Biomedical subjects
Publications and source records attributed to R Wild.
Two cases of epithelial ovarian tumors of borderline malignancy initially approached by laparoscopy are presented. The role of laparoscopy are presented. The role of laparoscopy in the management of ovarian tumors is discussed.
Three hundred and five patients undergoing exploratory laparotomy by adnexial tumors in our institution from January 1987 to October 1992 were studied. The results of the frozen sections vs permanent sections were compared. The diagnosis was concordant in 98.7% of the cases. Sensitivity was 96.9% and specificity was 99.6%. These results consagrate frozen sections as an accuracy and efficient intraoperative diagnostic form in the ovary tumoral pathology.
"Second look" laparotomy in ovarian cancer demonstrated negative result in 49%, microscopic positive result in 17%, and macroscopic positive result in 34%. The prediction factors were related with, clinical stage, degree of differentiation and the postsurgical residual tumors after the first operation.
The possible relationship between the intrauterine accumulation of fluid during the peri and post-menopause period and genital cancer are studied by ultrasonography. In our experience 22% of the patients had endometrial cancer.
Twenty patients bearing lesions caused by human papillomavirus and intraepithelial neoplasia of the lower genital tract and treated with electrosurgical excision of the lesions are presented. The technique used, the benefits of the histopathologic assessment of the specimen, and the changes that this procedure produces in the specimen tissue are analyzed. In general terms, the pre and postoperative diagnosis were concordant and the early and late morbidity was found to be not significative. The efficacy of this therapy in the long term remains to be evaluated.
Dermatomyositis (DM) is associated to malignant neoplasia in up to one third of the cases. Not considering breast neoplasia, ovarian cancer is the malignancy most frequently associated with DM in women. This study shows the evolution and outcome of a case of this association managed in our unit. The principal features of similar cases reported in the literature are summarized.
The microbiology of twenty-nine asymptomatic infertile women was evaluated prospectively. Samples were taken from the cervix and the endosalpinx during laparoscopy. Cultures for aerobes, anaerobes, Neisseria gonorrhoeae, Mycoplasma, Ureaplasma urealyticum and Chlamydia trachomatis were performed. No association was found between the presence of germs in the abdomen or cervix and tubal abnormalities. History of previous IUD use was associated with tubal disease.
The accuracy of frozen section biopsy was evaluated determining the deep of myometrial invasion in 30 samples of hysterectomies performed because of endometrial cancer. Results were compared with the definitive biopsy. Two sections were performed guided by the site of largest lesion seen when the uterus was sectioned in a frontal plane. The diagnosis of myometrial invasion was well determined in 29 cases with a 96.6% of accuracy. We conclude that frozen section is an exact and low cost method to determine intraoperatively, deep of myometrial invasion. This method helps the surgeon to decide the extent of surgery, specially if lymphadenectomy is necessary, during staging laparotomy.
We present the results on the treatment of 43 patients with epithelial ovarian cancer excluding borderline tumours. Nine cases were FIGO Stage I, 4 FIGO Stage II, 24 FIGO Stage III and 6 FIGO Stage IV. The protocol consists in cytoreductive surgery followed by chemotherapy for Stages I, III, and IV, mainly using cisplatin + cyclophosphamide (PC) or cisplatin + adriamycin + cyclophosphamide (PAC). We used pelvis and whole abdomen radiotherapy for patients on Stage II. The follow up was between 26 and 76 months. The undifferentiated tumours had bad prognosis in Stage I, instead of receiving chemotherapy. Radiotherapy for patients on Stage II reached satisfactory local regional disease control but with late recurrences. On Stage III, size of residual tumour less than 2 cm on primary surgery was of good prognosis (60% 44 months survival). The addition of adriamycin to PC seems to be of no benefit in long term results. The five year actuarial survival was 44% for FIGO Stage I, 75% for FIGO Stage II, 16% for FIGO Stage III and 0% for FIGO Stage IV. These results don't differ significantly from similar protocols.
Complications of radical surgery in 60 cases of cervicouterine cancer are presented with the purpose of evaluating the morbi-mortality associated with this treatment. Radical hysterectomy with pelvic lymphadenectomy was the most frequent surgery. Intraoperative complications reached to 13.3%; the most frequent was the vascular venous lesion. Minor postoperative complications reached to 15% and majors to 6.7%. There was no mortality associated with the treatment. Five year survival for this series was 91% for FIGO Stage IB and 86% for FIGO Stage IIA.
Twenty seven female patients immunosuppressed after renal transplantation were studied. Cytological, colposcopic and histologic studies of biopsies were used to determine the incidence of neoplastic intraepithelial lesions and those due to infection by human papilloma virus. Intraepithelial neoplasia was found in 7.4% and papilloma virus infection in 60%. Cervix cytology was insensitive (33%) for diagnosis of intraepithelial lesions. Therefore, cytology and colposcopy are recommended for routine follow up of immunosuppressed women.
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Body fat distribution as measured by the ratio of waist circumference to hip circumference (WHR) is now accepted as an important risk factor for a number of diseases. This study evaluated the association of WHR and coronary artery disease (CAD). Measurements included the subjects' height, weight, waist girth, hip girth, significant CAD on coronary angiography, and cholesterol levels. A history of myocardial infarction, angina, diabetes or hypertension was obtained from subject interviews. The subjects were analyzed in two age groups: younger than age 60 (88 men and 39 women) and age 60 or older (85 men and 63 women). For older women the relative odds of CAD comparing women at the 75th percentile of WHR to women at the 25th percentile was 3.67 (P = 0.003), with a 95 percent confidence interval of 1.57-8.57. The relative odds was reduced to 2.80 after adjusting for all other risk factors. WHR was significantly associated with angiographic evidence of CAD in all women combined after adjusting for age (P = 0.0004), but it was not significantly associated with CAD in younger women or in men. The results suggest that in older women the risk of CAD increases with a greater percentage of body fat in the abdomen.
CA-125 levels were measured in 27 normal women, 11 with benign gynecologic pathology and 13 with ovarian cancer in different stages of evolution. The analysis of data was made retrospectively. Considering a level of 65 U/ml as normal, no false positives were found. Patients with benign gynecologic pathology behave as the normal ones with no significative differences in their levels. Levels higher that 65 U/ml were always found in women with ovarian cancer. There were 4 patients with negative levels and clinically or surgically verified disease. Positive levels correlated with histologic type and with surgical staging. In patients with serial levels, decrease in tumoral volume was correlated with decrease in levels. These data suggest that the behaviour of CA-125 in our local population is the same as reported in the literature. It is useful, when is positive, in follow-up, management and prognosis of patients with ovarian cancer. Its negativity is not guarantee of cure and positive levels make evident the presence of the disease. It is a poor diagnostic method because of its low sensitivity.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.