and as an adjunct to clinical staging; further advances in MRI technology may alter this impression.

Adult↗
PubMed1984

A clinical evaluation of chlorhexidine gluconate spray as compared with iodophor scrub for preoperative skin preparation.

In a prospective, randomized study, 737 patients who were evaluated had the operative site prepared preoperatively by either a 0.5 per cent chlorhexidine gluconate spray or povidone-iodine scrub. The wound infection rate in these two comparable groups was not statistically different, although slightly favoring the spray technique (6.0 versus 8.1 per cent). The spray technique challenges the conventional preoperative scrub and offers further advantages of increased effectiveness while also offering savings of time and expense.

Aerosols↗
PubMed1983

Epithelioid sarcoma of the vulva. Evidence suggesting a more aggressive behavior than extra-genital epithelioid sarcoma.

The authors describe two cases of epithelioid sarcoma of the vulva and summarize the clinical and pathologic experience with this vulvar neoplasm. Findings indicate that epithelioid sarcoma of the vulva usually occurs in the labia majora of young women, but may occur in later life. Clinically it may mimic a Bartholin's duct cyst, thus leading to inadequate treatment. Pathologic findings are characterized by sheets and nests of acidophilic, polygonal cells. Follow-up study suggests that vulvar epithelioid sarcoma behaves more aggressively than extragenital epithelioid sarcoma. Four of five patients died of metastatic sarcoma. The courses of three patients were quite rapid, whereas a fourth patient had multiple recurrences over a long period, which is typical of extragenital epithelioid sarcoma. Complete initial excision is important. All patients with local recurrence died with distant metastases. Vascular invasion also indicates a poor outcome.

Adult↗
PubMed1983

Phase II trial of galactitol 1,2:5,6-dianhydro (NSC 132313) in the treatment of advanced gynecologic malignancies: a Gynecologic Oncology Group study.

Dianhydrogalactitol was administered intravenously to patients with advanced or recurrent gynecologic malignancies on a weekly schedule. The initial dosage was 60 mg/m2 with escalation to 75 mg/m2 if there were no adverse effects. Forty-two patients with ovarian epithelial adenocarcinoma (OEA) and forty-one patients with squamous carcinoma of the cervix (SCC) were entered into this study. Of these, 39 patients with OEA and 36 with SCC were evaluable for toxicity and response. Seven patients (19.4%) with SCC had an objective response, while six patients (15.4%) with OEA had an objective response. Adverse effects were frequent but tolerable. There were no drug-related deaths, and only two patients suffered life-threatening hematologic toxicity. Myelosuppression was observed more frequently among the patients with OEA. A higher percentage of OEA patients had received prior chemotherapy. The level of activity and frequency of adverse effects observed at this dose schedule warrant further studies of this drug in these two tumors.

Adenocarcinoma↗
PubMed1982

Bowenoid dysplasia of the vulva.

The histologic findings of five patients with clinically typical Bowenoid dysplasia (BD) allowed the authors to classify the vulvar and perineal biopsies of 18 patients under 40 years as BD and the vulvar biopsies of six patients under 40 years as squamous cell carcinoma in situ (CIS). The two best criteria for BD are cellular uniformity and absence of pilosebaceous involvement. Vesicular chromatin is a less constant feature of BD. Clinically, patients with BD were younger than those with CIS, more frequently had elevated and multiple lesions and other developed BD with pregnancy. Histologic features therefore discriminate between clinical BD and CIS, but the authors emphasize that both clinical and pathologic features are necessary for proper diagnosis. Follow-up of BD has been benign, with one exception. Spontaneous regression occasionally occurred. One patient with CIS developed microinvasive carcinoma. Patients with BD were regarded at lesser risk for invasive carcinoma than patients with CIS; they are therefore amenable to conservative therapy.

Adult↗