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1.
J Anim Sci ; 93(12): 5863-72, 2015 Dec.
Article in English | MEDLINE | ID: mdl-26641197

ABSTRACT

Vacuum-packaged Certified Angus Beef (CAB) subprimals ( = 72) that included the longissimus thoracis (LT), longissimus lumborum (LL), gluteus medius (GM), and infraspinatus (IF) muscles were purchased from a major beef packing facility. Subprimals were allocated to 1 of 3 aging periods (14, 28, or 42 d) and aged at 2°C. After aging, 5 steaks were cut from each subprimal and assigned to pH, water-holding capacity, Warner-Bratzler shear force (WBSF), cooked color, cooking yield, cooking loss, and sensory panel analysis. Infraspinatus steaks were more tender ( < 0.05) than all other steaks, and subprimals aged 14 d had greater ( < 0.05) WBSF values than the other 2 aging periods, regardless of muscle. Water-holding capacity and cook yield were greater ( < 0.05) for LL and LT than IF and GM steaks, whereas purge loss was greater ( < 0.05) for IF and GM than LL and LT steaks. Throughout the aging periods, pH declined for all muscle groups, with IF steaks having the greatest ( < 0.05) pH values among all muscles. Among IF steaks, sensory evaluations of all attributes did not ( ≥ 0.26) differ across aging periods; yet among LT steaks, consumers rated those aged 14 d greater ( < 0.05) in overall impression than LT steaks aged 28 and 42 d. Among LT steaks, those aged 14 d received greater ( < 0.05) flavor ratings than LT steaks subjected to longer aging periods, and LT steaks aged 14 d received the greatest ( < 0.05) overall impression, with consumers giving greater ( < 0.05) overall impression scores to LT steaks aged 42 d over those aged 28 d. Aging period had no effect ( ≥ 0.017) on consumer ratings for flavor, tenderness, juiciness, or overall impression of LL steaks. Among GM steaks, consumers rated steaks aged 14 and 28 d more ( < 0.05) flavorful than those aged 42 d, and consumer ratings for overall impression were greater ( < 0.05) for GM steaks aged 28 d than for GM steaks aged 42 d; however, consumers failed ( = 0.035) to note differences in tenderness scores of GM steaks in response to aging period. Furthermore, consumers indicated a greater ( < 0.05) likelihood to purchase LT steaks aged 14 d over LT steaks aged 28 d, LL steaks aged 42 d over LL steaks aged 14 d, and GM steaks aged 14 and 28 d over GM steaks aged 42 d. These results indicate that consumers struggled to identify steak flavor attributes and suggest that the benefit of aging for premium beef products does not offer a tremendous sensory advantage to the consumer.


Subject(s)
Muscle, Skeletal/chemistry , Red Meat/standards , Adult , Animals , Cattle , Color , Cooking/methods , Female , Humans , Hydrogen-Ion Concentration , Income , Male , Middle Aged , Random Allocation , Red Meat/economics , Taste , Time Factors , Water/metabolism , Young Adult
2.
Am J Transplant ; 10(9): 2099-104, 2010 Sep.
Article in English | MEDLINE | ID: mdl-20883544

ABSTRACT

There are no published series of the assessment process, profiles and outcomes of anonymous, directed or nondirected live liver donation. The outcomes of 29 consecutive potential anonymous liver donors at our center were assessed. We used our standard live liver assessment process, augmented with the following additional acceptance criteria: a logical rationale for donation, a history of social altruism, strong social supports and a willingness to maintain confidentiality of patient information. Seventeen potential donors were rejected and 12 donors were ultimately accepted (six male, six female). All donors were strongly motivated by a desire and sense of responsibility to help others. Four donations were directed toward recipients who undertook media appeals. The donor operations included five left lateral segmentectomies and seven right hepatectomies. The overall donor morbidity was 40% with one patient having a transient Clavien level 3 complication (a pneumothorax). All donors are currently well. None expressed regret about their decision to donate, and all volunteered the opinion that donation had improved their lives. The standard live liver donor assessment process plus our additional requirements appears to provide a robust assessment process for the selection of anonymous live liver donors. Acceptance of anonymous donors enlarges the donor liver pool.


Subject(s)
Altruism , Liver Transplantation , Living Donors/psychology , Adult , Confidentiality , Hepatectomy/adverse effects , Humans , Liver Diseases/surgery , Male , Middle Aged , Patient Selection , Pneumothorax/etiology , Social Support , Treatment Outcome , Young Adult
3.
Am J Transplant ; 10(2): 364-71, 2010 Feb.
Article in English | MEDLINE | ID: mdl-20415904

ABSTRACT

Right lobe living donor liver transplantation is an effective treatment for selected individuals with end-stage liver disease. Although 1 year donor morbidity and mortality have been reported, little is known about outcomes beyond 1 year. Our objective was to analyze the outcomes of the first 202 consecutive donors performed at our center with a minimum follow-up of 12 months (range 12-96 months). All physical complications were prospectively recorded and categorized according to the modified Clavien classification system. Donors were seen by a dedicated family physician at 2 weeks, 1, 3 and 12 months postoperatively and yearly thereafter. The cohort included 108 males and 94 females (mean age 37.3 +/- 11.5 years). Donor survival was 100%. A total of 39.6% of donors experienced a medical complication during the first year after surgery (21 Grade 1, 27 Grade 2, 32 Grade 3). After 1 year, three donors experienced a medical complication (1 Grade 1, 1 Grade 2, 1 Grade 3). All donors returned to predonation employment or studies although four donors (2%) experienced a psychiatric complication. This prospective study suggests that living liver donation can be performed safely without any serious late medical complications and suggests that long-term follow-up may contribute to favorable donor outcomes.


Subject(s)
Liver Transplantation , Living Donors , Tissue Donors , Adult , Female , Humans , Liver/surgery , Liver Failure/surgery , Male , Morbidity , Prospective Studies , Treatment Outcome , Universities
4.
Am J Transplant ; 10(3): 612-8, 2010 Mar.
Article in English | MEDLINE | ID: mdl-20121746

ABSTRACT

Donor safety is the paramount concern of living donor liver transplantation (LDLT). Although LDLT is employed worldwide, there is little data on rates and causes of 'no go' hepatectomies-patients brought to the operating room for possible donor hepatectomy whose procedure was aborted. We performed a single-center, retrospective review of all patients brought to the operating room for donor hepatectomy between October 2000 and November 2008. Of 257 right lobe donors, the donor operation was aborted in 12 cases (4.7%). The main reasons for stopping the operation were aberrant ductal or vascular anatomy (seven cases), unsuitable liver quality (three cases) or unexpected intraoperative events (two cases). Over the median period of follow-up of 23 months, there were no long-term complications of patients with aborted donor procedures. This report focuses exclusively on an important issue: the frequency and causes of no go decisions at a single large volume North American LDLT center. The rate of no go donor hepatectomies should be as low as possible without compromising donor safety--however, even with rigorous preoperative evaluation the rate of donor abortions will be significant. The default surgical position should always be to abort the donor operation if there is an unexpected finding that places the donor at increased risk.


Subject(s)
Donor Selection , Hepatectomy/methods , Liver Transplantation/methods , Adult , Female , Hepatic Artery/abnormalities , Hepatic Artery/pathology , Humans , Living Donors , Male , Middle Aged , Retrospective Studies , Safety , Tissue and Organ Harvesting/methods , Treatment Outcome
5.
Am J Transplant ; 9(5): 1169-78, 2009 May.
Article in English | MEDLINE | ID: mdl-19422341

ABSTRACT

To refine selection criteria for adult living liver donors and improve donor quality of care, risk factors for poor postdonation health-related quality of life (HRQOL) must be identified. This cross-sectional study examined donors who underwent a right hepatectomy at the University of Toronto between 2000 and 2007 (n = 143), and investigated predictors of (1) physical and mental health postdonation, as well as (2) willingness to participate in the donor process again. Participants completed a standardized HRQOL measure (SF-36) and measures of the pre- and postdonation process. Donor scores on the SF-36 physical and mental health indices were equivalent to, or greater than, population norms. Greater predonation concerns, a psychiatric diagnosis and a graduate degree were associated with lower mental health postdonation whereas older donors reported better mental health. The majority of donors (80%) stated they would donate again but those who perceived that their recipient engaged in risky health behaviors were more hesitant. Prospective donors with risk factors for lower postdonation satisfaction and mental health may require more extensive predonation counseling and postdonation psychosocial follow-up. Risk factors identified in this study should be prospectively evaluated in future research.


Subject(s)
Attitude to Health , Hepatectomy/psychology , Liver Transplantation , Living Donors/psychology , Mental Health , Motivation , Quality of Life , Counseling , Cross-Sectional Studies , Educational Status , Employment , Female , Health Status , Hepatectomy/methods , Humans , Income , Male , Personal Satisfaction , Predictive Value of Tests , Retrospective Studies , Surveys and Questionnaires , Treatment Outcome
6.
Am J Transplant ; 7(1): 142-50, 2007 Jan.
Article in English | MEDLINE | ID: mdl-17227563

ABSTRACT

Many centers are reluctant to use older donors (>44 years) for adult right-lobe living donor liver transplantation (RLDLT) due to concerns about possible increased morbidity in donors and poorer outcomes in recipients. Since 2000, 130 adult RLDLTs have been performed at our institution. Recipients were divided into those who received a right lobe graft from a donor 44 (n = 41, 32%; mean age 52). The two donor and recipient populations had similar demographic and operative profiles. With a median follow-up of 29 months, the severity and number of complications in older donors were similar to those in younger donors. No living donor died. Older donor allografts had initial allograft dysfunction compared to younger donors. Complication rates were similar among recipients in both groups but there was a higher bile duct stricture rate with older donor grafts (27% vs. 12%; p = 0.04). One-year recipient graft survival was 86% for older donors and 85% for younger donors (p = 0.95). Early experience with the use of selected older adults (>44 years) for RLDLT is encouraging, but may be associated with a higher rate of biliary complications in the recipient.


Subject(s)
Liver Transplantation/adverse effects , Liver Transplantation/methods , Living Donors , Adolescent , Adult , Age Distribution , Age Factors , Algorithms , Cholestasis , Delayed Graft Function , Female , Graft Survival , Humans , Liver Transplantation/mortality , Male , Middle Aged , Postoperative Complications , Retrospective Studies , Survival Analysis
8.
Clin Perinatol ; 26(4): 893-903, ix, 1999 Dec.
Article in English | MEDLINE | ID: mdl-10572728

ABSTRACT

Near-infrared spectroscopy (NIRS) is a noninvasive technique for assessing cerebral hemodynamic variables and oxidative status in the neonatal intensive care setting. It can be performed for extended periods of time at the bedside without interfering with routine patient care. NIRS appears to have the ability to not only assess relative changes in oxygenated and deoxygenated hemoglobin, total hemoglobin, and cytochrome aa3, but it can also produce estimates of cerebral blood volume and cerebral blood flow. Research data document significant changes in these hemodynamic variables with patient activity and clinical interventions in both premature and term infants. NIRS may evolve into an important diagnostic and prognostic tool for neonatal neurologic outcome.


Subject(s)
Intensive Care, Neonatal/methods , Spectroscopy, Near-Infrared , Cerebrovascular Circulation/physiology , Electron Transport Complex IV/blood , Hemodynamics/physiology , Hemoglobins/analysis , Humans , Infant, Newborn , Oxyhemoglobins/analysis
9.
Pediatr Neurol ; 19(4): 263-71, 1998 Oct.
Article in English | MEDLINE | ID: mdl-9830995

ABSTRACT

We examined the correlation between cranial sonogram and postmortem examination neurodiagnoses in 51 infants (30 boys and 21 girls) who underwent cranial sonogram before death. The mean gestation of the infants at birth was 32 weeks 6 days; the mean birth weight, 1,992 gm; and the mean survival, 27 days. Most infants had several postmortem examination neurodiagnoses; therefore the postmortem examination diagnosis considered to be most significant in terms of clinical management and long-term neurologic function was chosen for each infant and designated as the primary diagnosis. The ability of the cranial sonogram to diagnose the primary diagnosis was then evaluated. The accuracy of the cranial sonogram in defining primary diagnoses was 59%. There were 21 cases (41%) in which cranial sonogram failed to define the primary diagnosis; nine of these could be explained on the basis of the timing of the ultrasound in relation to the age of the lesion or to the microscopic nature of the lesion. In 12 patients the factors causing the failure of cranial sonogram to define primary postmortem examination diagnoses could not be identified. The positive predictive value of a cranial sonogram diagnosis was 77%; the negative predictive value was 19%.


Subject(s)
Brain Neoplasms/diagnostic imaging , Brain Neoplasms/pathology , Brain/pathology , Echoencephalography/standards , Brain/abnormalities , Brain Ischemia/diagnostic imaging , Brain Ischemia/pathology , Cadaver , Cerebral Hemorrhage/diagnostic imaging , Cerebral Hemorrhage/pathology , Female , Humans , Hydrocephalus/diagnostic imaging , Hydrocephalus/pathology , Infant, Newborn , Intensive Care Units, Neonatal , Male , Retrospective Studies
10.
Pediatr Radiol ; 28(5): 297-302, 1998 May.
Article in English | MEDLINE | ID: mdl-9569264

ABSTRACT

BACKGROUND: We have encountered bilateral hyperechoic foci in the region of the germinal matrix on cranial sonograms in neonates that have an appearance similar to germinal matrix hemorrhage (GMH), but are unusual either due to the age of the patient at presentation or to the evolution of the foci on follow-up. We believe that these findings represent hyperechoic caudate nuclei (HCN) rather than GMH. OBJECTIVE: To demonstrate that bilateral HCN can be seen on cranial sonography in neonates and can mimic bilateral GMH. MATERIALS AND METHODS: The cranial sonograms were reviewed in nine neonates (three term and six premature) who had HCN identified on at least one sonographic examination. CT (two patients) and MR (one patient) studies were also reviewed, as well as the neuropathological examination in one patient who died and had an autopsy. The patients' medical records were reviewed to identify any clinical markers for significant risk of perinatal ischemia. RESULTS: There was clinical evidence for risk of ischemia in five of the nine neonates. All nine patients had bilateral HCN on the initial or follow-up studies. Small cysts were seen sonographically in two patients. CT was normal in one patient and revealed a small unilateral focus of increased attenuation in one infant (very small compared to the bilateral HCN). MR was normal in one patient. Histopathological examination of the brain was normal in the one patient who died and had an autopsy. CONCLUSION: Hyperechoic caudate nuclei can occur in neonates either as a normal finding, or possibly related to ischemia, and should not always be attributed to GMH.


Subject(s)
Caudate Nucleus/diagnostic imaging , Cerebral Hemorrhage/diagnostic imaging , Diagnosis, Differential , Female , Humans , Infant, Newborn , Infant, Premature, Diseases/diagnostic imaging , Male , Retrospective Studies , Ultrasonography
12.
Gynecol Oncol ; 64(2): 237-41, 1997 Feb.
Article in English | MEDLINE | ID: mdl-9038269

ABSTRACT

In spite of efforts to reduce complications associated with inguinal-femoral lymphadenectomy (IFL), morbidity continues to be substantial. We sought to assess the efficacy of sartorius transposition (ST) in reducing groin wound complications following IFL, in patients with vulvar malignancy. The records of 101 patients with vulvar cancer undergoing IFL through separate incisions between March 1975 and December 1994 were examined. Sixty-two patients undergoing ST (group 1) were compared to 38 who did not (group 2). The groups were similar with respect to age, weight, tobacco/alcohol use, prior abdominal/vulvar surgery, prevalence of diabetes, hypertension, or peripheral vascular disease, and previous exposure to irradiation or chemotherapy. Additionally, there was no significant difference with respect to extent of disease, incidence of macro-/microscopic groin metastases, use of groin drains, and use of perioperative antibiotics or deep venous thrombosis prophylaxis. Groin wound complications were less frequent in patients undergoing ST (group 1). The incidence of groin cellulitis was 30% in group 1 compared with an incidence of 58% in group 2 (P = 0.011). Significant groin wound morbidity, defined as either wound breakdown or cellulitis, was seen less frequently in group 1 (41% vs 66%; P = 0.029). Employing a multivariate analysis, only patient weight < 150 lbs and performance of ST were established as independently associated with a reduction in groin morbidity following IFL (P = 0.0281 and P = 0.0075, respectively). In conclusion, despite waning enthusiasm for its performance, ST appeared to significantly reduce the incidence of wound morbidity after IFL. Our data confirmed that separate incisions, and improved perioperative antibiotics, have not eliminated the value inherent in this surgical modification. We suggest a prospective trial to further establish the benefit of sartorius transposition during IFL.


Subject(s)
Lymph Node Excision/adverse effects , Vulvar Neoplasms/surgery , Female , Humans , Inguinal Canal , Lymph Node Excision/methods , Lymphatic Metastasis , Multivariate Analysis , Postoperative Complications/epidemiology , Postoperative Complications/prevention & control , Vulvar Neoplasms/pathology
13.
Gynecol Oncol ; 64(2): 252-5, 1997 Feb.
Article in English | MEDLINE | ID: mdl-9038271

ABSTRACT

We report a pure brain metastasis of choriocarcinoma from a mixed germ cell tumor of the ovary in a 19-year-old patient. This condition is extremely rare. Following abdominal operative procedures, multiple courses of combination chemotherapy, and resection of chemotherapy-resistant pulmonary metastases, a brain metastasis developed during chemotherapy. Craniotomy with resection of the neoplasm, brain radiation, and further chemotherapy was followed by disappearance of a pulmonary metastasis and long-term survival of the patient.


Subject(s)
Brain Neoplasms/secondary , Choriocarcinoma/secondary , Germinoma/pathology , Neoplasms, Multiple Primary/pathology , Ovarian Neoplasms/pathology , Pregnancy Complications, Neoplastic/pathology , Adult , Brain Neoplasms/pathology , Choriocarcinoma/pathology , Female , Humans , Pregnancy
14.
Metab Brain Dis ; 12(1): 61-8, 1997 Mar.
Article in English | MEDLINE | ID: mdl-9101538

ABSTRACT

We assessed cytochrome oxidase (CytOx) staining in sham-operated control piglets and in piglets subjected to 30 minutes of cerebral hypoxia-ischemia (H-I) plus 4 hours of reperfusion (REP). The 1-day-old piglets were sedated, anesthetized, and ventilated. Cerebral blood flows (CBFs) were quantitated using microspheres. H-I was induced by a combination of phlebotomy and cervical tourniquet; the brain was reperfused for four hours after 30 minutes of H-I. CBF was reduced during ischemia in experimental animals from 42 + 13 to 12 + 5 ml/min/100g. CytOx staining of hippocampal sections from 3 control and 3 experimental animals was compared. The staining of the stratum pyramidale neurons of the same portion of the CA1 sector in a single high power field was assessed in a blinded fashion in 4 corresponding sections from each animal, and graded from 0 = no staining to 3 = heavy staining. The results were compared using one-way analysis of variance. Cells with grade 3 staining were significantly more numerous in controls compared to H-I/REP animals (p = 0.03). There were significantly more cells with no CytOx staining in the experimental animals (p = 0.01). These findings suggest that CytOx staining in newborn piglet CA1 is a reliable method of assessing cell dysfunction after H-I.


Subject(s)
Brain Ischemia/enzymology , Electron Transport Complex IV/metabolism , Hippocampus/enzymology , Hypoxia, Brain/enzymology , Animals , Blood Pressure/physiology , Brain Ischemia/physiopathology , Cerebrovascular Circulation/physiology , Histocytochemistry , Hypoxia, Brain/physiopathology , Microspheres , Reperfusion Injury/enzymology , Swine
15.
Metab Brain Dis ; 11(4): 359-67, 1996 Dec.
Article in English | MEDLINE | ID: mdl-8979254

ABSTRACT

The primary cause of neurologic impairment in newborn infants is hypoxic-ischemic injury. Studies of the mechanisms involved in the damaging effects of hypoxia-ischemia and reperfusion in brain tissue indicate significant contributions from reactive oxygen species, with the loss of homeostatic control of intracellular iron an important determinant of oxidant-mediated damage. We investigated the effects of cerebral hypoxia-ischemia and reperfusion on the redistribution of nonheme iron in newborn piglets. Anesthetized newborn piglets were subjected to reductions in cerebral blood flow by phlebotomy and cervical cuff compression. Control animals were sham-operated. Subcellular fractions were isolated from brain tissue homogenates by differential centrifugation, and nonheme iron contents of these fractions were measured with ferene-S. Iron contents in the homogenates were not altered. However, iron contents of the microsomal fractions of animals subjected to 30 minutes of hypoxia-ischemia increased from 0.517 +/- 0.053 to 0.930 +/- 0.061 nmol/mg protein (p < 0.01); 120 minutes of reperfusion caused no further changes. This translocation of iron may be linked to oxidative alterations of brain proteins, which we investigated by detection of dinitrophenylhydrazine-derivitized protein carbonyls, which are characteristic of iron-catalyzed oxidation reactions.


Subject(s)
Animals, Newborn/metabolism , Brain Ischemia/metabolism , Hypoxia/metabolism , Iron/metabolism , Microsomes/metabolism , Animals , Swine
16.
Gynecol Oncol ; 56(3): 362-9, 1995 Mar.
Article in English | MEDLINE | ID: mdl-7705669

ABSTRACT

Patients with gynecologic malignancies may develop stenosis of the large pelvic veins as a result of their disease or its treatment. The percutaneous insertion of a stainless steel vascular stent is a novel approach to the management of an extrinsically compressed vein. The objective of this study was to review the results of treating lower extremity edema secondary to a pelvic venous stenosis through the percutaneous insertion of a stainless steel vascular stent. A retrospective review was performed on gynecologic oncology patients who presented with an edematous lower extremity and underwent an evaluation to diagnose proximal venous stenosis. The evaluation included sonography, venography, and balloon angioplasty prior to the percutaneous insertion of a stainless steel vascular stent. If a venous thrombosis was documented, thrombolysis with urokinase was performed prior to evaluation for venous stenosis. Records were reviewed for the etiology of the venous stenosis, the location and type of stent inserted, and the ability of the stent to maintain patency and provide symptomatic relief. Patency was evaluated at 1-week and then at 1-, 3-, and 6-month intervals. The probability of vascular stent patency was calculated using life table analysis. Ten patients with cervical (n = 4), corpus (n = 3), ovarian (n = 1), vulvar (n = 1), and vaginal (n = 1) cancer had one or more vascular stents inserted for the treatment of a stenosed pelvic vein. The etiologies of venous stenosis were radiation fibrosis and surgery (n = 5), postoperative fibrosis (n = 3), and metastatic tumor (n = 2). The stented vessels were the left common (n = 5) or left external (n = 4) iliac veins, the right common (n = 1) or right external (n = 3) iliac veins, and the right common femoral vein (n = 1). The median follow-up was 21 months. All patients had subjective resolution of their edematous extremity while the stents were patent. The interval probability of patency of stented veins was greater than 85% at each evaluation interval. Patency was 100% for patients beyond 6 months of follow-up. There were no major complications. The percutaneous intravascular insertion of a stainless steel stent was safe and subjectively effective in the management of venous stenosis associated with a gynecologic cancer. A prospective trial with objective endpoints may be warranted.


Subject(s)
Edema/surgery , Leg/blood supply , Stainless Steel , Stents , Adult , Aged , Constriction, Pathologic/etiology , Constriction, Pathologic/surgery , Edema/etiology , Female , Follow-Up Studies , Genital Neoplasms, Female/complications , Humans , Middle Aged , Pelvis , Retrospective Studies , Vascular Diseases/etiology , Vascular Diseases/surgery , Veins
17.
Gynecol Oncol ; 55(3 Pt 1): 415-20, 1994 Dec.
Article in English | MEDLINE | ID: mdl-7530677

ABSTRACT

The purpose of this study was to review the clinical outcomes and cost of administration of a prophylactic antibiotic compared to G-CSF for the prevention of neutropenic morbidity associated with taxol. The study group was composed of 62 patients with ovarian cancer who received a 24-h infusion of a taxol-based regimen at doses less than or equal to 175 mg/m2 between June 1992 and April 1994. The records were retrospectively reviewed and the patients were grouped and analyzed according to the management of their myelosuppression. Group I patients (n = 29) were observed until their absolute neutrophil count (ANC) was less than 500/microliters and then were placed on ciprofloxacin 500 mg orally twice a day until their ANC was 1,000/microliters. Group II patients (n = 15) received G-CSF from Day 2 until the ANC was greater than 10,000/microliters beginning with their first cycle. Group III patients (n = 18) received their taxol regimen without either ciprofloxacin or G-CSF. Two hundred eighty-two taxol-based chemotherapy cycles were administered to these 62 patients. There was no statistically significant difference between the groups concerning disease status as measured by age, stage, performance status, dose intensity, or number of previous regimens. There were two episodes of febrile neutropenia in Group I and three episodes in Group II. Group III had 15 episodes of febrile neutropenia. The estimated cost of the different prophylactic regimens was $5,215.00 for Group I versus $104,000.00 for G-CSF in Group II. Within the three groups, there were 27 patients with an episode of febrile neutropenia (n = 20) or prolonged myelosuppression (n = 7) that were followed for an additional 104 taxol cycles. Twenty-four of these patients received G-CSF prophylaxis with intermittent ciprofloxacin and three received only ciprofloxacin. There were eight more episodes of febrile neutropenia in the patients receiving G-CSF. There were no additional febrile episodes on cycles prophylaxed with ciprofloxacin. There was no septic mortality. For patients receiving a 24 h infusion of taxol at doses less than 175 mg/m2, ciprofloxacin given through the ANC nadir may be effective in preventing febrile morbidity. A prospective randomized trial is underway to evaluate this approach.


Subject(s)
Bacterial Infections/prevention & control , Ciprofloxacin/therapeutic use , Ovarian Neoplasms/drug therapy , Paclitaxel/therapeutic use , Administration, Oral , Analysis of Variance , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bacterial Infections/etiology , Carboplatin/administration & dosage , Carboplatin/adverse effects , Chi-Square Distribution , Ciprofloxacin/administration & dosage , Ciprofloxacin/economics , Cisplatin/administration & dosage , Cisplatin/adverse effects , Costs and Cost Analysis , Female , Fever/etiology , Fever/prevention & control , Granulocyte Colony-Stimulating Factor/economics , Granulocyte Colony-Stimulating Factor/therapeutic use , Humans , Ifosfamide/administration & dosage , Ifosfamide/adverse effects , Leukocyte Count , Middle Aged , Neutropenia/blood , Neutropenia/chemically induced , Neutropenia/complications , Neutrophils , Paclitaxel/administration & dosage , Paclitaxel/adverse effects , Retrospective Studies
18.
Int J Radiat Oncol Biol Phys ; 29(5): 989-98, 1994 Jul 30.
Article in English | MEDLINE | ID: mdl-8083101

ABSTRACT

PURPOSE/OBJECTIVE: To report the long-term results of vulvectomy, node dissection, and postoperative nodal irradiation using a midline vulvar block in patients with node positive vulvar cancer. METHODS AND MATERIALS: From 1971 through 1992, 27 patients with carcinoma of the vulva and histologically involved inguinal lymph nodes were treated postoperatively with radiation therapy after radical vulvectomy and bilateral lymphadenectomy (n = 25), radical vulvectomy and unilateral lymphadenectomy (n = 1), or hemivulvectomy and bilateral lymphadenectomy (n = 1). Federation Internationale de Gynecologic et d'Obstetrique stages were III (n = 14), IVA (n = 8), and IVB (n = 5) squamous cell carcinoma. Inguinal lymph nodes were involved with tumor in all patients (average number positive = 4, range 1-15). Postoperative irradiation was directed at the bilateral groin and pelvic nodes (n = 19), unilateral groin and pelvic nodes (n = 6), or unilateral groin only (n = 1). These 26 patients had the midline blocked. In addition, one patient received irradiation to the entire pelvis and perineum. Doses ranged from 10.8 to 50.7 Gy (median 45.5) with all patients except 1 receiving > or = 42.0 Gy. RESULTS: Actuarial 5-year overall survival and disease-free survival estimates were 40% and 35%, respectively. Recurrences developed in 63% (17/27) of the patients at a median of 9 months from surgery (range 3 months to 6 years) and 15 of these have died; two patients with recurrences are surviving at 24 and 96 months after further surgery and radiation therapy. Central recurrences (under the midline block) were present in 13 of these 17 patients (76%), either as central only (n = 8), central and regional (n = 4), or central and distant (n = 1). Additionally, three patients developed regional recurrences and one patient developed a concurrent regional and distant relapse. One patient developed a squamous cell cancer of the anus under the midline block 54 months after the initial vulvar cancer and an additional patient developed transitional cell carcinoma of the ureter (outside the radiation field) 12 months after diagnosis. Factors associated with a decreased relapse-free survival included increasing Federation Internationale de Gynecologic et d'Obstetrique stage (p = 0.01) and invasion of the tumor into the subcutaneous (SC) fat or deep soft tissue (p = 0.05). Chronic lower extremity edema developed in four patients, but there have been no other complications. CONCLUSIONS: Radical vulvectomy has often been considered sufficient central treatment for vulvar carcinoma, with postoperative irradiation directed only to the nodes. Although designed to protect the radiosensitive vulva, use of a midline block in this series resulted in a 48% (13/27) central recurrence rate, much higher than the 8.5% rate previously reported with this technique. Routine use of the midline block should be abandoned and, instead, postoperative irradiation volumes should be tailored to the individual patient.


Subject(s)
Carcinoma, Squamous Cell/radiotherapy , Carcinoma, Squamous Cell/surgery , Postoperative Care , Vulva/surgery , Vulvar Neoplasms/radiotherapy , Vulvar Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Combined Modality Therapy , Erythema/etiology , Female , Humans , Lymph Node Excision , Lymphatic Irradiation , Middle Aged , Neoplasm Invasiveness , Neoplasm Staging , Radiation Injuries/etiology , Radiotherapy Dosage , Risk Factors
19.
Cancer ; 73(5): 1453-5, 1994 Mar 01.
Article in English | MEDLINE | ID: mdl-8111713

ABSTRACT

BACKGROUND: Ifosfamide has antitumor activity in previously treated ovarian epithelial tumors, squamous carcinomas of the cervix, trophoblastic disease, and untreated uterine sarcomas in Gynecologic Oncology Group (GOG) trials. Because cyclophosphamide and other alkylating agents are known to produce responses in adenocarcinoma of the endometrium, a Phase II trial of ifosfamide and the uroprotector, mesna, was undertaken. METHODS: Fifty-two patients with advanced adenocarcinoma of the endometrium recurrent after surgery and/or radiation therapy and refractory to first-line chemotherapeutic agents were treated with ifosfamide, 1.2 g/m2 intravenous daily for 5 days every 4 weeks, and mesna, 300 mg/m2 intravenous every 4 hours for 3 doses daily for 5 days. Two patients were ineligible--one due to prior therapy and one due to a second malignancy. Three patients had an inadequate trial, and 7 were inevaluable for response, leaving 47 patients evaluable for toxicity and 40 patients evaluable for response. Thirty-seven patients had undergone hysterectomy, 30 had received radiation therapy, and 32 had received prior cisplatin-based chemotherapy. All patients were GOG performance status 0, 1, or 2. RESULTS: Complete responses were observed in three (7.5%) and partial responses in three patients (7.5%), for a response rate of 15% (95% confidence interval for the true response rate was 5.5%-29.8%). Severe (Grade 3 or 4) leukopenia and anemia were seen in 25 and 4 patients, respectively. Severe thrombocytopenia was observed in 7 patients. Five patients had Grade 3 or 4 neurotoxicity, and one had Grade 3 renal impairment. Reversible alopecia was universal. CONCLUSIONS: This dose and schedule of ifosfamide and mesna is active in patients with adenocarcinoma of the endometrium failing platinum-based therapy. Phase II testing in untreated patients is under way.


Subject(s)
Adenocarcinoma/drug therapy , Endometrial Neoplasms/drug therapy , Ifosfamide/therapeutic use , Mesna/therapeutic use , Aged , Aged, 80 and over , Combined Modality Therapy , Female , Humans , Ifosfamide/administration & dosage , Mesna/administration & dosage , Middle Aged , Neoplasm Recurrence, Local
20.
Gynecol Oncol ; 51(3): 307-10, 1993 Dec.
Article in English | MEDLINE | ID: mdl-8112637

ABSTRACT

Twenty-seven patients under the age of 40 years were treated for invasive vulvar cancer at the Women's Cancer Center, University of Minnesota. Seventeen patients had Stage I, five patients had Stage II, two patients had Stage III, and two patients had Stage IV disease. Twenty patients (80%) gave a history of smoking. Associated medical and immunosuppressive conditions present in these patients included vulval HPV (N = 3), diabetes mellitus (N = 3), pregnancy (N = 2), autoimmune connective tissue disease (N = 2), renal transplant (N = 2), previous chemotherapy for invasive malignancies at other sites (N = 1), chronic hepatitis (N = 1), schizophrenia (N = 1), and one patient on Imuran for herpes zoster and multiple sclerosis. Two of the nonsmokers were in this group of immunosuppressed patients. Three patients have died of intercurrent disease while another is currently alive with invasive disease. All others are alive without evidence of disease. The mean duration of follow-up is 45.2 months (range, 1-158 months). Invasive vulvar tumors are uncommon in young women. Smoking and a history of an immunosuppressive medical illness is common in this patient population.


Subject(s)
Immunocompromised Host/immunology , Vulvar Neoplasms/epidemiology , Vulvar Neoplasms/immunology , Adult , Female , Follow-Up Studies , Humans , Incidence , Neoplasm Invasiveness , Neoplasm Staging , Papillomavirus Infections/complications , Papillomavirus Infections/epidemiology , Retrospective Studies , Risk Factors , Tumor Virus Infections/complications , Tumor Virus Infections/epidemiology , Vulvar Neoplasms/complications
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