Robert L. Coleman

Unexplained decrease in measured oxygen saturation by pulse oximetry following injection of Lymphazurin 1% (isosulfan blue) during a lymphatic mapping procedure

A rare case of alteration in measured pulse oximetry during a lymphatic mapping procedure for cervical carcinoma is reported. Over a 5‐min period following injection of perilesional Lymphazurin 1% dye (3 ml total), a profound pulse oximetry desaturation was observed. Concomitant arterial blood gas determinations confirmed patients well‐being. Interaction of this agents absorptive spectroscopy and wavelengths used to measure oxygen saturation by commercial pulse oximetry devices is suspected. J. Surg. Oncol. 1999;70:126–129.

Adequacy of oophorectomy at the time of gynecologic surgery.

Objectives: To determine the incidence of incomplete ovarian removal during gynecologic surgery and correlate the risk of inadequate removal with the procedure chosen. Methods: This is a prospective observational study. Ovaries received during a 4‐month period in the participating institutions were independently histologically evaluated. Gross inspection of the ovarian capsule, infundibulopelvic ligament, hilum and utero‐ovarian ligament was assessed. Grossly close margins were confirmed histopathologically. Any margin with histologically confirmed ovarian tissue at the margin was interpreted as incompletely removed. Details of each surgical procedure were recorded for comparison. Results: Ovaries (n=174) from 94 patients were collected and 155 were evaluable. The overall incidence of incomplete ovarian removal was 6.5%. Of the 125 ovaries removed abdominally, 23 were laparoscopically assisted and 7 were vaginal; inadequate removal was documented in 5%, 9% and 29%, respectively (P=0.04). There was no relationship of inadequate resection by underlying pathologic diagnosis (P=0.25) or by institution (4.6% university hospital vs. 8.8% community hospital; P=0.29). Conclusions: Incomplete ovarian removal occurs and is related to surgical approach. A larger study is warranted to evaluate the role of pelvic pathology or surgeon experience as a risk for incomplete oophorectomy.

Primary vaginal melanoma: A rare and problematic clinical entity

Understanding and planning efficacious management for a rare malignancy in which little specific pathobiological and clinical data are available is challenging and frequently calls for ones best appraisal of the reported trial and errors of treatment frequently modeled on the disease in a common locale or histology. In some cases, such as epithelial squamous cell carcinoma of the ovary, the treatment strategy is largely commutable (i.e., maximal surgical effort and adjuvant chemotherapy); others, such as small carcinoma of the cervix or uterine papillary serous carcinoma, require more deductive imagination as the standard management program may not address the specific natural history characteristics of the histology in that locale (e.g., a greater propensity for intraabdominal or distant metastases). 1-3 Unfortunately, meaningful randomized clinical trials of these entities are unlikely to be the methodology for outlining future treatment. Yet, for the patient, a treatment decision must be made--a decision that usually falls in the purview of empiricism. While tumormolecular profiling may help in modulating ones expectations in this regard and in some cases (e.g., gastrointestinal stromal tumors) may identify novel therapeutic targets, the additional information frequently only highlights the complexity of the malignant process? When enough patients, treated and untreated, are reviewed, specific attention can be paid to important characteristics of metastatic spread, patterns of recurrence, responses to specific therapeutic modalities, and natural history. While far from perfect, repeated assessment be-

Role of Pericytes in Resistance to Antiangiogenic Therapy

Angiogenesis plays an important role in the progressive growth of primary tumor and metastasis, and targeting tumor angiogenesis as a therapeutic strategy is showing promise. While these approaches have shown improved survival for some cancer patients, most eventually develop progressive disease due to resistance to antiangiogenic therapy. Recent evidence suggests a functional role for pericytes in acquired resistance to antiangiogenesis agents. Pericytes play an important role in stabilizing blood vessels in the microvasculature regulated by the PDGF ligand (PDGF-BB) and receptor (PDGFR-β) homeostasis, and serve as a local source of survival factors for endothelial cells. Therefore, dual targeting of pericytes (PDGF axis blockers) and endothelial cells (VEGF pathway blockers) may be more efficacious than targeting either cell type alone.

Vulvar lymphatic mapping: Coming of age?

Over the last 50 years, refinement in the management of vulvar carcinoma has progressed methodically through alterations in surgical radicality, incorporation of adjuvants (chemotherapy and radiation), and patient selection for the use of these modalities. Our challenge to the Halsteadian approach of oncologic surgery in the vulva has proceeded cautiously as that model proved efficacious for survival, albeit, often at the cost of lasting morbidity. The application of lymphatic mapping and sentinel node identification represents another tempting step in this process; the carrot being the promise of improved nodal precision and reduced morbidity. Examination of our past in this regard shows that the carrot is indeed enticing. Although cutaneous melanoma is an uncommon malignancy of the vulvar epithelium, its occurrence is enigmatic as our knowledge of the natural history and appropriate definitive treatment is lacking. Reviews from retrospective studies have been inconclusive and adaptation of the management from other cutaneous sites has dictated treatment strategy. Therefore, wide radical excision (up to 5 cm of normal appearing skin) of the local site or radical vulvectomy and inguinal-femoral lymphadenectomy has been the dictum of treatment. Recent experience, however, has called into question the necessity of both the degree of radicality at the primary site and the completeness of nodal dissection necessary to obtain what appears to be only prognostic information from the regional drainage basins. 1-3 Although more typical circumferential margins (1-2 cm) are replacing the radical approach locally, the decision of whether to complete full lymphadenectomy is often left to impre-

Prognostic and predictive factors in gynecologic cancers

Prognostic and predictive factors in gynecologic cancers / , Prognostic and predictive factors in gynecologic cancers / , کتابخانه دیجیتال جندی شاپور اهواز