Gynecologic oncology
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Gynecologic oncology · Jul 1990
Simplified postoperative patient-controlled analgesia on a gynecologic oncology service.
Twenty-nine women who underwent various abdominal operations for gynecologic malignancies self-administered postoperative analgesia by means of disposable Travenol Infusors with Patient Control Modules. Administration of morphine sulfate at a rate of 1 mg per injection and a maximum of 10 mg per hour via patient-controlled analgesia was judged satisfactory by all 29 patients. ⋯ No respiratory depression occurred and excessive sedation was reported by only 2 patients after the first 24 hr postoperatively. If further surgeries were required, more than 90% of these patients would prefer patient-controlled analgesia to intramuscular injections.
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Gynecologic oncology · Jul 1990
Case ReportsIntestinal complications associated with use of the Dexon mesh sling in gynecologic oncology patients.
Three cases of postoperative enterocutaneous fistula formation following use of the Dexon mesh sling are reported from two gynecologic oncology services. Two patients had intestinal trauma or bowel resection at the time of mesh placement. Postoperative submesh abscess formation was noted in only one patient. Factors which might predispose to fistula formation after mesh placement, particularly in previously radiated patients, and techniques which might be used to avoid this complication are discussed.
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Gynecologic oncology · Dec 1989
Comparative StudyPostoperative pain management in gynecology oncology patients utilizing epidural opiate analgesia and patient-controlled analgesia.
Intraoperative analgesia is the purview of anesthesiologists whereas postoperative pain is traditionally managed by surgeons. This series reports 19 months experience of anesthesiologists using epidural opiate analgesia (EOA) or patient-controlled analgesia (PCA) to treat postoperative pain in 302 patients following surgery for pelvic malignancy. For the 244 (81%) patients who received EOA, a lumbar epidural catheter was placed just prior to surgery, injected with local anesthetic for intraoperative analgesia, and injected with preservative-free morphine at appropriate intervals postoperatively to relieve pain. ⋯ The only side effect of significance with PCA was nausea or vomiting (21%). All patients improved with treatment of side effects. Acceptance of these techniques is indicated by a steady increase in the number of gynecologic oncology surgical patients utilizing these modalities (50% at the outset to 87% currently).
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Gynecologic oncology · Jan 1989
Percutaneous epidural catheterization for intractable pain in terminal cancer patients.
We examined the effects of long-term percutaneous epidural catheterization for pain relief in nine terminally ill gynecologic cancer patients. All patients were free of side-effects such as respiratory depression, nausea, vomiting, urinary retention, or pruritus. Analgesia was excellent in six patients. ⋯ Catheter dislodgement occurred in three patients. Although percutaneous epidural catheters were well tolerated in a few patients for an extended period of time, the frequency of catheter problems demonstrate that other methods such as catheter tunneling or implantable systems should be considered for long-term epidural administration of narcotics. This method appears to be most effective in patients suffering from pain due to nerve root involvement.
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Gynecologic oncology · Jan 1988
Recurrent acute leg cellulitis in patients after radical vulvectomy.
Recurrent acute leg cellulitis (ALC) known to occur in patients with impaired venous or lymphatic circulation was studied in 126 patients after radical vulvectomy with lymphadenectomy through the years 1973 to 1985. Among these patients surveyed for a total period of 6153 patient months, 33 (26%) experienced 75 episodes of ALC. Recurrent attacks were frequently observed. ⋯ Analysis of a number of assumed risk factors for ALC showed that the frequency of ALC was significantly higher in patients colonized with beta-hemolytic streptococci, mainly group B, than in patients not colonized with these microorganisms just prior to surgery. This suggests that non-group A beta-hemolytic streptococci are involved in the onset of ALC in patients after radical vulvectomy. However, portals of entry for microorganisms were not apparent in any of our patients.