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Biomedical subjects

R Yazigi

Publications and source records attributed to R Yazigi.

At least 19 recordsLinked to original sources
PubMed1996

[Defecation flowmetry. A new study technique for evaluating the evacuation function of the rectum].

In a prospective study carried out on 78 patients with chronic constipation (31, with slow transit, 47 with obstructive defecation disorders) the evacuation function of the rectum during defecation was assessed by defecoflowmetry. These patients were compared to a control group of normal volunteers (n = 32). The following parameters were evaluated: defecation and retention volume, defecation fraction, defecation time, maximum flow, mean flow rate and time to maximum flow. As expected, there was no difference in evacuation function between the group of patients with slow transit and the control group. Significant differences, however, existed between the two types of constipation, as well as between obstructive defecation disease and controls, regarding all parameters mentioned above. Evacuation function depends neither on rectal neck pressure nor on intrarectal pressure. In patients with obstructive defecation disorders, three subgroups were discernable: one with prolonged time of defecation and satisfactory evacuation, one with prolonged time of defecation and poor evacuation, and one small group of patients who were not able to defecate. Each group is based on a different underlying pathomechanism. We conclude that changes in evacuation function of the rectum refer either to volume or to time of defecation, or to both. Changes are found only in obstructive type constipation, not in slow transit constipation. Therefore, defeconflowmetry as a dynamic procedure can be used in screening for the classification of chronic constipation.

Adult↗
PubMed1995

The effect of naproxen on fever in patients with advanced gynecologic malignancies.

The antipyretic action of naproxen has been reported as sufficiently selective for neoplasm-related fever such that the use of this agent has been recommended to distinguish neoplastic from infectious fever. The antipyretic effect of naproxen was evaluated in gynecologic oncology patients with advanced pelvic malignancies and fever without obvious source of infection (suspected neoplastic fever). Naproxen (250 mg orally every 8 hr) was given to 12 patients with (i) a daily temperature greater than 38.3 degrees C, (ii) fever for at least 3 days, (iii) no evidence of infection on physical exam, (iv) negative results of blood and urine cultures, and (v) a chest roentgenogram negative for pneumonia. Ten of the 12 patients initially received a minimum of 3 days of empiric antibiotic therapy without resolution of fever. Within 24 hr of starting naproxen therapy, 10 patients' (83%) fever responded: Eight patients (80%) had a complete lysis of fever and two had partial lysis (20%). Temperature response was accompanied by subjective improvement in patient malaise and fatigue. Naproxen therapy was continued for 5-7 days in these patients, and chemotherapy was administered to those patients scheduled to receive it. Two patients did not respond to naproxen therapy in 24 hr; thus, it was stopped and the fever workup was continued. Of these two patients, one was eventually diagnosed with bacteremia after multiple negative blood cultures and initially no response to antibiotics. Naproxen is clinically useful in the palliation of fever-related symptoms in gynecologic oncology patients with suspected neoplastic fever. Naproxen may also allow the limitation of extensive fever workups and prolonged empiric antibiotic therapy in these patients, and prevent delays in systemic therapy or supportive care.

Adult↗
PubMed1992

Operative laparoscopy in the management of tubal ectopic pregnancy.

One hundred and seventeen consecutive patients with diagnosis of ectopic pregnancy admitted to Temple University Hospital between October 1989 and March 1992 were divided into two groups. Group 1 consisted of 56 patients with operative laparoscopy and Group 2 consisted of 61 patients treated by laparotomy. The two groups were similar for age, race, parity, gestation, presentation, and location of the ectopic gestations. Fifty seven percent of patients in the laparoscopy group were treated by salpingectomy and 43% by salpingostomy, compared to 84% and 16% respectively in the laparotomy group. Mean operative time for laparoscopy was 58 min and 42 min for laparotomy. Complication rates were similar in the two sub-groups. Only two patients in the laparoscopy group required subsequent laparotomy, one to assure hemostasis and one, 5 weeks following surgery, for persistent trophoblastic disease. Operative laparoscopy was associated with a significantly shorter length of hospital stay (1.25 v. 4.39 days). This reflected in a lower cost of hospital stay ($10,105 vs. $13,608). The present data demonstrates that operative laparoscopy is not only safe and effective, but also more economical than open laparotomy in the treatment of ectopic pregnancies. This procedure is expected to replace laparotomy for the treatment of most cases of tubal ectopic pregnancy.

Adolescent↗
PubMed1992

Management of the patient with an abnormal Papanicolaou smear.

Any patient with an abnormal Papanicolaou smear should undergo colposcopic evaluation. Histologic examination of tissue obtained by biopsy and by endocervical curettage is essential for a proper diagnosis. Conization of the cervix has very well-defined indications.

Female↗
PubMed1991

Mitomycin-C/5-FU and radiation therapy for locally advanced uterine cervical cancer.

To assess the feasibility and effectiveness of combined therapy on locally advanced cervical cancer, we entered 38 patients into a study. The patients were treated with mitomycin-C (10 mg/m2) on Days 1 and 30 and 5-FU (1000 mg/m2) on Days 1 to 4 and Days 30 to 33. In 5 weeks 4500-5000 cGy was given concurrently, followed by radioactive implants. Twenty-six patients had an early-stage disease (IB-IIB) and twelve had a late-stage disease (IIIB-IVA). Eighty-seven percent (33/38) of the patients had a tumor measuring 5 cm or more. The other 5 patients with a tumor size under 5 cm had biopsy-proven positive pelvic nodes; 2 of these 5 patients had a pretherapy hysterectomy. Tumor response, complete (CR) vs partial (PR), was assessed in 36 patients 3 months after completion of therapy. A CR was noted in 80% (29/36) of the patients. The PR status conferred a detrimental effect on the pelvic disease control (PDC), disease-free survival (DFS), and survival (S) while late stage correlated with the development of distant metastases (DM) and a poor DFS. PDC was obtained in 93% (27/29) of the patients who had a CR, as compared to only 43% (3/7) of those with a PR (P = 0.0228). The DFS and S rates were 59 and 77% for patients with a CR and 21 and 19% for those with a PR; respective P values were 0.0340 and 0.0002. Eleven percent (3/26) of the patients with an early stage developed DM, as compared to 50% (6/12) of those with late stage, (P = 0.0016). The DFS rates were 80 and 37% for patients with an early and late stage, respectively (P = 0.0141). Four patients developed transient neutropenia and one had transient thrombocytopenia. The second dose of mitomycin-C was omitted in 4 patients due to persistent neutropenia in 3 and to transfusion-related hepatitis in 1. Two percent (5/21) of the patients who had a staging laparotomy developed wound dehiscence. Three patients developed non-cancer-related small bowel obstruction requiring surgery. We concluded that this combined regimen was well tolerated. Although it was effective in controlling the cancer in the pelvis, this regimen failed to control DM in late-stage patients.

Adult↗
PubMed1991

Prognosis of ovarian cancer developing in the residual ovary.

Elective oophorectomy at the time of hysterectomy for benign disease in women during their fifth decade is an important issue for both gynecologist and patient. It has been suggested that cancer developing in the residual ovary has a worse prognosis than the national average (L. McGowan, Obstet. Gynecol. 69, 386, 1987). In an effort to corroborate such finding, 36 women with epithelial ovarian cancer developing in the residual ovary after prior hysterectomy were compared to a group of 121 patients with epithelial ovarian cancer and no previous surgery. Analysis was made of age, stage at diagnosis, feasibility of cytoreductive surgery, and survival in both groups. Only age distribution was found to be significantly different between the two groups of patients (P less than 0.001). Neither FIGO staging or quality of cytoreductive surgery showed a statistically significant difference between both groups. At 3 years, 41% of the subjects with cancer in the residual ovary were alive, compared to 42% in the group without previous hysterectomy. The corresponding figures for 5-year survival are 34 and 27%, respectively (P = 0.939). On the basis of our findings we conclude that the overall prognosis for patients with ovarian cancer developing in the residual ovary does not appear to be any worse than that reported for ovarian cancer in general.

Adult↗
PubMed1991

Correlation of squamous cell carcinoma antigen levels and treatment response in cervical cancer.

Squamous cell carcinoma antigen (SCC) was measured by serum radioimmunoassay in 82 patients with primary (55) or recurrent (27) squamous carcinoma of the cervix, to determine correlation with the clinical presence of tumor and response to radiation and chemotherapy. Sixty-seven percent of those with newly diagnosed cancer and eighty-one percent of those presenting with recurrence had values above 2.5 ng/ml. In the newly diagnosed patients, 17% of those with stage I and 80% of those with stages II and above had abnormal values. Mean titers for stages I through IV were 2, 9, 19, and 144 ng/ml, respectively, confirming an association with tumor burden. Twenty-four patients underwent radiation therapy; eighteen of these had elevated pretreatment levels and were assessed for response. Titers accurately predicted regression and progression in all cases. Thirty patients received chemotherapy; twenty-seven of them had elevated pretreatment levels and were evaluable for response correlation. Titers predicted response in 96% of cases. An additional group of 20 patients successfully treated and with no evidence of disease was followed with SCC levels every 3 months. In 19 of these 20 patients (95%), the marker accurately predicted the status of disease. In 2 of these patients, who recurred while on the study, the SCC level increased before the tumor became clinically apparent. We conclude that SCC levels are useful in evaluating the response of primary and recurrent squamous cell carcinoma of the cervix to radiation and chemotherapy.

Carcinoma, Squamous Cell↗
PubMed1991

Cisplatin based combination chemotherapy in the treatment of stage III ovarian epithelial tumors of low malignant potential.

Eleven patients diagnosed with Stage III epithelial ovarian tumors of low malignant potential were treated with a combination of cisplatin and cyslophosphamide with or without doxorubicin following primary cytoreductive surgery. Residual disease after initial cytoreduction was macroscopic in nine patients and not observable in two. Eight of the nine patients with macroscopic residual were assessed by second look laparotomy (one refused the procedure), seven showed tumor and one was found to be a complete responder. Of the two patients with no residual disease, one refused second look operation and one had a negative second look. Our findings plus those of other authors suggest that cisplatin based combination chemotherapy is of limited value in the treatment of metastatic ovarian epithelial tumors of low malignant potential.

Adult↗
PubMed1990

Adenosquamous carcinoma of the cervix: prognosis in stage IB.

The outcome of women with adenosquamous carcinoma of the cervix has been a controversial issue. To assess the prognostic significance of this cell type, the medical records of 29 patients with stage IB primary adenosquamous carcinoma of the cervix were reviewed. Twenty-six had cervical tumors measuring 3 cm or less. With a median follow-up of 60 months, the overall disease-free 5-year survival was 85%. Pelvic lymph node metastases were found in three of 19 patients (16%) with stage IB, and periaortic lymph nodes were negative in eight. A log-likelihood chi 2 test comparing lymphatic spread, recurrence rate, and 5-year disease-free survival in patients with stage IB disease and tumors less than 3 cm versus a similar group of 58 patients with pure squamous cell carcinoma of equivalent stage and comparable size treated during the same time disclosed no significant differences in any of the indicators analyzed. We conclude that stage IB adenosquamous carcinoma of the cervix does not differ in its metastatic potential or outcome from the more common pure squamous cell carcinoma.

Adenocarcinoma↗
PubMed1989

Endodermal sinus tumor of the ovary: a paradoxical response to chemotherapy.

A patient with ovarian endodermal sinus tumor metastatic to the liver responded unusually to chemotherapy. She experienced histologically documented regression of all intraperitoneal disease with the exception of the liver metastases when given vinblastine, bleomycin, and cisplatin. She eventually died of liver failure. A review of patients with ovarian endodermal sinus tumor who either presented with initial liver metastases or had recurrent disease in the liver leads us to conclude that the liver is a preferential site for spread, that liver metastases carry an ominous prognosis, and that failure to see prompt liver metastatic tumor response after systemic chemotherapy should signal a need for a more aggressive therapeutic approach to the liver lesions.

Adult↗
PubMed1989

Ovarian involvement in extragenital cancer.

Ovarian involvement from extragenital cancer often presents clinically as probable primary ovarian neoplasm. A retrospective review of the 29 such cases at Parkland Memorial Hospital from 1962 to 1985 was analyzed looking at clinical, surgical, and pathological parameters. The most frequent primary sites were colon (52%), breast (17%), stomach (10%), and pancreas (10%). Most common presenting symptoms were abdominal pain in 48% and increased abdominal girth in 45%. Preoperatively a palpable pelvic mass was detected in 93% and clinical ascites in 41% of patients. At surgery only 20% of patients had isolated ovarian metastases. Abdominal exploration identified the original tumor in 84% of the cases in which the primary originated in the abdomen. Bilateral ovarian involvement was found in 60%, and in 33% of these the contralateral involvement was occult. Eighty-three percent of patients have died with a median survival of 6 months. We conclude that mode of presentation, physical findings, and intraoperative assessment of patients with secondary ovarian neoplasms are no different from primary ovarian malignancy, and that when evaluating a pelvic mass, consideration should always be given to the possibility of secondary ovarian neoplasms.

Adolescent↗
PubMed1989

Magnetic resonance imaging determination of myometrial invasion in endometrial carcinoma.

Fifteen patients with FIGO stage I biopsy confirmed endometrial adenocarcinoma underwent preoperative pelvic magnetic resonance imaging (MRI) to evaluate the presence and depth of myometrial invasion. Imaging was performed with a Diasonics superconducting imaging system operating at 0.35 T (15 MHz); multislice multi-spin-echo pulse sequences were used exclusively, with 5-mm contiguous sections. All patients then received primary therapy consisting of abdominal hysterectomy and bilateral salpingo-oophorectomy. Imaging findings were then compared with the uterine specimen histopathology. MRI was accurate in predicting the presence or absence of invasion in 13 of 15 cases (87%) and was able to discriminate superficial from deep invasion in 9 of 11 cases (82%). Based on our findings, we conclude that MRI appears to be an excellent technique for determining myometrial invasion, and that it may play a significant role in the preoperative planning of a thorough search for lymphatic spread in those patients considered to be at high risk by virtue of myometrial invasion.

Adult↗
PubMed1989

Early diagnosis of gynecologic cancer.

Malignant gynecologic neoplasms comprise about 15% of cancers in American females. Analysis of cancer treatment results indicates that the most important prognostic factor is stage of disease; thus any strategy to improve survival must include early diagnosis. This can be accomplished by identification of the women at risk, adequate use of screening techniques, updating the primary care physician with clinical and laboratory diagnostic features, and prompt referral to the subspecialist. This approach should drastically reduce the incidence and mortality of invasive gynecologic cancers.

Female↗