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Biomedical subjects

J C Schink

Publications and source records attributed to J C Schink.

At least 19 recordsLinked to original sources
PubMed2006

Saline contrast sonohysterography and directed extraction, resection and biopsy of intrauterine pathology using a Uterine Explora Curette.

OBJECTIVE: To assess the utility of an endometrial sampling device, the Uterine Explora Curette, with concomitant saline contrast sonohysterography (SCSH) for ultrasound-directed extraction, resection and biopsy of endometrial pathology. METHODS: Use of the Uterine Explora Curette was prospectively evaluated in 20 women with either infertility (n = 14), recurrent miscarriage (n = 2) or peri-/postmenopausal bleeding (n = 4). Findings on SCSH were compared with those on pathological analysis. RESULTS: In all 20 cases the Uterine Explora Curette was used successfully during SCSH to treat endometrial filling defects. The procedure was well tolerated, with an average time from start to finish of 10 (range, 2-23) min. It was without complications, and appeared to remove or biopsy adequately endometrial filling defects in most patients, obviating the need for hysteroscopy. CONCLUSIONS: In properly selected patients, directed extraction, resection and biopsy using the Uterine Explora Curette during SCSH appears to be an effective and easy method for treating intrauterine pathology and provides a cost-effective alternative to operative hysteroscopy.

Abortion, Habitual↗
PubMed2001

A pilot study of whole body hyperthermia and carboplatin in platinum-resistant ovarian cancer.

The aim of this study was to determine whether the addition of whole body hyperthermia (WBH) to carboplatin (CBDCA) can induce responses in patients with platinum-resistant ovarian cancer. 16 pretreated patients with platinum-resistant ovarian cancer were entered on a Systemic Hyperthermia Oncological Working Group (SHOWG) study; (14 patients were eligible with 14 evaluable for toxicity and 12 for response). The patients were treated with WBH (Aquatherm) 41.8 degrees C x 60 min in combination with carboplatin (CBDCA) (area under the curve (AUC) of 8) every 4 weeks. Disease status was evaluated every two cycles. Patients were treated for a maximum of six cycles. One patient had a complete response (CR) and 4 had a partial response (PR). 4 patients had stable disease (SD). 3 patients had progressive disease (PD). 2 patients were unevaluable: 1 had a bowel obstruction shortly after her first treatment; the second patient achieved a CR, but only had one treatment secondary to an idiosyncratic reaction to sedative drugs. 2 patients entered on study were ineligible, as they did not meet criteria for platinum resistance; 1 entered a CR and 1 had SD. Dose-limiting toxicity, which required CBDCA dose reductions, was grade 4 thrombocytopenia. Other toxicities included neutropenia (grade 3/4), and nausea and/or vomiting. Consistent with preclinical modelling, these results suggests that 41.8 degrees C WBH can overcome platinum resistance in ovarian cancer. These observations suggest further investigation of the therapeutic potential of WBH in a group of patients who historically fail to respond to salvage therapies is warranted.

Adult↗
PubMed1999

High-dose-rate versus low-dose-rate brachytherapy in the treatment of cervical cancer: analysis of tumor recurrence--the University of Wisconsin experience.

PURPOSE: To retrospectively compare the clinical outcome for cervical cancer patients treated with high-dose-rate (HDR) vs. low-dose-rate (LDR) brachytherapy. METHODS AND MATERIALS: One hundred ninety-one LDR patients were treated from 1977 to 1988 and compared to 173 HDR patients treated from 1989 to 1996. Patients of similar stage and tumor volumes were treated with identical external beam fractionation schedules. Brachytherapy was given in either 1 or 2 LDR implants for the earlier patient cohort, and 5 HDR implants for the latter cohort. For both patient groups, Point A received a minimum total dose of 80 Gy. The linear-quadratic formula was used to calculate the LDR dose-equivalent contribution to Point A for the HDR treatments. The primary endpoints assessed were survival, pelvic control, relapse-free survival, and distant metastases. Endpoints were estimated using the Kaplan-Meier method. Comparisons between treatment groups were performed using the log-rank test and Cox proportional hazards models. RESULTS: The median follow-up was 65 months (2 to 208 months) in the LDR group and 22 months (1 to 85 months) in the HDR group. For all stages combined there was no difference in survival, pelvic control, relapse-free survival, or distant metastases between LDR and HDR patients. For Stage IB and II HDR patients, the pelvic control rates were 85% and 80% with survival rates of 86% and 65% at 3 years, respectively. In the LDR group, Stage IB and II patients had 91% and 78% pelvic control rates, with 82% and 58% survival rates at 3 years, respectively. No difference was seen in survival or pelvic control for bulky Stage I and II patients combined (>5 cm). Pelvic control at 3 years was 44% (HDR) versus 75% (LDR) for Stage IIIB patients (p = 0.002). This difference in pelvic control was associated with a lower survival rate in the Stage IIIB HDR versus LDR population (33% versus 58%, p = 0.004). The only major difference, with regard to patient characteristics, between the Stage IIIB patients was the incidence of hydronephrosis in the HDR vs. LDR group--28% vs. 12%, respectively (p = 0.05). For Stage IIIB patients treated with HDR, our analysis suggested that pelvic control rates improved when the first brachytherapy insertion was performed after the majority of external beam radiotherapy had been delivered. CONCLUSION: Similar outcome was observed for Stage IB and II patients treated with either HDR or LDR brachytherapy-regardless of tumor volume. However, poorer survival and pelvic control rates were observed for Stage IIIB patients treated with HDR brachytherapy. If HDR is used for Stage IIIB patients, our results suggest the majority of external beam radiotherapy should be delivered prior to initiating the brachytherapy to allow for adequate tumor regression. HDR brachytherapy is more convenient for patients, decreases the radiation exposure for health care workers, and should be considered a standard therapy for women with Stage I or II cervical cancer.

Adult↗
PubMed1999

Familial ovarian germ cell cancer: report and review.

Ovarian germ cell cancers are rare malignancies accounting for less than 5% of all ovarian cancers. We present a family in which three closely related women were diagnosed with ovarian germ cell malignancies. This family's cancer history prompted a family history investigation of women treated for ovarian germ cell malignancies in the Gynecologic-Oncology Clinic at the University of Wisconsin. One of the eight patients whose family histories were reviewed had an uncle who had been diagnosed with testicular germ cell cancer. A review found six other previously reported families in which more than one relative had been diagnosed with a malignant ovarian germ cell tumor. Additionally, several cases of families with both males and females diagnosed with germ cell cancers have been documented. The low incidence of ovarian germ cell cancers suggests that multiple occurrences in the same family may not be due to chance. Rather, it is possible that a gene conferring susceptibility to ovarian germ cell cancers, and possibly to germ cell tumors in males as well, is present in at least some of these families.

Adolescent↗
PubMed1999

Methotrexate sequestration in an ovarian cyst.

OBJECTIVE: Methotrexate has been documented to accumulate in pleural effusions and ascitic fluid, resulting in severe local and systemic toxicity. In the following case report, we publish results of intraoperative measurements of methotrexate levels in serum and an ovarian cyst and attempt to determine if ovarian cysts similarly act as a depot for methotrexate. METHODS: After determining intraoperative measurements of serum and ovarian cystic levels of methotrexate, we compared demonstrated pharmacokinetics to those expected by using pharmacokinetic systems analysis software. RESULTS: Intraoperative measurement of methotrexate levels on day 3 of a 5-day methotrexate regimen revealed a serum methotrexate concentration of 1.6 x 10(-7) M and a concentration of 3.1 x 10(-7) M within the 166.4 ml ovarian cyst. CONCLUSIONS: The measured levels demonstrate that methotrexate is sequestered within an ovarian cyst resulting in higher local drug levels. Our pharmacokinetic analysis suggests that methotrexate doses less than 100 mg/m2 can be safely administered to patients with small ovarian cysts. However, computed simulations support the possibility of local and systemic toxicity arising from large ovarian cysts when using high doses of methotrexate.

Adult↗
PubMed1999

Current initial therapy of stage III and IV ovarian cancer: challenges for managed care.

Patients with advanced ovarian cancer (International Federation of Gynecology and Obstetrics stage III or stage IV) have improved their long-term prognosis, but the majority will still die of their disease. The current standard therapy, which involves aggressive cytoreductive surgery (removal of all visible tumor) followed by platinum/paclitaxel chemotherapy, has increased 5-year survival rates considerably over the last three decades. The choice of treatment for patients with stage III or IV disease in the managed care setting must consider survival rates, patient quality of life, and cost-effectiveness. Two chemotherapy combinations, cisplatin/paclitaxel and carboplatin/paclitaxel, appear comparable in efficacy in advanced disease, but are currently being investigated in clinical trials to compare side effects, quality-of-life parameters, and cost-effectiveness. The results of these trials may determine which chemotherapy combination becomes the standard of care for first-line treatment. Managed care organizations and patients can also benefit from a multidisciplinary approach to cancer care that includes additional support, such as risk assessment programs, the use of specialists (gynecologic oncologists), and psychosocial counseling. As the search for more effective agents and other therapeutic modalities continues, the focus of future research may be to find specific biomarkers of ovarian cancer, which will help detect disease at its earliest stages.

Antineoplastic Agents↗
PubMed1998

Resection of a giant aggressive angiomyxoma in the Philippines.

INTRODUCTION: Medicine for Humanity is a multidisciplinary team of health care professionals, travelling to developing areas throughout the world on medical missions. The following is one of many technically challenging and unique cases presented for treatment. CASE: A 38-year-old woman gradually developed a giant mass arising from the right labium majus, extending into the retroperitoneum. Surgical resection was performed by abdominal and perineal teams. Intraoperative blood loss was approximately 10,000 ml, requiring 18 units of whole blood transfusion-including 6 units acutely donated by members of the surgical team. A "pack and go back" technique was used for hemostasis. The tumor weighed 19.8 kg. Final histology confirmed an aggressive angiomyxoma. CONCLUSION: This patient had the largest, histologically confirmed, aggressive angiomyxoma described to date. The surgical management of this case followed the principles in treating hemorrhagic shock, but required modifications based on availability of resources in Cebu City, Philippines.

Adult↗
PubMed1997

Infiltrating ductal carcinoma of the vulva.

The eleventh case of primary infiltrating ductal carcinoma of the vulva is reported with a review of the literature. The infiltrating tumor is associated with an intraductal component as well as noninvolved mammary-like glandular tissue (ectopic breast tissue) and metastases to inguinal lymph nodes. Estrogen receptor and progesterone receptor immunohistochemical staining is negative utilizing the HSCORE method. The treatment regimen is patterned after approach to node-positive breast carcinoma.

Aged↗
PubMed1996

The genetics of ovarian cancer: concepts in testing and counseling.

The discovery and sequencing of the BRCA1 gene is an exciting breakthrough for women and health care providers. BRCA1 is associated with inherited breast and ovarian cancer and the body of scientific information regarding its role in ovarian cancer is growing rapidly. The impact of this knowledge on counseling women with a family history of breast or ovarian cancer is profound. This review provides information about familial ovarian cancer syndromes and the emerging role of genetic testing in women with an inherited susceptibility for cancer.

DNA, Neoplasm↗
PubMed1993

DNA flow cytometric analysis of clinical stage I endometrial carcinomas with lymph node metastases.

Twenty-one (8%) of 264 consecutive evaluable patients with clinical stage 1 endometrial carcinoma had histologic evidence of pelvic and/or para-aortic lymph node metastases. DNA flow cytometry was performed on both the primary tumor and nodal metastasis. Seventeen of 21 sets could be analyzed. Overall, 11 (65%) of the primary carcinomas were aneuploid. Nine of 17 (53%) had consistent ploidy patterns when the primary tumor and lymphatic metastasis were compared. The remaining 8 (47%) had aneuploid primaries with diploid nodal metastases. Five (83%) of the 6 patients with diploid primary tumors were alive without evidence of disease compared to 3 of 11 (27%) patients with aneuploid tumors (P < 0.05). Other predictors of disease outcome included tumor histology, lymph vascular space invasion, and depth of myometrial invasion. Ploidy status of the lymphatic metastasis was not important in terms of overall survival. All 8 patients with para-aortic nodal metastases had aneuploid primary carcinomas compared to 4 (44%) of 9 patients with pelvic node involvement only (P < 0.01). Mean survival was 31 months for patients with para-aortic node metastases compared to 51 months for patients with only pelvic node metastases. Comparison of survival curves among these two groups demonstrated a significant survival advantage in patients with regional nodal metastases (P = 0.032). S-phase fraction of both the primary tumor and lymphatic metastasis did not correlate with survival or predict disease outcome. DNA index of the primary tumor, as a continuous variable, was inversely proportional to survival, demonstrating poorer survivorship with incremental increases of DI. Ploidy status of the lymph node metastasis was an inconsistent reflection of the primary tumor's expression and behavior and, therefore, little additional information was gained by knowledge of the lymphatic ploidy status.

Adult↗
PubMed1992

Etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine for the treatment of metastatic, high-risk gestational trophoblastic disease.

OBJECTIVE: To evaluate the efficacy and toxicity of a regimen of etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine in patients with metastatic, high-risk gestational trophoblastic tumors. METHODS: Twelve women with metastatic gestational choriocarcinoma received 64 treatment cycles. All met the National Cancer Institute criteria for high-risk gestational trophoblastic tumors. Response was evaluated by monitoring serial serum beta-hCG levels. Toxicity was recorded using standard World Health Organization criteria. RESULTS: There was no life-threatening toxicity. Neutropenia necessitating a 1-week delay of treatment occurred with only eight treatment cycles (12.5%) and deferral of vincristine and cyclophosphamide with three cycles. Anemia requiring transfusion complicated only two cycles. Peripheral neuropathy in two patients was treated by discontinuing vincristine. Other toxicities included nausea and vomiting, diarrhea, stomatitis, alopecia, conjunctivitis, thrombocytopenia, and fever. Ten of the 12 subjects experienced a complete response. Two had partial responses and one with an initial complete response had relapse 4 months after completing therapy; all three were successfully salvaged with cisplatin-based chemotherapy. Overall survival was 100%, and all 12 patients are disease-free with a median follow-up of 26 months. CONCLUSIONS: Chemotherapy with etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine is well tolerated and highly effective for metastatic, high-risk gestational trophoblastic disease.

Adult↗
PubMed1991

Tumor size in endometrial cancer.

Tumor size was determined in 142 patients with clinical Stage I endometrial cancer treated primarily by total abdominal hysterectomy, bilateral salpingo-oophorectomy, and lymph node biopsies between July 1979 and August 1988. Only 4% of patients with tumor size less than or equal to 2 cm had lymph node metastasis; this increased to 15% for tumors more than 2 cm and increased further to 35% when the entire uterine cavity was involved (multivariate P = 0.01). Five-year survival was 98% for patients with tumors less than or equal to 2 cm, 84% with tumors more than 2 cm, and 64% with tumors involving the whole uterine cavity (Mantel-Cox P = 0.005). For endometrial cancer patients with Grade 2 tumors and less than one-half myometrial invasion, the risk of lymph node metastasis is often considered too low to justify adjuvant pelvic radiation therapy. This intermediate-risk group is better defined by including tumor size as a prognostic factor. For this subgroup (Grade 2, less than one-half endometrial invasion) there were no lymph node metastasis associated with tumors less than 2 cm, but 18% had nodal disease when tumors were larger than 2 cm. Tumor size is an important prognostic factor that is particularly helpful in directing adjuvant radiation therapy in patients without staging lymph node biopsies.

Female↗
PubMed1991

Microinvasive cervix cancer.

Microinvasive cervix cancer (Stage Ia) is the earliest stage of squamous carcinoma, and has a 98% 5-year survival. This article reviews risk factors, etiology, and diagnosis of this disease. The important prognostic factors for treatment planning are depth of invasion, lateral extent of invasive tumor, and lymphvascular space invasion. Conservative management is appropriate in selected cases with the goal of preserving fertility.

Carcinoma, Squamous Cell↗
PubMed1991

An elevated maternal serum alpha-fetoprotein leading to the diagnosis of an immature teratoma.

A case report is presented of a woman with a maternal serum alpha-fetoprotein 17.46 multiples of the median (MOM), who was found to have an ovarian immature teratoma. It is suggested that patients who present with a maternal serum alpha-fetoprotein value greater than 9 multiples of the median receive a more comprehensive evaluation remembering that the alpha-fetoprotein in the adult can be a tumor marker.

Adult↗