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Biomedical subjects

M S Hoffman

Publications and source records attributed to M S Hoffman.

At least 19 recordsLinked to original sources
PubMed1992

Radical hysterectomy for treatment of cervical cancer: a prospective study of two methods of closed-suction drainage.

Two closed-suction drainage methods were prospectively compared in 96 patients after radical hysterectomy with pelvic lymphadenectomy in stage IB cervical cancer. In group 1 (n = 49) two pelvic sidewall drains and a vaginal drain were used, and in group 2 (n = 47) only the vaginal drain was used. The groups were similar for mean age, preoperative weight, hemoglobin and serum albumin level, operating time, operative blood loss, and blood transfusions. The febrile morbidity rates and the operative site infection rates were similar in the two groups. Ninety vaginal drains were removed by day 3. By day 6 55% of patients in group 1 had at least one sidewall drain, with a mean drainage of 150 ml/day. The median postoperative stay was similar in both groups. A pelvic lymphocyst developed in one patient in each group. The single vaginal closed-suction drain is safe, efficient, more acceptable to patients, and more cost-effective.

Adult↗
PubMed1992

Upper vaginectomy for in situ and occult, superficially invasive carcinoma of the vagina.

Between Aug. 1, 1985, and July 31, 1990, 32 patients underwent upper vaginectomy for grade 3 vaginal intraepithelial neoplasia. Thirty-one of these patients had undergone hysterectomy, 25 because of cervical neoplasia. Fourteen patients had undergone treatment for vaginal intraepithelial neoplasia. Nine (28%) had invasive cancer on final pathologic examination. Among the remaining 23 patients, recurrence of vaginal neoplasia developed in four (17%), with a mean time to recurrence of 78 weeks, and one was found to have superficial invasion at the time of recurrence. The remaining 19 patients remain alive with no evidence of recurrent disease at a mean follow-up interval of 152 weeks. In our patients upper vaginectomy was efficacious for the diagnosis of occult invasive carcinoma of the vagina and for the treatment of in situ and superficially invasive carcinoma of the vagina.

Adult↗
PubMed1992

Complications of colostomy performed on gynecologic cancer patients.

From 1/1/80 to 5/31/90 111 patients underwent a colostomy on a gynecologic oncology service. Six patients developed 7 (6.3%) early colostomy-related complications, including sepsis (1), stomal retraction (1), ostomy wound infection (3), and partial stomal obstruction (2). The sepsis was felt to be related to spillage of stool upon maturing the colostomy, and this patient expired on Postoperative Day 63. There were no other mortalities attributed to the colostomies. Fourteen patients developed 17 (15.3%) delayed colostomy-related complications, including parastomal hernia (5), stomal retraction (1), stomal prolapse (3), tumor replacement (2), and site-choice problems (6). These results compare favorably with those in the literature and support the continued role of the gynecologic oncologist in gynecologic cancer-related gastrointestinal surgery.

Adult↗
PubMed1992

Lymphoscintigraphy in vulvar cancer: a pilot study.

This pilot study was undertaken to correlate the patterns of lymphatic drainage demonstrated by vulvar lymphoscintigraphy with the clinical and pathologic findings of the inguino-femoral lymph nodes in patients with vulvar cancer. Ten patients were studied with the radionuclide Technetium-antimony trisulfide colloid (Tc 99m ASC) using a perilesional technique. Images were obtained at 2-4 hr postinjection. Four of the six patients with central lesions or lesions that crossed the midline had bilateral groin uptake, and two had unilateral uptake to the side on which the lesion was predominantly located. Three of these patients, each with suspicious groin nodes bilaterally, had metastatic nodal disease, two unilateral and one bilateral, in whom the uptake was bilateral and unilateral, respectively. Three of the four patients with unilateral lesions had ipsilateral groin drainage only and one had no drainage. Three underwent a bilateral lymphadenectomy and none had metastasis. The pattern of Tc 99m ASC uptake was not predictive of metastatic nodal disease. In two of the three patients with unilateral groin recurrence the side of recurrence was the same as that demonstrated on lymphoscintigraphy, and in the third case there was bilateral drainage. Further data are needed to determine the role of lymphoscintigraphy in the management of vulvar cancer.

Aged↗
PubMed1992

A comparative study of radical vulvectomy and modified radical vulvectomy for the treatment of invasive squamous cell carcinoma of the vulva.

Forty-five patients who underwent a modified radical vulvectomy for invasive squamous cell carcinoma of the vulva were compared with forty-five patients who underwent radical vulvectomy for similar lesions. Vulvar wound infection and breakdown were infrequent in both groups. Anal incontinence developed postoperatively in five of the modified radical vulvectomy patients and in none of the radical vulvectomy patients. Urinary incontinence developed postoperatively in two of the modified radical vulvectomy patients and in seven of the radical vulvectomy patients. Possible reasons for these differences are discussed. One invasive local recurrence (2.2%) developed in the modified radical vulvectomy group and two (4.4%) local recurrences developed in the radical vulvectomy group. A modified radical vulvectomy appears to be efficacious for the vulvar phase of treatment of localized invasive squamous cell carcinoma of the vulva.

Aged↗
PubMed1992

Percutaneous nephrostomy and ureteral stenting in gynecologic malignancies.

OBJECTIVE: To identify the indications, complications, and efficacy of percutaneous nephrostomies and ureteral stents in women with gynecologic cancer. METHODS: In a retrospective study, 40 women underwent urinary diversion with percutaneous nephrostomy and ureteral stents. Nine had ureteral stenosis on initial presentation, 18 had persistent or recurrent cancer, nine had no evidence of disease, and four had operative ureteral damage. Of the nine who were without disease, seven had a urinary conduit. RESULTS: Thirty-five patients had ureteral stenosis, which was bilateral in 24, and five had a ureteral fistula. Sixteen had a unilateral and 22 had bilateral percutaneous nephrostomies, with two cases having stents only. The most common complication was hematuria. Thirteen women were later hospitalized for pyelonephritis. Twenty-nine (72.5%) had ureteral stents, which were bilateral in 12. Renal function was abnormal in 26, but improved in 14 and returned to normal in six. Five fistulas were managed with ureteral stents alone and four were closed. The median time to death (N = 22) was 5.5 months, 12 months in primary cases versus 5.5 months in recurrent cases. Twelve of the remaining 18 were alive without evidence of disease at a median of 38 months, five were alive with disease at a median of 16 months, and one was lost to follow-up. CONCLUSIONS: These techniques are safe and often improve renal function. The procedures have different roles in women with primary and recurrent gynecologic cancer, in those without evidence of recurrent disease, and in those with urinary conduits.

Adolescent↗
PubMed1992

Erythromycin associated hearing loss in a patient with prior cis-platinum induced ototoxicity.

A case is reported of reversible sensorineural hearing loss associated with intravenous erythromycin treatment. Cis-platinum induced high frequency hearing loss developed nine months previously during treatment for stage IV papillary cystadenocarcinoma. Renal and hepatic function were normal; however, serum erythromycin levels were elevated. Clinical recovery promptly followed discontinuation of erythromycin.

Cisplatin↗
PubMed1992

Laser vaporization for vulvar intraepithelial neoplasia III.

Eighteen women with vulvar intraepithelial neoplasia (VIN) III were treated with laser vaporization. The majority had multifocal disease. After a single laser vaporization, 15 of the 18 remained free of recurrent disease, with a mean follow-up of 129.5 weeks (range, 24-253). There were no intraoperative complications. Two patients had delayed healing and persistent vulvar soreness for 4 and 10 months. Laser vaporization appears to be reasonably well tolerated and effective for VIN III, especially multifocal.

Adult↗
PubMed1991

Laser vaporization of grade 3 vaginal intraepithelial neoplasia.

Between March 1, 1984, and May 23, 1990, 26 patients underwent laser vaporization for grade 3 vaginal intraepithelial neoplasia. Twenty of these patients had prior hysterectomy, 12 of them because of cervical neoplasia. Ten patients had undergone prior treatment for vaginal intraepithelial neoplasia. Eleven (42%) developed recurrence of vaginal neoplasia with a mean time to recurrence of 22 weeks. Three of the 11 patients had invasive cancer at the time of recurrence. One patient had invasive cancer on biopsy at the time of laser vaporization and subsequently underwent radiation therapy. The remaining 14 patients remain alive with no evidence of recurrent disease at a mean follow-up interval of 117 weeks. In our hands, laser vaporizaiton did not appear to be efficacious treatment for grade 3 vaginal intraepithelial neoplasia, especially when diagnosed in the region of a vaginal cuff scar.

Adult↗
PubMed1991

The use of the Cytobrush cervical sampler in patients with cervical stenosis.

In 37 of 43 patients (86%) with cervical stenosis (inability to undergo passage of the cotton-tipped applicator), the Cytobrush cervical sampler was successfully passed into the endocervical canal. The use of the Cytobrush sampler for cervical cytologic screening appears to be valuable in patients with cervical stenosis.

Adolescent↗
PubMed1991

Management of radionecrosis of the vulva and distal vagina.

Twelve patients were seen between January 1983 and June 1989 with the clinical diagnosis of radionecrosis of the vulva or distal vagina. Seven patients received radiation for vulvar cancer, three for distal vaginal cancer, and two for recurrent endometrial cancer. No patient healed spontaneously and the mean delay in surgical therapy was 8.5 months. The radionecrotic site was treated with local therapy, radical local excision (with or without colostomy), or exenteration. The operative defect was closed primarily in three patients and covered with local flaps or myocutaneous flaps in seven patients. The two patients with local care still have radionecrotic ulcers. One of three patients who were closed primarily continues to have an ulcer. All other patients have healed satisfactorily except one who died after two attempts to correct the problem. Radionecrosis of the vulva and distal vagina should generally be treated surgically.

Adult↗
PubMed1991

Further experience with radiation therapy and concomitant intravenous chemotherapy in advanced carcinoma of the lower female genital tract.

Sixty-seven patients with advanced carcinoma of the lower female genital tract (cervix, vagina, and vulva) were treated with radiation and concomitant intravenous cisplatin and/or 5-fluorouracil. Fifty-seven patients (85%) responded completely clinically. Thirty-five (61%) complete responders recurred with a median time to recurrence of 6 months. Twenty-six of the thirty-five patients who recurred had some component of local failure. The 22 complete responders who have not recurred have been followed a median of 13 months. Acute toxicity was minimal, with only 6 patients requiring interruption of therapy. Nine (13%) patients developed severe late complications and eight required surgery. The actuarial 5-year survival is 22%. This treatment regimen is disappointing in terms of both survival and local control.

Adult↗
PubMed1991

Concentrated albumin infusion as an aid to postoperative recovery after pelvic exenteration.

Twenty-eight patients underwent pelvic exenterations for gynecologic malignancies between June 1986 and June 1989. The postoperative fluid and electrolytes were managed by one of two regimens. One group of 10 patients was given concentrated 25% albumin infusion for the first 16 hr after surgery in addition to maintenance intravenous crystalloid solution according to ideal body weight. The second group of 18 patients received only a standard crystalloid solution. The albumin infusion group was found to have a more stable postoperative course as evidenced by less fluid boluses (P less than 0.01), fewer electrolyte bolus requirements (P less than 0.01), and easier management of blood pressure and urine output. There was a 50% decrease in total fluid requirement, a higher mean right atrial pressure (P less than 0.05), and a lower maintenance intravenous fluid rate (P less than 0.01). As a consequence, central hyperalimentation was started earlier (P less than 0.01) and the albumin infusion group left the Intensive Care Unit sooner than the non-albumin infusion group. There was not a single instance of clinical fluid overload with this slow infusion technique. Thus, concentrated albumin infusion was beneficial in the acute fluid management of these difficult patients.

Aged↗
PubMed1991

A phase II evaluation of cisplatin, bleomycin, and mitomycin-C in patients with recurrent squamous cell carcinoma of the cervix.

Cisplatin, bleomycin, and mitomycin-C were used to treat 25 patients with recurrent squamous cell carcinoma of the cervix. Six patients had a partial response, yielding a total response rate of 27%. Nine patients had stable disease. The median survival for the whole group was 30 weeks. The median survival for responders was 32 weeks. The median progression free interval for the whole group was 12 weeks and the median progression-free free interval for responders was 14 weeks. The toxicities noted were primarily nausea, vomiting, and myelosuppression. The combination of cisplatin, bleomycin, and mitomycin-C has modest effectiveness in the treatment of recurrent squamous cell carcinoma of the cervix, but represents no improvement over single-agent chemotherapy.

Adult↗
PubMed1991

Giant colonic mucocele following palliative surgery for recurrent squamous cell carcinoma of the cervix.

We report an unusual complication following palliative surgery in a patient with carcinomatosis peritonei from recurrent squamous cell carcinoma of the cervix. At surgery the ascending colon was bypassed and isolated. Eight months later the patient presented with a giant mucocele. We believe this to be the first reported case in the gynecologic literature. This complication could have been prevented by adhering to the standard surgical management of fashioning a mucous fistula.

Aged↗
PubMed1991

Femoral vessel coverage with dura mater after inguinofemoral lymphadenectomy.

Twenty patients undergoing inguinofemoral lymphadenectomy for vulvar malignancy had the femoral vessels covered with freeze-dried human cadaver dura mater; 5 patients had a radical vulvectomy and 15 had a modified radical vulvectomy, and a total of 38 groins were explored. The dura mater was sutured to the inguinal ligament, sartorius muscle fascia, and adductor longus muscle fascia. Three of the thirty-eight wounds had wound breakdown uncovering the dura mater; each of the groins healed satisfactorily by secondary intention without exposing the femoral vessels. Three patients developed cellulitis without wound breakdown and three patients developed lymphocysts. All groin wounds have healed completely and there have been no delayed complications. The mean follow up was 12.5 months (range, 2-30 months). Coverage of the femoral vessels with dura mater after inguinofemoral lymphadenectomy appears to be a safe and effective alternative to the technically more difficult and more time-consuming sartorius muscle transplant.

Adult↗
PubMed1991

Williams' vulvovaginoplasty after supralevator total pelvic exenteration.

Seven patients had delayed Williams' vulvovaginoplasty after supralevator total pelvic exenteration. Of the three patients who died of carcinoma of the cervix (at 2, 5, and 15 months after vulvovaginoplasty), the first died before having a chance to attempt intercourse, but the other two had reported intercourse on at least two occasions after the reconstruction. One of the patients described the experiences as neither pleasant nor unpleasant but stated that her husband seemed satisfied. The other patient described the experience as satisfactory to both herself and her husband. The remaining four patients are alive with no evidence of recurrent disease at 28, 42, 56, and 106 months after operation. Two of these patients have reported entirely satisfactory sexual relations approximating pre-exenteration frequency, but the remaining two have not had sexual relations since surgery. Both give the main reason for this as lack of opportunity. The Williams' vulvovaginoplasty appears to be a reasonable alternative for vaginal reconstruction in patients who will have and especially who have had exenteration. To improve results, other methods of vaginal reconstruction should continue to be evaluated.

Adult↗