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Biomedical subjects

M L Pearl

Publications and source records attributed to M L Pearl.

At least 37 records · Page 2Linked to original sources
PubMed1994

Exponential regression of CA 125 during salvage treatment of ovarian cancer with taxol.

The role of serum CA 125 in monitoring the response of epithelial ovarian cancer to treatment has been extensively investigated. The exponential regression curve [1n(CA 125) = i+s (days after initiation of treatment)] has been reported to describe the rate of change of serum CA 125 during treatment. In this model, the y-axis intercept (i) represents the initial CA 125-secreting tumor burden, while the slope (s) is determined by the response to treatment. The exponential regression curve was calculated for 66 patients undergoing salvage chemotherapy with taxol. At a mean follow-up of 121 days, 50 (75%) patients had progressed and 35 (53%) had died. Stratification of the patients by stage, grade, or histology did not reveal any significant differences in the regression rate. When the patients were stratified by response, the mean regression rate was 0.0157 +/- 0.011 for patients with progressive disease (N = 19) vs -0.0250 +/- 0.031 for those with stable disease (N = 25) and -0.0250 +/- 0.015 for those with a partial response (N = 22) (P < 0.0001). The regression rate did not correlate with progression-free interval or survival (P > 0.05). We conclude that changes in serum CA 125 levels follow an exponential regression curve in patients undergoing salvage chemotherapy with taxol for progressive or recurrent ovarian cancer. A positive regression rate may predict which patients will progress prior to the time progression becomes clinically evident. However, a negative rate fails to provide discriminatory utility in predicting progression-free interval or survival.

Adult↗
PubMed1994

Open laparoscopy without special instruments or sutures. Comparison with a closed technique.

An important advantage of open laparoscopy over closed techniques is the avoidance of placing a sharp trocar blindly into the peritoneal cavity. Although an open technique theoretically minimizes the risk of major retroperitoneal vessel injury and bowel injury, most laparoscopies are performed using a closed technique. In an effort to simplify open laparoscopy, a technique was developed that can be done without special equipment or sutures and nearly as quickly as a closed technique. To compare the effectiveness of this open laparoscopic technique to a closed technique, a prospective, observational, cohort study was carried out on 66 women undergoing laparoscopy for either infertility or pelvic pain. The open technique was performed on 35 consecutive patients and compared to a closed technique performed on 31 patients on a different service during the same period. Evaluation included total duration of the procedure, length of the incision, incidence of CO2 leakage and complications. The open technique took slightly longer, and the incision was slightly longer. CO2 leakage occurred in 5 of 35 of the open cases but in none of the 31 closed cases. Leakage was controlled effectively in every case by application of a towel clip to the skin incision. No complications occurred with either technique. This study suggested that an open technique that requires no special equipment or sutures may be a useful alternative approach for laparoscopy when insertion of a sharp trocar is undesirable.

Adult↗
PubMed1993

Mitogenic activity of growth factors in the human endometrial adenocarcinoma cell lines HEC-1-A and KLE.

Endometrial adenocarcinoma is the most common gynecologic malignancy occurring in the United States. Evidence is accumulating that links peptide growth factors with malignant proliferation. Epidermal growth factor (EGF) and insulin-like growth factor I (IGF-I) are known mitogens for endometrial adenocarcinoma in vitro. However, the biological activity of other growth factors in this malignancy is unclear. This study was undertaken to determine the influence of growth factors on the mitogenic activity of the human endometrial adenocarcinoma cell lines HEC-1-A and KLE. Incubation with EGF, IGF-I, insulin-like growth factor II (IGF-II), or insulin stimulated a time-dependent mitogenic response in both cell lines, with the peak response occurring at 24 hr for HEC-1-A and 48 hr for KLE. After two doubling intervals, the number of HEC-1-A cells was increased 3.5-fold by EGF (100 ng/ml), 2.7-fold by IGF-I (100 ng/ml), 2.3-fold by IGF-II (100 ng/ml), and 2.2-fold by insulin (1000 ng/ml) when compared to untreated controls (P < 0.05). The number of KLE cells was increased 2.6-fold by EGF (100 ng/ml), 2.3-fold by IGF-I (100 ng/ml), 2.1-fold by IGF-II (100 ng/ml), and 2.0-fold by insulin (1000 ng/ml) when compared to untreated controls (P < 0.05). Similar results were obtained when DNA content was measured. PDGF failed to stimulate any mitogenic response in either cell line at all concentrations tested (0.1-100 ng/ml). These findings suggest that EGF, IGF-I, IGF-II, and insulin may play a regulatory role in the proliferation of endometrial adenocarcinoma.

Adenocarcinoma↗
PubMed1993

Synchronous dual primary ovarian and endometrial carcinomas.

OBJECTIVES: The synchronous occurrence of carcinoma confined to the ovary and endometrium presents a diagnostic and therapeutic dilemma. These tumors have been variously staged as FIGO Stage IIA ovarian carcinoma, Stage III endometrial carcinoma, or synchronous dual primary carcinomas. Accumulating evidence suggests such patients have a favorable outcome. This retrospective study was undertaken to review our experience with these fascinating tumors. METHODS: The clinical records and the pathologic findings of 16 patients with synchronous dual primary ovarian and endometrial carcinomas were reviewed. RESULTS: The median age was 51 years. Abnormal uterine bleeding was the most common presenting symptom (70%). All patients had Stage I ovarian and endometrial carcinomas. Fourteen patients (88%) had endometrioid carcinoma in both sites, while two patients (12%) had dissimilar histology. For 15 patients (94%), the grade of both tumors was identical. Only three (19%) patients had myometrial invasion, with less than 50% involvement in each case. All patients underwent surgical staging, 11 (70%) of whom received adjuvant radiation or chemotherapy. The five patients treated with surgery alone had Grade 1 endometrioid tumors. The only relapse occurred in a patient with a clear cell component in both sites. No patient has died of disease. CONCLUSIONS: Patients with synchronous dual primary carcinomas appear to have a more favorable prognosis than that expected with Stage IIA ovarian or Stage III endometrial carcinoma (100% vs. 63% or 42% survival at 3 years, respectively). The excellent survival for patients with Grade 1 dual endometrioid tumors treated with surgery alone suggests that adjuvant therapy may not be necessary for this sub-group.

Adult↗
PubMed1993

Vaginal delivery from the persistent occiput posterior position. Influence on maternal and neonatal morbidity.

We performed a retrospective study of 564 vaginal occiput posterior (OP) deliveries to investigate the influence of this position on maternal and fetal morbidity. The cases were compared to 1,068 controls matched for race, parity and delivery method. The OP group had a higher incidence of severe perineal laceration and episiotomy than the occiput anterior (OA) group. Within the OP group, operative delivery was associated with a higher incidence of severe perineal laceration, vaginal laceration and episiotomy than was spontaneous delivery. Similarly, the OP group delivered by forceps had a higher incidence of severe perineal lacerations, vaginal lacerations and episiotomy than those delivered by vacuum extraction. Mediolateral episiotomy was associated with a lower incidence of severe perineal lacerations than median episiotomy during delivery from the OP position. The infants delivered from the OP position had a higher incidence of Erb's and facial nerve palsy than did those delivered from the OA position. All these injuries occurred following forceps delivery. Vaginal delivery from the persistent OP position is associated with increased maternal morbidity, and operative vaginal delivery from this position is associated with increased neonatal morbidity.

Delivery, Obstetric↗
PubMed1993

Incontinence following rupture of the anal sphincter during delivery.

OBJECTIVE: To determine the frequency with which patients report incontinence of flatus or stool after rupture of the anal sphincter during delivery. METHODS: A chart review and telephone interview were conducted with 70 primiparas, 35 of whom had rupture of the anal sphincter at delivery and 35 of whom did not. All were contacted 9-12 months postpartum and questioned about the development of incontinence of gas or liquid or formed stool, persistent dyspareunia, and perineal pain. RESULTS: Incontinence of gas was reported by six women (17%) in the rupture group and one (3%) in the control group (P < .05). The incidence of incontinence of stool, both liquid and solid, dyspareunia, and persistent perineal pain were similar between the groups. CONCLUSION: Incontinence of flatus was reported six times more often by women who experienced a third- or fourth-degree perineal laceration than by those without anal sphincter rupture.

Adult↗
PubMed1993

Laparoscopic injury of abdominal wall blood vessels: a report of three cases.

BACKGROUND: Operative laparoscopy is being used for an increasing number of applications. Many of these innovative techniques require the insertion of large trocars through the anterior abdominal wall at points lateral to the midline. Because of the rich vascular supply of the anterior abdominal wall, the incidence of abdominal wall vessel injuries appears to be increased by these techniques. CASES: Three cases are reported in which abdominal wall blood vessels were injured during operative laparoscopy. Case 1 describes laceration of the inferior epigastric artery above the pubic crest. Despite initial hemostasis with a transabdominal suture ligation, postoperative blood loss necessitated transfusion and reoperation to control bleeding. Case 2 describes hematoma formation after unrecognized injury to one of the epigastric vessels. The hematoma resolved without sequelae with conservative treatment. Case 3 describes hematoma formation under a laparoscopic trocar incision lateral to the umbilicus that progressed to an abscess and was treated with drainage, irrigation, and antibiotics. CONCLUSIONS: Choosing appropriate trocar types and insertion sites based on a thorough understanding of anterior abdominal wall anatomy may minimize the risk of vessel injury during operative laparoscopy. However, because of anatomical variation, strategies for managing vessel injuries and their sequelae are also necessary.

Abdominal Muscles↗
PubMed1993

Routine endometrial curettage is not indicated at the time of cervical cone biopsy.

Endometrial currettage is commonly performed after cervical cone biopsy to detect occult endometrial abnormalities. Recently, this practice has been questioned and specific criteria promulgated to reduce the number of concomitant endometrial curettages performed at the time of cone biopsy. To investigate the reliability of these criteria, we reviewed the records of 370 women who underwent cold-knife cervical cone biopsy, 323 (87.3 percent) of whom underwent concomitant endometrial curettage. Significant endometrial abnormalities were present in only 18 women, each of whom met at least one specific criterion for endometrial currettage. In contrast, 23 endometrial currettings either contained cervical tissue (five patients) or were insufficient for diagnosis (18 patients). The incidence of complications directly attributable to endometrial curettage was 1.6 percent. We conclude that limiting endometrial curettage at the time of cone biopsy to those women meeting specific criteria would significantly reduce the number of endometrial currettings performed, without hindering the ability to detect significant endometrial abnormalities. Such a reduction would minimize surgical morbidity and could save $13 million annually in the United States.

Adolescent↗
PubMed1992

Diffuse adenomatoid tumor of the uterus with a serosal papillary cystic component.

A 39-year-old woman undergoing immunosuppressive therapy following kidney transplantation for systemic lupus erythematosus presented with a uterine adenomatoid tumor that diffusely infiltrated the entire myometrium and contained a serosal papillary cystic component that resembled a cystic mesothelioma. This is the first reported case of an adenomatoid tumor showing both of these features. Although adenomatoid tumors are considered benign, the patient may be at risk for recurrence of the papillary cystic component (which is known to recur in 50% of cases) if this tumor reflects an inability to limit neoplastic processes.

Adult↗
PubMed1992

Percutaneous transcatheter embolization for control of life-threatening pelvic hemorrhage from gestational trophoblastic disease.

Pelvic hemorrhage from gestational trophoblastic disease remains a common and vexing problem. Traditional surgical therapy, including hysterectomy and hypogastric artery ligation, may be technically difficult as well as hazardous to debilitated patients. In contrast, percutaneous transcatheter embolization specifically occludes the vessels that directly contribute to bleeding. Other potential advantages include avoidance of general anesthesia and major surgery, a rapid recovery period, and preservation of fertility. Various embolic materials allow one to tailor the duration of occlusion to the underlying disorder. Reported complications are rare and generally involve aberrant emboli or inadequate collateral circulation leading to ischemic injury. We believe that transcatheter embolization should be considered an alternative to operative intervention for control of pelvic hemorrhage from gestational trophoblastic disease.

Adult↗
PubMed1992

An electromyographic analysis of the shoulder during cones and planes of arm motion.

Shoulder motion has traditionally been described in reference to arbitrarily defined planes of motion (e.g., sagittal/flexion, coronal/abduction). This study examined shoulder muscle recruitment during conical arm movements, which include all planes of motion. Electromyographic (EMG) data was collected with intramuscular wire electrodes from ten muscles in five normal volunteers. Each muscle showed peak EMG activity in association with a direction of action consistent with its anatomic alignment. These findings were similar for movements in both the sagittal and coronal planes, calling into question conventionally held designations of shoulder muscles as flexors and abductors. Muscle recruitment was as follows: Clavicular pectoralis major, to move the arm medially along the horizontal; anterior deltoid, to move the arm obliquely upward inclined toward the midline; middle deltoid, to move the arm obliquely upward inclined away from the midline; posterior deltoid, to move the arm laterally along the horizontal; and teres major and latissimus dorsi, to move the arm obliquely downward away from the midline. Rotator cuff muscles were maximally active during elevation, consistent with the concept of a force couple.

Adult↗
PubMed1992

The relationship of the umbilicus to the aortic bifurcation: implications for laparoscopic technique.

OBJECTIVE: We evaluated the location of the umbilicus relative to the aortic bifurcation and the left common iliac vein where it crosses the midline. METHODS: Abdominal computed tomography images from 35 reproductive-age women were retrospectively reviewed to determine the location of the umbilicus. The results were correlated with body mass index using Pearson correlation coefficient and a two-tailed paired t test. RESULTS: The location of the umbilicus, but not the aortic bifurcation, was more caudal in heavier women and negatively correlated with body mass index. In nonobese women, the mean location of the umbilicus was 0.4 cm caudal to the aortic bifurcation, and was at or cephalad to the bifurcation in eight of 15 (53%). In overweight women, the mean umbilical location was 2.4 cm caudal to the bifurcation, and in obese women, 2.9 cm caudal to the bifurcation. In the last two groups of subjects, the umbilicus was located at the level of the bifurcation in six of 20 (30%). In every case, the umbilicus was located cephalad to where the common iliac vein crossed the midline. CONCLUSIONS: The umbilicus is often located at or cephalad to the aortic bifurcation, and consistently located cephalad to where the left common iliac vein crosses the midline. The laparoscopic approach should take these relationships into account to minimize injuries to major retroperitoneal vessels.

Adult↗
PubMed1991

Fibroepithelial polyps of the vagina in pregnancy.

A 38-year old pregnant woman presented with a polypoid tumor of the vagina. A biopsy revealed benign fibroepithelial polyps. Her pregnancy progressed normally, and she underwent an uncomplicated vaginal delivery. Once the benign nature of the lesion has been established, a spontaneous vaginal delivery is not contraindicated. However, operative vaginal delivery should be avoided to reduce the risk of trauma and hemorrhage. Local excision is curative and may be performed as an interval procedure when the vaginal vascularity has returned to normal.

Adult↗
PubMedDate not supplied

Retroversion of the proximal humerus in relationship to prosthetic replacement arthroplasty.

Arthroplasty of the proximal humerus positions a prosthetic articular surface in relation to the humeral canal. Most descriptions of surgical technique recommend positioning the humeral component in 30 degrees to 45 degrees of retroversion. This study measured retroversion in relationship to the surgically reamed canal and introduced a method of measurement pertinent to prosthetic reconstruction. The canals of 21 cadaveric humeri were surgically reamed, the articular margins of the humeral heads were outlined with steel wire, and the trochlear axes were transfixed with Steinman pins. Under fluoroscopy the humeri were rotated on a jig that allowed rotation around the reamer and measurement of retroversion relative to the plane of the articular surface. Retroversion of the proximal humerus is highly variable, ranging in this study from 10 degrees to 55 degrees (mean 29.8 degrees). Anatomic reconstruction of the retroversion angle must be individualized. Palpation of the rotator cuff insertion is recommended prior to humeral head resection to avoid inadvertant cuff injury.

Cadaver↗
PubMedDate not supplied

Coronal plane geometry of the proximal humerus relevant to prosthetic arthroplasty.

Most prosthetic designs for the replacement of the proximal humerus have one head shaft angle and several head sizes allowing limited replication of the anatomy. The necessity for press fit designs to follow the reamed canal adds an additional constraint. To better understand these limitations, this study measures proximal humeral anatomy in relationship to the surgically reamed canal. Measurements were made from radiographs of 21 humeri. Radius of curvature averaged 25.3 mm, head height 18.5 mm, head-shaft angle 40.7 degrees, and offset 9.7 mm. Longer humeri had proportionally larger shafts and larger heads (r = 0.7, p < 0.0005). Proximal humeral anatomy is extremely variable. The relatively fixed geometry of most prosthetic systems limits the surgeon's ability to replicate the original anatomy. As a generalization for existing press fit, modular systems, the surgeon must either position a similarly sized prosthetic articular surface superomedial to that of the original anatomy or use one with less articular surface area.

Aged↗
PubMedDate not supplied

Mesna, doxorubicin, ifosfamide, and dacarbazine (MAID) chemotherapy for gynecological sarcomas.

This report summarizes our experience with the combination of mesna, doxorubicin, ifosfamide, and dacarbazine (MAID) for patients with gynecological sarcomas. We reviewed the records of all patients who had received the MAID regimen for a gynecological sarcoma between 1993 and 2000. The MAID regimen was administered intravenously every 4 weeks in the hospital as follows: (1) mesna 1500 mg/m2/day x 4 days; (2) doxorubicin 15 mg/m2/day x 3 days; (3) ifosfamide 1500 mg/m2/day x 3 days; (4) dacarbazine 250 mg/m2/day x 3 days. The results of treatment with MAID were disappointing. Overall, the response rate was 9% with one complete response and one partial response (both in patients with uterine leiomyosarcoma). We did not observe any responses among the patients with carcinosarcomas of either ovarian or uterine origin. The median progression-free interval and survival were 11 months and 29 months, respectively. This regimen was associated with substantial toxicity (including a death from neutropenic sepsis) as well as high cost and inconvenience due to the requirement for inpatient administration. Although our study contains a limited number of patients with a variety of gynecological sarcomas, our review has led us to discontinue using MAID. It remains to be established if any combination chemotherapy regimen is better than single agent treatment.

Adult↗