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Biomedical subjects

H M Tarraza

Publications and source records attributed to H M Tarraza.

At least 19 recordsLinked to original sources

A view from the family: years after a loved one has died of ovarian cancer.

OBJECTIVE: When cancer strikes a patient, it has a major impact on the family. Whereas many health care providers deal with the family while the patient is living, few have any long-term interactions after she has died. The purpose of this study is to interface with family members and reflect upon the impact ovarian cancer had on them. METHODS: A retrospective chart review was conducted of 222 patients who had been diagnosed and treated for ovarian carcinoma between the years 1990 and 1994 at Maine Medical Center, a tertiary care medical center. Of these, 34 patients who had been deceased for longer than 1 year were selected on the basis of specific criteria. The families of these individuals were each mailed a questionnaire comprising seven questions tailored to evaluate one family member's impressions and experiences of coping with a loved one who had died from ovarian cancer. Candid responses of any length were invited. RESULTS: Written responses were received from 32 of the 34 families that were mailed questionnaires. Of those responding, 65% were spouses, 22% were children, and 13% were siblings of the deceased. Each questionnaire was answered by only one relative, and the majority of questions posed received multiple detailed answers. According to the vast majority of respondents, the worst part of treatment was continuing chemotherapy. The most common emotion expressed by family members at the time of diagnosis was one of something having gone wrong. Both travel and living longer appeared to be the most treasured aspects of the patient's life once the diagnosis had been made. Watching their loved one suffer and the overwhelming sense of helplessness were the worst aspects of the disease process. The loved one was most often thought of on her birthday, and 90.6% of the respondents thought another female in their family was likely to get ovarian cancer. CONCLUSION: This study attempted to define those concerns and thoughts that remain important to family members whose loved ones had died from ovarian cancer. Common emotions expressed by family members years after the death of their loved one include their sense of surprise at the diagnosis, their sense of helplessness during the progression of the disease, and their pain in watching their loved one suffer. For them, the worst part of their loved one's treatment was continued chemotherapy, and a common unfounded fear was that another female family member would likely die from ovarian cancer. The responses encourage us as health care providers to remain in touch with these families even after the death of their loved one and to address the misconceptions, fears, and anxieties that our patients and their families may have.

Family↗

Vaginal metastases from renal cell carcinoma: report of four cases and review of the literature.

Between 1987 and 1997, four patients presented with gynecologic symptoms that on evaluation revealed vaginal metastases from renal cell carcinoma. Two patients had isolated metastases and were treated with nephrectomy, local excision of the vaginal lesion and post-operative radiotherapy. Both are alive without evidence of disease at 24 and 30 months, respectively. The other two patients had widespread disease and died within a year of diagnosis. Seventy-one cases of vaginal metastases from renal cell carcinoma have been reported in the literature.

Aged↗

Pelvic radical surgery.

The management of gynecological malignancies is dictated by the stage and nature of the disease. Often, the optimal treatment requires radical pelvic surgery. This is especially true in cervical, ovarian, and vulvar carcinoma. Radical hysterectomy, exenterative procedures and tumor debulking comprise the armamentarium of gynecological oncologists. This article attempts to review the different surgical strategies with attention to their respective indications, potential complications, and overall efficacy.

Carcinoma↗

Gynecologic causes of the acute abdomen and the acute abdomen in pregnancy.

Evaluation of a female patient who presents with an acute abdomen must always consider surgical and gynecologic disorders. Laparoscopy and pelviscopy have had a major impact on the surgical approach in gynecology. Most acute abdomens can now be approached laparoscopically. Certain conditions that are discussed require the traditional laparotomy. Preservation of reproductive capability has a major impact on the wellness of a woman.

Abdomen, Acute↗

Malignant mixed müllerian tumors of the ovary: experience with surgical cytoreduction and combination chemotherapy.

BACKGROUND: The role of surgical cytoreduction and combination chemotherapy for malignant mixed müllerian tumors (MMMT) of the ovary was evaluated. METHODS: A retrospective review of 27 women with ovarian MMMT treated from 1980 to 1990 was performed. RESULTS: The International Federation of Gynecology and Obstetrics stages for the 27 women were 1 Stage I, 3 Stage II, 17 Stage III, and 6 Stage IV. Only 10 of the 23 patients with Stage III or IV disease were cytoreduced optimally. With respect to postoperative therapy, 3 women received no treatment, 6 were treated with whole abdomen radiotherapy, 1 received melphalan, and 17 received chemotherapy incorporating a platinum agent (3), doxorubicin (4), or both (10). The significant prognostic factors were stage (P < 0.001) and, for women with Stage III or IV disease, the feasibility of cytoreductive surgery (P = 0.03). The four patients in Stages I or II remained disease free after an interval of at least 5 years. The median and 5-year survival rates for patients with Stages III or IV disease was 18 months and 8%, respectively. Patients in Stage III or IV for whom optimal cytoreduction was not possible had a 2-year survival of 14%, whereas optimal cytoreduction was associated with a 52% 2-year survival. Median survival for the 14 women with Stage III or IV ovarian MMMT treated with combination chemotherapy was 25 months and nine women achieved progression free intervals of greater than 18 months. CONCLUSIONS: Aggressive surgical cytoreduction followed by combination chemotherapy may result in improved progression free intervals for women with advanced ovarian MMMT. However, a major improvement in prognosis for this rare malignancy has not yet been achieved.

Aged↗

A pilot study of cyclosporine for the prevention of postsurgical adhesion formation in rats.

OBJECTIVE: Our purpose was to evaluate the efficacy of cyclosporine in preventing primary postsurgical adhesions in the rat model. STUDY DESIGN: Thirty-two Sprague-Dawley rats underwent unilateral uterine horn injury with a combination of unipolar and bipolar cautery. Sixteen of the rats were randomized to the treatment group and received preoperative and daily cyclosporine dosing (10 mg/kg) by gavage for 14 days. At the end of the study all animals were killed, and a standard adhesion scoring system was applied by a blinded examiner. RESULTS: Adhesions were present in 75% of rats in both groups. Treatment did not affect the total adhesion score. CONCLUSION: Cyclosporine does not appear promising as a means to decrease postsurgical adhesion formation.

Animals↗

Intra-abdominal desmoplastic small round-cell tumor in a postmenopausal female. Report of a case and review of the literature.

Intra-abdominal desmoplastic small round cell tumor is a rare malignancy which tends to occur in adolescent males. Fewer than 30 cases of this malignancy have been described, and long term survival is poor. We present a case of intra-abdominal desmoplastic small round cell tumor occurring in a post-menopausal woman that mimicked ovarian carcinoma. The clinicopathologic features and literature are reviewed.

Desmin↗

Mesonephric remnant hyperplasia of the cervix: a clinicopathologic analysis of 14 cases.

Lesions derived from mesonephric remnants in the uterine cervix are rare. We describe 14 patients with benign, hyperplastic mesonephric remnant lesions. The patients ranged in age from 31 to 81 years (mean, 47). Four were postmenopausal. The lesions were incidental findings in all but 2 of the patients and frequently had been submitted for consultative pathologic opinion. Two patients did, however, present with symptoms (vaginal bleeding) likely attributable to their lesions and 1 of them had a cervical abnormality on clinical examination. Microscopically, the lesions were composed of lobular or diffuse proliferations of small, round mesonephric tubules which were frequently deep within the cervical wall and often extended to the surface of the cervix. Five of the patients had a referring diagnosis of probable or definite cervical adenocarcinoma due to the infiltrative appearance of the lesions. No mesonephric carcinomas were encountered. Hyperplastic lesions of mesonephric remnants are usually benign, incidental findings but may on occasion be associated with clinical symptomatology and are a potential source of diagnostic confusion for the pathologist.

Adult↗

Consolidation intraperitoneal chemotherapy in epithelial ovarian cancer patients following negative second-look laparotomy.

Fifty-six patients with Stage III ovarian carcinoma who had a negative second-look laparotomy following optimum cytoreduction, cisplatin, and cyclophosphamide chemotherapy were enrolled in a pilot study to receive consolidation intraperitoneal (IP) chemotherapy. Forty-one patients received three courses of IP cisplatin (80 mg/m2). Fifteen patients with cisplatin-induced toxicity received three courses of IP mitoxantrone (10 mg/m2). Toxicity was minimal, with only 2 patients suffering peritonitis and 1 patient developing an enterotomy at the time of catheter removal. Median follow-up for the IP cisplatin and IP mitoxantrone group has been 24 and 30 months, respectively. Ten of the 41 patients (24%) who received IP cisplatin and 4/15 (26%) of the IP mitoxantrone patients have recurred (P = ns). Median time to recurrence was 18 months for both groups. This study indicates that consolidation intraperitoneal chemotherapy following negative second-look laparotomy is feasible with either cisplatin or mitoxantrone. However, many of these patients still recurred and prospective trials will be required to determine which (if any) consolidation intraperitoneal treatment is best following a negative second-look laparotomy.

Carcinoma↗

Cervical metastases in advanced ovarian malignancies.

Cervical metastases from ovarian malignancies are a rare event. In order to better define the incidence and pathogenesis of this phenomenon we retrospectively reviewed the charts and pathologic material from 171 Stage III ovarian malignancies. Nine patients (5.3%) were identified with cervical metastases and three patterns of spread to the cervix were recognized: 1) lymphatic permeation only; 2) para-cervical soft tissue extension and 3) direct stromal myometrial invasion. All of the patients with cervical metastases had high grade (Broder's grade III or IV) tumors and extensive abdominal disease at presentation. Although four patients had a positive or suspicious pap smear, none of these had cervical involvement. We conclude that ovarian metastases to the cervix are a rare event, occurring late in the course of the disease and arise from a variety of modes of spread.

Adenocarcinoma↗

Isolated cerebellar metastasis from ovarian carcinoma. Case report and review of the literature.

Isolated cerebellar metastasis from ovarian cancer is a very rare entity with only one other reported case in the literature. We report an additional case. This patient had a single 3 x 3 cm cerebellar lesion that was removed revealing metastatic papillary carcinoma consistent with a known ovarian primary. We also present a review of the literature concerning central nervous system (CNS) metastases from ovarian cancer and the various methods of treatment currently being used. Current literature suggests that patients with isolated resectable lesions should be managed surgically.

Cerebellar Neoplasms↗

Post-hysterectomy carcinoma of the fallopian tube mimicking a vesicovaginal fistula.

A 49-year-old woman presented with a profuse watery vaginal discharge 16 years after a vaginal hysterectomy. Pelvic examination revealed clear fluid leaking from the vaginal apex. Cytologic evaluation of the draining fluid was normal, as was a biopsy of the vaginal apex. A vesicovaginal fistula was suspected. Intravenous pyelogram and cystogram did not reveal communication of the urinary tract with the fistula. Injection of radiopaque dye through the fistula tract demonstrated a 5-7-cm enclosed cystic space with a 4-cm pedunculated mass within the cyst lumen. Exploratory surgery revealed fallopian tube carcinoma involving the right tube. The tumor mass was completely excised, and there was no evidence of spread beyond the encapsulated cystic fallopian tube. The woman was treated with six cycles of cisplatin combination chemotherapy, and after 5 years remains free of disease.

Adenocarcinoma↗

Stage IE primary malignant lymphomas of the uterine cervix.

The experience of the authors with primary non-Hodgkin's lymphoma of the uterine cervix from 1980 to 1986 included five Ann Arbor Stage IE cases successfully managed by meticulous staging and radiation therapy. The clinicopathologic features of the patients are described and compared with 38 previously reported Stage IE cases. When all 43 patients were evaluated, the median age was 40 years of age (range, 20 to 80 years of age) and 77% were premenopausal. Most patients (74%) reported abnormal vaginal bleeding, although approximately 20% were asymptomatic. The primary cervical tumors were typically of large size, with half exceeding 4 cm in diameter. Using the International Federation of Gynecology and Obstetrics (FIGO) system for staging cervical cancer, stage distribution was 44% Stage I, 42% Stage II, 12% Stage III, and 2% Stage IV. Histologically, approximately 70% were of the diffuse, large cell type (Working Formulation). External beam radiation therapy supplemented by brachytherapy or hysterectomy was used for 76% of the patients reviewed. There was only one treatment failure among the 28 patients whose treatment included radiation and whose cases were followed for at least 2 years. This experience and a review of the literature indicate that most cases of primary lymphoma of the uterine cervix are Ann Arbor Stage IE, and can be cured with traditional combinations of surgery and radiation therapy after careful evaluation.

Aged↗

Combination chemotherapy in advanced adenocarcinoma of the fallopian tube.

Advanced adenocarcinoma of the fallopian tube has a poor prognosis, with 5-year survival rates commonly less than 20%. Since 1980, we have managed 12 patients with disseminated tumor with combination chemotherapy following surgical cytoreduction. Analogous to the International Federation of Gynecology and Obstetrics staging of ovarian carcinoma, 3 patients were classified in Stage II, 8 in Stage III, and 1 in Stage IV. Ten patients received cisplatin-containing regimens. The 3 Stage II patients, without measurable disease after primary surgery, had an indeterminate response to chemotherapy. In Stages III-IV there were 4 complete responses (3 confirmed by second-look laparotomy) and 2 partial responses, for an overall response rate of 67%. Disease progressed in 2 patients and was stable in 1 patient. After median follow-up of 3.5 years, 4 of the Stage III-IV patients have no evidence of disease, 1 is alive with disease, and 4 are dead.

Adenocarcinoma↗

Flow cytometric DNA analysis versus cytology in the evaluation of peritoneal fluids.

The use of flow cytometric DNA analysis as an adjunct to cytology in peritoneal fluid evaluation was studied. One hundred ninety-five fluids from 193 gynecologic patients were subjected to both DNA analysis and cytologic examination. It was found that 117/195 (60%) had invasive malignancies (50 ovarian, 48 endometrial, 17 cervical, and 2 miscellaneous); 34/117 (28%) patients with malignancies were positive by cytology, and 10/117 (8.5%) were positive (aneuploid) by DNA analysis. Of 34 cytologically positive cases, 7 (21%) were DNA positive, 25 (74%) were DNA negative, and in 2 (6%) insufficient cells were obtained. Only 3 fluids (3%) from malignancies were positive by flow cytometry and negative by cytology (1 stage I ovarian cancer, 1 stage I endometrial cancer, and 1 stage III ovarian cancer). No false-positive cytology and one probable false-positive flow result was obtained. If only those patients with histologically documented peritoneal involvement are considered, 29/43 (65%) had positive cytology and 8/43 (19%) had a positive flow result. We conclude that: (1) the high false-negative rate of flow cytometry (79%) versus cytology in this study may be related to a high percentage of diploid cancers, specimen preparation, or histogram interpretation, and (2) flow cytometry rarely adds to cytologic evaluation and is probably best reserved for use only in selected cases.

Ascitic Fluid↗

Extragenital malignant mixed müllerian tumor: review of the literature.

A case of extragenital malignant mixed mullerian tumor (MMMT) of the heterologous type 11 years after treatment of a Stage I ovarian neoplasm in a 65-year-old patient is described. There was no evidence of a histologic relationship between these two neoplasms. This case represents the 10th report of an extragenital MMMT. The medical literature and histogenesis of this rare tumor are discussed.

Aged↗