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Biomedical subjects

J L Cornella

Publications and source records attributed to J L Cornella.

17 recordsLinked to original sources
PubMed2001

Endometriosis: correlation between histologic and visual findings at laparoscopy.

OBJECTIVE: The purpose of this study was to correlate the diagnosis of endometriosis on the basis of visualization at laparoscopy with the pathologic diagnosis. STUDY DESIGN: A prospective study of 44 patients undergoing laparoscopy for the evaluation of chronic pelvic pain was carried out. All areas suggestive of endometriosis were excised and examined pathologically. Peritoneal biopsy specimens were obtained from areas of normal-appearing peritoneum to rule out microscopic endometriosis. All lesions were identified by anatomic site. Visual and histologic American Fertility Society scores were compared. The positive predictive value, sensitivity, negative predictive value, and specificity were determined for visually identified endometriosis versus the histologic correlate. RESULTS: The mean prevalence of abnormalities visually consistent with endometriosis was 36%, with 18% confirmed histologically. The positive predictive value was 45%; sensitivity, 97%; negative predictive value, 99%; and specificity, 77%; for visual versus histologic diagnosis of endometriosis. Thirty-six percent of the diagnoses were downstaged on the basis of histologic findings. CONCLUSION: A diagnosis of endometriosis should be established only after histologic confirmation.

Adolescent↗
PubMed2001

Harvesting autologous fascia lata for pelvic reconstructive surgery: techniques and morbidity.

OBJECTIVE: To determine donor site morbidity associated with harvesting of fascia lata. STUDY DESIGN: We reviewed medical records and evaluated responses to mailed questionnaires from all patients who underwent fascia lata harvesting during a 54-month period. Data were collected about immediate complications and long-term morbidity related to the donor site. RESULTS: The study comprised 71 patients. Immediate postoperative complications were limited to 1 (1%) hematoma that required drainage, 2 (3%) seromas, and 5 (7%) cases of cellulitis that required oral antibiotics. Questionnaire response rate was 77%, with a mean follow-up of 25 months. Of the responders, 22 (40%) reported mild symptoms, 3 (5%) reported clinically significant symptoms related to the donor leg, and 7 (13%) expressed dissatisfaction because of unacceptable cosmesis (n = 5), leg discomfort (n = 5), or both. CONCLUSION: There was little immediate postoperative morbidity. Although many patients may be expected to report long-term symptoms related to the donor leg, these symptoms are generally mild, and the incidence of patient dissatisfaction is relatively low.

Adult↗
PubMed2000

Percutaneous bone anchor sling using synthetic mesh associated with urethral overcorrection and erosion.

Percutaneous bone anchor bladder neck suspension has been recommended as a less morbid alternative to traditional anti-incontinence procedures. Specifically, it has reported to be associated with shorter duration of hospitalization, catheterization and urinary retention, and equivalent short-term cure rates. Recently, there have been reports of pubic osteomyelitis associated with bone anchor placement, and high incidences of recurrent incontinence. To improve the effectiveness of the procedure the placement of a suburethral synthetic collagen-impregnated mesh without tension was recommended. A specific device is included with the kit (Suture Spacer (Microvasive/Boston Scientific Corp., Natick, MA)) to prevent overcorrection of the urethrovesical junction. We present a case of urethral erosion and complete urinary retention secondary to use of a percutaneous bone anchor sling using a ProteGen mesh (Microvasive/Boston Scientific Corp., Natick, MA). Significant postoperative urethral overcorrection was noted despite intraoperative use of the Suture Spacer.

Aged↗
PubMed1999

Modified radical hysterectomy in the treatment of early squamous cervical cancer.

OBJECTIVE: The aim of this study was to evaluate the results of modified radical hysterectomy in the treatment of early cervical cancer. MATERIAL AND METHODS: A retrospective chart review of 56 patients with stage I (IA in 35, IB in 21) squamous cervical carcinoma treated with modified radical hysterectomy and followed for a minimum of 5 years (mean, 12 years; range, 5.1-29) was conducted. All pathology slides were reviewed for tumor size, grade, depth of invasion, and lymph-vascular permeation. RESULTS: The mean depth of invasion was 0.5 cm (range, 0.1-2.5 cm), and the mean tumor size was 1.1 cm (range, 0.1-7 cm). Only 3 patients (5.4%) had positive nodes. None of the patients with tumors 2 cm or less in size had positive nodes, whereas 33.3% of the patients with tumors more than 2 cm in size had positive nodes. A recurrence developed in 2 patients (5-year recurrence rate of 3.6%). There were 10 deaths during the entire follow-up period, but only 2 were related to cervical cancer. The disease-specific and overall 5-year survival rates were 96.4 and 94.6%, respectively. The disease-specific 5-year survival rate was 100% among the 47 patients with tumors 2 cm or less and 75% for the 9 patients with tumors larger than 2 cm. Univariate analysis identified stage, lymph node status, and tumor size as statistically significant prognostic factors for overall survival. Tumor grade, lymph-vascular permeation, and depth of invasion (1-3 mm vs >3 mm) were not statistically significant for overall survival. CONCLUSIONS: Modified radical hysterectomy appears to be effective surgical therapy for patients with squamous cervical carcinoma 2 cm or less in size.

Adult↗
PubMed1999

Laparoscopic lymphadenectomy and vaginal or laparoscopic hysterectomy with bilateral salpingo-oophorectomy for endometrial cancer: morbidity and survival.

OBJECTIVES: Our goal was to evaluate the morbidity, recurrence, and survival of patients with clinical stage I endometrial cancer treated by laparoscopic lymphadenectomy with vaginal or laparoscopic hysterectomy and bilateral salpingo-oophorectomy. STUDY DESIGN: This article is a retrospective review of records for 56 patients. The mean follow-up among those alive at last contact was 2.4 years (range, 32 days-5.2 years). Staging according to the International Federation of Gynecology and Obstetrics (1988) was as follows: I, 45 (80.4%); II, 3 (5.4%); III, 6 (10.7%); and IV, 2 (3.6%). RESULTS: Intraoperative complications occurred in 4 patients (7.1%). Transformation to laparotomy was necessary in 7 patients. Postoperative complications were observed in 9 patients (16.1%). Pelvic irradiation was administered postoperatively to 11 patients (19.6%). Among the 45 patients with surgical stage I disease, the 3-year recurrence rate was 2.5% and the 3-year cause-specific survival was 96.0%. CONCLUSIONS: Laparoscopic lymphadenectomy and vaginal or laparoscopic hysterectomy with bilateral salpingo-oophorectomy provided 3-year survival and recurrence rates similar to those of the traditional abdominal approach.

Adult↗
PubMed1998

Primary squamous cell cancer of the vulva: radical versus modified radical vulvar surgery.

OBJECTIVE: To evaluate the results of surgical therapy and to specifically compare radical and modified radical vulvar surgery relative to survival, recurrence, metastasis, and complications. METHODS: A retrospective review of 225 patients with primary squamous cell cancer of the vulva was performed. Clinical, pathologic, surgical, and follow-up data were collected from the patient records. All pathology slides were reviewed with a pathologist. Radical surgery included 134 patients treated by the Basset operation. Modified radical surgery accounted for 91 patients with vulvar excision alone (65) or with lymphadenectomy (26) via separate groin incisions. RESULTS: The 5-year recurrence rate was 14%. The overall and disease-free survival rates at 5 years were 76. 1 and 83.4%, respectively. There were no statistically significant differences between the two procedures regarding overall survival, disease-free survival, or the development of recurrence, even after adjusting for stage (P > 0.05). Patients undergoing radical vulvar surgery were more likely to develop surgical complications and sequelae than patients having modified radical surgery, even after adjusting for stage. CONCLUSIONS: Modified radical vulvar surgery is associated with decreased complications and 5-year overall and disease-free survival and recurrence rates similar to those of radical vulvar surgery.

Adult↗
PubMed1998

Osteitis pubis after Marshall-Marchetti-Krantz urethropexy: a pubic osteomyelitis.

OBJECTIVE: Our purpose was to review cases of osteitis pubis encountered at our institution after Marshall-Marchetti-Krantz retropubic urethropexy. STUDY DESIGN: The charts of patients diagnosed with osteitis pubis subsequent to Marshall-Marchetti-Krantz retropubic urethropexy from 1980 to 1994 were reviewed. RESULTS: Fifteen cases of osteitis pubis were diagnosed after 2030 Marshall-Marchetti-Krantz procedures (0.74%). Onset of symptoms related to osteitis pubis began a mean of 69.8 days postoperatively (range 10 to 459 days). Although initial plain films of the symphysis pubis were normal in 7 (54%), radiographic abnormality was eventually demonstrated in all a mean of 25.7 weeks after surgery (range 4 to 78 weeks). A variety of conservative treatments resulted in symptomatic relief in 47%. Seven of the remaining patients underwent operative therapy with partial or complete relief noted in all. Subsequent bone cultures were positive in 5 (71%). At follow-up a mean of 58 months after the Marshall-Marchetti-Krantz procedure complete resolution of symptoms was noted in 33% and continued pain or ambulatory difficulty in the remainder. There was no relationship between postoperative urinary tract infections, postoperative complications, presenting sign of fever, elevated leukocyte count or sedimentation rate, and subsequent operative intervention (P > .05). CONCLUSIONS: Osteitis pubis after urogynecologic surgery is an uncommon event requiring aggressive surgical and antibiotic therapy. When bone cultures are performed, a microbial cause may be demonstrated in as many as 71% of patients.

Aged↗
PubMed1998

Anatomic and physiologic measurements of the internal and external anal sphincters in normal females.

OBJECTIVE: To assess the correlation between anal sphincter magnetic resonance imaging (MRI) measurements and manometric anorectal vectography pressures. METHODS: Ten healthy, nulliparous women underwent anal sphincter MRI with examination of sagittal, axial oblique, and coronal planes. Anal manometry was performed with a radial eight-channel catheter. Customary functional measurements were recorded, including anterior and posterior sphincter length, squeeze length, length of the high-pressure zone, and maximal resting and squeeze pressures. The Spearman rank correlation coefficient was used to assess correlation. RESULTS: The manometric squeeze length and the manometric length to maximum squeeze pressure were correlated negatively with the posterior sphincter length by MRI (P = .049 and .044, respectively). The manometric high-pressure zone squeeze length was correlated positively with the posterior sphincter length by MRI (P = .042). The mean +/- standard deviation (SD) posterior sphincter length was 27.3 +/- 6.0 mm. Anatomically, the cylindric shape of the anal sphincter is characterized by a gradual increase in muscle thickness cephalad. The external striated sphincter was much thicker posteriorly (24.7 +/- 4.6 mm) than anteriorly (6.6 +/- 1.7 mm) in the proximal or caudal third. The proximal internal smooth muscle sphincter was nearly equal in thickness anteriorly and posteriorly (9.0 +/- 1.4 mm and 9.6 +/- 1.7 mm, respectively). Although variation in the thickness of both the smooth and striated muscle was found, manometric pressures did not correlate with the muscle thickness along the sphincter. CONCLUSION: The length of the anal sphincter correlated positively with the functional information, as determined by manometry. An anal sphincter length of 3 cm is consistent, from an anatomic and functional view, in these ten normal women.

Adult↗
PubMed1997

Leiomyoma of the female urethra and bladder: report of twenty-three patients and review of the literature.

OBJECTIVES: Our purpose was to review what may be the largest experience of bladder and urethral leiomyomas from a single institution. STUDY DESIGN: A retrospective review was done of 23 female patients with emphasis on presentation, symptoms, and operative approach for excision. RESULTS: The majority of bladder and urethral leiomyomas in this series were asymptomatic, nonobstructive, or incidental (discovered at surgery for another entity). Ten patients had a palpable mass on physical examination. Two patients had pain as a presenting complaint. The route of operative excision was transvaginal (10 patients), transurethral (6 patients), or abdominal (6 patients). One patient had the leiomyoma removed elsewhere with a resultant vesicovaginal fistula. CONCLUSIONS: Corollaries should be sought with the experience of uterine leiomyomas, which are histologically identical to bladder leiomyomas. Asymptomatic, nonobstructive, and nonproblematic leiomyomas should not serve as an indication for primary operation. Pedunculated endovesical lesions may be an exception because of the ease of transurethral removal and their tendency to cause future symptoms. Ultrasonographic imaging, cystoscopy, and biopsy should be considered to allow observation and follow-up of leiomyomas. Future investigative cytogenetic studies should be considered on these mesenchymal tumors.

Adult↗
PubMed1997

Office management of ovarian cysts.

Ovarian cysts are detected in female patients of all ages. The patient's age, the size of the cyst, and the ultrasound appearance are helpful in determining which ovarian cysts necessitate observation and which necessitate surgical excision. The cancer antigen 125 level alone does not help to distinguish between benign and malignant ovarian cysts. The combination of benign findings on pelvic examination, a benign ultrasound appearance, and a cancer antigen 125 level within normal limits indicates a benign origin in practically all cases.

Adolescent↗
PubMed1996

An algorithm for the management of urinary stress incontinence.

An algorithm for the management of urinary incontinence in the female is presented. The performance of history, physical examination, and simple office bladder testing are reviewed. Patients are categorized into a complex group which require multi-channel urodynamic testing or a non-complex group which may proceed to surgical intervention without such testing. Indications for collagen injection and pubo-vaginal sling procedure are discussed.

Algorithms↗
PubMed1996

Prolonged amenorrhea associated with total nodal irradiation for Hodgkin's disease.

Pelvic irradiation in the treatment of Hodgkin's disease, including total nodal irradiation, may result in substantial radiation to the ovaries unless oophoropexy and central pelvic shielding is used. Despite such precautions, temporary or permanent amenorrhea may result due to direct or scattered radiation. This article describes a 32-year-old patient who underwent oophoropexy followed by total nodal irradiation for Hodgkin's disease. The patient became amenorrheic for 14 consecutive months. Spontaneous recovery of ovarian function with resumption of menses then occurred and has remained normal to date. The occurrence of prolonged but temporary amenorrhea should be recognized after pelvic radiotherapy for the treatment of Hodgkin's disease.

Adult↗
PubMed1990

Prospective study utilizing transdermal scopolamine in detrusor instability.

Ten patients with pure detrusor instability were treated in a prospective fashion with transdermal scopolamine. Seventy percent of patients experienced moderate to severe untoward symptoms requiring discontinuation of medication. Three of 10 patients (30%) demonstrated a subjective improvement although only 1 was able to tolerate the medication. No objective change in detrusor instability was demonstrated.

Administration, Cutaneous↗
PubMed1990

Needle suspension procedures for urinary stress incontinence: a review and historical perspective.

Armand J. Pereyra introduced a new approach in the treatment of female urinary stress incontinence which did not require abdominal retropubic dissection. This operation and subsequent modifications by Pereyra serve as the foundation for various needle suspension procedures. The reported cure rates for the Modified Pereyra Procedure and its variations have exceeded 85 per cent in several studies. There has been some suggestion of an increased late failure rate in the Modified Pereyra Procedure compared to abdominal retroubic urethropexy. Additional long-term studies are needed to answer this important question utilizing preoperative and postoperative urodynamic evaluation. Karram and Bhatia in their review of transvaginal needle bladder neck suspension procedures cited three studies which accomplished this in a total of 60 patients. It seems the popularity of needle suspension procedures continues to grow. Increasingly, needle suspension procedures have been used in the outpatient treatment of urinary stress incontinence. A continuing tribute to the operative contributions of Armand J. Pereyra in the treatment of urinary stress incontinence.

Female↗
PubMed1988

A suburethral sling procedure with polytetrafluoroethylene for the treatment of genuine stress incontinence in patients with low urethral closure pressure.

One indication for suburethral sling procedures has been recurrent genuine stress incontinence after previous incontinence surgery. Patients with low urethral closure pressures (20 cm H2O or less) in association with genuine stress incontinence are at particular risk for failure of standard anti-incontinence procedures. Urodynamic evaluation was used to select 17 patients with genuine stress incontinence and low urethral closure pressures for surgical treatment with a sling procedure using polytetrafluoroethylene. The technique of the procedure, cure rate, and postoperative complications were assessed. An 85% subjective and objective cure rate was found on urodynamic testing three months postoperatively. Complications included wound seroma, urinary tract infection, and urinary retention.

Adult↗