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Biomedical subjects

J L Yon

Publications and source records attributed to J L Yon.

At least 19 recordsLinked to original sources
PubMed1999

Port-site recurrence after laparoscopic surgery for endometrial carcinoma.

BACKGROUND: Women with endometrial carcinoma are being treated with laparoscopic surgery, but the risk of port-site recurrences remains undefined. CASE: A 58-year-old woman underwent laparoscopically assisted vaginal hysterectomy, bilateral salpingo-oophorectomy, and laparoscopic lymphadenectomy for endometrial cancer. Final surgical stage was IA, with grade 2 histology. Twenty-one months later, she developed a 5-cm recurrent tumor mass at a lateral laparoscopic port site. The mass was resected, and a restaging laparotomy performed, without evidence of other metastases. Radiation therapy was administered to the involved anterior abdominal wall. Two and one half years later, there is no evidence of recurrence. CONCLUSION: An isolated laparoscopic port-site recurrence might be attributable to the initial laparoscopic management of an otherwise good-prognosis endometrial carcinoma.

Abdominal Neoplasms↗
PubMed1998

The antiestrogen tamoxifen in the treatment of recurrent benign cystic mesothelioma.

Benign cystic mesothelioma is a tumor characteristically found in women during the reproductive years. These tumors are infrequently found after castration or menopause, suggesting some degree of hormonal sensitivity. Such aspects of the tumor suggest a potential role for antiestrogens as medical management and an alternative to radical surgery. We treated a 19-year-old woman with a symptomatic pelvic mass secondary to a recurrent benign cystic mesothelioma 2 years after radical surgery with the antiestrogen tamoxifen. An initial reduction in volume and arrest of growth was followed by stabilization in size and disappearance of symptoms. Therapy was continued for 18 months with no change in the volume of the cystic structure. The patient continued to be asymptomatic. Periodic surveillance with quantitative digital radiography for bone density showed no change in bone mineral density. Serum testing for liver function studies was normal throughout treatment. This case suggests that antiestrogens may have a role in the medical management of these rare estrogen-dependent neoplasms. The initial reduction in size and arrest in growth further suggest extreme sensitivity of this tumor to manipulation of the hormonal milieu. Therapy with the antiestrogen tamoxifen in this setting may provide an option for long-term medical management in cases of symptomatic recurrent cystic mesotheliomas.

Adult↗
PubMed1998

Adenocarcinoma of the uterine cervix metastatic to lymph nodes.

OBJECTIVE: We set out to evaluate the prognostic factors in cervical adenocarcinoma metastatic to lymph nodes. STUDY DESIGN: We performed a retrospective review of 40 patients with cervical adenocarcinoma and lymph node metastasis from 1976 to 1996. RESULTS: Thirty-four patients had adenocarcinoma, and six had adenosquamous carcinoma. Median survival was 50 months. The median survival for patients with stage I disease was 69 months. Stage at diagnosis, treatment with radical hysterectomy, and receiving adjuvant therapy were associated with prolonged survival. A trend toward improved survival was noted with the use of concurrent radiation and chemotherapy as an adjuvant therapy. CONCLUSIONS: Adenocarcinoma metastatic to the lymph nodes does not have a uniformly poor prognosis, especially with early-stage disease. Improved survival was observed with the use of adjuvant therapy, specifically the use of combined chemotherapy and radiation after radical hysterectomy. The optimal therapy in this setting is yet to be determined.

Adenocarcinoma↗
PubMed1996

Carcinomatous meningitis complicating cervical cancer: a clinicopathologic study and literature review.

Patients with gynecologic malignancies may develop metastases throughout the neuraxis. Cervix-related carcinomatous meningitis is a distinctly unusual clinical event with only two previous cases reported in the English medical literature. We review clinical, radiographic, and pathologic findings of a woman with advanced adenocarcinoma of the uterine cervix, whose course was complicated by leptomeningeal metastases. Carcinomatous meningitis occurs in the setting of rapidly advancing systemic disease and represents a terminal complication of cervical cancer.

Adenocarcinoma↗
PubMed1995

Use of a long-acting GnRH agonist for benign cystic mesothelioma.

BACKGROUND: Benign cystic mesothelioma, a tumor characteristically found in women during the reproductive years, is rare after bilateral oophorectomy or menopause, suggesting hormonal sensitivity. CASE: We treated a 17-year-old woman with a rapidly increasing and symptomatic benign cystic mesothelioma with a long-acting GnRH agonist. A rapid and continued reduction in volume corresponded to the induction and maintenance of a hypoestrogenic state over a 6-month period. However, the subsequent addition of a combination of estrogen and progestin (known as add-back therapy) resulted in a gradual increase in cyst volume, which progressed after discontinuation of all therapy. Resumption of GnRH-analog therapy alone reduced cyst volume again, and the patient underwent surgical removal. CONCLUSION: Long-acting GnRH agonists may have a role in the conservative management of these rare neoplasms. The reduction in volume concomitant with a hypoestrogenic state and regrowth with addition of add-back therapy further suggest extreme sensitivity of this tumor to one or both hormones.

Adolescent↗
PubMed1992

Intraperitoneal P-32 is not an effective consolidation therapy after a negative second-look laparotomy for epithelial carcinoma of the ovary.

Thirty-four patients with epithelial carcinoma of the ovary were entered into a trial of adjuvant intraperitoneal P-32 following induction chemotherapy and a negative second-look laparotomy. The breakdown by initial Stage was Stage IC, 5; Stage II, 3; Stage III optimal, 22; and Stage III suboptimal, 4. Previous treatment consisted of 4-12 cycles (median 6) of cisplatin or carboplatin-based combination chemotherapy. Fifteen millicuries of P-32 were instilled via a Tenckhoff catheter placed at the time of second-look laparotomy. Because of a 22% incidence of bowel injury in the first 23 patients, the P-32 dose was reduced to 12 mCi in the last 11 patients. To date, there have been no bowel injuries at the lower dose. Eighteen of the 34 (53%) patients have relapsed with a median time to relapse of 20 months and a median follow-up for all patients of 31 months. There has been no difference in the relapse rate between a dose of 12 and 15 mCi. Intraperitoneal P-32 does not appear to reduce the relapse rate following a negative second-look laparotomy. The incidence of bowel injury is dose dependent and is higher than that seen in patients treated as an adjuvant following initial surgery without subsequent chemotherapy or second-look laparotomy.

Adult↗
PubMed1989

Effective decision-making in a changing healthcare environment: a P & T Committee interview.

In this exclusive Hospital Formulary interview, members of the Virginia Mason Medical Center discuss the challenges of a P & T Committee operating in a private, not-for-profit hospital. In order to accommodate the increasing volume of therapeutic issues, the Committee has successfully structured six subcommittees. Establishing a flexible and dynamic formulary has been critical, since drug therapy settings include hospitalized, ambulatory, and HMO patients. In addition to developing effective therapeutic interchange and drug usage guideline policies, the P & T Committee has been instrumental in organizing a successful home healthcare program. They outline their priorities for further strengthening their formulary system in an everchanging healthcare environment.

Decision Making, Organizational↗
PubMed1984

Alternating combination chemotherapy for stages III and IV ovarian carcinoma.

Thirty-nine previously untreated patients with stages III and IV ovarian carcinoma were treated with debulking surgery, followed by alternating combination chemotherapy with cisplatin, Adriamycin (Adria Laboratories, Columbus, Ohio), and cyclophosphamide (PAC); and hexamethylmelamine, cyclophosphamide, methotrexate, and 5-fluorouracil (HexaCAF). Of 19 patients with measureable disease at the onset of therapy, ten (53%) had at least a partial response to chemotherapy. Seven (18% of total) patients were found to be pathologically free of disease at secondlook surgery, but four patients relapsed 19 to 31 months after initiating therapy. The median progression-free survival period of all 39 patients entered into the study is 12 months, and the median crude survival is 21 months. The PAC/HexaCAF alternating combination chemotherapy regimen may be administered with moderate toxicity, but the treatment results are not superior to those reported for PAC or HexaCAF alone in advanced ovarian carcinoma.

Adenocarcinoma↗
PubMed1982

Intraperitoneal cisplatin with systemic thiosulfate protection.

Seventeen patients with intraperitoneal tumors were treated by 4-hour intraperitoneal dialysis with cisplatin alone, or in combination with an intravenous neutralizing agent, sodium thiosulfate. Cisplatin alone, 90 mg/m2 body surface area intraperitoneally, produced nephrotoxicity. When intraperitoneal cisplatin therapy was combined with intravenous thiosulfate treatment, the dose of cisplatin could be escalated to 270 mg/m2 body surface area without causing an increase in serum creatinine levels or undue myelosuppression. Even at doses up to 270 mg/m2, no local toxicity occurred. The peak peritoneal concentration of free reactive cisplatin averaged 21-fold higher than the plasma level, and the area under the peritoneal cisplatin elimination curve averaged 12-fold more than the area under the plasma curve. Neither of these ratios varied significantly with cisplatin dose. Regression of intraperitoneal tumor masses was observed in patients with far-advanced ovarian carcinoma, mesothelioma, and malignant carcinoid.

Adult↗
PubMed1981

Preoperative whole pelvic external irradiation in stage I endometrial cancer.

Between 1966 and 1978, 201 patients with adenocarcinoma of the endometrium were treated at two hospitals in San Diego. Of these patients, 161 had disease limited to the corpus at the time of diagnosis. The majority of these patients received external whole-pelvic irradiation, followed as soon as possible by simple extrafascial hysterectomy and bilateral salpingo-oophorectomy. When this treatment method was used, actuarial survivals of 95% for Stage I disease were achieved. Also reported is the low incidence of wound complications in the group of patients operated soon after cessation of irradiation. The patients treated in this fashion had good survival rates, little morbidity from the adjunctive irradiation, and fewer wound complications than previously anticipated.

Adenocarcinoma↗
PubMed1981

Cecal volvulus in pregnancy.

Cecal volvulus in pregnancy is an uncommon complication. A case is reported of a 28-year-old white female, gravida 2, para 1, who presented at 36 weeks' gestation with flu-like symptoms accompanied by regular uterine contractions every 3 minutes; she underwent repeat cesarean section without incident. The patient did well until the second postoperative day, when she developed obstructive bowel symptoms and underwent emergency laparotomy. Operative findings revealed cecal volvulus with partial malrotation of the small bowel, absence of the ligament of Treitz, agenesis of the left kidney, and a redundant sigmoid colon. Medical and surgical management of this case, as well as a general description of the symptoms of cecal volvulus, is discussed. Early diagnosis and operation are essential to avoid the high morbidity and mortality associated with this disease.

Adult↗
PubMed1977

Evaluation of the Gravlee Jet Washer using combined cell block/cytologic interpretations.

Two hundred patients at high risk for endometrial adenocarcinoma were screened using the Gravlee Jet Washer. Tissue obtained from the first 100 patients was processed by cell block technic alone; tissue from the second 100 patients was processed by cell block plus direct smear and Nucleopore filtration stained by the Papanicolaou method. All patients had histologic diagnosis by fractional curettage. Six of 12 patients with a tissue diagnosis of carcinoma were missed by the jet washer using the cell block technic alone. In the second 100 patients, no cases of cancer were missed using both cell block and cytologic technics. Technic and application of the jet washer in screening for endometrial carcinoma are discussed. We conclude that the Gravlee Jet Washer is a safe, effective screening tool which frequently may replace diagnostic curettage; however, if abnormal bleeding persists, curettage must be done.

Adenocarcinoma↗