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Cytoreductive surgery for ovarian cancer with the cavitron ultrasonic surgical aspirator and the development of disseminated intravascular coagulation
Citations from the literature /International Journal of Gynecology & Obstetrics 48 ( 1995) 245-254 Antisperm antibodies: Origin, regulation, and sperm reactivity in
human infertility Naz R.K.; Menge AC. USA FERTIL STERIL 199461/6 (1001-1013) Objective: To follow-up and expand discussionon the action mechanismsof antisperm antibodies in human infertility, the etiology and control of antispenn antibody induction, sperm antigens involved in immunoinfertility, and strategiesfor therapy. Design: A review of the recent literature with an emphasis on female immunoinfertility. Results: The role of antisperm antibodies in clinical infertility continues to be defined. Through assisted reproductive technologies, antisperm antibodies were shown to exert detrimental effects on different prefertilization and possibly postfertilization events. The female reproductive tract is part of the common mucosal immune system and is able to mount effective immune responses against infectious agents, foreign antigens, and, occasionally, sperm cells. Sperm membranes and constituents contain numerous antigenic components foreign to the human body, and yet antisperm antibodies become problematic in few women exposed to semen.Semen and sperm cells contain immunosuppressive factors capable of inhibiting different immune cells. Fertile women apparently produce antisperm antibodies but also possessneutralizing serum anti-idiotypic antibodies that are lacking in virgin and immunoinfertile women. Conclusions: Antisperm antibodies can affect adversely human fertility but normally may be controlled by antiidiotypic antibodies, which along with immunosuppressor factors in semen prevent their induction to a significant degree. This balance between detrimental and ‘beneficial’ immune responseto sperm may be shifted toward an antisperm antibody response by stimulatory factors such as infection. Therapies may be devised to stimulate the anti-idiotypic antibody system, to induce immune tolerance to sperm antigens, and to useantigens to adsorb antisperm antibodies from spermatozoa.
ONCOLOGY Cytoreductivesurgery for ovarian cancer with the cavibon ultrasonic surgical aspirator and the development of disseminated inbavascular coagulation Donovan J.T.; Veronikis D.K.; Powell J.L.; Lundy L.E.; Prefontaine M. USA OBSTET GYNECOL 1994 8316(1011-1014) Objective: To explore the association between the use of the Cavitron Ultrasonic Surgical Aspirator for cytoreduction of ovarian cancer and the intraoperative development of disseminatedintravascular coagulation (DIC). Methods: A retrospective chart review was performed of all patients undergoing surgery for ovarian cancer from September 1991to February 1993.Data were extracted to correlate clinical and hematologic evidence of DIC with and without intraoperative use of the Cavitron Ultrasonic Surgical Aspirator. Statistical analyses were done by chi2 and analysis of variance. Results: Fifty-one
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patients underwent surgery for ovarian cancer; 33 had stage IHB, IIIC, IV, or recurrent diseaseand could be evaluated for this study. Nineteen patients were treated with the surgical aspirator, five of whom developed an intraoperative coagulopathy, as compared to none of 14patients treated with conventional cytoreduction (P < 0.04, chi2). The duration of use of the surgical aspirator correlated with the risk of coagulopathy (P < 0.001,analysis of variance). Conclusion: These data suggesta potential risk of developing DIC after extended useof the Cavitron Ultrasonic Surgical Aspirator for cytoreduction of ovarian cancer.
The effect of diameter of largest residual diseaseon survival after primary cytoredwtive surgery in patients with suboptimal residual epitbelial ovarian carcinoma Hoskins W.J.; McGuire W.P.; Brady M.F.; Homesley H.D.; Creasman W.T.; Berman M.; Ball H.; Berek J.S. USA AM J OBSTET GYNECOL 1994 17014(974-980) Objective: The Gynecologic Oncology Group has divided patients with advanced epithelial ovarian cancer into those with optimal residual cancer, in which the maximum diameter of residual is 5 1 cm, and suboptimal residual cancer, in which the residual diseaseis > 1 cm. Within the optimal group of patients there is a survival difference between patients with microscopic residual disease and those with any macroscopic disease 5 1 cm. No analysis of the effect of various residual disease diametersin patients with residual diseasez 1 cm has been performed. This study evaluates the effect of residual diseasediameter in patients with suboptimal disease entered on a randomized trial of intense versus standard chemotherapy. Study design: Gynecologic Oncology Group protocol 97 compared cisplatin 50 mg at 100mg/m2 and 1000mp/m2 for four courses,respectively. There was no difference in progressionfree interval or survival between the two arms. Of the 458 stage III (with residual disease> 1 cm) and stage IV patients entered in this study, 294 stage HI patients comprise the current analysis. Surgical reporting forms, operation reports, and pathology reports were reviewed to determine initial greatest tumor diameter and residual tumor diameter. Patients were grouped by residual diameter. Multivariate analysis considered residual diameter of disease,age, histologic characteristics, performance status, and ascites. An adjusted relative hazard of dying of ovarian cancer was calculated for each residual diseasegroup, Results: Patients ranged in age from 20 to 80 years, with a median of 60 years. All patients were Gynecologic Oncology Group performance status 0 to 2. Fifty-two percent had grade 3 tumors, and 39% and 9%, respectively, had grade 2 or 1 tumors. All patients had stage III disease.Ninety percent had serous, endometrioid, or mixed epithelial cell type tumors. Multivariate analysis revealed a relative risk of dying as follows: residual disease < 2 cm, relative risk 1.OO;2 to 2.9 cm, relative risk 1.90;3 to 3.9 cm, relative risk 1.91;4 to 5.9 cm, relative risk 1.74;6 to 7.9 cm, relative risk 1.85;8 to 9.9 cm, relative risk 2.16; 2 10 cm, relative risk 1.82. The difference in survival between those with < 2 cm residual diseaseand those
human infertility Naz R.K.; Menge AC. USA FERTIL STERIL 199461/6 (1001-1013) Objective: To follow-up and expand discussionon the action mechanismsof antisperm antibodies in human infertility, the etiology and control of antispenn antibody induction, sperm antigens involved in immunoinfertility, and strategiesfor therapy. Design: A review of the recent literature with an emphasis on female immunoinfertility. Results: The role of antisperm antibodies in clinical infertility continues to be defined. Through assisted reproductive technologies, antisperm antibodies were shown to exert detrimental effects on different prefertilization and possibly postfertilization events. The female reproductive tract is part of the common mucosal immune system and is able to mount effective immune responses against infectious agents, foreign antigens, and, occasionally, sperm cells. Sperm membranes and constituents contain numerous antigenic components foreign to the human body, and yet antisperm antibodies become problematic in few women exposed to semen.Semen and sperm cells contain immunosuppressive factors capable of inhibiting different immune cells. Fertile women apparently produce antisperm antibodies but also possessneutralizing serum anti-idiotypic antibodies that are lacking in virgin and immunoinfertile women. Conclusions: Antisperm antibodies can affect adversely human fertility but normally may be controlled by antiidiotypic antibodies, which along with immunosuppressor factors in semen prevent their induction to a significant degree. This balance between detrimental and ‘beneficial’ immune responseto sperm may be shifted toward an antisperm antibody response by stimulatory factors such as infection. Therapies may be devised to stimulate the anti-idiotypic antibody system, to induce immune tolerance to sperm antigens, and to useantigens to adsorb antisperm antibodies from spermatozoa.
ONCOLOGY Cytoreductivesurgery for ovarian cancer with the cavibon ultrasonic surgical aspirator and the development of disseminated inbavascular coagulation Donovan J.T.; Veronikis D.K.; Powell J.L.; Lundy L.E.; Prefontaine M. USA OBSTET GYNECOL 1994 8316(1011-1014) Objective: To explore the association between the use of the Cavitron Ultrasonic Surgical Aspirator for cytoreduction of ovarian cancer and the intraoperative development of disseminatedintravascular coagulation (DIC). Methods: A retrospective chart review was performed of all patients undergoing surgery for ovarian cancer from September 1991to February 1993.Data were extracted to correlate clinical and hematologic evidence of DIC with and without intraoperative use of the Cavitron Ultrasonic Surgical Aspirator. Statistical analyses were done by chi2 and analysis of variance. Results: Fifty-one
251
patients underwent surgery for ovarian cancer; 33 had stage IHB, IIIC, IV, or recurrent diseaseand could be evaluated for this study. Nineteen patients were treated with the surgical aspirator, five of whom developed an intraoperative coagulopathy, as compared to none of 14patients treated with conventional cytoreduction (P < 0.04, chi2). The duration of use of the surgical aspirator correlated with the risk of coagulopathy (P < 0.001,analysis of variance). Conclusion: These data suggesta potential risk of developing DIC after extended useof the Cavitron Ultrasonic Surgical Aspirator for cytoreduction of ovarian cancer.
The effect of diameter of largest residual diseaseon survival after primary cytoredwtive surgery in patients with suboptimal residual epitbelial ovarian carcinoma Hoskins W.J.; McGuire W.P.; Brady M.F.; Homesley H.D.; Creasman W.T.; Berman M.; Ball H.; Berek J.S. USA AM J OBSTET GYNECOL 1994 17014(974-980) Objective: The Gynecologic Oncology Group has divided patients with advanced epithelial ovarian cancer into those with optimal residual cancer, in which the maximum diameter of residual is 5 1 cm, and suboptimal residual cancer, in which the residual diseaseis > 1 cm. Within the optimal group of patients there is a survival difference between patients with microscopic residual disease and those with any macroscopic disease 5 1 cm. No analysis of the effect of various residual disease diametersin patients with residual diseasez 1 cm has been performed. This study evaluates the effect of residual diseasediameter in patients with suboptimal disease entered on a randomized trial of intense versus standard chemotherapy. Study design: Gynecologic Oncology Group protocol 97 compared cisplatin 50 mg at 100mg/m2 and 1000mp/m2 for four courses,respectively. There was no difference in progressionfree interval or survival between the two arms. Of the 458 stage III (with residual disease> 1 cm) and stage IV patients entered in this study, 294 stage HI patients comprise the current analysis. Surgical reporting forms, operation reports, and pathology reports were reviewed to determine initial greatest tumor diameter and residual tumor diameter. Patients were grouped by residual diameter. Multivariate analysis considered residual diameter of disease,age, histologic characteristics, performance status, and ascites. An adjusted relative hazard of dying of ovarian cancer was calculated for each residual diseasegroup, Results: Patients ranged in age from 20 to 80 years, with a median of 60 years. All patients were Gynecologic Oncology Group performance status 0 to 2. Fifty-two percent had grade 3 tumors, and 39% and 9%, respectively, had grade 2 or 1 tumors. All patients had stage III disease.Ninety percent had serous, endometrioid, or mixed epithelial cell type tumors. Multivariate analysis revealed a relative risk of dying as follows: residual disease < 2 cm, relative risk 1.OO;2 to 2.9 cm, relative risk 1.90;3 to 3.9 cm, relative risk 1.91;4 to 5.9 cm, relative risk 1.74;6 to 7.9 cm, relative risk 1.85;8 to 9.9 cm, relative risk 2.16; 2 10 cm, relative risk 1.82. The difference in survival between those with < 2 cm residual diseaseand those