Biomedical subjects

H E Geisler

Publications and source records attributed to H E Geisler.

At least 55 records · Page 3Linked to original sources

PubMed1995

Brain metastases in epithelial ovarian carcinoma.

Central nervous system metastases from epithelial ovarian carcinoma are uncommon. A retrospective study was undertaken to see if there was a difference in brain metastases from ovarian cancer in our patient population as compared to the literature. A retrospective study of all patients diagnosed with brain metastases from epithelial ovarian carcinoma at two institutions was performed. All patients were analyzed for stage, grade, type of chemotherapy, sites of recurrence, time to relapse, and survival after relapse. The results were compared to a compilation of reported cases from the literature. Sixteen patients with central nervous system metastases of 479 patients treated for ovarian carcinoma between January 1, 1979 and December 31, 1992 were identified. All 16 patients were diagnosed with serous cystadenocarcinoma, and all were either stage III or IV on presentation. Fifteen of the 16 patients had grade 2 or 3 disease. Histologic grade, at the time of diagnosis, did not influence survival after central nervous system recurrence; however, stage at original diagnosis did influence survival after brain metastases (P < 0.001). Eight of 11 patients undergoing second-look laparotomy had no evidence of disease. The most common presenting symptom of central nervous system disease was a slowly worsening headache of several weeks duration. The median time from original diagnosis to diagnosis of central nervous system disease was 19 months with a median survival after diagnosis of central nervous system disease of 3 months. The incidence of brain metastases in patients with epithelial ovarian carcinoma in our institutions was 3.3%. In conclusion, our incidence of brain metastases of 3.3% was not statistically significant from other reported rates. Patients who underwent radiation therapy with either craniotomy or chemotherapy for their brain metastases fared better than those who received radiation alone.

Adult↗

PubMed1995

Hutch paraureteral diverticulum complicating radical hysterectomy.

BACKGROUND: Paraureteral diverticula are abnormalities of the urinary bladder which are more common in males, and thus are infrequently encountered in the patient population of the gynecologic oncologist. CASE REPORT: A 59 year old white female, with a history of recurrent bladder cancer treated by transurethral resection, presented with an abnormal cervical cone biopsy revealing invasive squamous cell carcinoma of the uterine cervix". The patient had a known Hutch paraureteral diverticulum for which she was receiving prophylactic cyprofloxacin. Computed tomography revealed an 8.5 x 8 x 7 cm paraureteral diverticulum on the right. There was no hydronephrosis of either renal pelvis. Laparotomy revealed a mass, resembling a second urinary bladder, which was very closely associated with the bladder and lateral proximal vagina on the right. Since a urological consultant advised that the diverticulum should not be resected, dissection around the bladder and vagina for the radical hysterectomy was made much more difficult. CONCLUSION: The presence of a paraureteral diverticulum increases the difficulty of performing a radical hysterectomy.

Carcinoma, Squamous Cell↗

PubMed1995

Change in MIB-1 staining between primary and recurrent epithelial ovarian cancer.

PURPOSE: In recent articles, MIB-1 staining has been shown to relate to length of survival of patients with epithelial ovarian malignancies. We report a case showing the difference in MIB-1 between the primary and recurrent tumor. CASE REPORT: A 63 year old female had a total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic and paraaortic lymphadenectomy, partial omentectomy, and a staging procedure which achieved optimal debulking of a clear cell adenocarcinoma of the ovary. Final pathology revealed Stage IIIc disease because of one positive left iliac node. All other specimens except for the ovaries were negative for malignancy. The proliferation index of the tumor based on MIB-1 monoclonal antibody staining was 4.10%. The patient then was treated with 6 courses of carboplatin and cyclophosphamide. After a microscopically positive second look laparotomy, the patient received 4800 cGy of external beam radiation to the pelvic and paraaortic lymph node bearing areas. Fifteen months after the original diagnosis, a suspicious vaginal mass was biopsied and found to be recurrent clear cell adenocarcinoma consistent with an ovarian primary. MIB-1 monoclonal antibody staining of the recurrent cancer gave a proliferation index of 38.73%. The patients is still alive with a CA-125 which has plateaued between 60 U/ml and 70 U/ml, fourteen months after recurrence. CONCLUSION: The proliferation index by MIB-1 staining may be affected by treatment for ovarian epithelial malignancies.

Adenocarcinoma, Clear Cell↗

PubMed1994

Radical hysterectomy in patients 65 years of age and older.

Since the percentage of elderly patients in the United States is increasing, the knowledge of whether radical surgery can be performed on these patients with acceptable morbidity and mortality is important. Therefore, a retrospective study of elderly patients having radical hysterectomy was performed. A retrospective case study of all patients over 65 years of age having undergone a radical hysterectomy in one private community practice of gynecologic oncology was performed. No patients between July 1, 1965, and December 31, 1992, were knowingly excluded. All patients were analyzed for preexisting medical conditions, length of postoperative stay, morbidity, and mortality. Sixty-nine patients who fit the above criteria were found. Preexisting medical problems were found in 72.5% of the study population. Minor morbidity occurred in 14.5% of the group, while major morbidity occurred in 10%. There was no mortality. Lengths of hospital stay were significantly different between patients 65 to 74 (8.7 days) and over age 75 (10.4 days). In conclusion, radical hysterectomy is a safe surgical procedure in patients 65 and over. This is true even in patients 75 and over. Careful preoperative assessment, perioperative monitoring, and meticulous postoperative care is vital to the success of any major surgery, especially in the older patient.

Age Factors↗

PubMed1994

Ovarian carcinoma presenting as intra-abdominal hemorrhage.

Ovarian carcinoma commonly has an insidious onset. By the time the diagnosis is made, advanced disease is usually present. Rarely does a patient have acute symptoms which require immediate medical attention and lead to the correct diagnosis. A 40-year-old white female presented with lower abdominal pain, nausea, and light-headedness. Physical examination revealed a markedly tender lower abdomen with the right lower quadrant slightly more tender than the left. Hemoglobin level was noted to have decreased 2.6 g/dl over 16 hr. At exploratory laparotomy, 1500 cc of blood and a ruptured right ovarian mass were found. Pathologic analysis revealed a malignant mixed mesodermal tumor of the right ovary and an endometrioma of the left ovary. In conclusion, ovarian carcinoma may present as an acute abdomen because of intra-abdominal hemorrhage. It should be part of the differential diagnosis in a woman with an acute surgical abdomen and a hemoperitoneum.

Abdomen, Acute↗

PubMed1994

Ovarian cancer causing upper and lower urinary tract obstruction.

BACKGROUND: Cervical cancer is the gynecologic malignancy most commonly associated with urinary tract obstruction. Ovarian cancer rarely causes this problem, but when it does, the obstruction is due to impedance of flow in the pelvic ureters. CASE REPORT: A 34 year old female treated by total abdominal hysterectomy with ovarian preservation 9 months earlier for presumed stage IV endometriosis and menorrhagia presented with a recurrent pelvic mass along with symptoms of bladder outlet obstruction. Intravenous urography and computed tomography showed bilateral hydronephrosis and confirmed the bladder outlet obstruction. Laparotomy revealed a large pelvic mass, grossly resembling endometriosis, obstructing the right ureter and impinging upon the urethrovesical junction. Final pathological analysis revealed a mucinous cystadenocarcinoma of the ovary. CONCLUSION: Urinary tract obstruction, including both urethrovesical junction and ureteral obstruction, may be caused by ovarian cancer.

Adult↗

PubMed1994

Retrograde lymphatic metastasis of an ileal carcinoid.

BACKGROUND: Carcinoid tumors are uncommon tumors, derived from Kulchitsky cells, which generally follow a slow, orderly metastatic spread. They are often associated with second primary malignant neoplasms either synchronously or metachronously. CASE REPORT: A 62 year old white female with a history of severe dysplasia of the vulva and carcinoid of the distal ileum presented with a presumed vulvar malignancy by biopsy from a referring hospital. She did not have symptoms of the carcinoid syndrome. Wide vulvar excision revealed chronic inflammation without residual tumor. Bilateral superficial and deep inguinal lymphadenectomy revealed metastatic carcinoid. CONCLUSION: The inguinal lymph nodes should be considered a site of distant metastasis for carcinoid tumors of the distal ileum.

Carcinoid Tumor↗

PubMed1989

Features associated with survival and disease-free survival in early endometrial cancer.

Age, clinical stage, histologic grade, depth of myometrial penetration, adnexal status, peritoneal cytology, and progesterone and estrogen receptor status were available for 139 patients with clinical stage IA, IB, or II endometrial adenocarcinoma who had therapy at Indiana University Hospital or St. Vincent Hospital in Indianapolis. These features were analyzed for their association with survival and disease-free survival. Patients treated at Indiana University Hospital were similar to those from St. Vincent Hospital when comparisons were made by chi 2 test for age, clinical stage, grade, adnexal metastases, peritoneal cytologic results, progesterone receptor status, or estrogen receptor status. However, patients treated at Indiana University Hospital had lesions that were deeper (p = 0.03) than those treated at St. Vincent Hospital. Survival differences were observed for patients with progesterone receptor-rich versus progesterone receptor-poor tumors (p = 0.004), grades 1 and 2 versus grade 3 lesions (p = 0.013), and malignant versus benign peritoneal cytologic results (p = 0.01). Differences in disease-free survival were observed for those patients with adnexal metastases versus those with no adnexal disease (p = 0.002), those with estrogen receptor-rich versus estrogen receptor-poor tumors, outer third myometrial invasion (p = 0.002), and patients with clinical stage I versus clinical stage II disease (p = 0.03). A stepwise Cox proportional hazards model was constructed to determine correlates of disease-free survival. In the final model, grade (p = 0.0002), peritoneal cytologic results (p = 0.0002), progesterone receptor status (p = 0.004), and age as a continuous variable (p = 0.008) were most closely associated with disease-free survival.

Adenocarcinoma↗

PubMed1988

The importance of peritoneal cytology in endometrial carcinoma.

From 1971-1986, peritoneal washings were obtained for cytologic examination at the time of primary exploratory laparotomy in 340 patients with endometrial adenocarcinoma. Seventy-two samples (21.2%) contained malignant cells. The finding of malignant cytology increased with stage of disease: stage I, 17%; stage II, 19.5%; stage III, 68.7%; and stage IV, 85.7% (P less than .001). In 248 patients with clinical stage I disease for whom uterine evaluation was complete, there was an increasing incidence of malignant cytology with increasing grade (P = .002), depth of myometrial invasion (P = .003), and adnexal spread (P less than .001). Twelve of 41 patients (29.3%) with clinical stage I and positive cytology developed recurrent disease, compared with six of 207 (2.9%) with negative cytology (P less than .001). Survival for all stages together was poorer in patients with positive washings than in those with negative washings (P less than .001). This difference in survival was also observed in patients with clinical stage I disease (P less than .001). Among patients with surgical stage I disease, disease-free survival was also superior in the group with negative cytology. In both clinical and surgical stage I, intra-abdominal recurrences were more common among patients with malignant peritoneal cytology.

Adenocarcinoma↗

PubMed1985

The use of high-dose megestrol acetate in the treatment of ovarian adenocarcinoma.

This study investigated the use of a progestin, megestrol acetate, in high doses for 34 patients with ovarian adenocarcinoma and related gynecologic tumors. Megestrol acetate was administered in doses of 800 mg/d orally for one month, followed by 400 mg/d until the first signs of progression of disease. Of 23 evaluable patients, seven patients showed a complete response and four patients a partial response. Ten of the responders had ovarian adenocarcinoma, and one, who is alive and free of disease 96 months after treatment, had a mesothelioma. The remaining six patients achieving complete response survived from 5 to 36 months, and those achieving partial response survived from 4 to 10 months. In contrast, studies of progestins administered in conventional doses to ovarian carcinoma patients have yielded minimal response at best. Our results confirm the benefits of high-dose progestins for ovarian carcinomas and related gynecologic tumors and warrant further investigation of hormonal therapy for this patient group.

Adenocarcinoma↗

PubMed1983

Megestrol acetate for the palliation of advanced ovarian carcinoma.

High doses of the oral progestin megestrol acetate were used to treat patients with ovarian cancer who had suffered relapses following conventional therapy. In all but 2 of these patients, second-line drugs or other additional therapeutic measures had been tried before resorting to the high-dose oral progestin. The response of 24 patients is the subject of this report. Megestrol acetate proved to be useful for those who were able to take oral medication and who failed to respond to other forms of therapy.

Administration, Oral↗

PubMed1983