Long-term follow-up and prognostic factor analysis in advanced ovarian carcinoma: the Gynecologic Oncology Group experience.

Long-term follow-up was obtained on 726 women with advanced ovarian carcinoma (suboptimal stage III and stage IV) who had received primary chemotherapy on two Gynecologic Oncology Group (GOG) protocols between 1976 and 1982. The first study compared melphalan alone versus melphalan plus hexamethylmelamine versus cyclophosphamide plus doxorubicin (CA). The second study evaluated the same CA regimen with or without cisplatin.

Ovarian remnant syndrome: difficulties in diagnosis and management.

Ovarian remnant syndrome should be considered in the differential diagnosis of pelvic pain with a mass in a patient who has had extirpative surgery. Although rarely reported in the literature, it is probably much more prevalent than is suspected. Most commonly, the initial surgery was performed for endometriosis or pelvic inflammatory disease, with incomplete excision of the ovaries.

Play narratives in 36-month-old children. Early moral development and family relationships.

Whether there is significant moral development prior to the resolution of the oedipal conflict has been a source of debate between classic psychoanalytic and more recent clinical theories. We devised a play narrative technique, using standard story stems, to elicit 36-month-olds' representations of affective themes related to moral conflicts. Since morality is both influenced by interactions with significant others and involves dealing with the roles of others in the midst of conflict, we also explored narrative representations of the family.

Surgical staging of carcinoma of the ovaries.

One hundred and eighty-seven patients with stages I, II and III optimal (metastatic lesions of less than 3 centimeters) epithelial carcinoma of the ovaries were evaluated preoperatively and had standardized exploration and biopsy. The protocol called for examination and biopsy of the peritoneum, diaphragm, omentum, pelvic and para-aortic lymph nodes and aspiration of ascites or peritoneal washings for cytologic examination. Of those patients with metastases to the omentum, the clinical impression did not correlate with pathologic findings in 45 per cent.

Abdominal gunshot wounds in pregnancy.

The incidence of gunshot wounds in the civilian population is increasing. Likewise, pregnant women are more frequently sustaining wounds of the abdomen. We report on three women who sustained abdominal gunshot wounds during pregnancy.

Peritoneal cytology in malignant mixed müllerian tumors of the uterus.

Peritoneal cytologic studies (10 ascitic fluids, 18 peritoneal washings) were performed on 28 patients with malignant mixed müllerian tumors of the uterus. The frequency of recovery of malignant cells from the peritoneal cavity was directly related to stage of disease and depth of myometrial invasion. In stage I, positive peritoneal cytology was of greater prognostic importance than depth of invasion: all patients with negative cytology are alive without evidence of disease; all patients with positive cytology are dead.

Pulmonary lymphangitic carcinomatosis secondary to cervical carcinoma: a case report.

Pulmonary lymphangitic carcinomatosis is a rare form of metastatic cervical cancer. A patient with persistent squamous cell carcinoma of the cervix presented with symptoms suggestive of pulmonary embolism and right heart failure. Pulmonary lymphangitic spread of the cancer was found postmortem.

Multiple sclerosis, euthyroid restrictive Grave's ophthalmopathy, and myasthenia gravis. A case report.

A 53-year-old physician with a 13-year history of multiple sclerosis presented with the subacute onset of an atypical, restrictive, euthyroid Grave's ophthalmopathy. The hypotropia and monocular upgaze restriction responded to a course of systemic and local steroids. Three months later, the patient developed ocular and systemic features of myasthenia gravis.

The influence of pretreatment celiotomy and para-aortic lymphadenectomy on the management of advanced stage squamous cell carcinoma of the cervix.

Thirty patients with advanced stage squamous cell carcinoma of the cervix underwent exploratory celiotomy and para-aortic lymphadenectomy prior to beginning radiation therapy. Para-aortic lymph node metastases were found in 9 patients (30%), and visceral metastases in 2 patients (7%). Findings at celiotomy prior to initiation of therapy allowed patients to be divided into 3 groups: Patients with 1) visceral metastases, 2) para-aortic lymph node metastases but without visceral or scalene lymph node metastases, and 3) patients with disease confined to the pelvis.

Aminothiadiazole (NSC 4728) in patients with advanced ovarian carcinoma. A phase II study of the Gynecologic Oncology Group.

Thirty-two evaluable patients with advanced epithelial ovarian cancer were treated with aminothiadiazole at a dosage of 125 mg/m2 weekly. Two patients had partial responses, 12 had stable disease, 16 had increasing disease, and two were inevaluable for response. Aminothiadiazole used in this dosage and schedule has minimal activity in ovarian carcinoma patients previously treated.

Shigellosis complicated by acute appendicitis.

Acute appendicitis developed in a 23-year-old Mexican-American man with acute bacillary dysentery (shigellosis). This is the first such case reported in the English literature.

Transverse colon conduit diversion.

The versatility and other advantages of the transverse colon conduit for urinary diversion have been described and implemented in 50 patients. Because most patients considered for this procedure will be at high risk because of a history of significant pelvic irradiation, underlying malignancy, poor renal function, fistula, and so forth, the technical details of surgery and patient selection cannot be minimized. The transverse colon segment is indicated for primary supravesical diversion as well as for salvage of problems related to ileal conduits.

Phase II trial of acivicin in patients with advanced epithelial ovarian carcinoma. A Gynecologic Oncology Group Study.

Twenty-four evaluable patients with epithelial ovarian cancer resistant to primary therapy, or relapsing after response to initial therapy, were treated with acivicin utilizing a daily X 5 schedule. One patient achieved a partial response lasting five months; the remaining 23 patients showed no objective response. Profound and dose-limiting neurological toxicity was seen in 11 patients.

The canine laboratory in the training of the oncology fellow.

This report deals with one fellow's experience in the dog lab established to aid in the surgical training of the gynecologic oncology fellow. The first experiment was designed to train the fellow in bowel resection and end-to-end anastomosis, comparing suture and staple techniques. A second study evaluated the physical and biological properties of polyglactin 910 (Vicryl) mesh to determine its applicability in reconstructing the pelvic floor following pelvic exenteration.

Vicryl mesh in pelvic floor reconstruction.

A new synthetic absorbable mesh made of polyglactin 910 (Vicryl) fiber was used to reconstruct the pelvic floor in seven women undergoing pelvic exenteration. The technique is described. The follow-up ranged from three to 31 months and no patient developed a bowel problem.

Recurrent cervical cancer presenting as small bowel obstruction.

A case report of a patient with recurrent squamous cell carcinoma of the cervix is presented in whom the recurrence was confined to the gastrointestinal tract and omentum in the upper abdomen. No evidence of recurrent disease was present in the pelvis or paraaortic lymph node bearing areas. Possible mechanisms for this unusual location of recurrence are discussed.

Long-term follow-up, further experience with and modifications of the transverse colon conduit in urinary tract diversion.

In the past 6 years, an additional 22 patients with extensive pelvic irradiation have had their upper urinary tracts diverted employing the transverse colon conduit. Most procedures were performed with radical cystectomy following high dose radiotherapy in patients with bladder cancer or with pelvic exenteration for recurrent cervical cancer. The operative mortality rate was unchanged at 4%.

Radical vulvectomy and bilateral groin lymphadenectomy utilizing separate groin incisions: report of a case with recurrence in the intervening skin bridge.

Postoperative wound breakdown is very common following the en bloc dissection of the vulva and inguinal/femoral lymph nodes for carcinoma of the vulva. To decrease the incidence of wound morbidity, techniques have been described for performing the inguinal/femoral lymphadenectomy through separate groin incisions. This approach leaves a bridge of tissue between the vulvar excision and the lymph node dissection.

Self-inflicted gunshot wound to the pregnant uterus: report of two cases.

Attempts to terminate a pregnancy by self-inflicted gunshot-wounds is a new mechanism whereby women sustain gunshot wounds of the pregnant uterus. Two patients with self-inflicted gunshot wounds of the gravid uterus in an attempt to induce abortion are presented. The conservative management of such wounds is discussed.

Prevalence of papillomarvirus infection in colposcopically directed cervical biopsy specimens in 1972 and 1982.

A total of 1264 consecutive cervical biopsy specimens obtained at the Parkland Memorial Hospital Dysplasia Clinic during 1972 were reviewed. Histopathologic specimens were assessed with special reference to changes induced by human papillomavirus. In 1972, only 0.

Extravasation of dactinomycin, vincristine, and cisplatin: studies in an animal model.

Extravasation of some cytotoxic drugs results in chemical cellulitis. Management of suspected extravasation has been empiric and difficult to evaluate clinically. We investigated dactinomycin, vincristine, and cisplatin by means of intradermal injections in Balb-c mice.

Mucin production in defining mixed carcinoma of the uterine cervix: a clinicopathologic study.

Eighty-seven Stage 1 cervical carcinomas treated by radical hysterectomy between 1970 and 1979 were reviewed for histologic type, outcome, and factors predicting behavior. Initially, the cases were histologically classified by the Wentz and Reagan system and graded according to the Broders method. Stains for intracellular mucin were then examined in 69 cases and 39% were shown to contain intracellular mucin.

Hypersensitivity reaction to sulindac (Clinoril).

Sulindac (Clinoril), a nonsteroidal anti-inflammatory agent, has few reported neurologic toxic effects, all of which have been associated with systemic disease. To our knowledge, we describe the first reported case of isolated paresthesia and peripheral neuropathy, without systemic involvement, secondary to sulindac administration. A healthy, 30-year-old man, exposed to sulindac on two separate occasions, had an incapacitating isolated idential sensory neuropathy.

Staging and surgical evaluation of ovarian cancer.

Ovarian carcinoma is the only female genital malignancy surgically staged. Appropriate preoperative roentgenographic, isotopic, and endoscopic studies can help define the spread of disease and the extent of surgery required. At surgery, the common sites of metastases--pelvic and para-aortic lymph nodes, diaphragm, serosal surfaces and omentum--should be examined and biopsied or excised.