Helmut F. Schellhas

Radiation-Induced Bladder Tumors

A recent 25-year experience with patients treated for carcinoma of the uterine cervix who subsequently had bladder tumors is presented. Of the 3,091 patients treated 2,674 had received radiotherapy and 8 suffered vesical malignancies of varied histopathological type 6 months to 20 years after irradiation. This incidence rate is 299.9 per 100,000, which is 57.6 times that of the general female population. Benign radiation reactions of the bladder and the possible etiology of radiation-induced bladder cancers are discussed.

Successful treatment of placental choriocarcinoma metastatic to brain followed by primary brain glioblastoma

Abstract A 17-year-old patient was found to have metastatic choriocarcinoma to the brain and lungs while pregnant. A primary lesion was found in the placenta. Complete remission was obtained with combination chemotherapy and whole brain radiation therapy. Subsequently, the patient delivered two normal infants. Six years after therapy she developed two foci of glioblastoma in the contralateral cerebral and cerebellar hemispheres.

Vaginal reconstruction after total pelvic exenteration using a modification of the Williams' procedure.

Abstract The complete rehabilitation of women who have been subjected to ultraradical pelvic surgery should include the reconstruction of a functional vagina. The creation of a vaginal pouch as described by Williams for patients with congenital absence of the vagina or vaginal stenosis may be considered in some of these patients. The principle of his operative procedure can be applied to anatomic conditions in which the vagina and vulva have been resected utilizing perineal tissue structures and skin grafts. This is demonstrated in two patients with different postoperative perineal defects.

Prognostic factors and the significance of cytologic grading in invasive squamous cell carcinoma of the vulva: A clinicopathologic study

Clinical staging, tumor size, histologic differentiation, cytologic grading, depth of stromal invasion, and vascular channel involvement by tumor cells were studied in 42 patients with invasive squamous cell carcinoma of the vulva who were treated with radical vulvectomy and inguinal-femoral lymphadenectomy. All parameters were found to correlate well in predicting groin node metastasis. Cytological grading was found to be more significant compared to histologic grading in regard to nodal metastasis (P less than 0.02). No patient with cytologic or histologic grade 1 tumor and less than 5 mm stromal invasion was found to have nodal metastasis.

Extraperitoneal surgical approach to the pelvis after radiation therapy or radical surgery

Use of extraperitoneal surgical procedures in patients who have developed a retroperitoneal surgical problem after radiation therapy, primary radical surgery, or both has the advantages of excellence of exposure, shortness of operating time, isolation of infections, and avoidance of bowel manipulation. The surgical technique was adjusted to each individual patients needs in the 21 patients involved in this study. Intensified pelvic fibrosis with constriction of ureter and pelvic vessels postoperatively was experienced in one patient. The surgical exploration should remain confirmed to the area of interest.

Surgical Lasers In Gynecology

Multipurpose surgical CO2 lasers marketed in the USA have been developed to be applicable to a variety of surgical procedures in many surgical fields. They are all suited for endoscopic surgical procedures and can be fitted to all standard surgical microscopes. They all can adjust the focal length of the laser beam to the different standard focal lengths of the surgical microscope which for instance in laryngoscopy is 400 mm and in colposcopy 300 mm. One laser instrument can even change the spot size in a given focal distance which is very advantageous for some microsurgical procedures (Merrimack Laboratories 820). All multipurpose surgical CO2 laser systems provide a multi-articulated surgical arm for free-hand surgery. The surgical arms are cumbersome to use but they are adapted to the surgeons needs with ingenuity. The practicality of the multi-articulated surgical arms depends mostly on the distance of the handpiece from the surgical console which now is also overbridged by the laser tube in most surgical laser system. The spot size of the beam is variable in most handpieces by interchangeable lenses which modify the focal distance of the beam and the power density. Another common feature in all systems is a coaxial He-Ne pilot light which provides a red spot which unfortunately becomes invisible in a bleeding surgical field. Most surgical laser systems have a spacial mode of TEM 00 which is essential for incisional surgery. The continuous mode of beam delivery is used for incisional surgery and also for most endoscopic procedures.