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Biomedical subjects

H J Buchsbaum

Publications and source records attributed to H J Buchsbaum.

At least 19 recordsLinked to original sources

Long-term follow-up and prognostic factor analysis in advanced ovarian carcinoma: the Gynecologic Oncology Group experience.

Long-term follow-up was obtained on 726 women with advanced ovarian carcinoma (suboptimal stage III and stage IV) who had received primary chemotherapy on two Gynecologic Oncology Group (GOG) protocols between 1976 and 1982. The first study compared melphalan alone versus melphalan plus hexamethylmelamine versus cyclophosphamide plus doxorubicin (CA). The second study evaluated the same CA regimen with or without cisplatin. Eligibility for the two studies was the same. At last contact, 76 patients were alive. In a multivariate analysis, cell type other than clear cell or mucinous, cisplatin-based treatment, good performance status, younger age, lower stage, clinically nonmeasurable disease, smaller residual tumor volume, and absence of ascites were favorable characteristics for overall survival (P less than .05). Second-look laparotomy was negative significantly more often among those with endometrioid tumors; there were no negative second-look laparotomies among those with mucinous or clear cell tumors. There were 30 patients with suboptimal stage III disease who had a negative second-look laparotomy; 18 (60%) have experienced recurrence, and 13 (43%) have died. Although cisplatin treatment was beneficial, new treatments are clearly needed.

Adult

Ovarian remnant syndrome: difficulties in diagnosis and management.

Ovarian remnant syndrome should be considered in the differential diagnosis of pelvic pain with a mass in a patient who has had extirpative surgery. Although rarely reported in the literature, it is probably much more prevalent than is suspected. Most commonly, the initial surgery was performed for endometriosis or pelvic inflammatory disease, with incomplete excision of the ovaries. Surgical excision of the ovarian remnant, the definitive treatment, is itself difficult, and is often attended by serious complications. Medical therapy is empiric, and hormonal manipulation may help prevent recrudescence. Three cases are reported, their pathology and the literature is reviewed.

Adult

Extrapelvic lymph node metastases in cervical carcinoma.

One hundred and fifty patients with invasive cervical carcinoma underwent preradiation therapy celiotomy and para-aortic node excision. The incidence of histologically documented metastases in these nodes was 33% (34/102) in Stage IIIB. The last 23 patients with positive para-aortic nodes had left sclanene node excision; nodes were positive in eight patients (34.8%). Sixteen patients had visceral metastases including 11 with small and large bowel metastases, two with liver metastases, and one with metastases to the liver and intestine. Pretreatment celiotomy with para-aortic lymph node excision and, where positive, followed by scalene lymph node excision is valuable in treatment planning in advanced cervical carcinoma limited to the pelvis.

Abdomen

Urologic complications of pelvic exenteration for gynecologic malignancy.

We reviewed 43 cases of pelvic exenteration for gynecologic malignancies. Particular attention was paid to the postoperative urologic complications encountered in these patients. The major disease process was carcinoma of the cervix. Six patients had early postoperative complications and 2 of these patients died. Nine patients had late postoperative problems caused by urinary tract infections or stones. Nine other patients had problems related to the urinary diversion that necessitated a secondary operation in the majority of the cases and 2 of these patients died. Advantages of the ileal and colon conduits are discussed.

Adult

Phase II trial of adriamycin in the treatment of advanced or recurrent endometrial carcinoma: a Gynecologic Oncology Group study.

Forty-three patients with advanced or recurrent endometrial carcinoma no longer amenable to management with surgery or radiotherapy were treated with adriamycin. Sixteen of the 43 patients demonstrated objective response to drug therapy with a greater than or equal to 50% reduction in the size of measurable disease. There were 11 complete responses among these 16 responders. Responders had a significantly better survival than nonresponders (P less than 0.05). Initial performance status was the only factor of demonstrable prognostic significance. Toxicity was similar to that observed in other phase II trials of adriamycin. Adriamycin, based on these data, is an active agent in the treatment of advanced or recurrent endometrial carcinoma.

Age Factors

Accuracy of lymphangiography in the diagnosis of paraaortic lymph node metastases from carcinoma of the cervix.

A study was undertaken to evaluate the use of lymphograms as a method of diagnosing cancer of the cervix metastatic to the paraaortic lymph nodes. Twenty-one patients underwent lymphograms, surgical biopsy, and histologic examination of the paraaortic nodes. The specificity of lymphangiographic examinations is not accurate enough to be of clinical significance in the detection of paraaortic lymph node metastasis from carcinoma of the cervix. Lymphangiography can be of assistance in locating suspicious lymph nodes. These nodes should then be biopsied. The final therapeutic decisions should be based on tissue diagnosis.

Aorta

Intraarterial pelvic infusion chemotherapy in advanced gynecologic cancer.

Fourteen patients with advanced localized gynecologic cancer were treated with 44 courses of intraarterial pelvic infusion chemotherapy. All patients received methotrexate with folinic acid rescue; 9 patients also received vincristine. Tumor regression was observed in 3 of 14 patients (21.4%). In 5 patients there were major complications related to 28 intraarterial catheter placements. Two patients developed leukopenia following chemotherapy. The value of intraarterial infusion chemotherapy in gynecologic cancer is limited. Its use in gynecologic oncology is discussed.

Adult

Pyometra complicating radiation therapy of uterine malignancy.

This report concerns our experience with the clinical management of pyometra in 12 patients receiving radiation therapy at the University of Iowa Hospitals and Clinics for uterine epithelial malignancy. The effect of pyometra on radiation therapy is discussed. Adequate drainage is imperative, and appropriate cultures should be obtained. External radiation therapy may be continued as planned; however, intracavitary radium applications should be deferred.

Adult

Transverse colon conduit for supravesical urinary tract diversion.

Twenty-two patients with extensive pelvic irradiation underwent supravesical urinary diversion using a transverse colon conduit. Primary diseases were most often carcinoma of the cervix and urinary bladder. Indications for diversion included original treatment planning, radiation cystitis, vesicovaginal fistula, and ureteral obstruction. Operative mortality was low (4 per cent), and most complications were managed by further surgery. Normal upper urinary tracts usually remained normal after diversion; relief of existing hydroureteronephrosis was seen in a majority of patients. Stomal problems have been minimal, and renal function has remained normal or stable. The method affords the use of nonirradiated transverse colon as well as the ureter high above the field of pelvic irradiation and is the preferred diversion in such patients.

Adult

The role of scalene lymph node biopsy in advanced carcinoma of the cervix uteri.

Considerable controversy exists in the role of scalene lymph node biopsy in the pretreatment assessment of patients with carcinoma of the cervix uteri. Scalene lymph node biopsy was carried out on ten patients having advanced carcinoma of the cervix uteri with documented para-aortic nodal involvement. Metastatic carcinoma was found in the scalene lymph nodes in five of ten patients. These preliminary findings suggest that excision of scalene lymph nodes should be carried out prior to the institution of therapy in all patients with carcinoma of the cervix uteri which is metastatic to the para-aortic lymph nodes.

Adult

Lymphaticoperitoneal fistula.

Two cases of lymphaticoperitoneal fistula are reported. One patient had a recurrent carcinoma of the cervix and the other had a recurrent vaginal carcinoma. A brief discussion of the pathophysiology is presented.

Carcinoma, Squamous Cell