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Biomedical subjects

J M Fowler

Publications and source records attributed to J M Fowler.

At least 37 records · Page 2Linked to original sources
PubMed1995

Blood flow characteristics of ovarian tumors: implications for ovarian cancer screening.

OBJECTIVES: Our purpose was to investigate the blood flow characteristics of benign and malignant ovarian tumors. Questions posed by our research were as follows: (1) Can malignant ovarian tumors be predicted by color flow Doppler imaging? (2) What are the sensitivity, specificity, and positive and negative predictive values of such prediction? (3) Which color flow Doppler parameter is superior in its accuracy of prediction? STUDY DESIGN: One hundred twenty-three consecutive patients seen for suspected pelvic masses were evaluated by transvaginal ultrasonography and color flow Doppler imaging. A morphologic assessment was initially performed, followed by color flow Doppler analysis. A comparison of findings between the benign and malignant tumors was made by analyzing different thresholds of the intratumoral pulsatility and resistance index values by means of receiver-operator characteristic curves. By calculation of the area index under each receiver-operator characteristic curve the efficiency of the pulsatility and resistance index values in predicting malignancy was determined. RESULTS: Fifty-six benign and 23 malignant tumors were pathologically confirmed. Patients with malignant tumors were more likely to be postmenopausal and were older than patients with benign tumors. Malignant tumors were more likely to be larger and to have either a complex or solid pattern. Absent color flow was more common in benign tumors, and increased color flow was found equally among benign and malignant tumors. There was no difference in systolic, diastolic, or mean velocities between benign and malignant tumors. The calculated pulsatility and resistance index values were lower in patients with malignant tumors compared with those with benign tumors. No significant difference exists in performance of either the pulsatility or resistance index in predicting malignancy. The best thresholds for predicting malignancy were obtained with a pulsatility index of 1.0 and resistance index of 0.6. CONCLUSIONS: Transvaginal ultrasonography is accurate in distinguishing benign from malignant ovarian tumors. Color flow Doppler findings are not specific enough to be used independent of gray-scale ultrasonography.

Female↗
PubMed1995

Incisional bowel herniations after operative laparoscopy: a series of nineteen cases and review of the literature.

OBJECTIVES: The objectives of this report were (1) to identify all cases of incisional bowel herniations noted after operative laparoscopy in 11 participating institutions and (2) to report the clinical details of such patients. STUDY DESIGN: A retrospective case review was performed. RESULTS: Nineteen cases of incisional bowel herniation were identified. The average age of the patients was 50.5 years. Initial laparoscopic procedures varied and included laparoscopically assisted vaginal hysterectomy (six patients), laparoscopically assisted vaginal hysterectomy with lymphadenectomy (five patients), oophorectomy (two patients), adhesiolysis (two patients), myomectomy (two patients), lymphadenectomy alone (one patient), and ovarian cystectomy (one patient). The average time to reoperation was 8.5 days. CONCLUSIONS: Incisional bowel herniation is a serious complication of operative laparoscopy. Herniations occur through ports > or = mm in size at both umbilical and extraumbilical sites. New techniques are needed to avoid this serious complication.

Adult↗
PubMed1994

Radical vulvectomy with postoperative irradiation for vulvar cancer: therapeutic implications of a central block.

PURPOSE/OBJECTIVE: To report the long-term results of vulvectomy, node dissection, and postoperative nodal irradiation using a midline vulvar block in patients with node positive vulvar cancer. METHODS AND MATERIALS: From 1971 through 1992, 27 patients with carcinoma of the vulva and histologically involved inguinal lymph nodes were treated postoperatively with radiation therapy after radical vulvectomy and bilateral lymphadenectomy (n = 25), radical vulvectomy and unilateral lymphadenectomy (n = 1), or hemivulvectomy and bilateral lymphadenectomy (n = 1). Federation Internationale de Gynecologic et d'Obstetrique stages were III (n = 14), IVA (n = 8), and IVB (n = 5) squamous cell carcinoma. Inguinal lymph nodes were involved with tumor in all patients (average number positive = 4, range 1-15). Postoperative irradiation was directed at the bilateral groin and pelvic nodes (n = 19), unilateral groin and pelvic nodes (n = 6), or unilateral groin only (n = 1). These 26 patients had the midline blocked. In addition, one patient received irradiation to the entire pelvis and perineum. Doses ranged from 10.8 to 50.7 Gy (median 45.5) with all patients except 1 receiving > or = 42.0 Gy. RESULTS: Actuarial 5-year overall survival and disease-free survival estimates were 40% and 35%, respectively. Recurrences developed in 63% (17/27) of the patients at a median of 9 months from surgery (range 3 months to 6 years) and 15 of these have died; two patients with recurrences are surviving at 24 and 96 months after further surgery and radiation therapy. Central recurrences (under the midline block) were present in 13 of these 17 patients (76%), either as central only (n = 8), central and regional (n = 4), or central and distant (n = 1). Additionally, three patients developed regional recurrences and one patient developed a concurrent regional and distant relapse. One patient developed a squamous cell cancer of the anus under the midline block 54 months after the initial vulvar cancer and an additional patient developed transitional cell carcinoma of the ureter (outside the radiation field) 12 months after diagnosis. Factors associated with a decreased relapse-free survival included increasing Federation Internationale de Gynecologic et d'Obstetrique stage (p = 0.01) and invasion of the tumor into the subcutaneous (SC) fat or deep soft tissue (p = 0.05). Chronic lower extremity edema developed in four patients, but there have been no other complications. CONCLUSIONS: Radical vulvectomy has often been considered sufficient central treatment for vulvar carcinoma, with postoperative irradiation directed only to the nodes. Although designed to protect the radiosensitive vulva, use of a midline block in this series resulted in a 48% (13/27) central recurrence rate, much higher than the 8.5% rate previously reported with this technique. Routine use of the midline block should be abandoned and, instead, postoperative irradiation volumes should be tailored to the individual patient.

Adult↗
PubMed1994

Erythropoietin increases hemoglobin during radiation therapy for cervical cancer.

PURPOSE: Anemia during radiation therapy independently predicts poor outcome in patients with cervical cancer. Despite a randomized trial demonstrating red cell transfusions improve local control and survival, many patients are not transfused due to toxicity concerns. This study evaluates the efficacy of recombinant human erythropoietin (r-HuEPO) in reversing anemia in patients undergoing radiation therapy. METHODS AND MATERIALS: Twenty patients with criteria of anemia (Hgb < 12.5 g/dL) and surgically staged cervical cancer FIGO stages IB (n = 7), IIA (n = 1), IIB (n = 9), and IIIB (n = 3), ranging in ages from 23-75 years (median 43), were included in this Phase I/II study. Fifteen were treated with r-HuEPO (200 U/kg/day) and ferrous sulfate 5-10 days prior to initiation of external beam radiation therapy, continuing until Hgb was < or = 14 g/dL or completion of radiation therapy. Five patients were treated with ferrous sulfate alone. An additional 61 historical controls meeting eligibility criteria were analyzed. All received external beam radiation therapy and two intracavitary cesium applications. Cisplatinum chemotherapy (20 mg/m2/week) was given as a radiosensitizer in 14 r-HuEPO patients, 4 concurrent controls, and 17 historical controls. RESULTS: A marked reticulocytosis was seen in the r-HuEPO group, but not the study controls. In the r-HuEPO group, the mean +/- SD serum Hgb rose + 30% over the course of radiation therapy from a baseline of 10.3 +/- 1.04 g/dL to 13.2 +/- 1.7 g/dL. Average increase in Hgb was 0.5 g/dL per week. Average Hgb during RT was 13.4 g/dL. In study and historical controls, mean initial Hgb levels were 10.7 +/- 1.04 g/dL and 11.1 +/- 1.3g/dL, respectively, remaining unchanged over the course of radiation therapy. Average Hgb levels during radiation therapy were 11.1 g/dL in study controls and 11.4 g/dL in historical controls, significantly lower than r-HuEPO patients (p = 0.0001). Erythropoietin was well tolerated. There were no significant differences in white blood counts (p = 0.6) or platelet counts (p = 0.4) between r-HuEPO patients and both control groups. No patients had blood pressure changes during r-HuEPO therapy. The only possible side effect was deep venous thrombosis, occurring in two patients who were withdrawn from r-HuEPO therapy. Two additional patients developed deep venous thrombosis 9 and 10 days after radiation therapy and r-HuEPO were completed. CONCLUSION: Erythropoietin appears to be both safe and effective at raising Hgb levels in anemic cervical cancer patients receiving radiation therapy and chemotherapy.

Adult↗
PubMed1994

Pelvic adhesion formation after pelvic lymphadenectomy: comparison between transperitoneal laparoscopy and extraperitoneal laparotomy in a porcine model.

Compared to extraperitoneal laparotomy, the transperitoneal approach is associated with increased enteric morbidity. Recently, transperitoneal laparoscopy has been employed as a method to surgically stage patients with gynecologic malignancies. The objective of this study was to investigate pelvic adhesion formation in a porcine model after pelvic lymphadenectomy performed via transperitoneal laparoscopy (LS) compared to extraperitoneal laparotomy (EP). Ten adult, female hogs underwent LS and 10 underwent EP. A complete pelvic lymphadenectomy was performed in each animal. Three weeks after the lymphadenectomy, the animals underwent exploratory laparotomy, and the adhesions were quantified. Nineteen animals were evaluable. The adhesion scores for the laparoscopy group (N = 10, mean = 0.075 +/- 0.17) were not statistically different from those of the laparotomy group (N = 9, mean = 0.28 +/- 0.52, P > 0.5). Eight of 10 (80%) and 5 of 9 (56%) animals in the LS and EP groups, respectively, had no adhesions after pelvic lymphadenectomy. Adhesion formation is one of many critical issues concerning the utility of pretreatment surgical staging, especially for cancer of the cervix. It is remarkable that only 20% of the animals undergoing laparoscopy in this study had de novo adhesions after pelvic lymph node dissection and that the mean total adhesion score was not statistically different from the extraperitoneal laparotomy. Therefore, transperitoneal laparoscopic pelvic lymphadenectomy may not induce the degree of adhesion formation associated with the transperitoneal laparotomy technique.

Animals↗
PubMed1994

Chemoprophylaxis with oral ciprofloxacin in ovarian cancer patients receiving taxol.

The purpose of this study was to review the clinical outcomes and cost of administration of a prophylactic antibiotic compared to G-CSF for the prevention of neutropenic morbidity associated with taxol. The study group was composed of 62 patients with ovarian cancer who received a 24-h infusion of a taxol-based regimen at doses less than or equal to 175 mg/m2 between June 1992 and April 1994. The records were retrospectively reviewed and the patients were grouped and analyzed according to the management of their myelosuppression. Group I patients (n = 29) were observed until their absolute neutrophil count (ANC) was less than 500/microliters and then were placed on ciprofloxacin 500 mg orally twice a day until their ANC was 1,000/microliters. Group II patients (n = 15) received G-CSF from Day 2 until the ANC was greater than 10,000/microliters beginning with their first cycle. Group III patients (n = 18) received their taxol regimen without either ciprofloxacin or G-CSF. Two hundred eighty-two taxol-based chemotherapy cycles were administered to these 62 patients. There was no statistically significant difference between the groups concerning disease status as measured by age, stage, performance status, dose intensity, or number of previous regimens. There were two episodes of febrile neutropenia in Group I and three episodes in Group II. Group III had 15 episodes of febrile neutropenia. The estimated cost of the different prophylactic regimens was $5,215.00 for Group I versus $104,000.00 for G-CSF in Group II. Within the three groups, there were 27 patients with an episode of febrile neutropenia (n = 20) or prolonged myelosuppression (n = 7) that were followed for an additional 104 taxol cycles. Twenty-four of these patients received G-CSF prophylaxis with intermittent ciprofloxacin and three received only ciprofloxacin. There were eight more episodes of febrile neutropenia in the patients receiving G-CSF. There were no additional febrile episodes on cycles prophylaxed with ciprofloxacin. There was no septic mortality. For patients receiving a 24 h infusion of taxol at doses less than 175 mg/m2, ciprofloxacin given through the ANC nadir may be effective in preventing febrile morbidity. A prospective randomized trial is underway to evaluate this approach.

Administration, Oral↗
PubMed1994

Physiological basis of the low calcium response in Yersinia pestis.

It is established that duplication in vitro of that amount of Ca2+ (2.5 mM) and Mg2+ (1.5 mM) present in blood permits vegetative growth of Yersinia pestis with repression of virulence factors encoded by the Lcr plasmid (Lcr+); similar simulation of intracellular fluid (no Ca2+ and 20 mM Mg2+) promotes bacteriostasis with induction of these virulence determinants. However, proliferation of yersiniae in mice occurs primarily within necrotic focal lesions (supplied by Ca(2+)-deficient host cell cytoplasm) within visceral organs rather than in Ca(2+)-sufficient blood. The present study addressed this enigma by defining conditions necessary for achieving vegetative growth of Lcr+ yersiniae at 37 degrees C in simulated intracellular fluid. Maximum optical densities were increased by substitution of K+ for Na+ and elimination of Cl-; the combination of Na+ plus L-glutamate was selectively toxic to Lcr+ cells. This phenomenon was attributed in part to the absence of aspartase in Y. pestis (a lesion known to facilitate massive accumulation of L-aspartate via transamination of the oxalacetate pool by L-glutamate). Replacement of L-glutamate by exogenous L-aspartate or alpha-ketoglutarate reversed this toxicity by favoring retention of oxalacetate. Proliferation of Lcr+ cells in a medium containing K+ and L-aspartate but lacking added Ca2+ and Na+ was markedly enhanced by increasing the concentration of fermentable carbohydrate. Accordingly, in the worst-case scenario (i.e., added Na+, Cl-, and L-glutamate), Lcr+ yersiniae underwent restriction of growth after one doubling, and in the best-case scenario (i.e., added K+ and L-aspartate), the organisms completed more than five doublings, thereby achieving full-scale growth. Both of these Ca(2+)-deficient media promoted maximum induction of Mg(2+)-induced V antigen, a virulence factor encoded by the Lcr plasmid.

Antigens, Bacterial↗
PubMed1994

Gray scale and color flow Doppler characterization of uterine tumors.

The aim of this study was to investigate gray scale and color flow characteristics of a group of patients with a suspected uterine pathologic condition. One hundred and twenty-two consecutive patients at the Women's Cancer Center, University of Minnesota, undergoing transvaginal sonography and color flow Doppler imaging for suspected uterine corpus abnormality made up the study group. After gray scale morphologic assessment, color flow Doppler imaging of the tumor and uterus was performed, including the ipsilateral uterine artery. Malignant tumors were confirmed pathologically in all 35 patients who had them. In comparing patients with benign versus malignant tumors, gray scale morphologic assessment confirmed that malignant uterine tumors (31 endometrial cancers and four sarcomas) were more likely to have a thickened echoic endometrium (P = < 0.0001), be enlarged (P = 0.004), to be retroverted (P = 0.02), and to lack a subendometrial halo (P < 0.0001). Patients with four benign and 13 malignant tumors demonstrated increased flow when assessed by CFD. The calculated sensitivity of increased color flow in predicting malignancy was 39%, with a specificity of 92%, a positive predictive value of 77%, and a negative predictive value of 71%. No difference existed between the benign and malignant groups for the systolic, diastolic, and mean velocities and for the calculated pulsatility index and resistive index in both sampled uterine and intramyometrial or tumor vessels.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Ascites levels of haptoglobin in patients with ovarian cancer.

BACKGROUND: Haptoglobin is an acute-phase reactant protein involved in immune regulation. It has been isolated from malignant ovarian ascites and has been shown to be capable of mediating nonspecific immune suppression in vitro in humans and in vivo in experimental animals. The range of concentrations under which such a nonspecific suppression is observed lies well within concentrations of haptoglobin observed in vivo. This immune suppression could adversely affect patient outcome. METHODS: Based on this information, ascites haptoglobin levels of 21 consecutive patients with ovarian cancer who underwent initial surgical debulking were determined. After the patients received chemotherapy, they were divided into those having a positive and those have a negative second-look operation. RESULTS: Seventeen patients with positive pathology at second look had an initial mean ascites haptoglobin level of 99 +/- 49 mg/dl. The mean haptoglobin level in the four patients with negative findings was 67 +/- 42 mg/dl. The difference in these mean haptoglobin levels is not statistically significant (P > 0.05). CONCLUSION: Although the number of patients in this study is small, the wide range of values documented in both groups make it doubtful that an initial absolute ascites haptoglobin level will prove clinically prognostic of eventual disease status at the time of second look laparotomy.

Adenocarcinoma↗
PubMed1993

Ketorolac tromethamine, a nonsteroidal anti-inflammatory drug: ability to inhibit post-radical pelvic surgery adhesions in a porcine model.

The objective of this study was to investigate the ability of ketorolac tromethamine, a parenterally administered nonsteroidal anti-inflammatory drug (NSAID), to inhibit post-radical pelvic surgery adhesion formation (PRPSA). Twenty adult female hogs undergoing radical hysterectomy, bilateral salpingo-oophorectomy, and resection of pelvic peritoneum were used. Animals were randomized to either ketorolac (4 mg/kg loading dose 45 min prior to skin incision, followed by 2 mg/kg IM every 8 hr for nine doses) or no adjuvant therapy. Four weeks after surgery, repeat celiotomy was performed, and adhesions were quantified. Note was made of any bowel segments adherent to the pelvis. Adhesion scores for the ketorolac-treated animals (n = 9, mean = 0.92 +/- 0.54, median = 0.90) were significantly less than those for control animals (n = 10, mean = 6.73 +/- 2.21, median = 7.03, P = 0.0001). Similarly, significantly fewer treated animals had small bowel loops adherent in the pelvis when compared to control animals (11% vs 90%, P = 0.001). Ketorolac is an effective inhibitor of PRPSA formation and limits small bowel adherence to the pelvis.

Animals↗
PubMed1993

Lymph node yield from laparoscopic lymphadenectomy in cervical cancer: a comparative study.

Pretreatment surgical staging in cervical cancer has been studied extensively but remains controversial because a surgical procedure is required and the information gained may benefit only a small portion of the patients staged. Pelvic and paraaortic laparoscopic lymphadenectomies have been successfully performed in animal models and humans. Little information regarding the validity of the procedure in patients who have had subsequent laparotomy exists. In this series, we report our preliminary experience in 12 patients who underwent laparoscopic lymphadenectomy and then laparotomy. Overall, 377 pelvic nodes were removed, with 282 (75%) obtained at laparoscopy. The average number of pelvic nodes removed at laparoscopy was 23.5 (range 7-33). Two patients had positive pelvic nodes. No patient with negative nodes at laparoscopy had positive nodes at laparotomy. When studied in chronological order, the lymph node yield from our second 6 patients was much improved over our first 6 patients, 85% versus 63% (P < 0.005). Laparoscopy also proved to be a better predictor of lymph node spread than computed tomography. Two patients also had right-sided paraaortic lymphadenectomies, yielding 8 and 5 nodes. No additional right-sided paraaortic nodes were detected at laparotomy for either patient. In this preliminary series, laparoscopic lymphadenectomy appears to be a feasible procedure for surgical staging of cervical cancer. The yield of pelvic lymph nodes is adequate and improved with experience. Most importantly, no positive lymph nodes were missed by laparoscopy. The indications for operative laparoscopy have expanded rapidly. Gynecologic oncologists performing this procedure should be involved in prospective studies of this technique to set the standards and indications of this new technology.

Adult↗
PubMed1993

Rectus abdominis myocutaneous flap for primary vaginal reconstruction.

Reconstructive procedures are being performed with increasing frequency in conjunction with pelvic exenterations and other radical gynecologic surgeries. The most common reconstructive procedures include continent urinary diversion, rectosigmoid anastomosis, and vaginal reconstruction. Historically, the gracilis myocutaneous flap has been the procedure of choice for vaginal reconstruction. However, the gracilis myocutaneous flap has a history of partial to severe necrosis, a propensity to prolapse, and leaves ipsilateral donor scars on the thigh. In contrast, neovaginal reconstruction using a relatively new procedure, the distally based rectus abdominis myocutaneous flaps, has the advantage of using a large, single flap that can be incorporated into the primary incision. This flap is mobilized on a long vascular pedicle, the rectus muscle. In relation to the underlying rectus muscle, the orientation of the cutaneous portion of this flap may be customized to accommodate the pelvic defect or the surgeon's preference. Depending on their primary orientation, they are referred to as either a vertical or transverse rectus abdominis myocutaneous flap. The versatility and reliability of the rectus flap is demonstrated here through the presentation of a small pilot series of seven patients. The technique was used for vaginal reconstruction, primarily in conjunction with pelvic exenteration. The flaps were mobilized from the supraumbilical area and had a flap viability of 100% for the 2 years that they have been followed. There were no postoperative incisional or flap infections. There was one infraumbilical fascial dehiscence. The advantages of primary pelvic reconstruction along with the description of the operative techniques are presented.

Adult↗
PubMed1992

Laparoscopic para-aortic lymph node sampling: development of a technique.

Clinical staging is woefully inadequate in predicting lymph node metastasis and dictating prudent radiation ports in women undergoing therapy for cervical malignancies. Surgical staging with evaluation of the precaval lymph nodes (via a transperitoneal or extraperitoneal approach) has associated rates of complication that are felt by many clinicians to be excessive. A laparoscopic approach could avoid many of these complications while still obtaining valuable information regarding spread of disease. After experimentation with different forms of laparoscopic approaches in the swine model, we have found an easy and efficient way to visualize and sample the infrarenal precaval lymph nodes. The laparoscope is placed suprapubically, and accessory operating trocars are placed suprapubically and periumbilically. Laparoscopically placed sutures are placed on the incised posterior peritoneum. The sutures exit through the periumbilical trocars. When drawn taut, the sutures pull the peritoneum in a cephalad and ventral fashion so as to act as a tent, retracting the intraperitoneal contents and exposing the precaval area. Using this technique in the swine, we were able to remove 88% of all right-side common iliac and paraaortic nodes laparoscopically without injuring surrounding structures. Evaluation of this technique in humans should be considered.

Animals↗
PubMed1992

Natural history of the minimally abnormal Papanicolaou smear.

OBJECTIVE: We sought to determine the natural history of the cytologic and colposcopic changes in patients with minimal abnormalities on their Papanicolaou smears (atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion [SIL]). METHODS: Between November 1988 and November 1990, 632 women with abnormal Papanicolaou smears as listed above were evaluated at Los Angeles County-Olive View Medical Center. Each had review of cytology, repeat Papanicolaou smear, and colposcopy of the lower genital tract. We excluded those who were pregnant or had findings demonstrative of moderate dysplasia or worse, or had a cervical biopsy for any other indication. Women with symptomatic vaginal discharge were treated and remained in the study. Subjects were followed every 3 months with repeat Papanicolaou smear and colposcopy for a minimum of 9 months. If at any time the Papanicolaou smear or colposcopy was consistent with moderate dysplasia or worse, directed biopsies and endocervical curettage were performed, and treatment was given accordingly. Two hundred ninety-four patients fulfilled all inclusion criteria and had adequate follow-up data. RESULTS: Nine months after enrollment, 42 of 91 women (46.2%) with atypical squamous cells had persistent changes, none had progression, and 49 (53.8%) had regression to normal. In those with low-grade SIL, 37 of 203 cases (18.2%) persisted, seven (3.4%) progressed, and 159 (78.3%) regressed by 9 months. Patients in the first group were more likely to have persistence of the cytologic abnormalities than were those in the second (P less than .01). Only the latter group progressed to high-grade dysplasia during the 9-month study interval. CONCLUSION: The majority of women with confirmed minimal cytologic changes on Papanicolaou smear will have complete colposcopic and cytologic regression over a short interval.

Adult↗
PubMed1992

Effect of CO2 laser conization of the uterine cervix on pathologic interpretation of cervical intraepithelial neoplasia.

The CO2 laser has become a valuable tool for the treatment of lower genital tract neoplasia. The records of 52 women who underwent CO2 laser cervical conization were analyzed retrospectively to evaluate the effect of tissue thermal damage on histopathologic interpretation. Lesion evaluability, defined by the ability to diagnose neoplasia accurately in the specimen, was satisfactory in only 26 cases; in the other 26, thermal damage was severe enough to preclude accurate diagnosis. A postoperative diagnosis of cervical intraepithelial neoplasia III was made in 17 instances, and microinvasion was suspected but unverifiable in two of these. Two patients had frankly invasive cancer, but vascular space involvement in one could not be evaluated accurately because of thermal damage. Tissue thermal damage sufficient to interfere with accurate histologic evaluation was noted in the majority of laser conization specimens. The value of a conization is both diagnostic and therapeutic. The potential impact of a diagnosis compromised by thermal damage is serious.

Adolescent↗
PubMed1991

The ability of recombinant tissue plasminogen activator to inhibit post-radical pelvic surgery adhesions in the dog model.

We investigated the ability of recombinant tissue plasminogen activator to inhibit post-radical pelvic surgery adhesions formation in 40 adult female canines undergoing radical hysterectomy, bilateral salpingo-oophorectomy, omentectomy, resection of pelvic and abdominal peritoneum, and placement of a peritoneal access catheter. Immediately after operation one half of animals received either recombinant tissue plasminogen activator, 1 mg/kg weight, diluted in 9 ml sterile normal saline solution per milligram of the plasminogen activator or 10 ml vehicle per kilogram intraperitoneally every 12 hours for a total of 10 doses. A single control animal died postoperatively of complications of intestinal obstruction. No bleeding abnormalities were noted in either group of animals. Four weeks after surgery, animals underwent reexploration and adhesions were quantified. Adhesion scores for the animals treated with recombinant tissue plasminogen activator (n = 20; mean score, 1.29 +/- 1.97; median, 0.6) were significantly less than for control animals (n = 19; mean score, 4.64 +/- 3.71; median, 3.86; p = 0.03). Whereas recombinant tissue plasminogen activator appears to effectively prevent post-radical pelvic surgery adhesions in this canine model, phase I and II trials in humans will be required to determine safety and clinical benefit.

Animals↗
PubMed1991

The inability of Gore-Tex Surgical Membrane to inhibit post-radical pelvic surgery adhesions in the dog model.

We investigated the ability of Gore-Tex Surgical Membrane (Gore-SM) to inhibit PRPSA formation in 10 adult female canines undergoing radical hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and resection of the pelvic/abdominal peritoneum. At the time of surgery, one-half of the pelvic/abdominal peritoneal defect was covered with a tailored single layer of the Gore-SM. The membrane was sutured into place with 3-O Dexon in an interrupted manner. Each animal served as its own internal control. No operative/postoperative deaths or postoperative complications occurred. Four weeks postsurgery, euthanasia was effected, necropsy performed, and adhesions quantified. Adhesion scores for the Gore-SM-covered areas (n = 10; mean score, 2.76 +/- 1.47; median, 2.46) were significantly higher than those for control areas (n = 10; mean score, 1.46 +/- 2.13; median, 1.81; P = 0.01). Adhesions to the Gore-SM occurred at wrinkles in or at the edges of the membrane. In contradistinction to the findings of other investigators using different animal models, the Gore-SM appears to increase PRPSA in this unique model.

Animals↗