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Biomedical subjects

R C Kline

Publications and source records attributed to R C Kline.

At least 19 recordsLinked to original sources
PubMed2001

Predictors of complications and hospital stay in gynecologic cancer surgery.

OBJECTIVE: To test the hypothesis that comorbid medical conditions can predict length of hospital stay and incidence of postoperative complications. METHODS: We reviewed the medical records of 187 women who had surgery for known or suspected gynecologic malignancies during 1996 and 1997, and 179 were included in the present study. Information on each woman's comorbid medical conditions, surgical history, surgicopathologic cancer diagnosis, American Society of Anesthesiologists' classification, surgical procedures, and postoperative complications was collected and analyzed. RESULTS: Women with two or more comorbid medical conditions had significantly longer mean hospital stays (8.62 days) than those with none or one comorbid medical condition (6.43 days) (P <.001). Women with two or more postoperative complications had significantly longer mean hospital stays (11.88 days) than those with none or one complication (6.02 days) (P <.001). Women with two or more postoperative complications also had significantly more comorbid medical conditions (mean 2.5) than those with none or one complication (mean 1.7) (P <.001). The American Society of Anesthesiologists class also was a significant predictor of postoperative complications and length of hospitalization. Age over 60 years also was associated with statistically significant increase in comorbid medical conditions and significantly longer hospitalizations. CONCLUSION: Our findings indicated that certain high-risk patients can be identified before hospital admission based on comorbid medical conditions. Certain risk indices, such as the American Society of Anesthesiologists classification score, also can predict postoperative complications and length of hospital stay. This information can be used to coordinate preoperative and postoperative hospital care and be a reference for certain future disease management systems.

Adult↗
PubMed1999

Detection of sentinel lymph nodes with lymphazurin in cervical, uterine, and vulvar malignancies.

BACKGROUND: Identification of sentinel lymph nodes may allow prediction of metastatic disease in cancer patients. We did a prospective study to determine whether lymphazurin dye could identify sentinel lymph nodes in patients with cervical, uterine, and vulvar cancer. METHODS: In 33 patients having surgery for either uterine, cervical, or vulvar carcinoma, lymphazurin dye was injected into the respective organs before the tumor and node dissection began. Sentinel lymph nodes were identified and dissected in situ. RESULTS: The identification rate of sentinel lymph nodes was 0/8 (0%) for uterine cancer patients, 2/13 (15.4%) for cervical cancer patients, and 9/12 for vulvar cancer patients (75%). CONCLUSIONS: In a limited number of patients, lymphazurin day may be useful in identifying or assessing the sentinel nodes draining vulvar and cervical cancers. The role of this procedure in treatment planning for patients with gynecologic malignancies is yet to be determined.

Adenocarcinoma↗
PubMed1998

Body mass predicts the survival of patients with new International Federation of Gynecology and Obstetrics Stage IB1 and IB2 cervical carcinoma treated with radical hysterectomy.

BACKGROUND: The authors evaluated the impact of body mass on survival and morbidity of patients with new International Federation of Gynecology and Obstetrics (FIGO) Stage IB1 and IB2 cervical carcinoma managed with radical hysterectomy. METHODS: Two hundred twenty-nine patients with Stage IB1 or IB2 cervical carcinoma treated with radical hysterectomy were studied in a multivariate logistic regression analysis. The body mass index (BMI) and the ponderal index (PI) were used as measures of body mass and were analyzed as predictors of recurrence, survival, and complications in light of the new staging system. RESULTS: Twenty-seven of 229 patients died of recurrent disease. A low BMI or a high PI were predictive of poor survival. Tumor greatest dimension, lymph node involvement, BMI, and PI were all independent predictors of survival (P=0.0006). The only independent predictor of complications was para-aortic lymph node dissection (P=0.0026). CONCLUSIONS: Cervical carcinoma patients with a low body mass, as indicated by a low BMI or a high PI, were found to have poor survival after undergoing radical hysterectomy. Additional predictors of poor survival included lymph node metastases and increased tumor size. BMI and PI are more important predictors of survival than the new FIGO Stages IB1 and IB2. Body mass is not predictive of complications.

Adolescent↗
PubMed1998

Correlation between endometrial cells on Papanicolaou smear and endometrial carcinoma.

BACKGROUND: A retrospective study was done to assess the correlation between endometrial cells on routine cervical cytology and carcinoma of the endometrium. METHODS: In a 4-year period, endometrial cells of some type were identified on the Papanicolaou (Pap) smears of 61 women, of whom 52 had further diagnostic evaluation of the endometrium. Data were analyzed with a multivariate stepwise logistic regression. RESULTS: The results indicated an association of endometrial cells in Pap smears with carcinoma of the endometrium in seven patients (13.5%). In 45 patients (86.5%), the final diagnosis was benign. Factors that impacted the diagnosis of carcinoma were the findings of atypical or cancerous endometrial cells on Pap smear and abnormal vaginal bleeding. CONCLUSIONS: These data indicate the importance of further diagnostic evaluation with endometrial sampling in postmenopausal patients with endometrial cells seen in Pap smears, especially those with abnormal bleeding.

Endometrial Neoplasms↗
PubMed1998

Recurrent catamenial hemopneumothorax.

A case of recurrent hemorrhagic catamenial hemopneumothorax resulting from diffuse pleural endometriosis is presented. The pathogenesis of this rare entity is discussed, and the immediate and long-term surgical and medical options for therapy are reviewed.

Adult↗
PubMed1997

Turbo-gracilis myocutaneous flap for perineal reconstruction.

The turbo-gracilis flap, which has been described previously for the purpose of extending the unreliable gracilis skin island, and previously applied in forearm reanimation surgery, is now adapted for reconstruction in the perineal region. We present a case report of a patient with previous vulvar carcinoma treated with resection and radiation who presented with a very large defect of the perineal region. Reconstruction was carried out using a turbo-gracilis flap. The advantages of the flap are well demonstrated in the successful reconstruction, in that it provides an extensive amount of well-vascularized tissue due to an extended gracilis skin island which is vascularized by way of a vein graft from the proximal pedicle blood supply to a distal gracilis pedicle which, in turn, supplies the extended skin island. This allows an extensive amount of tissue to be harvested from a single donor site and ensures the viability of the skin island. A review of the advantages and disadvantages of various types of perineal reconstruction is also presented and contrasted with the turbo-gracilis method.

Aged↗
PubMed1997

Surgical resection of endometriosis after prior hysterectomy.

Twenty-seven patients who underwent laparotomy after a prior hysterectomy for endometriosis were studied. The mean interval from index surgery to repeat surgery was 7.8 years. Abdominal/pelvic pain was the most common presenting complaint, followed by the objective finding of a pelvic mass. Six patients were taking estrogen replacement therapy. Physical findings suggested a pelvic mass or nodularity in 15 patients. Extensive pelvic adhesions with dense involvement of the ovaries was common. Surgery in 2 patients was complicated by an enterotomy, with 4 patients requiring a bowel resection and anastomosis. Postoperatively, 5 patients developed fever, 3 a postoperative ileus, 1 a wound breakdown, and 1 a small bowel obstruction. The mean hospital stay was 5 days. We conclude that in patients who have undergone a hysterectomy as treatment for endometriosis, subsequent surgery to remove the ovaries involved with recurrent endometriosis carries considerable morbidity. In light of readily available estrogen replacement therapy, conservation of the ovaries in patients who are undergoing a hysterectomy for endometriosis should be applied with caution.

Abdominal Pain↗
PubMed1997

Retained surgical needle in the perineum. Report of a case with a novel method of search and rescue.

BACKGROUND: Retrieval of a broken or lost surgical needle can be a difficult task, often requiring extensive surgical exploration. CASE: A surgical needle was retained in the perineum. Needle-hookwire placement with biplane fluoroscopy allowed the precise localization and marking of the foreign body; surgical removal without extensive exploration was therefore possible. CONCLUSION: The use of needle-hookwire localization with biplane fluoroscopy should be considered for retrieval of foreign bodies in the perineum.

Female↗
PubMed1996

Intraoperative liver biopsy with the loop electrosurgical excision procedure in patients with gynecologic malignancies.

When patients with gynecologic malignancies undergo exploratory surgery, hepatic lesions suggestive of malignancy are occasionally encountered. In 18 patients undergoing laparotomy for gynecologic cancer, visible liver lesions suggestive of malignancy were biopsied with the loop electrosurgical excision procedure (LEEP). Hemostatic suture placement was required in 3 of these 18 patients, and in 15, hemostasis was achieved with electrocautery only. Three of the 18 biopsies (16.7%) were positive for malignancy. No intraoperative or postoperative complications were attributed to the liver biopsy. One patient required postoperative transfusion of 2 units packed red blood cells. A new technique is described using the LEEP to remove suspicious lesions during exploratory laparotomy in patients with gynecologic malignancies.

Adult↗
PubMed1996

Radical hysterectomy for stage IB1 vs IB2 carcinoma of the cervix: does the new staging system predict morbidity and survival?

Two hundred twenty-nine patients with Stage IB cervical cancer treated with radical hysterectomy were assigned to the new FIGO substages IB1 (n = 181) and IB2 (n = 48) based on clinical tumor diameter. Our purpose was to determine the impact of the new staging system for IB1 and IB2 cervical cancer on nodal status and survival. Additionally, we analyzed the morbidity of radical hysterectomy in light of the new staging system. The complications were similar between the two groups. Para-aortic lymphadenectomy was the only independent predictor of complications (P = 0.00026). Stage IB2 patients did have a significantly worse 5-year survival (72.8%) when compared with IB1 (90.0%) (P = 0.0265). Multivariate stepwise logistical regression analysis indicated that the new staging system did not have an independent impact on survival. Stage acts through nodal status in its impact on survival. Positive lymph nodes, tumor diameter, and Ponderal Index are all independent predictors of survival (P = 0.0001). Patients with Stage IB2 carcinoma of the cervix undergoing radical hysterectomy showed no significant increase in morbidity when compared with patients with Stage IB1 disease treated with the same procedure.

Analysis of Variance↗
PubMed1992

Body temperature fluctuations in the periparturient horse mare.

The objective of this study was to determine the pattern of mare deep body temperature fluctuations associated with parturition using biotelemetry. A radio transmitter was implanted in one flank in each of six mares. Telemetered data were received by a pair of antennae placed at right angles in a 3.3 x 6.6-m stall and stored on a computer hard disk. Hourly temperature data were recorded for the period of -168 through 168 hours post partum. A decrease of 0.76 degrees C in body temperature began at 4 hours prior to parturition (P < 0.1) then decreased rapidly between the 3 hours prior to and the time of parturition (Time 0). The lowest mean body temperature recorded was at the time of parturition (36.58 +/- 0.16 degrees C; P < 0.001). A supranormal increase in mean body temperature began one hour post partum, peaked at 38.02 +/- 0.08 degrees C and remained elevated for 48 hours post partum until gradually decreasing to the level of the prepartum mean by 106 hours.

Journal Article↗
PubMed1991

Telemetric monitoring of body temperature in the horse mare.

The objective of this study was to develop a radiotelemetric system capable of frequent monitoring of mare body temperature. A radio transmitter was implanted in the flank of each of four mares. Telemetered data were received by a pair of antennae placed at right angles in a 3.3 x 6.6-m stall and stored on a computer hard disk. The data were recorded every 5 minutes except when mares were out of the stall for a 1- to 2- hour exercise period. No effect of environmental temperature, ranging from 5 degrees C to 30 degrees C, on mare body temperature was apparent. The radiotelemetric system used in this study was effective for frequent measurement of mare body temperature.

Journal Article↗
PubMed1991

Uterine electromyographic activity in horse mares as measured by radiotelemetry.

The objective of this study was to determine if radiotelemetry could be used to measure myometrial electromyographic (EMG) activity. A radio transmitter with one pair of biopotential leads was implanted in the flank ipsilateral to the pregnant uterine horn at least five weeks prior to the expected date of parturition in two mares. The biopotential leads were implanted in the base of the pregnant uterine horn. Telemetered data were received by a pair of antennae placed at right angles in a 3.3 by 6.6-m stall. Data were recorded on VHS format videocassette tapes continuously for the 24h prior to and following parturition. Simultaneous physiograph recordings were made as a hard copy reference. In addition, 10 mg of prostaglandin F(2 alpha) was administered to two mares in the luteal phase of the estrous cycle. Myometrial EMG during parturition was increased similarly to that of previously published reports that used myometrial electrodes wired directly to a physiograph. Prostaglandin F(2 alpha) also caused an increase in myometrial EMG activity within 8 min of administration. This study demonstrated that radiotelemetry can be used for measuring myometrial EMG activity.

Journal Article↗
PubMed1990

Endometrioid carcinoma of the ovary: retrospective review of 145 cases.

From 1967 through December 1987, 145 patients with endometrioid carcinoma of the ovary were treated at the University of Texas M. D. Anderson Cancer Center. Thirty-eight patients (26.2%) had stage I disease, 28 (19.3%) stage II, 60 (41.4%) stage III, and 11 (7.6%) stage IV; 8 patients (5.5%) were unstaged. Grade 2 or 3 histology was seen in 119 patients (82.1%). In addition to surgical therapy, 128 patients underwent chemotherapy, including single-agent therapy, noncisplatin combination therapy, and cisplatin-based therapy. No statistically significant improvement in median survival was noted among these three chemotherapy groups for stages II, III, and IV (P = 0.22). A significant improvement in median survival was noted for those patients who achieved a complete clinical response, regardless of type of chemotherapy (96 or more months for single-agent therapy, P = 0.001; 31.5 months for noncisplatin combination therapy, P = 0.016; and 85 months for cisplatin-based therapy, P = 0.0001). Synchronous ovarian and uterine malignancies were seen in 18 patients (12.4%). No difference in survival was seen for patients with endometriosis (P = 0.13) or endometrial cancer (P = 0.09) when compared with those who did not have these histologic findings.

Adenocarcinoma↗
PubMed1989

Equine body temperature and progesterone fluctuations during estrus and near parturition.

Body temperature and serum progesterone concentrations were measured in mares to determine if a change in either could be useful in predicting estrus, ovulation or parturition. There was no significant correlation (P > 0.1) between rectal temperature and the environmental temperature or progesterone concentration. Progesterone concentration did correlate with stage of estrous cycle and the stage of pregnancy. Significant differences (P < 0.05) in temperature were noted at different times throughout the day. No change in temperature occurred that could be utilized to predict estrus, ovulation or parturition. The changes in serum progesterone concentration were only useful in detecting estrus.

Journal Article↗
PubMed1988

Intraoperative complications and unexpected pathology at the time of cesarean section.

During cesarean section, operative complications include injury to the uterus, urinary tract, and bowel. A variety of types of fetal injuries have been reported, and some are associated with permanent handicap. The relative risk of intraoperative complications varies widely depending on such clinical variables as gestational age, station of the presenting part, and the experience of the operating physician. Ideally, each physician should be able to review his or her rate and type of complications so that continuous improvement in technique is fostered. Gynecologic tumors (malignant and benign) are rarely associated with pregnancy, and their incidental finding at the time of cesarean section is also rare. Management of malignant tumors depends greatly on the stage of the tumor. Conservative management of early-stage malignant ovarian tumors is permissible. More advanced malignant ovarian tumors and malignant tumors of the uterus and fallopian tube should be treated aggressively with removal of the reproductive organs.

Cesarean Section↗
PubMed1987

Nature of cervical involvement in endometrial carcinoma.

In patients with endometrial carcinoma the prognostic significance of clinical and histopathologic variants of cervical involvement is unknown. Fifty-eight patients with endometrial carcinoma and cervical involvement diagnosed by gross examination or endocervical curettage are reviewed. Three clinicopathologic groups were identified: gross cervical involvement (10 patients), occult stromal invasion (25), and no evidence of stromal invasion (23). There were no differences in clinical, pathologic, surgical, or therapeutic characteristics. There was no significant difference in actuarial 5-year survival rates between patients with gross cervical involvement (70%) and occult disease (65%). There was also no significant difference in survival rates among patients with occult cervical stromal invasion (67%). The presence of cervical involvement in endometrial carcinoma is an important prognostic factor. However, the extent of cervical involvement does not appear to be of significant prognostic value.

Adult↗