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Biomedical subjects

M P Hopkins

Publications and source records attributed to M P Hopkins.

At least 19 recordsLinked to original sources
PubMed2002

Spontaneous prolonged hypertonic uterine contractions (essential uterine hypertonus) and a possible infective etiology.

The management of a pregnant woman presenting with prolonged hypertonic uterine contractions (essential uterine hypertonus) and mildly elevated temperature at term is described. Histology of the placenta, cord and membranes, following delivery, revealed evidence of chorioamnionitis, funisitis and deciduitis. Our findings raise the possibility that essential uterine hypertonus may have an infective or inflammatory component to its etiology.

Adult↗
PubMed2001

Vaginal leiomyoma co-existing with broad ligament and multiple uterine leiomyomas.

A 48 year old African American woman presented with bladder pressure leading to the diagnosis of broad ligament and multiple uterine leiomyomas. She was also found to have a lateral vaginal wall mass which was confirmed to be a leiomyoma. Unlike uterine leiomyomas, vaginal leiomyomas are uncommon and are most often found in Caucasian women. Cases of such coexisting tumors are rare and their etiologic relationship is uncertain.

Fallopian Tubes↗
PubMed2001

Carcinoma of the vulva.

Vulvar cancer will probably become a more common disease as the population ages. It is primarily a disease of the elderly. Fortunately, most vulvar cancers remain localized for extended periods of time and can be treated adequately with radical surgery.

Biopsy↗
PubMed2001

Complementary and alternative medicine use in the Amish.

OBJECTIVE: To examine the rate of utilization of complementary and alternative medicine (CAM) in Amish women, a population that traditionally uses non-mainstream medicine. METHODS & RESULTS: Sixty-six Amish women completed a survey concerning their use of CAM. Thirty-six percent of the Amish women used at least one form of CAM, primarily reporting a use of diet and nutrition programs, herbal therapies, and chiropractic medicine. In addition, ten pregnant Amish women reported using echinacea, St. John's Wort, red clover, garlic and ginseng. CONCLUSION: This survey highlights the need to address potential adverse effects of herbal therapies in young women who are a member of a group that may use non-mainstream medicine.

Adult↗
PubMed2000

Alternative medicine in gynecologic oncology: A case report.

A patient with Stage IIB squamous cell cancer of the cervix presented 10 days into her primary radiation therapy with neutropenic fever and diarrhea requiring hospitalization and delay in treatment. The patient's history revealed extensive use of alternative therapies including potential toxic botanicals. This case raises the possibility that a patient's use of alternative therapies may have caused toxicity and delayed primary therapy. Gynecologic oncology patients may be using alternative therapies justifying the need for incorporating this classification into the historical exam.

Carcinoma, Squamous Cell↗
PubMed2000

Laparoscopic port site implantation with ovarian cancer.

We report the cases of 3 patients in whom tumor implantation developed at the port site at which ovarian cancer was removed laparoscopically. The 3 patients, who were aged 30, 32, and 40 years, all had an ovary that did not appear cancerous removed by laparoscopy through a port site. All 3 patients underwent re-exploration within 3 weeks and were found to have tumoral spread and port site implantation of tumor. When ovarian cancer is removed laparoscopically, the potential exists for intra-abdominal tumoral spread. When surgical staging is undertaken after laparoscopic removal of ovarian cancer, the port site should be excised in a full-thickness fashion.

Adult↗
PubMed2000

The prevalence of thromboembolic events among women with extended bed rest prescribed as part of the treatment for premature labor or preterm premature rupture of membranes.

OBJECTIVE: This study was undertaken to determine the prevalence of thromboembolic events among women with extended bed rest prescribed as part of the treatment of premature labor or preterm premature rupture of membranes. STUDY DESIGN: A retrospective chart review was undertaken of all women who had bed rest of >/=3 days' duration prescribed as part of the treatment of premature labor or preterm premature rupture of membranes in the Akron General Medical Center Perinatal Unit during the period January 1, 1997-December 31, 1998. The prevalence of thromboembolic events in this population was determined. The charts of all additional gravid women with antepartum or postpartum deep vein thrombosis or pulmonary embolism diagnosed during the study period were also reviewed. The prevalence of these disorders among the pregnant population for whom extended bed rest was not prescribed as part of the treatment of premature labor or preterm premature rupture of membranes was also calculated. Statistical comparison of the prevalences in the 2 populations was undertaken by means of the chi(2) analysis with the Fisher exact test. RESULTS: There were 192 patients admitted during the study period who had extended bed rest prescribed as part of the treatment of premature labor or preterm premature rupture of membranes. Three of these women had thromboembolic events, for a prevalence of 15.6 cases per 1000 women. Five additional gravid women were admitted for the treatment of deep vein thrombosis or pulmonary embolism. There were 6164 deliveries among women not treated with extended bed rest for premature labor or preterm premature rupture of membranes during this period. Thus the prevalence of these phenomena among the remaining pregnant women was 0.8 cases per 1000 women. The prevalences of these disorders in the 2 populations were highly significantly different. CONCLUSION: The prevalence of thromboembolic events among women for whom extended bed rest is prescribed as part of the treatment of premature labor or preterm premature rupture of membranes is significantly increased with respect to that among gravid women who do not receive this therapy and is substantially higher than previously reported. If this finding is confirmed in other populations, it may be prudent to undertake further studies to determine whether this prevalence can be reduced.

Bed Rest↗
PubMed2000

The myths of laparoscopic surgery.

Laparoscopic surgery has been rapidly accepted without rigorous scientific study. New procedures and technologies have advanced rapidly, and most gynecologists have embraced these techniques. I believe that the new technology has given rise to the following myths: (1) that there are associated cost savings, (2) that new technology is always better than the old, (3) that a steep learning curve is acceptable, (4) that market share will be lost without the new techniques, (5) that oncologic surgery is not different when performed laparoscopically, (6) that operations are the same with the laparoscope, and (7) that every gynecologist can do these procedures. A critical evaluation of new technology and of laparoscopic techniques needs to be performed.

Costs and Cost Analysis↗
PubMed2000

Panniculectomy at the time of gynecologic surgery in morbidly obese patients.

OBJECTIVE: Our goal was to demonstrate that panniculectomy performed at the time of gynecologic surgery aids in reducing the operative time and exposure and does not increase the wound infection rate in morbidly obese patients. STUDY DESIGN: A retrospective survey was performed of massively obese patients who underwent panniculectomy at the time of gynecologic surgery at Northeastern Ohio Universities College of Medicine consortium hospitals from 1990-1999. Data collected during surgery included the patient's weight, operative opening and closing times, blood loss, and weight of the removed panniculus adiposus. Postoperative wound infection rates were monitored, and patients were followed up for 6 months. RESULTS: Seventy-eight patients underwent the following operations: radical hysterectomy (n = 19), extrafascial hysterectomy (n = 18), standard hysterectomy (n = 32), or other gynecologic surgery (n = 9). The average blood loss was 71 mL. Opening and closing times were 27 and 33 minutes, respectively, adding a minimal amount of operative time to the required gynecologic surgery. The average removed panniculus adiposus weighed 4745 g. Efficiency in obtaining exposure to the operative site was noted. A total of 2 wound infections were recorded in the postoperative period. In 1 case debridement was required, and in the other healing occurred by secondary intention. Minimal separation occurred in 4 other cases and required no intervention. CONCLUSION: Massively obese patients can safely undergo panniculectomy simultaneously with a gynecologic procedure. The difficulty with operative exposure is reduced, and these patients are better served intraoperatively. Postoperatively, the wound infection rates quoted for this population were markedly improved from prior studies and involved a larger group of patients.

Adult↗
PubMed1999

The effects of carbon dioxide pneumoperitoneum on seeding of tumor in port sites in a rat model.

OBJECTIVES: The use of laparoscopic surgical techniques for the resection of intraperitoneal malignancies has been rapidly increasing in recent years; concomitantly, tumor recurrences at trocar sites have also been reported. These reports bring into question the appropriateness of pneumoperitoneum and laparoscopic techniques for carcinoma removal. We hypothesized that the carbon dioxide pneumoperitoneum and instrumentation used during laparoscopic procedures contribute to a greater incidence of tumor implantation into the ventral peritoneal wall wound sites than seen with laparotomy. This study, which used port placement and carbon dioxide pneumoperitoneum in an animal model, was designed to determine the relative incidences of tumor implantation into wound sites of the ventral peritoneal wall for laparoscopy and laparotomy. STUDY DESIGN: Viable MAT B III rat mammary adenocarcinoma cells were injected into the lower right quadrant of the peritoneal cavity of Fisher 344 rats (1 x 10(5) cells/rat). The animals were then divided into 4 groups: 1 group (n = 9) served as a control group and received no further manipulations; another (n = 8) underwent a midline laparotomy; another (n = 8) had four 18-gauge trocars inserted into the peritoneal cavity; and the last (n = 8) underwent induction of a 7- to 8-mm Hg carbon dioxide pneumoperitoneum in addition to the insertion of four 18-gauge trocars. All animals were maintained under surgical conditions for 2 hours. Animals were killed at 7 days, and the ventral peritoneal wall was examined for macroscopic evidence of tumor formation. RESULTS: A total of 32 possible sites of tumor implantation were measured. The control group showed no significant macroscopic evidence of tumor translocation to the ventral peritoneal wall. Among the 32 measured sites the laparotomy group had an overall lower incidence of tumor implantation at the peritoneal wall wound sites (n = 5) than did the group with the trocars alone (n = 20) group (P =.003) and the group with trocars plus carbon dioxide insufflation (n = 29, P <.0001). The group with trocars alone had a lower incidence of tumor implantation than did the group with trocars plus carbon dioxide pneumoperitoneum (P =.02). CONCLUSIONS: Trocar use during laparoscopic surgical procedures led to greater translocation of free tumor cells to peritoneal wall wound sites than did laparotomy in this animal model. The addition of carbon dioxide pneumoperitoneum further increased implantation of tumor cells at trocar sites. These results provide evidence that the use of laparoscopic techniques for resection of intraperitoneal malignancy needs further long-term study.

Adenocarcinoma↗
PubMed1998

The role of AT1 angiotensin receptor activation in the pathogenesis of preeclampsia.

OBJECTIVES: Preeclampsia is characterized by an increase in vascular tone associated with reduced uteroplacental flow. The nature of hypertension arising in pregnancy suggests that the abnormal increase in blood pressure is dependent on some humoral factor that mediates vasospasm. There is evidence that preeclampsia results from a breakdown in the balance between vasodilators such as prostacyclin and prostaglandin E2 and nitric oxide and the vasoconstrictors angiotensin II, thromboxane A2, serotonin, and endothelin. Furthermore, vascular reactivity to angiotensin II is greatly enhanced in preeclampsia as opposed to normal pregnancies. The increased vascular tone and the enhanced thromboxane production noted in preeclampsia may be mediated by the increased sensitivity to angiotensin II because angiotensin II coupled to an AT1 receptor is a potent vasoconstrictor and stimulates the accumulation of free arachidonic acid, the precursor of thromboxane and the prostaglandins. STUDY DESIGN: We used a rat model that has been shown to express the relevant clinical features of human preeclampsia to investigate the involvement of the AT1 angiotensin receptor in this pathologic condition. Pregnant rats were divided into three groups that were either infused with saline or endotoxin on the 14th day of pregnancy. One of the endotoxin-infused groups was further treated with the AT1-selective antagonist losartan from day 11 until day 19 of pregnancy. RESULTS: Perinatal outcome, blood pressure, and urine protein were monitored for each group. We observed that endotoxin infusion resulted in a decrease in pup weight and number of pups and caused an increase in mean arterial pressure as well as increased proteinuria when compared with saline solution-infused animals. In contrast, endotoxin-infused rats receiving losartan exhibited no change in number or weight of pups when compared with control, and losartan tended to diminish the rise in mean arterial pressure. In addition, the increase in urinary protein excretion was completely blocked by losartan. CONCLUSIONS: Endotoxin infusion in pregnant rats appears to be a suitable model for the study of preeclampsia. Moreover, the angiotensin II-dependent activation of an AT1 receptor appears to mediate a portion of the pathophysiologic features associated with preeclampsia.

Albuminuria↗
PubMed1997

The effect of intermittent-release intraperitoneal chemotherapy on wound healing.

OBJECTIVE: Our purpose was to study the effect on wound healing when intraperitoneal chemotherapy was instilled on a daily basis. STUDY DESIGN: Intraperitoneal carboplatin, Taxol, or saline solution was instilled daily into 70 rats after they underwent laparotomy. The animals were killed and analyzed for adhesions. An area measuring 5 x 5 cm including the incision was also harvested for biomechanical testing. The wound thickness was measured, and the Shore Western Materials Testing System (Monrovia, Calif.) was used to test the force required to break the wound, the stress, and the stiffness. RESULTS: Groups of 10 rats received saline solution control, carboplatin 6 mg/kg, 7 mg/kg, 8 mg/kg, or Taxol 2.5 mg/kg, 3.0 mg/kg, or 3.5 mg/kg. The total dose was divided into seven equal amounts, administered daily. No significant adhesions developed in any of the animals. The carboplatin group experienced no significant decrease in wound thickness whereas the higher-dose Taxol group had a significant decrease in thickness from 1.06 mm to 0.72 mm (p = 0.02). The wound-breaking strength (force) also decreased for the highest-dose Taxol group from 710 gm to 411 gm (p = 0.02). The wound stiffness was also decreased from 69 gm/mm to 46 gm/mm (p = 0.01). The other measured parameters for both the Taxol and carboplatin groups were not significantly decreased when compared with those of controls. CONCLUSION: The immediate instillation of divided daily carboplatin did not influence wound strength whereas the use of Taxol on a similar schedule significantly decreased wound strength.

Animals↗
PubMed1997

Uterine problems discovered after presumed hysterectomy: the Manchester operation revisited.

BACKGROUND: The Manchester operation consists of amputation of the cervix, leading some patients to believe that they have undergone a hysterectomy. CASES: A 69-year-old woman with vaginal discharge proved to have a well-differentiated adenocarcinoma in the retained uterine corpus. Another 69-year-old woman with a central fluid-filled pelvic mass proved to have a retained blood-filled corpus with an early-stage fallopian tube cancer. The third patient was a 90-year-old woman with symptoms of constipation and urinary frequency, who was found to have a large fluid-filled central mass. At surgery, the retained corpus was distended and filled with mucoid material. CONCLUSION: Patients who have undergone a Manchester operation may develop disease in the retained uterine corpus, which should be considered in the differential diagnosis of a pelvic mass.

Aged↗
PubMed1996

Endometrial rollerball ablation.

OBJECTIVE: To study a standardized technique for endometrial rollerball ablation and various methods of preoperative preparation. STUDY DESIGN: All patients had refractory symptomatic menorrhagia and previously failed conservative surgery and other forms of medical therapy, such as progestogens. Patients received a preoperative regimen of either leuprolide acetate, danazol, Nolvadex or Depo-Provera. They then underwent hysteroscopically controlled rollerball ablation at 80-100 W with 1.5% glycine as the distending medium. The endometrium was evaluated hysteroscopically and considered to be completely atrophic, intermediate or no response. RESULTS: Refractory symptomatic menorrhagia was treated successfully in 38 of 40 patients. Nineteen reported amenorrhea; the other 21 reported subjective and objective improvement of bleeding. Three patients, despite improvements in flow, were unhappy with the overall result. Two did not wish repeat ablation and subsequently underwent vaginal hysterectomy. The third underwent repeat ablation and became amenorrheic. The ability to achieve complete endometrial atrophy prior to ablation was improved with leuprolide acetate (19/24) and danazol (5/6) when compared to tamoxifen (0/4) and Depo-Provera (0/6). Attainment of amenorrhea after ablation was significantly improved when complete atrophy (19/24) was achieved prior to ablation as compared to the ability to achieve amenorrhea when no endometrial response was achieved (0/7). The only significant complication was one uterine perforation in a patient undergoing repeat ablation. CONCLUSION: Endometrial rollerball ablation is a safe, effective means of controlling refractory menorrhagia. Amenorrhea is best attained when complete preoperative atrophy is achieved. Leuprolide and danazol were superior to tamoxifen and Depo-Provera.

Antineoplastic Agents↗
PubMed1994

Overexpression of p53 is not a feature of benign and early-stage borderline epithelial ovarian tumors.

Since overexpression of mutant p53 protein is a common feature of invasive epithelial ovarian cancers, we investigated whether overexpression of the p53 tumor suppressor gene product occurs in benign and borderline epithelial ovarian tumors. Immunohistochemical staining for p53 was performed in frozen samples of 17 benign tumors and in 49 borderline tumors (4 frozen, 45 paraffin embedded). Overexpression of p53 was observed in 0/17 (0%) benign ovarian tumors and 2/49 (4%) borderline tumors. Overexpression of p53 in borderline tumors was only seen in advanced stage cases; overexpression was seen in 2/8 (25%) stage III cases, but not in any of 41 stage I/II cases. In conclusion, overexpression of p53 is not a feature of benign epithelial ovarian tumors or early-stage borderline ovarian tumors. Similar to invasive epithelial ovarian cancers, however, a fraction of metastatic borderline tumors also overexpress p53.

Adult↗
PubMed1994

Wound seeding associated with endometrial cancer.

We report a patient with well-differentiated adenocarcinoma of the endometrium who developed a recurrence in the anterior abdominal wall probably secondary to wound seeding at the time of her original surgery. She underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy. She then received 15 mCi of 32P for positive peritoneal washings. She was free of disease until 2 years later when a large lower incision mass developed. She had no evidence for intra-abdominal disease and a radical resection with a myocutaneous flap was undertaken. Radical resection for isolated metastases may be of benefit for patients with endometrial cancer. Patients with positive cytology should be observed closely for incisional recurrence.

Adenocarcinoma↗