James B Unger

Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, United States

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Publications (14)35.33 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The objective of the study was to determine the integrity of flat square knots. Three sutures were used in both 0 and 2-0 suture gauges: poliglecaprone 25 (Monocryl), polyglactin 910 (Vicryl), and silk. For each, flat square knots were tied with either 3 or 5 throws. Knots were tested to failure. The major outcome measured was the proportion of 3 throw knots untying, compared with that of 5 throw knots. There were high rates of untying for the poliglecaprone 25 and for the polyglactin 910 with both suture gauges when tied with only 3 throws. The failure rate decreased significantly when the throws were increased. There was no statistical benefit to increasing the number of throws for silk. Knot failure is decreased by increasing the number of throws for poliglecaprone 25 and polyglactin 910. However, there is no advantage to increasing the number of throws from 3 to 5 for silk.
    American journal of obstetrics and gynecology 09/2007; 197(2):172.e1-3. · 3.28 Impact Factor
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    ABSTRACT: The elderly population is increasing in number. Aggressive therapeutic intervention in this patient group may not always be possible because of age, the presence of co-morbidity, and poor functional status. Hence, individualized management of cervix cancer (CC) in the elderly is often practiced. Because of the preceding consideration, the cases of 79 women 65 years of age and older with CC treated with radiation over the last 20 years were reviewed. The cases were classified into two groups--those who were aggressively irradiated (group 1: 43 patients) and those managed less intensively for palliation (group 2: 36 patients). Local tumor control, complications, and survival were assessed. There were fewer extremely aged (> or = 75 years of age) women (p = 0.006) with advanced stage disease (p = 0.012) in group 1 than in group 2. Also, group 1 women experienced fewer treatment failures (p < 0.0003) and more of them were alive and well at last follow-up (p < 0.005) than those from group 2. The median survival periods for groups 1 and 2 were 60 months and 11 months, respectively (p < 0.0001); the corresponding 5-year crude survival rates were 54% and 19%, respectively (p = 0.002). Two women required remedial surgery for bowel obstruction/perforation after irradiation, and one patient sustained chronic radiation cystitis.
    European journal of gynaecological oncology 02/2006; 27(2):115-8. · 0.58 Impact Factor
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    ABSTRACT: This study was undertaken to evaluate the integrity of the loop-to-strand knot when tied with square and nonidentical sliding knots. The synthetic absorbable monofilament suture poliglecaprone 25 in 0 and 2-0 suture gauges was used in this experiment. For each suture gauge, 3 groups of knots were tested: (1) single strand-to-single strand, flat square knot, (2) loop-to-single strand, flat square knot, and (3) loop-to-single strand, nonidentical sliding knot. All knots were tied with 6 throws. The proportion of knots becoming untied was compared among the 3 groups for each suture gauge. Ultimate load required to untie or break knots within each group was also evaluated. The loop-to-strand knot performed well in both suture gauges tested as long as it was tied with a flat square knot. The loop-to-strand knot tied with a nonidentical sliding knot had an unacceptably high failure rate. The loop-to-strand termination of a continuous suture may be acceptable when tied with a 6-throw flat square knot but not acceptable if tied with sliding knots.
    American Journal of Obstetrics and Gynecology 05/2005; 192(4):1094-7. · 3.88 Impact Factor
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    ABSTRACT: The study was undertaken to test the integrity of nonidentical sliding knots made with 3 throws compared with those made with 6 throws with monofilament and braided absorbable suture. The 3 throw nonidentical sliding knot was compared with the 6 throw nonidentical sliding knot in 4 different suture groups. The groups were 0-0 polydioxanone, 2-0 polydioxanone, 0-0 polyglactin 910, and 2-0 polyglactin 910. Knots were tested to failure with a tensiometer. The proportion of 3 throw knots becoming untied was compared with the 6 throw knot within each group. Ultimate load required to break tied knots within each suture group was also evaluated. The 3 throw knots had very high rates of knot failure and untied significantly more often than the 6 throw knots. The 6 throw nonidentical sliding knot demonstrates superior knot integrity compared with the 3 throw knot with both monofilament and braided absorbable suture.
    American Journal of Obstetrics and Gynecology 12/2004; 191(5):1618-20. · 3.88 Impact Factor
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    ABSTRACT: To determine the ability of whole-body [(18)F]fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) scan to detect recurrent cervical carcinoma in both symptomatic and asymptomatic women. We retrospectively reviewed the records of 44 women previously treated for cervical cancer who underwent 47 posttreatment whole-body FDG PET scans in an attempt to detect recurrent disease. Twenty-six scans were performed in asymptomatic women, whereas 21 scans were performed in women with symptoms suggestive of recurrence. About 30.8% of asymptomatic women had recurrent disease detected by PET scan compared to 66.7% of women in the symptomatic group. The sensitivity of PET scan for recurrent disease in asymptomatic women was 80.0%, specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 88.9%. For symptomatic women, the sensitivity of PET was 100%, specificity of 85.7%, a positive predictive value of 93.3%, and a negative predictive value of 100%. The whole-body FDG PET scan is a sensitive imaging modality for the detection of recurrent cervical carcinoma in both symptomatic and asymptomatic women.
    Gynecologic Oncology 08/2004; 94(1):212-6. · 3.93 Impact Factor
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    ABSTRACT: Most cervical tumors are classified as squamous cell carcinoma or adenocarcinoma, both of which are associated with persistent human papillomavirus (HPV) infection. Although other (rare) types represent less than 5% of all cervical carcinomas, it is necessary that these more unusual tumors be studied in the current era of papillomavirus vaccine development, especially in regions with high incidence of cervical cancer. To compare papillomavirus types found in histologically rare cervical carcinomas (n = 29) with those types found in common cervical carcinomas (n = 14) archived at the Institute of Cancer in Mexico City, Mexico. Paraffin-embedded tissues were received and sectioned at the Louisiana State University Health Sciences Center at Shreveport. One section for each block was stained and examined by 2 pathologists. Specific histologies were categorized into 2 broad groups: common (squamous cell carcinoma or adenocarcinoma) or rare (adenosquamous, papillary, villoglandular, anaplastic, transitional, spindle, adenoid basal, colloid, neuroendocrine, and glassy cell carcinomas). Papillomavirus typing results were based on Roche Molecular Systems line-blot assay. No significant difference was found for dual HPV types (21% of both groups), positivity for HPV-16 (66% of rare tumors and 71% of common tumors), or absence of HPV types 16 or 18, although the rare cancers had a greater tendency toward more unusual HPV types (8/29 rare tumors and 1/14 common tumors had no HPV- 16 or HPV-18 DNA). Non-HPV-16/18 types found only in rare tumors included HPV types 52, 84, 26, 35, and 58. Rare types of cervical carcinoma also are associated with papillomavirus, most with types similar to those found in common cervical neoplasias.
    Archives of pathology & laboratory medicine 06/2004; 128(5):553-6. · 2.78 Impact Factor
  • Joseph J Ivy, James B Unger, Debi Mukherjee
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    ABSTRACT: The study was performed to test the knot integrity of parallel and nonidentical sliding knots with the use of monofilament suture. We investigated the proportion of parallel sliding knots that become untied compared with nonidentical sliding knots in four different monofilament suture configurations: group A, 6 throws, 0-0 gauge; group B, 10 throws, 0-0 gauge; group C, 6 throws, 2-0 gauge; group D, 10 throws, 2-0 gauge. Each combination was tested 20 times, for a total of 160 knots. The nonidentical sliding knot untied 40% of the time in group A compared with 0% for the parallel knot (P=.003). In the other 6-throw group, group C, 45% of the nonidentical knots became untied compared with 0% of the parallel knots (P=.001). There were no significant differences in the proportions of untying for each knot type in the 10-throw groups. Parallel sliding knots demonstrate superior knot integrity compared with nonidentical sliding knots with monofilament suture. The addition of throws to the nonidentical knot improves its knot security.
    American Journal of Obstetrics and Gynecology 02/2004; 190(1):83-6. · 3.88 Impact Factor
  • Joseph J Ivy, James B Unger
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    ABSTRACT: To evaluate our experience with malignant mixed mullerian sarcomas of the uterus (MMMT) and the clinical factors affecting survival. The records of 18 women with MMMT who received treatment at our hospital between 1989-2002 were reviewed. We analyzed factors influencing survival such as stage, presence of heterologous components, and post-operative radiation. Survival analysis was performed using Kaplan-Meier survival curve. All women underwent surgical tumor debulking. Eleven women were Stage I, three were Stage II, two were Stage III, and two were Stage IV. Five women had tumors with heterologous elements. As expected, survival was most influenced by stage of disease, with the best overall survival in women with Stage I tumors, P < 0.001. Cumulative 5-year survival was 60% for Stage I disease, for Stage II, 34%, and 0% for Stage III and Stage IV. The initial stage of women presenting with MMMTs is the most important predictive factor for survival.
    The Journal of the Louisiana State Medical Society: official organ of the Louisiana State Medical Society 01/2004; 156(6):324-6.
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    ABSTRACT: The study was undertaken to test the integrity of various flat and sliding knots with the use of braided and monofilament absorbable sutures. There were four study groups, each of which consisted of a single suture type and size, with five different knots. Each combination was tested 10 times for a total of 200 experiments. The suture types used were 0-0 and 2-0 Glycomer 631 (Biosyn) and 0-0 and 2-0 coated Lactomer (Polysorb). Knots tested were the square knots, surgeon's knots, modified granny flat knots, and modified identical and nonidentical sliding knots. Knots were tested to failure with a tensiometer. We compared the proportion of knots becoming untied within each group and the ultimate load required to break tied knots. In the 0-0 and 2-0 Lactomer groups, 90% and 60% of modified identical sliding knots, respectively, became untied, significantly more than all other knots. When 0-0 and 2-0 Lactomer sutures were used, modified identical sliding knots should be avoided.
    American Journal of Obstetrics and Gynecology 01/2003; 187(6):1438-40; discussion 1441-2. · 3.88 Impact Factor
  • Randy Davis, James B Unger
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    ABSTRACT: To determine the proportion of women with ovarian cancer treated at our institution who may have had their disease prevented if oophorectomy had been performed during prior hysterectomy. One hundred twelve women with ovarian cancer treated at our institution were identified through records in our Gynecologic Oncology office. We identified 19 women (17%) who had undergone prior hysterectomy without bilateral oophorectomy (Group 1). We compared age at cancer diagnosis, stage of disease, and cell type between these women and the 93 without prior hysterectomy (Group 2). The mean age at hysterectomy for women in Group 1 was 33.8+/-5.9 years (range 21-44 years). There were 7 women over the age of 35 years, 3 of whom were over the age of 40 years at time of hysterectomy. Overall, 17.0% of ovarian cancer cases theoretically could have been prevented if bilateral oophorectomy had been performed at the time of hysterectomy. However, this drops to only 2.7% if oophorectomy was limited to women over 40 years. Women in our study who underwent prior hysterectomy did so at a relatively young age. This limited the impact prophylactic oophorectomy could have had on ovarian cancer prevention in our population.
    The Journal of the Louisiana State Medical Society: official organ of the Louisiana State Medical Society 01/2003; 155(2):113-5.
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    ABSTRACT: The purpose of this study was to measure patient health-related quality of life/satisfaction with the results of hysterectomy in 2 distinct groups of women. A health-related outcomes questionnaire was completed 3 months after hysterectomy by 50 low-income women who underwent operation at a state-supported teaching hospital and by 50 women who underwent operation at a private hospital. The women at the teaching hospital had a significantly worse outcome satisfaction score than the women at a private hospital. However, 98% of the patients at the teaching hospital and 100% of patients at the private hospital noted their symptoms to be improved. Factors such as race, age, preoperative indications, route of hysterectomy, oophorectomy, and hormone replacement therapy did not affect outcome scores. Low-income women who undergo operation at a university teaching hospital experience lower satisfaction after hysterectomy than do other women.
    American Journal of Obstetrics and Gynecology 01/2003; 187(6):1528-32. · 3.88 Impact Factor
  • Obstetrics and Gynecology - OBSTET GYNECOL. 01/2003; 101(4).
  • James B Unger, Ricky Paul, Gloria Caldito
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    ABSTRACT: To determine if the complication rate of abdominal hysterectomy is increased in women with greatly enlarged myomatous uteri. Three groups of women undergoing abdominal hysterectomy were analyzed according to uterine size: group 1, 208 women with uteri less than 500 g; group 2, 63 women with uterine weights of 500-999 g; and group 3, 47 women with leiomyomata whose uteri weighed at least 1000 g. Logistic regression was used to compare the groups on the risks of having at least one major complication. Adjusted comparisons on other surgical outcomes were performed using a logistic model (for qualitative variables) or a general linear model (for quantitative variables). The risk of experiencing at least one perioperative complication, including blood loss over 500 mL, perioperative blood transfusion, major organ injury, therapeutic antibiotic use, and hospital readmission, increased significantly with uterine weight (P =.006). Group 3 women were at greater risk of having at least one of these complications than either group 1 or group 2 women, with adjusted odds ratios of 3.42 (95% confidence interval [CI] 1.62, 7.25) and 2.64 (95% CI 1.14, 6.13), respectively. Estimated blood loss with surgery also increased with increasing uterine weight (P <.001). Mean estimated blood losses for the study groups were 555.8 +/- 386.5 mL (group 3), 464.3 +/- 285.2 mL (group 2), and 387.6 +/- 281.4 mL (group 1) (P =.032). The complication rate from hysterectomy increases with increasing uterine weight, due mainly to an increased blood loss associated with surgery for larger uteri.
    Obstetrics and Gynecology 12/2002; 100(6):1271-5. · 4.80 Impact Factor
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    ABSTRACT: A retrospective comparative study of 41 patients with stage I corpus cancer, negative surgical staging, and adverse pathological features either treated or untreated by posthysterectomy radiotherapy (PHR) during a 13-year period was undertaken. The patients were matched for age, intermediate-risk classification, number of sampled nodes and the presence of coexisting illness. After complete follow-up, there was no significant difference in outcome between the patient groups. Unless it can be shown definitely that PHR is beneficial, its use in intermediate-risk node-negative stage I corpus cancer patients must be seriously questioned.
    European journal of gynaecological oncology 02/2001; 22(4):269-72. · 0.58 Impact Factor

Publication Stats

116 Citations
35.33 Total Impact Points

Institutions

  • 2002–2007
    • Louisiana State University Health Sciences Center Shreveport
      • Department of Obstetrics and Gynecology
      Shreveport, Louisiana, United States
    • Louisiana State University Health Sciences Center New Orleans
      • Department of Obstetrics and Gynecology
      Baton Rouge, LA, United States