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R B Councell

Publications and source records attributed to R B Councell.

8 recordsLinked to original sources
PubMed1994

Endometrial carcinoma arising within extensive intrauterine synechiae.

In patients with intrauterine adhesions severe enough to produce amenorrhoea, biologically active endometrium can undergo malignant change. To our knowledge, this is the first reported case of endometrial carcinoma arising within intrauterine synechiae. A 71-year-old woman receiving unopposed estrogen developed post-menopausal bleeding. At endovaginal sonography we detected a polypoid mass. Extensive intrauterine synechiae within the uterus were noted during hysteroscopy, and a polypoid lesion was seen adjacent to a synechia. Biopsy demonstrated endometrial adenocarcinoma arising from a synechia. Hysterectomy and bilateral salpingo-oophorectomy were performed. A well-differentiated adenocarcinoma of the endometrium was demonstrated. Asherman syndrome and endometrial adenocarcinoma can exist simultaneously. In such cases, hysteroscopy is essential for diagnosis of synechiae and for target biopsy.

Adenocarcinoma↗
PubMed1994

Assessments of laparoscopic-assisted vaginal hysterectomy.

STUDY OBJECTIVE: To assess laparoscopic-assisted vaginal hysterectomy (LAVH) by operative intervention, recovery time, morbidity, and patient satisfaction. DESIGN: A retrospective, cohort study conducted from 1990 to 1992. SETTING: Two community hospitals. PATIENTS: One hundred seventy-eight women thought to require abdominal hysterectomy. INTERVENTIONS: Three gynecologic surgeons performed the LAVHs. For each case, several features were tabulated and final pathologic diagnoses were recorded. Patient satisfaction was measured by survey. Data were divided into three time epochs, early, middle, and late, and the outcomes were compared. We also measured the impact of LAVH on th number of abdominal hysterectomies. MEASUREMENTS AND MAIN RESULTS: The mean operative time was 119.4 minutes (SD 34.1 min). The mean uterine weight was 153.4 g (SD 100.3 g), and only 29 patients (16.3%) had no pathologic condition. The mean length of hospital stay was 1.3 days (SD 0.92 days) and diminished over the 2 years of the study. Mean hemoglobin decrement was 2.6 g (SD 1.2 g). Thirteen patients had complications other than febrile morbidity and seven had febrile morbidity, for an overall complication rate of 11.2% There were no significant differences in blood loss, complication rate, uterine weight, or operative time among the three epochs. One hundred thirty-two patients (73.0%) responded to the survey and expressed high satisfaction. The proportion of hysterectomies performed abdominally diminished over the course of the study. CONCLUSIONS: Morbidity associatd with LAVH was similar to that reported for vaginal hysterectomy. The lack of controls precludes knowing whether patient satisfaction was related to type of procedure. Randomized, controlled trials of women not considered candidates for vaginal hysterectomy are necessary to assess this procedure.

Adnexal Diseases↗
PubMed1993

Doctors vs lawyers.

Explore the source record for details and available documents.

Expert Testimony↗
PubMed1992

Antepartum diagnosis of placenta previa percreta by magnetic resonance imaging.

BACKGROUND: Placenta previa percreta is a rare but highly morbid condition usually diagnosed intraoperatively. Placental manipulation results in severe bleeding. Magnetic resonance imaging (MRI) might allow antepartum diagnosis of this condition. CASE: A multiparous woman with five previous abdominal deliveries had complete placenta previa diagnosed at 16 weeks' gestation. Bleeding ensured at 29 weeks and she was managed with bed rest. Before planned abdominal delivery, MRI was performed and placenta percreta was diagnosed, which allowed her physician to avoid placental manipulation. Hysterectomy was accomplished with an estimated blood loss of only 2000 mL. CONCLUSION: Antepartum diagnosis of placenta previa percreta by MRI altered the usual diagnostic and surgical approach, diminishing blood loss and morbidity.

Adult↗
PubMed1989

Malignant degeneration of a mature ovarian teratoma.

Malignant components are present in 1-2% of mature teratomas (dermoid cysts) and historically have been associated with a very poor prognosis. Patients with malignant mature cystic teratomas typically are postmenopausal and may present with a rapidly enlarging tumor or systemic symptoms suggestive of malignancy. However, the diagnosis is rarely made pre-operatively and, if the tumor is not metastatic, may not be made until the tumor is examined microscopically. Squamous cell carcinoma is the most common malignancy found in mature cystic teratomas. We present a 26-year-old woman with this cancer in whom the disease proved fatal. A surgical approach to patients with malignant mature teratomas is suggested. Prognostic factors and adjuvant therapy are discussed.

Adult↗
PubMed1986

Folate deficiency presenting as pancytopenia in pregnancy.

Folate deficiency is a well-known complication of pregnancy. We present a case of folate deficiency with profound pancytopenia. Although this is a well-known consequence of folate deficiency, we wish to reemphasize this dramatic complication of pregnancy.

Adult↗