Cameron R. John

The impact of frontal and non-frontal brain tumor lesions on Wisconsin Card Sorting Test performance

Several lesion and imaging studies have suggested that the Wisconsin Card Sorting Test (WCST) is a measure of executive dysfunction. However, some studies have reported that this measure has poor anatomical specificity because patients with either frontal or non-frontal focal lesions exhibit similar performance. This study examined 25 frontal, 20 non-frontal low-grade brain tumor patients, and 63 normal controls (NC) on the WCST. The frontal patients were also assigned to either a left frontal (n=10) group or a right frontal group (n=15) and compared with the non-frontal group and NC. It was hypothesized that the frontal brain tumor patients would display greater deficits on categories achieved and a higher number of perseverative errors than non-frontal brain tumor patients on the WCST. Finally, it was predicted that right frontal brain tumors would result in greater executive functioning deficits than left frontal or non-frontal brain tumors. Results indicated that the left frontal group achieved the fewest categories and committed the most perseverative errors compared to the other patient and normal control groups. In addition, the left frontal group committed significantly more perseverative errors than the right frontal group. These results suggest that the WCST is sensitive to the effects of low-grade brain tumors on executive functioning.

The impact of low-grade brain tumors on verbal fluency performance

Verbal fluency has traditionally represented left hemispheric function, based on large acquired lesion studies. However, recent functional imaging studies have demonstrated bilateral hemispheric activation during phonemic and semantic word generation tasks. We examined 25 left hemisphere (LH) and 26 right hemisphere (RH) low-grade brain tumor patients on semantic and phonemic fluency. Patients were also assigned to a combined anterior (left and right) group (n=26) or a combined posterior (left and right) group (n=20) and compared with normal controls (NC; n=57). We hypothesized that there would be greater left than right hemispheric phonemic and semantic fluency impairments. We also hypothesized that there would be greater anterior, specifically left anterior, than posterior impairments on phonemic fluency given their respective retrieval and initiation requirements. Finally, it was predicted that the LH patients, particularly the left posterior group, would exhibit the greatest semantic fluency impairments. Results indicated that on semantic fluency, the LH group produced significantly fewer semantic fluency responses compared to the RH group, but the expected left posterior and left frontal group differences were not found. There were no significant patient group differences associated with phonemic fluency. While we encountered semantic fluency impairments in this brain tumor population, we did not find the extensive deficits associated with the distinct or localized brain regions previously reported in the literature.

A Retrospective Review of the GelPort System in Single-Port Access Pelvic Surgery

STUDY OBJECTIVE Since the advent of single-port access surgery, novel instruments have been developed to facilitate this laparoscopic approach. The GelPort system is an innovative sealing device that permits abdominal access and frequent instrument exchange during surgery while preserving the pneumoperitoneum. The GelPort system has been previously reported in gastric, colorectal, and urologic single-port access procedures but has yet to be described during pelvic surgery. DESIGN A retrospective pilot study reviewing 19 single-port access pelvic surgeries that involved the GelPort system was undertaken. Patient and operative statistics, including diagnosis, surgery and anesthesia times, complications and length of hospital stay were evaluated (Canadian Task Force Classification II-2). RESULTS Operative time exhibited a direct association with anesthesia time (p=.001). Additionally, patient blood loss (p=.043) and anesthesia time (p=.003) were significant prognostic indicators for length of hospital stay. There were no significant patient complications or subsequent port site hernias. CONCLUSIONS The GelPort system appears to contribute favorably to single-port access surgery because the device permits circumferential access and retraction during instrumentation. Furthermore, the specialized design augments a surgeons versatility and access to complicated anatomic regions without compromising the peritoneum.

Perivascular Epithelioid Cell Neoplasms: A Systematic Review of Prognostic Factors

Perivascular epithelioid cell tumors (PEComas) are rare, soft tissue tumors characterized by epithelioid cells with clear or eosinophilic cytoplasm and a perivascular disbursement. We compiled the treatment and follow-up results from an extensive collection of reported gynecologic PEComa cases and statistically analyzed their respective therapy modalities and corresponding patient outcomes. In the group of patients with PEComa who received surgical management alone, there was a tendency for them to exhibit a lower disease recurrence rate. Conversely, patients with PEComa who initially received surgery and chemotherapy or radiation therapy were associated with a higher disease recurrence rate (P =.024). Metastatic involvement was related to higher patient mortality rates (P =.0001), although this finding was unrelated to treatment type. Surgical management alone may suffice for nonaggressive lesions, but chemotherapy and radiotherapy appear necessary for patients who present with high-risk histologic condition or metastatic disease. Because PEComas exhibit varying biologic behavior and an ill-defined presentation, the treatment for these lesions necessitates further evaluation.

Individual physician experience with laparoscopic supracervical hysterectomy in a single outpatient setting.

The authors report the surgical experience of a single physician operating at 1 outpatient surgery center using laparoscopic supracervical hysterectomy for the treatment of 100 patients with benign gynecologic disease. Operative status was evaluated in terms of patient morbidity, length of surgery, blood loss, and duration of hospital stay. The mean operative time was 2.6 hours, and the mean anesthesia time was 3.2 hours. The mean estimated blood loss was 116.6 mL, and the mean patient hospital stay was 16.5 hours. There were no reported intraoperative or postoperative complications. Laparoscopic supracervical hysterectomy was not feasible and was converted to laparotomy and total abdominal hysterectomy in 4 patients. The authors present one of the first individual physician experiences at a single outpatient surgery center using laparoscopic supracervical hysterectomy for benign gynecologic conditions. Optimal patient postoperative stay and a minimal complication rate suggest that this procedure performed at a single outpatient surgery center is feasible.

Attention in adult intracranial tumors patients.

This study investigated the neuropsychological effects of intracranial tumors on attention, prior to irradiation and chemotherapy. Subjects (n =55) being treated for low-grade, supratentorial brain tumors were administered tests of attention and working memory. We divided the tumor patients into a “superficial” regional group (e.g., gliomas that infiltrate white matter and meningiomas attached to the cortical surface) and classified them into four brain regions: anterior left side, anterior right side, posterior left side, posterior right side. The groups were also classified into either a combined anterior group or combined posterior group, and either a combined left hemispheric group or combined right hemispheric group. All groups were compared to deep tumor (DT) patients (e.g., pituitary and pineal tumors) and a demographically normal control (NC) group (n =63). While the NC group primarily outperformed the brain tumor groups on the neuropsychological measures, there were instances where the individual brain tumor groups demonstrated higher scores than the NC group. Significant differences among the brain tumor groups were only found on Digits Forward. The DT group performed significantly worse than the superficial regional groups and the combined anterior and combined posterior groups on Digits Forward. The DT group was also worse than the combined left hemispheric and right hemispheric groups on Digits Forward. The fact that the DT group performed similarly to the other patient groups on the remaining attention measures suggests that these tumors are associated with especially poor attentional performance.

Clinical utility of CA-125 for maintenance therapy in the treatment of advanced stage ovarian carcinoma.

Abstract Maintenance therapy has been extensively studied to discern any prospective therapeutic advantage in the treatment of advanced stage ovarian carcinoma. The CA-125 assay may have prognostic benefit in determining whether this treatment regimen is appropriate for ovarian carcinoma patients who achieve a complete response to first-line therapy. We retrospectively documented the CA-125 levels of 2 advanced ovarian cancer patient groups who exhibited a clinically defined complete response to their primary induction therapy. Patients were then treated with a paclitaxel-based maintenance therapy regimen. The first group (group A; n = 13 patients) received 3 cycles of single-agent paclitaxel maintenance therapy, and the second group (group B; n = 13 patients) received 12 cycles of single-agent paclitaxel maintenance therapy. The premaintenance therapy CA-125 serum levels (<10 or ≥10 U/mL) of the 2 treatment groups were then retrospectively evaluated in an intragroup analysis to discern any relationship with progression-free survival (PFS) and overall survival. There was a statistically significantly relationship between the CA-125 levels (<10 U/mL) premaintenance therapy and PFS. The patients who had the lowest CA-125 levels exhibited the most favorable PFS results. Despite the limited sample size and nonrandomized nature of this study, these results are provocative and suggest that advanced ovarian cancer patients who achieve an excellent response to primary platinum-based chemotherapy with a CA-125 serum level less than 10 U/mL may be more amenable to the benefits of paclitaxel maintenance therapy.

Impact of Gynecologic Oncologists on Referral Patterns and Care of Patients with Uterine Malignancies at a Community Hospital

Objective: The purpose of this study was to assess the impact of the introduction of gynecologic oncology services at a community hospital on patterns of referral and responsibility for management of patients with uterine malignancies. The number of patients treated at, and referred from, the study hospital over a 19-year period is reported. The increase in the utilization of the gynecologic oncologist by the general gynecologist over the study period is detailed. Methods: From January 1981 to December 1999, 543 patients were diagnosed and received total or partial treatment for uterine malignancy at Hoag Memorial Hospital Presbyterian in Newport Beach, CA. Patients were categorized according to the type of treatment (surgery, radiotherapy) administered, stage of disease, and degree of gynecologic oncologist involvement with patient care. Results: Utilization of a gynecologic oncologist as a primary surgeon, assistant surgeon, or postoperative consultant increased gradually to more than 90%. The number of...