ObGyn
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Item Open Access Influence of Exercise Type on Maternal Blood Pressure Adaptation throughout Pregnancy(2022) Murphy, Sarah E.; Isler, Christy; Haven, Kelley; Newton, Edward; May, Linda E.; Johnston, Carol A.; Strom, Cody; McDonald, SamanthaItem Open Access Expectations of and for Clerkship Directors 2.0: A Collaborative Statement from the Alliance for Clinical Education(2021) Sutton, Jill; Morgenstern, Bruce Z.; Roman, Brenda J. B.; DeWaay, Deborah; Golden, W. Christopher; Malloy, Erin; Reddy, Rishindra M.; Rutter, Ann E.; Salash, Rachel; Sonii, Madhu; Starr, Stephanie; Wald, David A.; Pangaro, Louis N.Item Open Access The Influence of Exercise During Pregnancy on Racial/Ethnic Health Disparities and Birth Outcomes(2021-03-26) Raper, Madigan J.; McDonald, Samantha; Johnston, Carol; Isler, Christy; Newton, Edward; Kuehn, Devon; Collier, David N.; Broskey, Nicholas T.; Muldrow, Adrienne; May, Linda E.Item Open Access Postpartum Prolapsed Leiomyoma with Uterine Inversion Managed by Vaginal Hysterectomy(2014) Pieh-Holder, Kelly L.; Bell, Heidi; Hall, Tana; DeVente, James E.Background. Uterine inversion is a rare, but life threatening, obstetrical emergency which occurs when the uterine fundus collapses into the endometrial cavity. Various conservative and surgical therapies have been outlined in the literature for the management of uterine inversions. Case. We present a case of a chronic, recurrent uterine inversion, which was diagnosed following spontaneous vaginal delivery and recurred seven weeks later. The uterine inversion was likely due to a leiomyoma. This late-presenting, chronic, recurring uterine inversion was treated with a vaginal hysterectomy. Conclusion. Uterine inversions can occur in both acute and chronic phases. Persistent vaginal bleeding with the appearance of a prolapsing fibroid should prompt further investigation for uterine inversion and may require surgical therapy. A vaginal hysterectomy may be an appropriate management option in select populations and may be considered in women who do not desire to maintain reproductive function.Item Open Access Correlation of pretreatment drug induced apoptosis in ovarian cancer cells with patient survival and clinical response(2012) Salom, Emery; Penalver, Manuel; Homesley, Howard D.; Burrell, Matthew; Garrett, Audrey; Presant, Cary A.; Rutledge, James; Chernick, Michael; Hallquist, Allan; Perree, MathieuBackground This study was performed to determine if a chemotherapy-induced apoptosis assay (MiCK) could predict the best therapy for patients with ovarian cancer. Methods A prospective, multi-institutional and blinded trial of the assay was conducted in 104 evaluable ovarian cancer patients treated with chemotherapy. The MiCK assay was performed prior to therapy, but treating physicians were not told of the results and selected treatment only on clinical criteria. Outcomes (response, time to relapse, and survival) were compared to the drug-induced apoptosis observed in the assay. Results Overall survival in primary therapy, chemotherapy naïve patients with Stage III or IV disease was longer if patients received a chemotherapy which was best in the MiCK assay, compared to shorter survival in patients who received a chemotherapy that was not the best. (p < 0.01, hazard ratio HR 0.23). Multivariate model risk ratio showed use of the best chemotherapy in the MiCK assay was the strongest predictor of overall survival (p < 0.01) in stage III or IV patients. Standard therapy with carboplatin plus paclitaxel (C + P) was not the best chemotherapy in the MiCK assay in 44% of patients. If patients received C + P and it was the best chemotherapy in the MiCK assay, they had longer survival than those patients receiving C + P when it was not the best chemotherapy in the assay (p = 0.03). Relapse-free interval in primary therapy patients was longer if patients received the best chemotherapy from the MiCK assay (p = 0.03, HR 0.52). Response rates (CR + PR) were higher if physicians used an active chemotherapy based on the MiCK assay (p = 0.03). Conclusion The MiCK assay can predict the chemotherapy associated with better outcomes in ovarian cancer patients. This study quantifies outcome benefits on which a prospective randomized trial can be developed.Item Open Access Surgical Management of Massive Labial Edema in a Gravid Preeclamptic Diabetic(2014) Lindsey, Jennifer S.; DeVente, James E.Background. Massive labial edema is a rare complication during pregnancy that can jeopardize vaginal delivery, as well as leading to maternal and fetal morbidity. It can be related to systemic pathologies, but has been commonly associated with preeclampsia and diabetes. This increased and sometimes longstanding pressure may result in a “labial compartment syndrome” leading to microvascular damage and tissue necrosis if not resolved in a timely fashion. Case. Massive labial edema was treated first conservatively and then surgically in a gravid diabetic patient with severe preeclampsia. Immediately after Cesarean section, the labial compartment syndrome was relieved surgically and resolved rapidly. Conclusion. When conservative attempts at management of labial edema fail, or rapid resolution is critical to maternal and fetal outcome, surgical alternatives should be considered.Item Open Access Gestational Diabetes Is Characterized by Reduced Mitochondrial Protein Expression and Altered Calcium Signaling Proteins in Skeletal Muscle(2014) Boyle, Kristen E.; Hwang, Hyonson; Janssen, Rachel C.; DeVente, James E.; Barbour, Linda A.; Hernandez, Teri L.; Mandarino, Lawrence J.; Lappas, Martha; Friedman, Jacob E.The rising prevalence of gestational diabetes mellitus (GDM) affects up to 18% of pregnant women with immediate and long-term metabolic consequences for both mother and infant. Abnormal glucose uptake and lipid oxidation are hallmark features of GDM prompting us to use an exploratory proteomics approach to investigate the cellular mechanisms underlying differences in skeletal muscle metabolism between obese pregnant women with GDM (OGDM) and obese pregnant women with normal glucose tolerance (ONGT). Functional validation was performed in a second cohort of obese OGDM and ONGT pregnant women. Quantitative proteomic analysis in rectus abdominus skeletal muscle tissue collected at delivery revealed reduced protein content of mitochondrial complex I (C-I) subunits (NDUFS3, NDUFV2) and altered content of proteins involved in calcium homeostasis/signaling (calcineurin A, α1-syntrophin, annexin A4) in OGDM (n = 6) vs. ONGT (n = 6). Follow-up analyses showed reduced enzymatic activity of mitochondrial complexes C-I, C-III, and C-IV (−60–75%) in the OGDM (n = 8) compared with ONGT (n = 10) subjects, though no differences were observed for mitochondrial complex protein content. Upstream regulators of mitochondrial biogenesis and oxidative phosphorylation were not different between groups. However, AMPK phosphorylation was dramatically reduced by 75% in the OGDM women. These data suggest that GDM is associated with reduced skeletal muscle oxidative phosphorylation and disordered calcium homeostasis. These relationships deserve further attention as they may represent novel risk factors for development of GDM and may have implications on the effectiveness of physical activity interventions on both treatment strategies for GDM and for prevention of type 2 diabetes postpartum.Item Open Access Monoclonal antibody DS6, tumor-associated antigen CA6, and methods of use thereof(2003-07-22) Wennerberg, Anne Elizabeth; Semer, Diane A.The present application describes a monoclonal antibody selected from the group consisting of monoclonal antibody DS6, monoclonal antibodies that specifically bind to the antigen or epitope bound by monoclonal antibody DS6, and fragments of the foregoing that specifically bind to the antigen or epitope bound by monoclonal antibody DS6. Methods of use of such antibodies and the isolated antigen bound by such antibodies are also described.Item Open Access Present status and future direction of clinical trials in advanced endometrial carcinoma(East Carolina University, 2008-09) Homesley, Howard D.Endometrial adenocarcinoma is staged surgically, and advanced endometrial carcinoma is considered to be FIGO stage III and IV. The Gynecologic Oncology Group (GOG) has come a long way in developing new strategies in the management of advanced endometrial carcinoma. Combining surgery, radiation, and chemotherapy, the 5-year survival has improved to between 40-60% in newly diagnosed advanced endometrial carcinoma. Recent findings in GOG184 indicate that multiple risk factors noted at the time of surgical staging could lead to concurrent clinical trials that could be completed expeditiously rather than a subsequent ten year long phase III trial including all the various risk subgroups of patients. This review is a focus on the accomplishments of the GOG in advanced endometrial carcinoma with an emphasis on future challenges. Originally published Journal of Gynecologic Oncology, Vol. 19, No. 3, Sep 2008Item Open Access Endometrial carcinoma in vitro chemosensitivity testing of single and combination chemotherapy regimens using the novel microculture kinetic apoptosis assay: implications for endometrial cancer treatment(East Carolina University, 2010-03) Ballard, Karen S.; Homesley, Howard D.; Hodson, Charles; Presant, Cary A.; Rutledge, James; Hallquist, Allan; Perree, MathieuObjective: The in vitro microculture kinetic (MiCK) apoptosis assay has been used to predict single or combination chemotherapy response in leukemia patients. This feasibility study addressed MiCK in endometrial cancer specimens. Methods: Endometrial cancer specimens from total abdominal hysterectomies were processed at a central laboratory. Single cell suspensions of viable endometrial cancer cells were plated in individual wells. Single and combination regimens were tested: combinations of doxorubicin, cisplatin, and paclitaxel and carboplatin and paclitaxel (Gynecologic Oncology Group [GOG] 209 endometrial cancer phase III trial arms) as well as single agent testing with paclitaxel, carboplatin, doxorubicin, cisplatin, ifosfamide, and vincristine (active agents in GOG trials). Apoptosis was measured continuously over 48 hours. Results: Fifteen of nineteen patients had successful assays. The highest mean chemo sensitivity was noted in the combination of cisplatin, doxorubicin, and paclitaxel with lower mean chemosensitivity for carboplatin and paclitaxel. Combination chemotherapy had higher chemosensitivity than single drug chemotherapy. However, in 25% of patients a single drug had higher chemosensitivity than combination chemotherapy. As single agents, ifosfamide, cisplatin, and paclitaxel had the highest kinetic unit values. Conclusion: Using a panel of agents simulating clinical dose regimens, the MiCK assay was feasible in evaluating in vitro chemosensitivity of endometrial cancer. MiCK assay results correlated with GOG clinical trial results. However, 25% of patients might be best treated with single agent chemotherapy selected by MiCK. Ifosfamide, cisplatin, and paclitaxel appear to have high activity as single agents. MiCK may be useful in future new drug testing and individualizing endometrial cancer patient’s chemotherapy management. Originally published Journal of Gynecologic Oncology, Vol. 21, No. 1, Mar 2010