Laurel W Rice

Hartford Hospital, Hartford, Connecticut, United States

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Publications (29)94.15 Total impact

  • M Heather Einstein, Laurel W Rice
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    ABSTRACT: It is reasonable to perform complete lymphadenectomy in patients at significant risk of lymph node metastases, and use the results to guide adjuvant treatment decisions.(24,25) Criteria for staging based on intraoperative pathology should be determined in consultation with the pathologist, preferably with an institution-specific quality-assurance review.(34) Patients with more aggressive histologies should undergo a staging procedure including an omental biopsy whenever possible, with the understanding that most require systemic adjuvant therapy. Minimally invasive surgery is associated with shorter recovery and fewer postoperative complications than open endometrial cancer staging,(4,5,45) with preliminary data showing similar oncologic outcomes (Walker and colleagues, late breaking abstract SGO 2010 Annual Meeting). Whenever feasible, patients should be offered minimally invasive surgery for endometrial cancer staging. Retrospective data support an attempt at complete cytoreduction in patients with advanced endometrial cancer and a good performance status.(8-12) The decision to perform aggressive cytoreductive surgery should be individualized, taking into account the patient's comorbidities, her performance status, her symptoms, and the risks associated with more aggressive surgical procedures.
    Hematology/oncology clinics of North America 02/2012; 26(1):79-91. · 2.05 Impact Factor
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    ABSTRACT: Concerns have been raised about gynecologists as vaccinators. This survey evaluated use of the human papillomavirus (HPV) vaccine, attitudes, and barriers among gynecologists and family practitioners for differences between the 2 specialties. A cross-sectional survey was conducted using a 50-item, self-administered questionnaire mailed to participants. The study was conducted in Virginia through the University of Virginia Center for Survey Research. The questionnaire was mailed to 500 family practitioners and 500 gynecologists. The questionnaire asked provider and practice demographics, vaccine practices, knowledge, HPV vaccine attitudes, and barriers to vaccination. We compared gynecologists to family practitioners for the outcome of offering HPV vaccination. Logistic regression was performed to determine factors associated with providers choosing to offer and recommend the HPV vaccine. After exclusion of ineligible physicians, 385 of 790 doctors responded (48.7%). Seventy percent of family practitioners and 73.5% of gynecologists currently offer the HPV vaccine. There were no significant differences in demographics or practice patterns between the specialties. The most frequent barrier to vaccination reported by both groups was reimbursement. In multivariate logistic regression, inadequate reimbursement was negatively associated with offering the HPV vaccine (odds ratio [OR] 0.41; 95% confidence interval [CI] 0.15-1.1) and with recommending the vaccine to patients (OR 0.45; 95% CI 0.26-0.76). Experience treating HPV- related disease was positively associated with offering the HPV vaccine (OR 2.3; 95% CI 1.1-4.8). Gynecologists are providing HPV vaccination at rates similar to family practitioners. Reimbursement concerns may negatively have an impact on doctors' recommendation of the HPV vaccine.
    Journal of pediatric and adolescent gynecology 09/2011; 24(6):380-5. · 0.90 Impact Factor
  • Laurel W Rice
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    ABSTRACT: The development of effective prevention strategies for breast, endometrial and ovarian cancers (CA), based on hormonal responsiveness, is a paramount opportunity in the care of women at risk for these malignancies. Breast CA prevention, utilizing Selective Estrogen Receptor Modulators (SERMs) is a well-established paradigm in the management of high risk women. Aromatase inhibitors (AI) and prophylactic bilateral salpingo-oophorectomy are presently under investigation for that same purpose. Endometrial carcinoma (EC), specifically Type 1, is the most common gynecologic malignancy in the United States. Its positive association with excess estrogen exposure provides significant opportunity for hormonal chemoprevention. Population-based studies have established that oral contraceptives (OC) significantly decrease the incidence of this malignancy. This risk reduction lasts up to 20 years after discontinuation of OCs. The association between elevated BMI and risk of developing EC (due to increased peripheral estrogen exposure) has prompted investigation into the role of weight reduction in EC prevention. The prevention of epithelial ovarian cancer (EOC) is of particular interest given its high mortality rate and the lack of a cost-effective screening program. OC usage significantly diminishes the incidence of EOC, in both the general population, as well as in patients with BRCA 1 or 2 mutations. Risk reduction is greatest with prolonged usage and persists for more than 30 years after OC use, but diminishes over time. Prospective, randomized trials, designed to control for all known variables, are mandatory to fully assess the potential for hormonal chemoprevention in breast, endometrial and ovarian cancers.
    Gynecologic Oncology 08/2010; 118(2):202-7. · 3.93 Impact Factor
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    J Stuart Ferriss, Laurel W Rice
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    ABSTRACT: Epithelial ovarian cancer (EOC) continues to be the most lethal gynecologic malignancy. Efforts to personalize chemotherapy treatments by utilizing in vitro tumor assays to predict chemotherapeutic response have been tested in both the primary and recurrent treatment setting. To date, several retrospective studies have suggested improved response rates to predicted chemotherapeutic agents. However, a prospective, controlled trial merely found equivalence between in vitro prediction and empirical treatment selection. This review summarizes the current data regarding in vitro directed chemotherapy in EOC.
    Reviews in obstetrics and gynecology 01/2010; 3(2):49-54.
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    ABSTRACT: To examine the clinicopathologic features, progression-free interval, and survival of patients with grade 3 endometrioid endometrial cancer (G3 EEC) and malignant mixed müllerian tumors (MMMTs). Akt, epidermal growth factor receptor (EGFR), and HER-2/neu expression in these histologic subtypes was also investigated. Associations between phosphorylated Akt and clinicopathologic features were tested. One hundred nineteen women whose conditions were diagnosed with MMMT or G3 EEC from January 1, 1990, to December 31, 2003, met inclusion criteria. Retrospective data review was performed. In addition, Akt and EGFR protein expression was measured in tissue samples using Western blotting and immunohistochemistry. Fluorescence in situ hybridization was used to assay HER-2/neu gene amplification. Fifty-nine patients with MMMT and 60 patients with G3 EEC were identified. Patients with MMMT were older (P = 0.055), more likely to be African American (P = 0.049), have a family history of breast cancer (P = 0.039), have disease involving the uterine cervix (P = 0.007), and experience postoperative complications (P = 0.012). Patients with MMMT had a significantly shorter progression-free interval (23 vs 57 months, P = 0.001) and survival (55 vs 92 months, P = 0.001) than patients with G3 EEC.Grade 3 EEC and MMMT have significantly higher phospho-Akt levels than grade 1 EEC and normal controls. Phospho-Akt was associated with depth of myometrial invasion (r = 0.46, P = 0.05), but not with stage, lymph-vascular space invasion, or tumor size. The mesenchymal component of MMMT preferentially demonstrated EGFR expression relative to the epithelial component (45% vs 13%, P = 0.06). HER-2/neu amplification was observed in 1 of 37 samples. Improved therapy is warranted for both poorly differentiated EEC and MMMT. Recognition of similarities and differences between MMMT and other high-grade histologic types of uterine cancer may provide rationale for new treatment approaches possibly incorporating targeted biological therapies.
    International Journal of Gynecological Cancer 01/2009; 19(2):261-5. · 1.94 Impact Factor
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    ABSTRACT: The purpose of the study was to implement a uniform system for assigning tumor grade in serous ovarian cancer and evaluate its correlation with response to conventional chemotherapy. Serous ovarian cancer tumor samples were retrospectively reviewed by 3 pathologists who were blinded to the original report. Samples were scored for architectural pattern, nuclear pleomorphism, and mitotic activity. Sum scores from these 3 indices were used to classify tumors as low grade or high grade. A total of 21 patients were identified as low-grade tumors and 21 were identified as high-grade tumors. Of low-grade tumors, 16 (76%) were found to be platinum resistant, defined as recurrent or persistent disease, 180 days from completion of the final cycle of chemotherapy, Of 21 patients defined as high grade, 9 (43%) were platinum resistant (P = .028). Utilization of a uniform grading system retrospectively correlates with platinum sensitivity.
    American journal of obstetrics and gynecology 06/2008; 199(2):189.e1-6. · 3.28 Impact Factor
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    ABSTRACT: Recent surveys have indicated that four alternatives are employed for adjuvant treatment of stage I endometrial adenocarcinoma: observation (OBS), high dose rate vaginal brachytherapy (VB), whole pelvic external beam radiotherapy (EBRT), or a combination of pelvic external beam with vaginal brachytherapy (COMB). Our goal was to evaluate the cost-effectiveness of these alternatives for management of stage I endometrial adenocarcinoma. We designed a decision analysis model comparing the four possible treatments in terms of their utility and cost. We reviewed the existing literature and utilized published data to estimate complication and recurrence rates from each treatment option. We obtained cost data from a chart review of patients treated with each approach at a single institution between 1995 and 2005. OBS yielded the lowest expected cost, $437 million per 100,000 women. COMB yielded the highest cost, at $2.93 billion per 100,000 women. VB yielded the highest 5-year quality adjusted survival, 86%. In a population of 100,000 women, VB would result in an additional 8200 quality adjusted survivors compared to OBS, at a cost of $65,900 per survivor. In contrast, EBRT and COMB result in either fewer survivors and/or greater costs when compared to OBS or VB. Routine use of adjuvant EBRT or COMB in the management of surgical stage I endometrial adenocarcinoma is not cost-effective. Compared to OBS, post-operative VB improves survival at a cost of $65,900 per survivor, supporting further investigation of this adjuvant therapy.
    Gynecologic Oncology 02/2008; 108(1):77-83. · 3.93 Impact Factor
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    ABSTRACT: Endometrial carcinoma affects over 40,000 American women annually, making it the most common gynecologic malignancy. Over 80% of disease is diagnosed in the early stages, resulting in a generally favorable prognosis for most patients. However, discrepancies still exist with regard to primary surgical management and postoperative adjuvant therapies directed at reducing recurrence rates and improving survival. In this review, we outline the surgical management of newly diagnosed disease and review the risk factors that guide clinicians in the recommendation for postoperative adjuvant therapy.
    Reviews in obstetrics and gynecology 02/2008; 1(3):97-105.
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    ABSTRACT: Uterine smooth muscle tumors can usually be divided histologically into leiomyoma (L) and leiomyosarcoma (LMS). Occasionally, the histologic features are indeterminate and classified as smooth muscle tumor of uncertain malignant potential (STUMP). Recent gene expression studies have found p16 overexpressed in LMS when compared with normal myometrium. This study evaluated the protein expression of p16 by immunohistochemistry in LMS, L, and normal myometrium. Additionally, 8 tumors originally classified as STUMP were evaluated for p16 expression and correlated to their clinical outcome. A tissue microarray was constructed and composed of 15 LMS, 8 STUMPs, 22 L, and 10 samples of normal myometrium. p16 expression was correlated with clinical outcome and histologic features. Twelve of the 15 LMS strongly and diffusely expressed p16, 3 of the L had focal p16 staining, and none of the normal myometria were p16 positive. Three of the tumors originally classified as STUMP developed metastatic disease and 2 of these tumors had strong, diffuse p16 positivity. Histologically, these 2 cases were characterized by coagulative tumor cell necrosis and only mild cytologic atypia. p16 is preferentially expressed in LMS with only rare L showing positivity. Histologically, tumors with coagulative tumor cell necrosis alone were clinically LMS. In those cases in which the type of necrosis is uncertain (coagulative tumor cell vs. hyalinized), the addition of p16 may aid in discerning a subset of STUMP that should be classified as LMS.
    American Journal of Surgical Pathology 02/2008; 32(1):98-102. · 4.87 Impact Factor
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    ABSTRACT: Patients with stage IB2 cervical cancer at our institution are treated primarily with definitive chemoradiation, or chemoradiation followed by adjuvant hysterectomy. We sought to compare the cost differences associated with these two strategies. We identified all patients with stage IB2 cervical cancer who received their entire treatment regimen at our institution between 1995 and 2004. All patients received a combination of chemotherapy, external beam radiation, and one brachytherapy procedure, followed by either a second brachytherapy procedure or a simple hysterectomy. We retrieved cost data associated with hospitalization for the completion of respective treatment, including pharmacy, laboratory and pathology, radiation, and operating room services, as well as the costs of supplies and room and board. We identified 46 patients with stage IB2 cervical cancer, 23 who received a second brachytherapy procedure and 23 who underwent simple hysterectomy. Patients displayed similar demographics and similar disease characteristics including initial tumor diameter and histology. The cost of care for adjuvant hysterectomy group was greater ($8,316.70 vs 5,508.70, P < 0.0001). Specific differences included higher operating room costs ($1520 vs 414, P < 0.0001), pharmacy costs ($675 vs 342, P < 0.0001), and laboratory/pathology costs ($597 vs 89, P < 0.0001). We conclude that definitive chemoradiation appears to be associated with lower costs for management of stage IB2 cervical cancer when compared to simple adjuvant hysterectomy.
    International Journal of Gynecological Cancer 01/2008; 18(2):274-8. · 1.94 Impact Factor
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    ABSTRACT: The optimal treatment strategy for stage IB2 cervical carcinoma that maximizes survival while minimizing toxicity remains controversial. The purpose of this study was to compare survival and toxicity in stage IB2 cervical cancer patients treated with chemoradiation and adjuvant extrafascial hysterectomy (cRT + H) versus definitive chemoradiation (cRT). Data were abstracted from patients with IB2 cervical carcinoma primarily treated at a single institution from January 1994 to December 2004. All patients received chemotherapy concurrent with external beam radiation therapy. Patients were subsequently treated with either a single low-dose rate brachytherapy applicator followed by adjuvant extrafascial hysterectomy (n = 24) or a second brachytherapy application to complete full-dose definitive chemoradiation (n = 30). Analyses were conducted using Kaplan-Meier survival and Chi-square statistics. Groups did not differ demographically with the exception of smoking. Smokers were significantly (P = 0.04) more likely to have been treated with definitive chemoradiation. Median tumor size was similar between groups. There was no difference in overall or disease-free survival between patients who received cRT + H versus cRT (P = 0.82 and 0.75, respectively). All recurrences in the cRT arm were in smokers. There were two grade 3-4 toxicities in each group. No treatment-related deaths occurred. In this small retrospective cohort study, we observed no difference in survival between patients treated with cRT + H versus cRT. These data complement published results of Gynecologic Oncology Group studies in patients with IB2 cervical cancer. Definitive comparison between the two treatment strategies would require a randomized prospective trial with stratification based on smoking.
    International Journal of Gynecological Cancer 11/2007; 18(4):730-5. · 1.94 Impact Factor
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    ABSTRACT: We evaluated the impact of conization margin status on outcomes of patients diagnosed with cervical adenocarcinoma in situ. A retrospective chart review identified patients at a University hospital from 1988-2006 with adenocarcinoma in situ (AIS) on conization. Seventy-four patients were included. Median follow-up was 26 months. Twenty-two of 74 patients (30%) had positive margins, 46 patients (62%) had negative margins, and 6 patients had indeterminate margins. Of patients with positive margins, 55% (12/22) were diagnosed with residual or recurrent disease, including 3 patients diagnosed with adenocarcinoma on hysterectomy. Thirteen percent of patients with negative conization margins (6/46) were diagnosed with residual or recurrent disease, including 2 patients diagnosed with adenocarcinoma during follow-up. Cold knife conization resulted in a significantly higher number of negative margins compared to other conization procedures (P = .013). Even with negative conization margins, women still face a risk of residual, recurrent, or invasive disease.
    American journal of obstetrics and gynecology 09/2007; 197(2):195.e1-7; discussion 195.e7-8. · 3.28 Impact Factor
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    ABSTRACT: The purpose of this study was to evaluate the results of substituting cisplatin for carboplatin in women who experienced a carboplatin-associated hypersensitivity reaction while undergoing treatment for gynecologic cancers. Using a comprehensive data repository, we identified all epithelial ovarian cancer and primary peritoneal cancer patients who experienced a documented significant hypersensitivity reaction to carboplatin and were subsequently treated with cisplatin at our institution from 1995 to the present. We also performed a review of published case reports of similar patient management. We identified a total of 24 patients who met inclusion criteria. Eighteen patients (75%) tolerated cisplatin without any adverse events. Six patients (25%) eventually developed a reaction to cisplatin; none was life threatening, and only 1 required hospitalization. Twenty-three of the 24 patients (96%) tolerated at least 1 cycle of cisplatin. Of the 5 patients who initially tolerated cisplatin but eventually experienced a reaction, the mean number of cycles tolerated was 3.4. The use of cisplatin without desensitization is a reasonable approach for continuing platinum-based chemotherapy in patients with a significant carboplatin hypersensitivity reaction. Patients should be advised of risks and closely monitored, given published case reports of anaphylaxis.
    American journal of obstetrics and gynecology 09/2007; 197(2):199.e1-4; discussion 199.e4-5. · 3.28 Impact Factor
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    ABSTRACT: The purpose of this study was to investigate the AKT signaling cascade in endometrial cancers and to assess its therapeutic potential. Western blotting and immunohistochemistry were used to investigate the expression of estrogen receptor, progesterone receptor, HER2, AKT, and 4EBP1 proteins in 27 atrophic endometria, 31 grade 1 and 24 grade 3 endometrioid endometrial cancers, and 19 malignant mixed müllerian tumors. Inhibition of the AKT signaling cascade was investigated in cell lines. Malignant mixed müllerian tumors and grade 3 endometrioid endometrial cancers demonstrated higher levels of AKT and 4EBP1 activation and hormone receptor loss compared with grade 1 endometrioid endometrial cancers and atrophic samples. HER2 over-expression was identified most often in grade 3 tumors without gene amplification. In endometrial cancer cell-lines, AKT cascade inhibitors decreased cell proliferation by apoptosis and cell cycle arrest. AKT cascade activation in grade 3 endometrioid endometrial cancers and malignant mixed müllerian tumors is a novel finding. Apoptosis and growth arrest that results from AKT inhibition expose opportunities for therapeutic intervention.
    American journal of obstetrics and gynecology 05/2006; 194(4):1119-26; discussion 1126-8. · 3.28 Impact Factor
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    ABSTRACT: The purpose of this study was to determine if a suboptimal cytoreduction can be predicted preoperatively in women with advanced ovarian cancer. All women with stage III/IV epithelial ovarian cancer treated with initial surgery at our hospital between January 1, 1995 and January 1, 2003 were eligible; 56 patients met inclusion criteria and underwent retrospective chart review. Statistical analysis was performed using SPSS. Twenty-nine women (52%) had optimal cytoreduction (OC), and 27 (48%) had suboptimal cytoreduction (SC). Women in the SC group had higher median CA-125 values at surgery (954 SC vs 597 OC, P = .07). Three sites of disease on preoperative CT were reported more frequently in the SC patients; omentum (P = .007), parietal peritoneum (P = .096), and ascites (P = .093). A suboptimal cytoreduction confers no survival advantage to women with advanced ovarian cancer. Thus, these patients may be the best candidates for initial chemotherapy, and identifying them preoperatively becomes important.
    American Journal of Obstetrics and Gynecology 09/2005; 193(2):568-74; discussion 574-6. · 3.88 Impact Factor
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    ABSTRACT: Given the demonstrated utility of human papilloma virus DNA triage in the management of atypical squamous cells of undetermined significance, this study sought to evaluate the potential role of human papilloma virus DNA testing in the evaluation and management of cytological atypical glandular cells. Following institutional review board approval, 28 women presenting with cytological atypical glandular cells underwent repeat thin-prep cytology, Hybrid Capture 2 human papilloma virus DNA testing, colposcopic evaluation, Fisher electrosurgical conization, and endometrial sampling. Human papilloma virus test results in each patient were then correlated with histologic lesions, if present. Sixteen of the 28 study patients had pathologic lesions (11/28 high-grade squamous intraepithelial lesion, 3/28 low-grade squamous intraepithelial lesion, 1/28 adenocarcinoma in situ, 1/28 simple endometrial hyperplasia). Human papilloma virus DNA testing was available in 24 of 28 subjects (86%). The sensitivity of human papilloma virus positivity to predict the presence of cervical intraepithelial neoplasia was 100% (confidence interval 77% to 100%), specificity 64% (confidence interval 35% to 85%), positive predictive value 76%, and negative predictive value 100%. Women who tested human papilloma virus positive were 12 times more likely to have cervical intraepithelial neoplasia than women who were human papilloma virus negative (Fisher P<.001). Human papilloma virus positivity was not predictive of endometrial pathology; women who were human papilloma virus positive were less likely to have endometrial pathology than were women who were human papilloma virus negative (risk ratio 1.6, 95% confidence interval 0.01-1.7). Atypical glandular cells can represent a variety of lesions. The majority of the lesions will be squamous intraepithelial lesions of the cervix (50%), with high-grade squamous intraepithelial lesion present in 40% of subjects. Human papilloma virus DNA testing is a sensitive test for the presence of squamous intraepithelial lesion, with excellent negative predictive value for the absence of squamous intraepithelial lesion. The results of this study suggest human papilloma virus DNA testing might be an effective screening test in the initial evaluation and management of cytological atypical glandular cells.
    American Journal of Obstetrics and Gynecology 08/2005; 193(2):559-65; discussion 565-7. · 3.88 Impact Factor
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    ABSTRACT: Estrogen receptor (ER)alpha is a ligand-inducible transcription factor that mediates the physiological effects of 17beta-estradiol (E2). In the uterus, E2 is involved in tissue growth, maintenance, and differentiation. Delta5ERalpha (Delta5) is an ERalpha variant protein expressed in uterine tumors but not in normal tissue. We examined the transcriptional activity of Delta5 and its modulation of human ERalpha basal and E2-stimulated activity in Ishikawa cells, an endometrial cancer cell line. In transient transfection assays, Delta5 increased basal activity of an estrogen response element-containing promoter in the absence or presence of ERalpha but lessened stimulation by ERalpha and E2. Effects of Delta5 were not limited to model reporters, given that cyclin D1 and complement 3 promoters were similarly affected. Increases in basal transcription required dimerization and DNA binding of Delta5, whereas decreased E2 stimulation with ERalpha required only DNA binding. Decreased ligand stimulation was not unique to E2 but also applied to the selective ER modulators tamoxifen and genistein. However, promoter stimulation by epidermal growth factor is retained with Delta5. The ERalpha coactivator small nuclear ring finger protein is expressed in Ishikawa cells and uterine tumors, and it enhances effects of Delta5 alone and with ERalpha on basal activity of an estrogen response element reporter. Thus, in the presence of Delta5 plus ERalpha, there is a lower transcriptional response to E2 and SERMS, but stimulation by epidermal growth factor is retained. The expression of Delta5 in uterine carcinoma may provide a mechanism by which tumors could maintain expression of E2-responsive genes in the absence of E2.
    Endocrinology 03/2005; 146(2):751-9. · 4.72 Impact Factor
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    ABSTRACT: The association of intraoperative neurologic injuries with gynecologic surgical procedures is well established. The sequelae of such injuries are usually transient and resolve with minimal intervention, although long-term disability can and does occasionally occur. The purpose of this study was to examine the mechanisms by which these injuries occur in order to reduce the risk of their occurrence. A MEDLINE search was performed cross-referencing the index terms "neurological injury" and "gynecological surgery," from January 1, 1960 to December 31, 2002. This article, based on the data and results (Level I-III) obtained from the MEDLINE search, examined the most common neurologic injuries that occur in association with abdominal and vaginal surgical procedures routinely performed by gynecologists. Neurologic injuries after pelvic surgery all generally share a common etiology, specifically injury to one or more components of the lumbosacral nerve plexus. Three major factors that predispose to neurologic injury at the time of gynecological surgery are 1) the improper placement or positioning of self-retaining or fixed retractors, particularly those with deep lateral retractor blades; 2) improper positioning of patients in lithotomy position preoperatively; and 3) radical surgical dissection resulting in autonomic nerve disruption. Level I data strongly implicate the improper placement of self-retaining or fixed retractors as the most common cause of femoral nerve injury arising in association with abdominal surgical procedures. A thorough understanding of the anatomy of the lumbosacral nerve plexus and the mechanisms by which operative injuries to this plexus occur will enable the gynecologic surgeon to reduce the subsequent risk of their occurrence in his or her own surgical practice.
    Obstetrics and Gynecology 03/2004; 103(2):374-82. · 4.80 Impact Factor
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    ABSTRACT: To conduct a prospective analysis of whether endocervical curettage contributes to the management of patients with abnormal cervical cytology. Three hundred four consecutive patients being evaluated for abnormal squamous cervical cytology at the University of Virginia underwent routine endocervical curettage at the time of diagnostic colposcopy. Among the 304 patients evaluated colposcopically, the information provided by endocervical curettage changed treatment planning in only 13, or 4.27%. In none of these 13 patients would the omission of endocervical curettage at the time of diagnostic colposcopy have resulted in overlooking an occult invasive or microinvasive carcinoma. This prospective analysis did not find the information provided by the routine application of endocervical curettage at the time of diagnostic colposcopy to be helpful in the subsequent treatment planning of patients undergoing evaluation for cervical intraepithelial disease.
    The Journal of reproductive medicine 02/2004; 49(1):1-7. · 0.75 Impact Factor
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    ABSTRACT: Epithelioid leiomyosarcoma arising from the uterine cervix is extremely rare, with only three cases reported in the world literature. We present the case report of a 14-cm epithelioid leiomyosarcoma arising from the uterine cervix. A 47-year-old female presented with a 1-year history of worsening menorrhagia and was found to have a large pelvic mass extending into and filling the upper vagina. She underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy, revealing a 14 x 10 x 9 cm cervical epithelioid leiomyosarcoma. Although exceedingly rare, leiomyosarcoma is able to arise primarily from the uterine cervix. Given its extreme rarity, management of cervical LMS must be extrapolated from the currently accepted management for uterine LMS.
    Gynecologic Oncology 01/2004; 91(3):636-42. · 3.93 Impact Factor

Publication Stats

545 Citations
94.15 Total Impact Points


  • 2012
    • Hartford Hospital
      Hartford, Connecticut, United States
  • 2008–2012
    • University of Wisconsin, Madison
      • Department of Obstetrics and Gynecology
      Mississippi, United States
  • 2011
    • Medical University of South Carolina
      • Department of Obstetrics and Gynecology
      Charleston, SC, United States
  • 1999–2008
    • University of Virginia
      • • Department of Obstetrics and Gynecology
      • • Department of Pathology
      Charlottesville, VA, United States
  • 2007
    • Gynecologic Oncology Group
      Buffalo, New York, United States