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Autoamputation of teratoma
dure (average: 16.36 days) and at two points (average 23.14 and 70.25 days) postprocedure. Results: For patients with a primary diagnosis related to abnormal uterine bleeding (AUB), the use of endometrial ablation as a treatment for AUB relative to all procedures (endometrial ablation ⫹ hysterectomies) increased from 35% to 48% during the study period. In addition, the selection of the abdominal route for hysterectomies decreased 8.8%, from 57.6% preintervention to 48.8% at 1 year. An increase of the same magnitude was demonstrated in hysterectomies performed via the vaginal route (both with and without laparoscopic assistance). Significant differences in procedure time, uterine weights, return to normal activity, and selected postprocedure quality-of-life measures by procedure, route, and method were found. Conclusions: A systematic program, including guideline development, physician education, peer-reviewed precertification, and second-opinion options can substantially reduce the invasiveness of procedures performed for the treatment of benign uterine disease. Quality of care, as indicated by the monitoring of clinical, economic, and quality-of-life variables, was maintained and in selected areas improved as a result of the intervention.
Autoamputation of Teratoma Laura H. Lowder, MD East Carolina University School of Medicine, Greenville, NC
CoStop in the Prevention of Adhesions Camran Nezhat, MD Stanford Endoscopy Center for Training and Technology, Palo Alto, CA
T.D. Estridge, PhD, K.E. Rodgers, PhD, N. Roda, and G.T. Coker, PhD Adhesion formation is a significant source of postoperative morbidity. Current barrier products on the market in the United States are difficult to use during a laparoscopic procedure or over irregular surfaces. The efficacy of a sprayable adhesion prevention barrier, CoStop, was evaluated in three separate rabbit adhesion models. In an initial study, the effect of CoStop and Seprafilm bioresorbable membrane was evaluated in a rabbit uterine horn abrasion model. At necropsy, 67% of the CoStop-treated rabbits and 61% of the Seprafilm-treated animals were adhesion free. In a rabbit sidewall adhesion formation model, 90% of rabbits treated with CoStop were free of adhesions at necropsy, whereas all surgical controls formed adhesions. A comparable level of efficacy was observed in a rabbit re-formation model in which adhesions were generated and lysed 1 week later. After adhesiolysis, all control rabbits re-formed adhesions over 95% of the area. In contrast, 67% of the CoStop- and 38% of the Seprafilm-treated rabbits were adhesion free. Histological evaluation performed on tissues from the studies indicates that the CoStop barrier is biocompatible in all three surgical situations. CoStop-treated animals in all adhesion models showed a significant reduction in the incidence, extent, and severity of adhesion formation.
Jennifer Ferguson, MD Objective: To describe a case of autoamputation of a benign teratoma discovered at the time of laparoscopy. Methods: A patient with severe mental retardation presented with a complex pelvic mass seen on ultrasound examination. An imaging study was originally obtained because of the possibility that she had swallowed a foreign body. The patient was unable to verbally communicate complaints; however, caregivers denied any change in behavior indicating pain or other symptoms. The patient was unable to tolerate a pelvic examination. CA 125 was normal. Operative laparoscopy revealed a 6-cm, smooth, encapsulated, white mass in the anterior cul-de-sac of the pelvis. There was no blood supply or attachment to the mass. The mass was grasped with smooth graspers and removed through the laparoscopic port. Thick, white material was expressed from the mass. Pathology revealed a benign teratoma. Results: In a 55-year-old female with a complex pelvic mass seen on ultrasound examination, an autoamputated benign teratoma was diagnosed at the time of operative laparoscopy. Conclusion: A pelvic mass may outgrow its blood supply and autoamputate, as seen in the case described previously.
VOL. 97, NO 4 (SUPPLEMENT), APRIL 2001
Clinical Safety in Use of a Layered-Fiber Tampon Anne E. Hochwalt, PhD Procter & Gamble, Cincinnati, OH
Michaelle A. Jones, MS, Frank C. Sarbaugh, and Johna D. Lucas, MD Objective: To confirm the safety of layered-fiber (TAMPAX) tampons compared with blended-fiber control tampons. Methods: Potential product-related irritation (determined by colposcopic examination and subject diary data); prevalence and count of E coli, yeast, group B streptococci, and S aureus (obtained by vaginal swab cultures); vaginal pH; and vaginal discharge were assessed monthly in a 4-month double-blind, randomized, crossover clinical safety-in-use study.
Monday Posters 19S
Autoamputation of Teratoma Laura H. Lowder, MD East Carolina University School of Medicine, Greenville, NC
CoStop in the Prevention of Adhesions Camran Nezhat, MD Stanford Endoscopy Center for Training and Technology, Palo Alto, CA
T.D. Estridge, PhD, K.E. Rodgers, PhD, N. Roda, and G.T. Coker, PhD Adhesion formation is a significant source of postoperative morbidity. Current barrier products on the market in the United States are difficult to use during a laparoscopic procedure or over irregular surfaces. The efficacy of a sprayable adhesion prevention barrier, CoStop, was evaluated in three separate rabbit adhesion models. In an initial study, the effect of CoStop and Seprafilm bioresorbable membrane was evaluated in a rabbit uterine horn abrasion model. At necropsy, 67% of the CoStop-treated rabbits and 61% of the Seprafilm-treated animals were adhesion free. In a rabbit sidewall adhesion formation model, 90% of rabbits treated with CoStop were free of adhesions at necropsy, whereas all surgical controls formed adhesions. A comparable level of efficacy was observed in a rabbit re-formation model in which adhesions were generated and lysed 1 week later. After adhesiolysis, all control rabbits re-formed adhesions over 95% of the area. In contrast, 67% of the CoStop- and 38% of the Seprafilm-treated rabbits were adhesion free. Histological evaluation performed on tissues from the studies indicates that the CoStop barrier is biocompatible in all three surgical situations. CoStop-treated animals in all adhesion models showed a significant reduction in the incidence, extent, and severity of adhesion formation.
Jennifer Ferguson, MD Objective: To describe a case of autoamputation of a benign teratoma discovered at the time of laparoscopy. Methods: A patient with severe mental retardation presented with a complex pelvic mass seen on ultrasound examination. An imaging study was originally obtained because of the possibility that she had swallowed a foreign body. The patient was unable to verbally communicate complaints; however, caregivers denied any change in behavior indicating pain or other symptoms. The patient was unable to tolerate a pelvic examination. CA 125 was normal. Operative laparoscopy revealed a 6-cm, smooth, encapsulated, white mass in the anterior cul-de-sac of the pelvis. There was no blood supply or attachment to the mass. The mass was grasped with smooth graspers and removed through the laparoscopic port. Thick, white material was expressed from the mass. Pathology revealed a benign teratoma. Results: In a 55-year-old female with a complex pelvic mass seen on ultrasound examination, an autoamputated benign teratoma was diagnosed at the time of operative laparoscopy. Conclusion: A pelvic mass may outgrow its blood supply and autoamputate, as seen in the case described previously.
VOL. 97, NO 4 (SUPPLEMENT), APRIL 2001
Clinical Safety in Use of a Layered-Fiber Tampon Anne E. Hochwalt, PhD Procter & Gamble, Cincinnati, OH
Michaelle A. Jones, MS, Frank C. Sarbaugh, and Johna D. Lucas, MD Objective: To confirm the safety of layered-fiber (TAMPAX) tampons compared with blended-fiber control tampons. Methods: Potential product-related irritation (determined by colposcopic examination and subject diary data); prevalence and count of E coli, yeast, group B streptococci, and S aureus (obtained by vaginal swab cultures); vaginal pH; and vaginal discharge were assessed monthly in a 4-month double-blind, randomized, crossover clinical safety-in-use study.
Monday Posters 19S