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Biomedical subjects

R H Nalick

Publications and source records attributed to R H Nalick.

16 recordsLinked to original sources
PubMed1993

Peritoneal implant elimination during cytoreductive surgery for ovarian cancer: impact on survival.

A case-control study was performed to evaluate the potential benefit of peritoneal and serosal implant elimination (PIE) during primary cytoreductive surgery for patients with Stage IIIC epithelial ovarian cancer. Peritoneal implant excision and/or ablation was accomplished with electrocautery, CO2 laser, sharp dissection, argon beam coagulator, and cavitron ultrasonic surgical aspirator. Three groups of patients were compared: Group A (7 patients); macroscopically disease-free after cytoreduction without needing PIE; Group B (26 patients); macroscopically disease-free after cytoreduction, including PIE; Group C (34 patients); macroscopic disease < or = 1 cm remaining exclusively on peritoneal surfaces with PIE not attempted. Each group had statistically equivalent mean ages, estimated blood loss, extent of disease, and variety of cytoreductive operations performed. Group B had a longer mean operating time than that of A or C (4.0 vs 2.8 hr P = 0.002). No serious morbidity occurred from PIE. Comparison of survival by log rank analysis and Cox proportional hazards regression shows a survival advantage for patients rendered free of macroscopic peritoneal implants (Group B vs Group C; P = 0.003). The result suggests that complete elimination of all visible peritoneal metastases might be of benefit during surgical cytoreduction for ovarian cancer if this renders the patient macroscopically disease-free. We also suggest the need of a randomized, prospective study to clarify the clinical role of PIE.

Case-Control Studies↗
PubMed1992

The impact of subspecialty training on the management of advanced ovarian cancer.

A retrospective study was conducted to determine the influence of subspecialty training in gynecologic oncology as well as several other covariates on the feasibility, operative mortality, and survival benefits of cytoreductive surgery for 263 patients with stages IIIC and IVA epithelial ovarian cancer. Covariates most predictive of an optimal (< or = 1 cm) cytoreductive outcome were the diameter of the largest metastases before cytoreduction (< or = 10 cm vs > 10 cm, P < 0.001) and the specialty training of the physicians present at surgery (gynecologic oncologists vs other, P < 0.001). Age influenced operative mortality most (< 60 vs > or = 60, P < 0.001). Covariates found to most significantly influence survival time include the specialty training of the physicians present at surgery (gynecologic oncologists vs other, P < 0.0001), cytoreductive outcome (complete vs optimal, P = 0.001, optimal vs suboptimal, P < 0.0001), grade of tumor (grade 1 vs grades 2 and 3, P = 0.01), and pelvic disease status (frozen pelvis vs mobile primary tumor, P = 0.03). We conclude that patients with advanced epithelial ovarian cancer should undergo aggressive cytoreductive surgery by gynecologic oncologists, with the objective to remove all macroscopic disease. Subsequent treatment with platinum-based chemotherapy offers the best chance for long-term survival or cure.

Adenocarcinoma↗
PubMed1991

Modified posterior exenteration for ovarian cancer.

The operative description of a modified posterior exenteration along with operative findings, other operative procedures, postoperative course, and follow-up information are presented for 47 patients (37 primary cytoreduction, ten secondary cytoreduction). All had stage IIIC or IV epithelial ovarian cancer with pelvic disease encasing the reproductive organs, pelvic peritoneum, cul-de-sac, and sigmoid colon. In addition to modified posterior exenteration, all patients had multiple other procedures performed as part of the cytoreductive efforts. Forty-five (95.7%) had optimal (less than 2 cm) cytoreduction and 18 (38.3%) had complete cytoreductive surgery. Thirty-four patients were ultimately rendered continent of feces (25 primarily and nine after colostomy reversal). Nine patients (19.1%) had serious morbidity and one (2.1%) died postoperatively. The median follow-up for those undergoing primary cytoreduction was 13.3 months (6-84). Nineteen (51.4%) were alive at the time of writing, 16 (43.2%) were dead, and two (5.4%) were lost to follow-up. Modified posterior exenteration effectively removes all visible pelvic disease with acceptable mortality. Hence, even patients with the most advanced cases of ovarian cancer may attain optimal cytoreduction and become ideal candidates for adjunctive therapy, with improved survival or a chance for cure.

Adult↗
PubMed1984

Single-dose actinomycin D in the treatment of postmolar trophoblastic disease.

From 1973 to 1982 single-dose (0.04 mg/kg or 1.25 mg/m2), biweekly actinomycin D was used to treat 28 women with postmolar, good-prognosis trophoblastic disease. Among the 17 patients fully evaluable for response to treatment 12 were nonmetastatic (NMTD) and 5 had lung metastases (MTD). Nine NMTD patients and 5 MTD patients achieved titer remission for an overall cure rate of 82.5%. Three patients were lost to follow-up with elevated serum human chorionic gonadotropin titers. The average number of treatment cycles to achieve titer remission in the successfully treated patient was 4.3. Since the efficacy of the pulse actinomycin D therapy for good-prognosis, postmolar trophoblastic disease is similar to that of the traditional 5-day regimens, it is concluded that it is the treatment of choice because of its greater convenience and lower cost.

Chorionic Gonadotropin↗
PubMed1984

Anal involvement by carcinoma in situ of the perineum in women.

This study reviewed 20 cases of extensive squamous carcinoma in situ of the vulva and posterior perineum. Two patients had concurrent, overt invasive carcinoma of the vulva, 14 patients had concurrent extensive vulvar carcinoma in situ, three patients had previous skinning vulvectomy for carcinoma in situ, and one patient had prior treatment for invasive vulvar cancer. Six patients had microinvasive carcinoma in the perianal region, which was unsuspected in five of the women. Nineteen of the 20 patients had involvement of the anal canal, and eight patients had disease extending to, or above, the pectinate line. Nineteen patients were managed by regional resection of the involved perianal/anal skin and mucosa with split thickness skin graft. Routine resection of the anal mucosa to the pectinate line was performed, with margin checks when there was dysplasia in the anal canal. The only noteworthy, long-term adverse effect of resecting the anal mucosa and replacing it with a split thickness skin graft was occasional incontinence of flatus in three of the 19 patients. The skinning procedure with split thickness skin graft produced excellent functional and cosmetic results.

Adult↗
PubMed1983

Treatment of cervical carcinoma employing a template for transperineal interstitial Ir192 brachytherapy.

The development of a template technique at this institution for transperineal interstitial-intracavitary brachytherapy employing Ir192 wire has previously been reported. In this paper we report the results of radiation treatment of 84 women with fresh, primary squamous carcinoma of the cervix admitted to the Los Angeles County--University of Southern California Medical Center from April, 1975 to September, 1979 who received at least one transperineal template implant as part of their initial treatment. The 75 evaluable patients were followed 3 to 60 months, with a median of 17 months. Recurrence rates in the pelvic treatment field by clinical (FIGO) stage grouping were 35.7% (5/14) Stage IB;0% (0/8) Stage IIA; 20% (5/25) Stage IIB; 46.2% (12/26) Stage III; and 0% (0/2) Stage IVA. The overall failure rate within the treatment field was 29.3% (22/75). The non-tumor associated rectovaginal and vesicovaginal fistula rate was 14.3% (2/14) in Stage IB; 0% (0/8) in Stage IIA; 16.0% (4/25) in Stage IIB; 15.4% (4/26) in Stage III; and 0% (0/2) in Stage IVA. The non-tumor associated fistula rate for all stages was 13.3% (10/75). Severe or grade III nonfistulous, delayed adverse effects (proctosigmoiditis, cystitis, vault necrosis) occurred in an additional 6 patients. Thus, 21.3% (16/75) of all evaluable patients experienced severe adverse radiation effects during the follow-up period. Pre-radiation staging laparotomy was performed on 31 patients. It had no obvious effect on the pattern or rate of radiation complications. The role of the interstitial-intracavitary template in the treatment of primary cervical carcinoma is discussed.

Adult↗
PubMed1983

Postmolar trophoblastic disease in women using hormonal contraception with and without estrogen.

One hundred thirteen patients with a molar pregnancy evacuated from January 5, 1976, through February 15, 1980, had close follow-up at the Los Angeles County-University of Southern California Women's Hospital. Twenty-seven patients (23.9%) developed postmolar trophoblastic disease, all of whom achieved remission with treatment. Of the 113 patients, 71 (62.8%) used only oral contraceptives, 32 patients (28.3%) used only intramuscular medroxyprogesterone acetate, seven patients (6.2%) used both oral contraceptives and medroxyprogesterone acetate, and three patients (2.7%) used nonhormonal contraception after evacuation of their molar pregnancy and before titer remission. Analysis of significant clinical and laboratory correlates of postmolar trophoblastic disease for the study group revealed no substantial bias in assignment of contraceptive method. There was no significant difference between the oral contraceptive and the medroxyprogesterone acetate groups with respect to the development of postmolar trophoblastic disease or the time to spontaneous titer remission. The study shows no apparent adverse effect of the estrogen (50 mg mestranol) component in oral contraceptives on the frequency of postmolar trophoblastic disease.

Chorionic Gonadotropin↗
PubMed1981

Evidence for the existence of an androgen binding protein in hydatidiform mole vesicles.

Extracts of hydatidiform mole vesicles and the fluid contained in these vesicles were shown to contain a trophoblastic androgen binding protein. This protein was found to be distinct from serum testosterone-estradiol binding globulin (TEBG) by its isoelectric point, its affinity for dihydrotestosterone (DHT) and by Concanavalin A binding. The elution pH of this binding protein was shown to be 4.6, whereas that of TEBG was pH 5.2-5.3. The apparent dissociation constant (Kd app) for TEBG as determined by Scatchard analysis was 2.0 X 10(-9) M, whereas the Kd app for the trophoblastic binding protein after isoelectric focusing was 1.5 X 10(-10) M. A second binding protein found in both vesicular extracts and mole fluid was shown to have an isoelectric elution value (pH 5.2) similar to TEBG and an Kd app of 1.7 X 10(-9) M DHT, very close to the TEBG value. Apparent equilibration for both proteins with DHT was shown to occur in approximately 4H, and both proteins were shown to be high affinity, low capacity binders. The relative affinities of both proteins for other steroids was found to be similar except for methyltrienolone, which appeared to have a higher affinity for the trophoblastic binding protein.

Androgen-Binding Protein↗
PubMed1981

Prognostic characteristics of serum human chorionic gonadotropin titer regression following molar pregnancy.

The postevacuation serum beta human chorionic gonadotropin (hCG) regression curves of 77 women with hydatid moles were analyzed from the perspective of refining the criteria for diagnosis of gestational trophoblastic neoplasia. Forty-nine patients (64%) demonstrated a spontaneous, progressive fall in serum hCG titers to levels nondetectable by radioimmunoassay within 15 weeks. The regression curves of the remaining 28 patients exhibited a plateau or rise in titer, usually during the first 6 weeks after evacuation. Analysis of the 2 groups demonstrates a statistically significant difference in regression curves that permits early identification of the patient with gestational trophoblastic neoplasia. The significance of these curves is discussed.

Chorionic Gonadotropin↗
PubMed1977

The origin of androgen and estrogen in a virilized postmenopausal woman with bilateral benign cystic teratomas.

Clitoromegaly was observed in a 73-year-old woman who had bilateral ovarian benign cystic teratomas that contained only epithelial derivatives. Scattered in the stroma of these ovaries were clusters of hyperplastic cells. The plasma testosterone production rate was 2.4 mg/day, a value that is ten times greater than that of normal postmenopausal women. The elevated plasma concentrations of testosterone and androstenedione decreased to normal by the second day after bilateral oophorectomy. Ovarian venous concentrations of testosterone and androstenedione were also increased and were considerably greater than those in peripheral blood. Estrone production was 68 microng/day, most of which could be accounted fo by the extraglandular formation from androstenedione. Estradiol production was 71 microng/day, of which 75% was computed to arise from extraglandular formation and the remainder likely arose by ovarian secretion. The modest increase in estrogen production was associated with slight cystic hyperplasia of the endometrium. From this study we conclude that the hyperplastic ovarian stroma was the source of the excessive androgen production.

Aged↗
PubMed1977

Covert bilaterality of mature ovarian teratomas.

Over a 21-year period, 213 women with mature teratoma of the ovary were operated on at Parkland Memorial Hospital. Twenty-seven had bilateral tumors. In 22 of these 27 patients, bilateral involvement was evident on clinical examination, and in 5, biopsy of an abnormal but nonteratoid appearing ovary was required to make the diagnosis. Ninety patients with a visually normal opposite ovary had no identifiable tumor in that ovary by investigative incision or incidental excision. Neither incision nor excision of the normal contralateral ovary was performed in 58 cases, and subsequently, one of these women is known to have developed a teratoma in that ovary. We conclude that synchronous covert bilaterality of mature teratomas is not common, and a visually normal contralateral ovary should not routinely be bivalved or wedge biopsied.

Adolescent↗
PubMedDate not supplied

Efficacy of cotton-tipped applicators for obtaining cells from the uterine cervix for Papanicolaou smears.

A study was made of the efficacy of two techniques for the preparation of Papanicolaou smears. In one technique ("swab-spatula technique"), a scraping of the endocervix with a saline-moistened cotton-tipped applicator was combined with a scraping of the ectocervix with a plastic spatula. In the second technique ("swab technique"), the endocervix and ectocervix were scraped with only a saline-moistened cotton-tipped applicator. The swab technique produced more inadequate smears with a scanty cellular yield (24/408 = 6%) than did the swab-spatula technique (9/361 = 3%). The swab technique also produced higher false-negative rates (60% for CIN I, 42% for CIN II, 16% for CIN III, 20% for invasive cancer, and 32% overall) as compared with those of the swab-spatula technique (27% for CIN I, 29% for CIN II, 14% for CIN III, 0% for invasive cancer and 18% overall). Because of the higher rates of inadequate samples and false negativity in smears prepared by cotton-tipped applicators alone, it is recommended that the spatula not be omitted in taking cervical samples for the preparation of Papanicolaou smears for the detection of dysplasia or cancer. This study also reflects a poor performance of a cervical cancer detection system in the setting of a major medical school and suggests the need for instruction and periodic evaluation of the performance of the staff taking the smears. This study also substantiates doubt on the value of a second recent smear as a follow-up procedure for cervical dysplasia.

Adolescent↗