Steven G. Bernstein

Pathology slide review in gynecologic oncology.

Objective To analyze the diagnostic accuracy and alteration in treatment planning from interinstitution (different institution) pathologic consultation. Methods We reviewed pathologic reports from 720 referred patients. The diagnosis rendered from a gynecologic pathologist was compared with the original diagnosis. Discrepancies were coded as none, minor, or major. A discrepancy was major if it led to treatment alteration. A discrepancy was minor if it did not lead to treatment alteration. The judgment to declare a discrepancy was made by a gynecologic pathologist, a gynecologist, and three gynecologic oncologists. The review cost was

Adenoid cystic carcinoma of Bartholin’s gland

150 per case. The Cochran Mantel-Haenszel test evaluated any systematic pattern in discrepancies. Results Seven hundred twenty specimens consisted of 113 vulvar, 170 uterine, 289 cervical, 105 ovarian, and 43 vaginal tissues. Six hundred one (84%) pathologic diagnoses showed no discrepancy. There were 104 (14%) minor and 15 (2%) major discrepancies. After reviewing 15 major discrepancies, six surgeries were canceled, two surgeries were modified, one adjuvant radiation treatment was added, one chemotherapy treatment was modified, and five adjuvant chemotherapy treatments were cancelled. No systematic error was identified with regard to the sources (tissue origin) or methods of obtaining the specimen (P = .675). The cost of reviewing 720 specimens was

Preventing major operative site infection after radical abdominal hysterectomy and pelvic lymphadenectomy

108,000. The cost of identifying each major discrepancy was

Prevalence of papillomavirus infection in colposcopically directed cervical biopsy specimens in 1972 and 1982

7200. Conclusion Reviewing pathology slides before definitive treatment reveals notable discrepancies in diagnoses. The cost of pathology review is globally expensive but has consequential impact on proper treatment planning for the individual patient.

Adenocarcinoma of the Endometrium

A patient with adenoid cystic carcinoma of Bartholins gland is reported and the literature relevant to this disease reviewed. The clinical presentation is characterized by a vulvar mass that has existed for a prolonged period prior to the onset of symptoms, usually infection, pain, and burning. Histologically the tumor is characterized by a cribriform pattern and perineural invasion. Electron microscopy confirms the epithelial nature of this lesion. Conclusions concerning therapy are presented, including emphasis on initial radical vulvectomy and the fact that the efficacy of routine lymphadenectomy and adjuvant radiotherapy has not been demonstrated.

MP13-17 CATHETER MANAGEMENT AFTER TRANSURETHRAL RESECTION AND ABLATION PROCEDURES FOR BENIGN PROSTATIC HYPERPLASIA: APPROPRIATENESS CRITERIA OBTAINED USING THE RAND/UCLA APPROPRIATENESS METHOD

Twenty-one women who underwent radical abdominal hysterectomy and pelvic lymphadenectomy were enrolled in a prospective, comparative, randomized, placebo-controlled clinical trial of antimicrobial prophylaxis. Preoperative endocervical flora was identified and was similar in pre- and postmenopausal private and clinic service women; 46% of the 119 preoperative isolates produced beta-lactamase enzyme. Women were given three doses of either placebo or cefoperazone plus sulbactam, an irreversible beta-lactamase enzyme inhibitor. Three women (27%) given placebo developed abdominal incision infections; one women given placebo also developed a pelvic infection. None given antibiotic developed operative site infection, but one women developed a drain site infection. A major operative site infection rate of 27% observed with placebo is high enough to warrant prophylaxis. Although antimicrobial prophylaxis at radical hysterectomy and pelvic lymphadenectomy eradicted operative site infection in our patient populations, a literature review indicates that individual determination of a requirement for prophylaxis is necessary.

Vicryl mesh in pelvic floor reconstruction

A total of 1264 consecutive cervical biopsy specimens obtained at the Parkland Memorial Hospital Dysplasia Clinic during 1972 were reviewed. Histopathologic specimens were assessed with special reference to changes induced by human papillomavirus. In 1972, only 0.7% of biopsy specimens were reported as consistent with human papillomavirus infection. Upon review, however, 36.5% of these specimens were found to demonstrate histologic criteria for the diagnosis of human papillomavirus infection. Approximately half of biopsy specimens reclassified as human papillomavirus were originally interpreted as inflammation; the others were interpreted as cervical intraepithelial neoplasia. Patients with human papillomavirus infection were significantly younger than patients with cervical intraepithelial neoplasia (24.9 versus 30.2 years). These findings were compared with 965 cervical biopsy specimens obtained in 1982. Thirty-four percent of these biopsy specimens revealed human papillomavirus infection. These observations support the concept that human papillomavirus infection of the cervix is not a new entity but a previously unrecognized finding whose prevalence has been relatively stable over a 10-year period.

Intraoperative lymphatic mapping in cervix cancer patients undergoing radical hysterectomy: A pilot study.

Endometrial carcinoma is the most common malignancy of the female genital tract, with an estimated 39,000 new cases of invasive carcinoma of the endometrium and 3000 deaths in 1982.1 During the three decades before 1970 the incidence of cancer of the uterine corpus in the United States had been stable. Weiss et al.2 examined the incidence rates of endometrial cancer from eight areas in the United States served by population-based cancer reporting systems and concluded that the incidence of endometrial cancer had risen sharply in the 1970s. The use of estrogen preparations by postmenopausal women is presumed to be responsible for this increasing incidence of endometrial cancer. More recently, a trend in decreasing incidence of endometrial carcinoma has been noted. This is speculated to be due to an increased number of hysterectomies being performed and a decreasing use of estrogen preparations by postmenopausal women.3

Vicryl mesh in pelvic floor reconstruction.

vs 76.9%, p1⁄4.013). There was a similar trend in patients with diabetic nephropathy (defined as significant proteinuria) as shown in Table 1. CONCLUSIONS: Increased age, Caucasian race and more medical co-morbidities are associated with an increased risk of LUTS in men with DM. While diabetics with evidence of end organ damage report an increase in specific urinary symptoms, they report fewer total number of LUTS. This data demonstrates the importance of screening diabetics for LUTS and suggests specific LUTS may be a harbinger of clinical deterioration in these patients.

Effects of Race and Socioeconomic Factors on Emergency Department Management of Threatened Abortion [26J]

women undergoing pelvic exenteration. The technique is described. The follow-up ranged from three to 31 months and no patient developed a bowel problem. The material seems to be appropriate for this use, is completely absorbed, and acts as a latticework for the deposition of granulation tissue. The technique can be applied in patients requiring pelvic irradiation following surgery for malignant neoplasms of the gastrointestinal or genitourinary tracts. The small bowel is effectively held out of the pelvis and the radiation field, and is spared the effects of the radiation beam. (Arch Surg 1985;120:1389-1391)