Transvaginal evisceration after hysterectomy.
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Adult↗
Biomedical subjects
J L Powell
Publications and source records attributed to J L Powell.
Nd:YAG laser excision of a giant gingival pyogenic granuloma of pregnancy.
A 19-year-old Hispanic nullipara experienced the rapid growth of an oral lesion on the right lower gingiva which she had first noticed at 29 weeks gestation. The lesion interfered with oral hygiene and eating. At surgery, the lesion measured 3.5 x 2.5 x 2.0 cm. Biopsy confirmed a pyogenic granuloma ("granuloma gravidarum"). Panorex films showed no bony invasion. The lesion was excised using the Nd:YAG laser under general anesthesia when the patient had reached 36 3/7 weeks gestation. We chose the Nd:YAG laser over the CO2 laser for the removal of this very vascular lesion, because of its superior coagulation characteristics. This technique results in removal of the lesion with less danger of bleeding than with any other surgical technique. The patient did well postoperatively, delivered a healthy 3,884 g infant at 40 6/7 weeks gestation, and has had no recurrence after 15 months of follow-up.
Adult↗
The safety and efficacy of extensive abdominal panniculectomy at the time of pelvic surgery.
Nine massively obese patients underwent excision of a large abdominal panniculus in conjunction with pelvic surgery. The most frequent indication for surgery was endometrial cancer. The charts of the patients were reviewed with careful attention to the outcome of the operation and the postoperative course. Comparison was made to previously reported data. The patients ranged in age from 48 to 72 years (mean 56). Weight range was 216 to 325 pounds (mean 261) and averaged more than twice ideal body weight. The weight of the resected abdominal wall was 3900 to 11,000 grams (mean 6247). Hospital stay ranged from 6 to 18 days (mean 8.2). Postoperative complications were chiefly those associated with the dead space created by the large resection without flap undermining (seromas in 2 and wound infections in 3). Four patients required prolonged wound drainage as outpatients. The average length of time to complete wound healing was 40.3 days (range 10 to 65). There were no dehiscences, pulmonary emboli, or operative mortalities. No patients required reoperation. Our study demonstrates that it is possible to safely combine plastic and gynecologic surgery without significantly increasing operative time, blood loss, postoperative complications, or hospital stay.
Abdomen↗
Reproducibility of tumor measurements in ovarian cancer: a study of interobserver variability.
We evaluated the accuracy and interobserver variability of intraoperative tumor measurements in ovarian cancer. Thirty-four obstetrician-gynecologists, 26 gynecologic oncologists, and 12 residents estimated the size of a primary ovarian cancer and four metastases in a simulated patient at laparotomy. The validity of the model was rated from 1 (poor) to 10 (excellent) as 6.9 +/- 1.3 (range 4-10). Actual diameters and range of estimates were, respectively, primary ovarian tumor, 13 cm and 4 to 20 cm; plaque right pelvic sidewall, 8.5 cm and 0 to 12 cm; paraaortic nodes, 2 cm and 0 to 5 cm; right hemidiaphragm, 1 cm and 0.3 to 3 cm; and left hemidiaphragm, 5 cm and 2 to 7 cm. There was no significant difference in measurements between the three groups of surgeons. More surgeons underestimated than overestimated tumor diameters. Tumor measurements in individual patients are highly variable; interpretation of the surgical literature and ovarian cancer treatment protocols based on tumor volume are subject to significant measurement error.
Analysis of Variance↗
Cytoreductive surgery for ovarian cancer with the Cavitron Ultrasonic Surgical Aspirator and the development of disseminated intravascular coagulation.
OBJECTIVE: To explore the association between the use of the Cavitron Ultrasonic Surgical Aspirator for cytoreduction of ovarian cancer and the intraoperative development of disseminated intravascular coagulation (DIC). METHODS: A retrospective chart review was performed of all patients undergoing surgery for ovarian cancer from September 1991 to February 1993. Data were extracted to correlate clinical and hematologic evidence of DIC with and without intraoperative use of the Cavitron Ultrasonic Surgical Aspirator. Statistical analyses were done by chi 2 and analysis of variance. RESULTS: Fifty-one patients underwent surgery for ovarian cancer; 33 had stage IIIB, IIIC, IV, or recurrent disease and could be evaluated for this study. Nineteen patients were treated with the surgical aspirator, five of whom developed an intraoperative coagulopathy, as compared to none of 14 patients treated with conventional cytoreduction (P < .04, chi 2). The duration of use of the surgical aspirator correlated with the risk of coagulopathy (P < .001, analysis of variance). CONCLUSION: These data suggest a potential risk of developing DIC after extended use of the Cavitron Ultrasonic Surgical Aspirator for cytoreduction of ovarian cancer.
Disseminated Intravascular Coagulation↗
Prognostic significance of intraoperative rupture of ovarian cancer.
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Female↗
Gynecologic and dermatologic electrosurgical units: a comparative review.
Electrosurgery is a popular surgical technique in which high-frequency, low-voltage electrical energy produced by an electrosurgical unit is used to excise abnormal tissue with hemostasis. In this study, electrosurgical units were critically evaluated for safety, electrical specifications, design, and performance characteristics. Quantitative electrical specification and histologic thermal artifact measurements and qualitative observations were recorded for 13 electrosurgical units representing 11 manufacturers. The Aspen Sabre 180 and Laerscope e10 were considered exemplary units based on safety criteria alone. Cut-mode thermal artifact was less than 10 microns for the Cooper Leep 6000, Laserscope e10, and Utah Finesse. A maximum fulguration distance of greater than 0.5 mm was demonstrated by the Gyne-Tech Autolepe 2000 and 4000, Laserscope e10, and the Elmed ESU 30. For gynecologic electrosurgery, the Aspen Sabre 180 and Laserscope e10 were rated best, followed closely by the Utah Finesse and Finesse II and the Gyne-Tech Autolepe 4000. Dermatologic electrosurgery may be well accomplished with many of the electrosurgical units, except as noted.
Ambulatory Surgical Procedures↗
Management of advanced juvenile granulosa cell tumor of the ovary.
Juvenile granulosa cell tumor of the ovary occurs most frequently in young women and children. Ten percent of cases present during pregnancy. The majority of tumors are in FIGO Stage I and have a favorable prognosis. The prognosis of higher stage tumors, however, is generally less favorable. We report the long-term, disease-free survival of a patient with FIGO Stage III juvenile granulosa cell tumor of the ovary. We believe this to be the first report of a successful pregnancy following "MAC" chemotherapy for this particular malignancy.
Adolescent↗
Cushing's syndrome secondary to malignant lipoid cell tumor of the ovary.
Malignant lipoid cell tumors of the ovary are rare lesions that are frequently associated with endocrinologic abnormalities. A case of a woman with this lesion who developed Cushing's syndrome with progression of tumor is presented. Neither aggressive medical therapy with ketoconazole nor multiagent chemotherapy was beneficial in controlling tumor growth or physical and biochemical manifestations of Cushing's syndrome.
Aged↗
Primary breast cancer of the vulva.
Supernumerary breasts on the vulva are a rare occurrence. There have been 26 cases previously reported and only 4 case reports of primary mammary carcinoma of the vulva. This is the fifth case report of mammary carcinoma of the vulva and the second report using tamoxifen for adjuvant treatment.
Aged↗
Outpatients' attitudes and understanding regarding living wills.
OBJECTIVE: To assess outpatients' attitudes toward and understanding of a standard living will. DESIGN: Survey using a self-administered questionnaire that patients completed after they had read a sample living will. SETTING: General medicine clinic of a Department of Veterans Affairs medical center. PATIENTS: Two hundred fourteen patients (85% of those approached) attending a continuity care clinic appointment. Eighty-seven percent were men; mean age was 60 years. MEASUREMENTS AND MAIN RESULTS: Patients' attitudes toward living wills, understanding of the terminology contained in living wills, desire to discuss living wills with their doctors, and desire to prepare a living will. RESULTS: Seventy-two percent of the patients had prior knowledge of living wills, though only 53% had discussed the topic with family members and only 14% with physicians. Half felt that the living will terminology should be simplified, and 55% were unable to identify the correct definition for at least one commonly used term. Desire to prepare a living will was positively associated with better understanding of the sample document and previous knowledge of and exposure to living wills, and was negatively associated with concern about its use and revocability (all p < 0.001). Patients who reported poor understanding of the living will were more likely to want to discuss the topic with a physician (p < 0.01). CONCLUSIONS: In this ambulatory patient population attitudes toward living wills were influenced by knowledge and understanding of these documents. Primary care physicians and institutions should develop patient education strategies that enhance understanding of advance directives.
Attitude to Death↗
Pitfalls in cervical colposcopy.
An awareness of the pitfalls associated with the various aspects of the colposcopic examination should minimize erroneous diagnosis and inappropriate treatment. The colposcopist, armed with current knowledge and guided by a diagnostic and therapeutic protocol, should be able to avoid them (summarized in Table 1).
Adenocarcinoma↗
Hip disarticulation for recurrent vulvar cancer in the groin.
A patient with squamous cell carcinoma of the vulva treated with a radical vulvectomy and bilateral inguinal and femoral lymphadenectomies utilizing separate groin incisions, subsequently developed a recurrence in the skin bridge between the vulvar and groin excisions. Following groin irradiation with chemosensitization, the tumor progressed to involve the superior public ramus and femoral vessels. A left hip disarticulation and resection of a portion of the superior pubic ramus was performed. The patient has been free of disease for 3 years. The advantages of this procedure over a hemipelvectomy include shorter operative time, reduced blood loss, better fascial closure of the abdomen, and the creation of a stump which is more amendable to prosthetic fitting.
Carcinoma, Squamous Cell↗
Ovarian serous borderline epithelial tumors with multiple retroperitoneal nodal involvement: metastasis or malignant transformation of epithelial glandular inclusions?
One of four patients who underwent lymph node excision at exploration for ovarian serous borderline epithelial tumor (OSBT) at Baystate Medical Center was found to have FIGO Stage III C lesion associated with extensive ovarian external (surface) papillary growth, peritoneal implants in the omentum and cul-de-sac, and involvement of multiple pelvic and periaortic lymph nodes by the tumor. Histologically, the lymph nodes showed an admixture of endosalpingeal glandular inclusions with neoplastic tissue identical to the ovarian tumor. The exact histogenesis and the prognostic significance of the nodal involvement by OSBT are still not fully understood. Although there is a small number of reported cases of lymph node involvement associated with OSBT, they are described as examples of nodal metastases or independent primary foci of malignant transformation. This paper presents an interesting association of OSBT with extensive pelvic and periaortic nodal involvement and reviews the relevant literature.
Adult↗
Intermediate filamentous proteins in adult granulosa cell tumors. An immunohistochemical study of 25 cases.
Adult granulosa cell tumors (AGCTs) are classified as sex cord-stromal tumors of the ovary. However, they may be confused with other primary ovarian neoplasms. Intermediate filaments, specifically vimentin and cytokeratins, have been identified in AGCTs by immunohistochemistry performed on frozen and formalin-fixed, paraffin-embedded tissue and two-dimensional electrophoresis. Recently, however, immunohistochemical demonstration of cytokeratin has been used as supporting evidence of epithelial rather than sex cord-stromal differentiation in ovarian neoplasia. To investigate further intermediate filamentous proteins in AGCTs, 25 such tumors were studied by immunohistochemistry in formalin-fixed, paraffin-embedded sections. Cytoplasmic staining was observed, frequently in a distinct punctate, paranuclear pattern, in 14 of 25, 14 of 25, and seven of 17 tumors using monoclonal antibodies AE1/AE3, CAM 5.2, and 35BH11, respectively, which share the ability to detect low molecular weight cytokeratins. Staining for cytokeratin was not seen in any of the 17 tumors studied using the antibody 34BE12. Twenty-three of 25 tumors showed strong positivity for vimentin, characteristically seen as globoid paranuclear staining. Nine of 25 tumors contained desmin, which was restricted to the intermixed spindle cell, cortical type stromal component of the tumors. These patterns of immunoreactivity for intermediate filaments, particularly cytokeratins, are different than in common epithelial tumors of the ovary and may be useful in the differential diagnosis of ovarian neoplasia. Moreover, the immunohistochemical detection of cytokeratins should not be used as a criterion for excluding AGCT from the differential diagnosis of an ovarian neoplasm.
Electrophoresis, Gel, Two-Dimensional↗
Hemangioma of the cervix managed with the Nd:YAG laser.
A large hemangioma of the cervix was treated successfully with the neodymium:yttrium-aluminum-garnet (Nd:YAG) laser. A survey of the literature disclosed 39 cases of hemangioma of the cervix and vagina. Hysterectomy was the primary mode of therapy in 15 cases. More conservative approaches have been used in young women requesting preservation of their childbearing ability, including CO2 laser excision, knife excision, cryotherapy, and electrocauterization. In the case presented, the Nd:YAG laser was used in the non-contact mode for a photocoagulative effect. This technique results in destruction of the lesion with less danger of bleeding than with any other surgical technique.
Adult↗
Ovarian carcinoma metastatic to breast: a case report and review of the literature.
Breast metastasis from ovarian carcinoma is a rare event, with only 26 cases being previously reported in the English literature. The twenty-seventh such case is presented herein, and the literature on this topic is reviewed. Metastases to the breast from the ovary signal widespread metastases and generally herald a rapid deterioration and death. Although rare, it is important that metastatic cancer to the breast be differentiated from primary breast carcinoma as both the treatment and prognosis differ significantly.
Adult↗
Histiocytosis X of the vulva: a case report and review of the literature.
Histiocytosis X of the female genital tract is unusual. Thirty-two cases have been reported to date in the world literature. An additional case is reported herein, presenting as a vulvar ulcer in a 2.5-year-old child with osteolytic lesions of the skull, splenomegaly, and otitis media. The diagnosis of histiocytosis X may be established by identifying the Langerhans histiocyte, characterized by nuclear grooves, immunoreactivity for S-100 protein, and pentalamellar cytoplasmic structures seen by electron microscopy. Prognosis is difficult to determine with certainty. However, age of less than 2 years at presentation, multi-organ involvement, and/or organ dysfunction appear to be associated with a less favorable prognosis. The patient presented herein is currently receiving vinblastine chemotherapy for recurrence of disease, manifested as an osteolytic lesion in the skull.
Bone Diseases↗