ABSTRACT
Review of a 20-month experience with 241 peritoneal washes performed on 191 patients showed that the use of these specimens has expanded greatly. Of the 19 patients with neoplastic cells in their peritoneal washing cytology specimens, 12 had primary ovarian neoplasms, 4 had primary uterine cervical neoplasms, 2 had primary endometrial neoplasms, and 1 had mammary carcinoma metastatic to the ovary. Gynecologic oncologists at this institution are now routinely obtaining peritoneal washing cytology specimens whenever there is intraabdominal surgery on patients known to have or suspected of having a pelvic neoplasm. The following criteria were found to be essential to the accurate evaluation of these specimens: (1) cells considered to be malignant should be present both singly and in groups and should be malignant by the usual cytologic criteria, (2) the patients must have or be known to have had a neoplasm whose cells are similar to those in the washing specimen, and (3) the cells considered to be neoplastic must be different from and not confused with reactive mesothelial cells. The last criterion is important because the peritoneal lavage traumatically removes mesothelium, which can appear atypical. These criteria make the cytologic interpretation of most peritoneal washing specimens straightforward; interesting diagnostic problems occur, however, including the evaluation of neoplasms of borderline malignancy, those "spilled" during surgery and second neoplasms found by peritoneal washing cytology.
Subject(s)
Ascitic Fluid , Cytodiagnosis/methods , Ovarian Neoplasms/diagnosis , Uterine Cervical Neoplasms/diagnosis , Uterine Neoplasms/diagnosis , Breast Neoplasms/diagnosis , Female , Humans , Neoplasm Staging , Ovarian Neoplasms/drug therapy , Ovarian Neoplasms/pathology , Peritoneum , Therapeutic Irrigation , Uterine Cervical Neoplasms/drug therapyABSTRACT
We reviewed a series of 181 patients who were treated with therapeutic plasma exchange ( TPE ) a total of 1,389 times. Complications were associated with 22 (1.6%) of the procedures and involved 20 (11%) of the patients. Six of the complications were of a technical nature and did not affect the medical conditions of the patients. 8 patients developed the following serious medical problems: unexplained death during the post- TPE period, myocardial infarction, pulmonary embolus, loss of consciousness, myocardial ischemia, cerebral ischemia and chest pain. Although these problems were temporally associated with TPE none of them could be attributed to the TPE with certainty. The remaining eight medical complications were of a less serious nature.
Subject(s)
Plasma Exchange/adverse effects , Adolescent , Adult , Aged , Brain Ischemia/etiology , Child , Coronary Disease/etiology , Female , Hemolysis , Humans , Hypoxia/etiology , Male , Middle Aged , Myocardial Infarction/etiology , Plasma Exchange/mortality , Pulmonary Embolism/etiology , Unconsciousness/etiologyABSTRACT
Significant hypocalcemia is infrequently encountered during therapeutic plasma exchange. An increase in parathyroid hormone secretion during the procedure may be responsible for maintaining the calcium levels.
Subject(s)
Hypocalcemia/etiology , Parathyroid Hormone/blood , Plasma Exchange/adverse effects , Adult , Calcium/blood , Female , Humans , Hypocalcemia/blood , MaleABSTRACT
A patient with Sezary syndrome underwent cytapheresis on the IBM 2997 cell separator. Four procedures were performed over a 12-day period. A total of 8.3 x 10(10) Sezary cells were removed. The patient's skin lesions and lymphadenopathy regressed. Transient thrombocytopenia occurred, requiring platelet transfusion. Although a significant number of platelets were removed by pheresis, this was not sufficient to explain the thrombocytopenia. The patient subsequently died of causes unrelated to the cytapheresis.