J. George Moore
University of California, Los Angeles
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American Journal of Obstetrics and Gynecology | 1990
Joseph C. Gambone; Robert C. Reiter; Joel B. Lench; J. George Moore
A criteria-based quality assurance process for hysterectomy was instituted at a large teaching hospital. After this process was initiated, the overall frequency of hysterectomy decreased by 24%, p less than 0.001. Significant reductions were seen in hysterectomy rates for the following indications: chronic pelvic pain (77%, p less than 0.0001), recurrent uterine bleeding (46%, p less than 0.001), preinvasive disease of the uterus (55%, p less than 0.005), and severe infection (70%, p less than 0.025). Adenomyosis was the single indication for which an increase in hysterectomy rate was observed. This increase, however, was completely reversed during the last 2 years of the study. This quality assurance process also resulted in a significant increase in the histologic verification rate (i.e., 82% vs 93%, p less than 0.001). These observations suggest that using such a criteria-based process can reduce the number of hysterectomies performed and improve the accuracy of the preoperative diagnosis.
Cancer | 1978
Watson G. Watring; James A. Roberts; Leo D. Lagasse; Michael L. Berman; Samuel C. Ballon; J. George Moore; Roger E. Schlesinger
Seven patients with recurrent Pagets disease of the vulva underwent treatment with topical bleomycin (NSC 125066‐Blenoxane®, Bristol Laboratories) ointment. None had an associated invasive carcinoma. Four patients experienced a complete, objective response to this therapy, and one of these has responded completely to treatment of a subsequent recurrence. In two patients the response could not be evaluated. All patients experienced pain in the treated area; one, developed systemic toxicity to bleomycin requiring cessation of therapy. Topical bleomycin appears to benefit selected patients with recurrent Pagets disease of the vulva.
American Journal of Obstetrics and Gynecology | 1961
J. George Moore; Daniel G. Morton; John W. Applegate; William R. Hindle
Summary 1. Two hundred and eighty-five patients suspected to have early, usually subclinical cervical cancer were subjected to cervical conization. 2. Systematic investigation of the conization specimens revealed 28 infiltrative cervical cancers, 156 intraepithelial or superficially invasive (microinvasive) cancers, and 37 severe squamous atypias. 3. The superficially invasive cancers (68 patients) were grouped with the truly intra-epithelial cancers as Stage 0. 4. Seventy-five percent of the Stage 0 cancers were treated by total hysterectomy. Residual cancer was demonstrated in 30 per cent of the hysterectomy specimens. 5. If during investigation of the cone, the Stage 0 lesion was assessed to be cleared, residual cancer could be found in only 6.5 per cent of the hysterectomy specimens. If the lesion was not designated as cleared by the cone, 45 per cent residual cancer was demonstrated. 6. Conization, as such, has a definite place in the management of young women with Stage 0 cervical cancer. This restricted treatment should only follow a thorough diagnostic evaluation and should be undertaken only if adequate follow-up surveillance can be assured.
American Journal of Obstetrics and Gynecology | 1988
J. George Moore; Mark A. Binstock; William A. Growdon
Over the past 10 years five patients with endometriosis involving only retroperitoneal structures in the pelvis without intraperitoneal involvement have been managed at the University of California-Los Angeles Hospital. These patients have presented difficult diagnostic and therapeutic problems. Moreover, this interesting but uncommon distribution of the disease has led to speculation concerning its pathogenesis. The substantial threat to the urinary tract and rectosigmoid colon is noted. Although a concurrent study at this hospital indicates a low incidence of endometriosis involving pelvic lymph nodes, it is quite apparent from the distribution of these instances of retroperitoneal involvement that its spread from the endometrium very likely takes place through pelvic lymphatics.
Gynecologic Oncology | 1976
Michael L. Berman; Leo D. Lagasse; Watson G. Watring; J. George Moore; McClure L. Smith
Abstract Enteroperineal fistulae represent one of the most serious complications following pelvic exenteration. Thirteen patients with this complication were treated at UCLA and City of Hope hospitals since 1956. Of the first nine patients managed with a variety of methods, there was only one survivor. Because of these poor initial results, a 10-point program of management of this complication was developed. This program consisted of preoperative Hypaque small bowel X rays, a small bowel tube, hyperalimentation, prophylactic antibiotics, and early surgical intervention. Specific recommendations for surgical management included the isolation of the fistula without resection, the creation of a double-barreled mucous fistula to drain the involved segment of small bowel, and the performance of an anastomosis between more proximal ileum and ascending or transverse colon. Results in four patients so managed have been encouraging and all four patients were subsequently discharged from the hospital ambulatory.
American Journal of Obstetrics and Gynecology | 1973
Leo D. Lagasse; G.H. Johnson; McClure L. Smith; Munir F. Nasr; Ralph Byron; J. George Moore
Abstract Pelvic exenteration with rectal substitution using a mobilized segment of sigmoid colon was carried out in 11 selected patients with advanced pelvic malignancy. Satisfactory “rectal” function was achieved in six patients, eliminating the need for permanent colostomy. Rectal substitution was made possible by preserving the rectal sphincter to which the sigmoid colon segment was anastomosed. The portion of the procedure dealing with excision of the tumor and surrounding structures was not altered in patients selected for rectal substitution. With apparent increasing success in radical pelvic surgery, including decreasing operative mortality rates, efforts to increase patient acceptance by alleviating the disfigurement and disability of a permanent colostomy would seem worthwhile.
Obstetrical & Gynecological Survey | 1982
Jonathan S. Berek; Thomas W. Castaldo; Neville F. Hacker; Edmund S. Petrilli; Leo D. Lagasse; J. George Moore
One hundred patients with primary adenocarcinoma of the uterine cervix were evaluated. Of the 48 Stage I patients, 13 were treated with radical surgery, 16 with radiation alone, and 19 with combination therapy. Life table analysis of Stage I patients showed no significant difference in survival for those treated with radical surgery or combination therapy. Both groups had a greater five-year survival (P less than 0.05) than those treated with radiation. Recurrences in Stage I were more frequent with primary radiation alone, both locally and at distant sites (P less than 0.01). Greater tumor size was related to poorer survival, and failures in patients with larger lesions were more common in those treated with radiation therapy. Survival for the 32 Stage II patients was greater for those treated with combination therapy. Higher tumor grade was associated with poorer survival for each stage, regardless of treatment. More complications were associated with radiation therapy than with radical surgery. Radiation therapy alone is not sufficient for patients with Stage I and II disease, and radical surgery may be appropriate treatment for Stage I disease.
Obstetrical & Gynecological Survey | 1978
Michael L. Berman; Leo D. Lagasse; Watson G. Watring; Samuel C. Ballon; Roger E. Schlesinger; J. George Moore; Robert C. Donaldson
Seventy patients with cervical cancer who were not candidates for primary operative treatment underwent operative evaluation prior to radiation therapy. Thirty-one were explored through a transperitoneal approach and 39 through an extraperitoneal approach. The operative procedure consisted of bilateral pelvic and periaortic lymphadenectomy and exploratory laparotomy, with additional intraperitoneal biopsies taken as indicated by operative findings. Poor correlation was seen between operative findings, lymphangiography, and clinical staging. Radiation therapy was extended to include sites of biopsy proven metastases. The group of patients operated on through a transperitoneal approach experienced a 30% complication rate secondary to small bowel damage following radiation therapy, and 2 patients died as a result of complications. All patients with small bowel complications explored in this manner required surgical correction. The group of patients operated on through an extraperitoneal approach had a 2.5% morbidity secondary to small bowel complications, and there were no deaths or serious complications in these patients. No patients explored in this manner required subsequent operation for complications following radiation therapy.
Archive | 1998
Neville F. Hacker; J. George Moore
Gynecologic Oncology | 1983
Neville F. Hacker; Roberta K. Nieberg; Jonathan S. Berek; Ronald S. Leuchter; William E. Lucas; Hisham K. Tamimi; James F. Nolan; J. George Moore; Leo D. Lagasse