Robert W. Schmidt

The Prognosis and Treatment of Stage I Adenocarcinoma of the Cervix

&NA; A review of 125 patients with stage I adenocarcinoma of the cervix is reported. The subtypes included endocervical (60), adenosquamous (38), papillary (15), clear cell (nine), and mucoid (three). The cumulative 5‐year survival was 60%, and was significantly related to the following: tumor differentiation—well‐differentiated 80%, moderately differentiated 69%, poorly differentiated 41%; lymph node status—nodes positive 28%, nodes negative 82%; the amount of residual disease present in the cervix after radical hysterectomy; and the interval from the previous pelvic examination. Survival was not significantly influenced by histologic subtype, patient age, number of positive lymph nodes, or tumor size beyond 3 cm. Treatment included radical hysterectomy with or without bilateral salpingo‐oophorectomy, radiation therapy, radiation therapy with hysterectomy, and hysterectomy followed by radiation therapy. The best cumulative 5‐year survival (93%) was found in patients treated by radical hysterectomy without bilateral salpingo‐oophorectomy, whereas the poorest survival (18%) was in those treated by standard hysterectomy followed by radiation therapy. Ovarian conservation seems to be an acceptable alternative to bilateral salpingo‐oophorectomy in the young patient undergoing radical hysterectomy.

Control of experimental traumatic renal hemorrhage by embolization with autogenous blood clot.

Hemorrhage from artificially produced renal lacerations was controlled by selective arterial embolization with either plain or Amicar-mixed autogenous blood clot in ten dogs. The laceration sites healed as renal scars. Despite the presence of scattered, small renal infarcts caused by the embolization, hypertension did not develop in any dog during the two-month follow-up. No long-term differences could be detected between kidneys embolized with plain or modified clot. Although it is recognized that dogs have a more active fibrinolytic system than humans, the results of this study suggest that selective arterial embolization is a feasible method for controlling renal hemorrhage.

The university experience of clinical and pathological findings of ovarian neoplasms in children and adolescents

Abstract Study Objective: A retrospective study to evaluate the clinical and pathological findings of ovarian neoplasms in children and adolescents at the University of Michigan Hospitals was designed. Design, Setting, Participants: From January 1964 to December 1989, 88 patients (aged 8½ months to 19 years) with ovarian neoplasms were evaluated at the University of Michigan Hospitals. Interventions, Main Outcome Measures: Clinical and pathological features were analyzed. The age at diagnosis and pertinent symptoms and signs of the tumors were reviewed. Lower abdominal pain was the most common presenting symptom. The survival status for the malignant neoplasms was examined. Results: A total of 101 ovarian neoplasms were found in 88 patients. Sixty-eight percent of the tumors were benign and 32% were malignant. Fifty-five of the neoplasms were tumors of germ cell origin. Of these, approximately two-thirds were benign teratomas. The remaining germ cell tumors consisted of immature teratomas, dysgerminomas, embryonal cell carcinomas, and endodermal sinus tumors. Twenty-seven of the benign tumors were of epithelial origin. Five of the benign tumors were of sex cord-stromal origin. The malignant tumors consisted of 4 epithelial, 8 sex cord-stromal, and 18 neoplasms of germ cell origin. Two of the malignant tumors were lymphomas. Conclusion: With the current use of chemotherapy, patients with malignant tumors often can undergo conservative surgery, resulting in the maintenance of reproductive and endocrine function.

Alterations in Gastric Physiology Caused by Selective Embolization and Vasopressin Infusion of the Left Gastric Artery

Alterations in gastric physiology caused by selective embolization and vasopressin infusion of the left gastric artery were evaluated in 29 dogs. Gastric acidity was not significantly altered following Gelfoam embolization but decreased sharply with vasopressin infusion. These results suggest that the segmental occlusion caused by Gelfoam embolization permits significant collateral blood flow to the gastric mucosa, while the arteriolar and capillary constriction caused by vasopressin effectively decreases mucosal blood flow. These findings are consistent with the clincal observation that embolization is more effective in controlling bleeding ulcers, while vasopressin infusion is more effective for controlling hemorrhagic gastritis.

Selective arterial infusion of vasoconstrictors for control of traumatic splenic hemorrhage.

The spleen of each of 20 mongrel dogs was traumatized by creating a wedge laceration, and selective arterial infusion was then performed with vasopressin in four dogs, pituitrin in eight, and epinephrine in eight. Infusion therapy with vasoconstrictors controlled the splenic hemorrhage in 19 of 20 dogs. The 15 dogs surviving the experimental period of four to eight weeks showed well-healed scars at the sites of lacerations. Three dogs had small contracted spleens as a result of massive infarction. The results of this experiment indicate that splenic hemorrhage in the experimental dogs can be controlled by selective infusion of pituitrin or vasopressin, but is more effectively controlled with epinephrine.