Papers by Veronica Schimp
The Journal of maternal-fetal medicine, Jul 1, 2000
To investigate the role of subspecialization in maternal-fetal medicine (MFM) on the frequency of... more To investigate the role of subspecialization in maternal-fetal medicine (MFM) on the frequency of a trial of labor in term pregnancies with breech presentation. We conducted a retrospective study of 332 singleton pregnancies > or =37 weeks with nonfootling breech presentation that delivered over a 6-year period (1994-1998) at a university-based, tertiary care hospital. Patients were divided into two groups based on whether the delivery was attended by an MFM or non-MFM obstetrician-gynecologist. Demographic and clinical data were compared between groups and outcome variables included whether the patient had an attempt at vaginal delivery, cesarean delivery after a labor attempt, or vaginal breech delivery. The frequency of labor attempt (OR 1.4, 95% CI 0.9-2.3), vaginal breech success rate (OR 0.6, 95% CI 0.3-1.5), and overall cesarean rates (OR 0.9, 95% CI 0.5-1.7) were similar between groups. Using discriminant function analysis, only nulliparity (R2 = 1.6%, F = 6.0, P = 0.005) and birthweight (R2 = 2.0% F = 6.4, P = 0.01) were associated with trial of vaginal delivery. Subspecialization in MFM had no impact on the frequency of trial of labor in the term pregnancy with a breech presentation.
Gynecologic Oncology, May 1, 2003
The goal of this study was to review the clinical presentation, management, and outcome of upper ... more The goal of this study was to review the clinical presentation, management, and outcome of upper extremity deep vein thrombosis (UEDVT) in women with gynecologic malignancies who had indwelling peripheral venous access catheters. From a retrospective review of medical records, we identified 13 patients with various gynecologic malignancies who were diagnosed with UEDVT during their disease course. We obtained tumor data, detailed information regarding the indwelling catheters used, and the diagnosis and management of UEDVT. Two hundred sixty-four women with gynecologic malignancies underwent insertion of an indwelling peripheral catheter by interventional radiology over a 5-year period. A total of 325 catheters were placed in these patients. Thirteen patients developed UEDVTs, and all had a catheter in situ at the time of DVT diagnosis. Eleven of thirteen patients had Peripheral Access System (PAS) Ports and two had peripheral indwelling central catheters (PICCs). The mean age of the patients was 53 years (range, 32-70). At the time of UEDVT diagnosis patients had the following: progressive cancer (n = 8), stable disease (n = 1), no evaluable disease (n = 4), and actively receiving chemotherapy (n = 7). Clinical signs/symptoms at the time of diagnosis included: catheter occlusion (n = 2), arm swelling and pain (n = 10), and superior vena cava syndrome (n = 1). Diagnosis of thrombosis was confirmed using Doppler ultrasound (n = 4), venography (n = 5), and both modalities (n = 4). Management of UEDVT consisted of anticoagulation with warfarin (2-6 months) (n = 9), urokinase infusion (n = 2), intravenous antibiotics for 21 days and heparin for 10 days (n = 1), arm elevation only (n = 1), Lovenox for 60 days (n = 1), and no therapy (n = 1). There were no complications associated with anticoagulation. No patient had a pulmonary embolism. The incidence of UEDVT among our patients with indwelling venous catheters was 5.7%. Symptomatic UEDVT is an uncommon complication of indwelling peripheral venous catheters in women with gynecologic malignancies. The risk of pulmonary embolism is low in this patient population.
Journal of Clinical Oncology, May 20, 2012
5012 Background: VEGF receptor-mediated-signaling contributes to ovarian cancer pathogenesis. Ele... more 5012 Background: VEGF receptor-mediated-signaling contributes to ovarian cancer pathogenesis. Elevated VEGF expression and serum levels are associated with poor clinical outcomes. We investigated RAM, a fully human VEGFR-2 antagonist antibody, in patients (pts) with persistent or recurrent EOC/FTC/PPC. Methods: Adult women with EOC/FTC/PPC who had completed ≥1 platinum (P)-based chemotherapeutic (ct) regimen and had a P-free interval (PFI) of <12 months (m), progression on, or persistent disease after P-based therapy were eligible. Any number of prior ct regimens was allowed. ECOG PS 0-1 and adequate organ function were required. Pts received 8 mg/kg RAM IV every 2 weeks. Primary endpoints were progression-free survival at 6m (PFS-6) and confirmed objective response rate (ORR) by RECIST 1.0. Results: 60 pts were treated; 1 remains on study as of Dec 2011. Median age was 62 years (range 27-80). Median number of prior regimens was 3 (range 1– 14). 51 pts (85%) received ≥ 2 prior regimens; 25 pts (42%) received >3 prior regimens. 45 pts (75%) were P resistant or refractory, with 65% (39 pts) serous tumors. PFS-6: 34.2% (95% CI: 21.7% – 47%). Best overall response: 3 PR (5%), 34 SD (57%), 20 PD (33%) and 3 not evaluable (5%). Median duration of PR: 5.6m (3.7, 5.6, 17.5); median PFS: 3.5m (95% CI: 2.3 – 5.3). Median OS: 11.1m (95% CI: 8.3 – 17.0). No unexpected toxicities were observed. Grade (G) 3 adverse events (AEs) observed in >5% of pts were: headache (10%) and fatigue (8%). No G4 AEs were observed in >5% of pts. 5 deaths occurred on RAM or within 30 days of discontinuation; 4 due to PD, and 1 due to intestinal perforation. 1 G4 bowel perforation and one G4 colo-vaginal fistula were noted. All 3 cases of perforation/fistula occurred in the setting of progressive, large-volume disease. Correlative biomarker studies are ongoing to identify patients most likely to benefit. Conclusions: Ramucirumab was reasonably tolerated and demonstrated single-agent activity in persistent or recurrent ovarian carcinoma, with approximately one-third of patients progression free at 6 months.
Journal of Minimally Invasive Gynecology, Nov 1, 2011
Journal of stroke and cerebrovascular diseases, Sep 1, 2001
Posterior occipital and parietal lobe infarcts shown by computed tomography (CT) scan and magneti... more Posterior occipital and parietal lobe infarcts shown by computed tomography (CT) scan and magnetic resonance imaging have been associated with eclampsia. Gray-white matter, infarct-like lesions of the right basal ganglia, right posterior parietal, and left posterior parieto-occipital lobes were found by CT scan in a patient at 26 weeks gestation with severe preeclampsia and neurologic deficits. A magnetic resonance image taken 3 days postpartum had similar abnormalities, despite total resolution of the patient's symptomatology. A repeat CT scan performed 6 weeks postpartum showed complete resolution of the multiple infarctions. This is a unique case report that describes these severe brain-imaging findings in a patient with severe preeclampsia and neurologic deficits.
Gynecologic Oncology, Jun 1, 2008
Objective-Topotecan at a dose of 1.5 mg/m 2 on days 1 to 5 of a 21-day cycle is an approved thera... more Objective-Topotecan at a dose of 1.5 mg/m 2 on days 1 to 5 of a 21-day cycle is an approved therapy for recurrent ovarian cancer. However, heavily pretreated patients may be predisposed to hematologic adverse events. This prospective study, therefore, investigates the safety and efficacy of an alternate weekly schedule of topotecan in patients with recurrent ovarian or peritoneal cancer. Methods-Patients with potentially platinum-sensitive recurrent ovarian or peritoneal cancer were treated with 4.0 mg/m 2 weekly topotecan as tolerated until disease progression. Antitumor response and safety were assessed. Dose reductions, delays, or omissions were implemented for grades 3-4 adverse events. Results-Of the 41 enrolled patients (median age, 62 years; range, 42 to 82 years), 39 patients had ovarian cancer, and 2 patients had peritoneal cancer. The median platinum-free interval was 11.7 months. A median of 9 topotecan cycles (range, 1 to 45 doses) was administered. Weekly topotecan was well tolerated: 7 (17%) patients had grades 3-4 neutropenia, and 9 (22%) had grades 3-4 fatigue. No grade 4 thrombocytopenia or anemia was reported. Of 38 responseevaluable patients, 1 (3%) had a complete response, 8 (21%) had a partial response, 16 (42%) had stable disease, and 13 (34%) had progressive disease. Conclusions-Weekly topotecan was well tolerated in patients with platinum-sensitive ovarian or peritoneal cancer at first relapse, with a hematologic profile that compared favorably with that of the 5-day topotecan regimen. Moreover, antitumor activity was similar to that reported for the 5-day regimen.
Gynecologic Oncology, Dec 1, 2008
Chemotherapy remains an essential part of the treatment of advanced ovarian cancer. Intraperitone... more Chemotherapy remains an essential part of the treatment of advanced ovarian cancer. Intraperitoneal (IP) administration has been demonstrated to provide a survival advantage over intravenous chemotherapy in three phase 3 studies. However, IP catheter complications have been a significant factor in aborting IP therapy. A 42-year-old woman receiving IP chemotherapy for carcinoma of the ovary presented with complaints of incontinence. Examination revealed the catheter protruding through the external urethral meatus. The reservoir was intact, and the catheter was immobile. Laparoscopic and cystoscopic evaluation demonstrated that the catheter tip had eroded through the dome of the bladder. The catheter was re-secured to the abdominal wall, and the bladder was laparoscopically repaired. IP chemotherapy was resumed 16 days postoperatively without incident. This is the first report of an IP catheter eroding through the bladder. Increased usage of IP chemotherapy may offer new challenges in the diagnosis and management of catheter-related complications.
Case Reports in Oncology, Mar 19, 2019
Ovarian carcinosarcoma is also referred to as malignant mixed Mullerian tumor (MMMT). It is a rar... more Ovarian carcinosarcoma is also referred to as malignant mixed Mullerian tumor (MMMT). It is a rare neoplasm, and although it represents less than 5% of malignant ovarian tumors, it remains generally well-known among clinicians and pathologists. Rarer yet is ovarian teratoid carcinosarcoma, defined as carcinosarcoma with the added feature of immature neuroectodermal tissue, with or without elements of primitive germ cell tumor. To our knowledge, six ovarian teratoid carcinosarcomas have been reported in the literature [Matsuura et al. J Obstet Gynaecol Res. 2010 Aug;36(4):907-11]. These tumors resemble nasopharyngeal tumors of the same name. We report a 55-year-old woman seen at Orlando Health's division of gynecological oncology whose pathology showed ovarian teratoid carcinosarcoma, and present what we believe to be a seventh report of this entity.
Gynecologic Oncology, Feb 1, 2004
Objective. Negative pressure wound vacuum therapy can expedite the healing of complex wound failu... more Objective. Negative pressure wound vacuum therapy can expedite the healing of complex wound failures. Our aim was to evaluate the use of a vacuum-assisted closure (VAC) device to treat complex wound failures in gynecologic oncology patients. Methods. We retrospectively identified 27 patients with gynecologic malignancies in whom the device was used to treat complex wound failures from January 2001 to May 2002 at our institution. We analyzed operative data and information regarding the diagnosis and management of these complex wound failures and the length of time the device was used. Results. The procedures performed before wound VAC placement were total abdominal hysterectomy with bilateral salpingooopherectomy with or without tumor reductive surgery in 14 patients, vulvectomy with or without inguinal lymph node dissection in five patients, skin or myocutaneous grafting in three patients, parastomal herniorrhaphy in two patients, retroperitoneal lymph node dissection in two patients, and incision and drainage of a gluteal abscess after radiation therapy in one patient. Four of the 27 patients had the VAC device placed at the time of a reoperation, while the remaining 23 patients had the VAC device placed postoperatively for wound failures. Wound breakdown occurred at a median of 9 days (range: 0-88 days) postoperatively. Overall, there was a 96% reduction (range: 0-100%) in the median size of wound defects from 330 to 14.0 cm 3 with use of the VAC device. The median number of days of VAC therapy was 32 days (range: 3-88 days). Twenty patients used this device as outpatients, and the charge per day was approximately US$150.00. One patient experienced bleeding, and 26 patients experienced no complications. The only complaint was pain during dressing changes (67% of patients). The mean follow-up was 52 days (range: 0-270 days). At the time of last contact, 26 (96%) of 27 patients had complete wound healing. Conclusions. VAC therapy is a novel treatment using controlled negative pressure to evacuate wound fluid, stimulate granulation tissue, and to decrease bacterial colonization of the wound. Our experience indicates that this is a safe method to treat complex wound failures in gynecologic oncology patients.
International Journal of Gynecological Cancer, 2004
The rate of groin breakdown after radical wide vulvar excision and inguinal lymphadenectomy for v... more The rate of groin breakdown after radical wide vulvar excision and inguinal lymphadenectomy for vulvar cancer remains significant despite conservative surgical approaches. An 86-year-old Latin American woman underwent wide radical excision and bilateral inguinal lymphadenectomy for vulvar cancer. The postoperative course was complicated by bilateral groin wound separation and high output lymphorrhea. The patient responded to the application of a gelatin matrix-thrombin tissue sealant (FloSeal) to the bases of each groin with resolution in lymphorrhea and formation of granulation tissue. The application of a gelatin matrix-thrombin tissue sealant (FloSeal) may be a viable treatment in the management of groin breakdown in selected patients when conventional therapy produces suboptimal results.
Gynecologic Oncology, Jul 1, 2010
International journal of gynaecology and obstetrics, Aug 28, 2008
Objective: To determine general attitudes and approaches to complementary and alternative medicin... more Objective: To determine general attitudes and approaches to complementary and alternative medicine (CAM) among physicians who care for gynecologic oncology patients. Methods: Surveys were mailed to members of the Society of Gynecologic Oncologists and the Michigan Oncology Group. Physicians were asked to rate their general attitude toward CAM. Results: Surveys were obtained from 462 physicians. Gynecologic oncologists and female physicians were more likely to have positive attitudes toward CAM, and to believe that clinical care should integrate conventional and CAM practices, compared with other oncologists and male physicians. Conclusion: Discrepancies exist among oncologists regarding attitude and use of CAM in their practice. Education of physicians regarding the safety and efficacy of CAM modalities may ultimately improve patient care.
Cancer Research, May 1, 2005
Journal of Minimally Invasive Gynecology, Nov 1, 2010
Measurements and Main Results: 40 yo woman with primary infertility and irregular vaginal bleedin... more Measurements and Main Results: 40 yo woman with primary infertility and irregular vaginal bleeding had a pelvic sonogram which was suspicious of uterus didelphys. The endometrial thickness in the right endometrial cavity was 15mm and that of left was irregular, 6mm. Endometrial biopsy showed simple hyperplasia without atypia, bilaterally. The patient was treated with Provera, but returned three months later with continued irregular bleeding. Diagnostic hysteroscopy revealed that the right endometrial cavity was smooth and the left endometrial cavity contained multiple polyps. Curettings from both cavities demonstrated grade 2 endometrioid adenocarcinoma. A MRI and CT of the abdomen and pelvis revealed no myometrial invasion, no intra-abdominal disease and no lymphadenopathy. Chest x-ray was negative for metastasis. The patient had staging laparotomy. At the time of surgery, the diagnosis of didelphys uterus with complete vaginal septum was confirmed .The tumor was identified as high grade, poorly differentiated uterine papillary serous carcinoma, with extensive involvement of full thickness myometrium extending to the serosa. The tumor infiltrated full thickness of the cervix, upto parametrial resection margin. The omental and posterior bladder wall biopsies, bilateral fallopian tubes, bilateral ovaries, bilateral paraaortic and bilateral iliac lymph nodes were also involved (FIGO stage-IVB). Patient received 2 cycles of chemotherapy, developed liver metastasis and progressive anasarca and died of multisystem failure. Conclusion: We present the first ever case of synchronous UPSC arising in both endometrial cavities of a didelphys uterus. This case demonstrates that both horns of a uterus didelphys may be involved with malignancy and this combination may behave more aggressively.
Journal of Clinical Oncology, Jun 20, 2007
16000 Background: Although the majority of women with EC are postmenopausal, 25% are under the ag... more 16000 Background: Although the majority of women with EC are postmenopausal, 25% are under the age of 50 years at the time of diagnosis. The aim of this study is to describe the demographic and survival data for women presenting with EC at age 35 years or younger (YOY). Design: Patients with a diagnosis of EC were identified from the Surveillance, Epidemiology, and End Results (SEER) cancer database from 1988 to 2003. Demographic and pathologic data were collected. Chi-square and t-tests were used to examine differences between the younger and older women, and survival analyses were performed using Kaplan Meier and Cox regression models. Results: Of the 61,364 women diagnosed with EC in the study period, 931 patients 1.5% were 35 YOY. Compared to women 36 years of age or older at diagnosis, the young-onset women were more diverse in terms of race/ethnicity (p<0.0001), with white women comprising 48% of the younger population, and 80.4% of the older population. Hispanic 23.7%, black 8.3%, and other race/ethnicities 18.4% were more common in the younger age group. The mean age in the young population was 31.5 years. Mean age at diagnosis was greater for the young whites compared to the other racial groups combined (32.0 years vs. 31.0 years, p<0.0001). Younger women were more likely to be diagnosed in earlier stages and grades compared to their older counterparts (both p<0.0001). The overall stage by AJCC in younger women was 75.4%, 6.6%, 4.1% and 5.2% (stages I-IV, respectively), with 8.7% unstaged. In the younger women, 54.6%, 26.3%, and 9.5% of grade 1, 2, and 3 tumors were reported, respectively. Type II tumors comprised 4% (N=36) of the study population. The overall mean survival was significantly better for younger (75.4 months, 95% CI 71.8–79.0) compared to older women (66.6 months, 95% CI 66.2–67.0). The survival difference was seen for every AJCC stage of disease. Conclusions: The changing race and ethnicity demographics in the US, coupled with the increase in obesity, suggest that EC incidence may be on the rise in younger women. Early stage, well-differentiated EC represents the most common type of EC in the younger patients. As treatment standards differ for younger women who hope to preserve their fertility, it is important to follow the long-term outcomes in this group. No significant financial relationships to disclose.
American Journal of Clinical Pathology, Sep 11, 2019
Background: Alveolar soft part sarcoma (ASPS) is a rare malignant soft tissue tumor, mainly local... more Background: Alveolar soft part sarcoma (ASPS) is a rare malignant soft tissue tumor, mainly localized in the extremities, occurring principally in adolescents and young adults. ASPS is uncommon in the female genital tract. Case report: We here report a case of ASPS in a 20-year-old nullipara, presenting with vaginal bleeding and profound anemia requiring blood transfusions. Ultrasonographic examination revealed a polyp in the lower uterine segment. Surgical resection of the polyp was performed, and pathological evaluation showed the typical histological, immunohistochemical, and molecular features consistent with ASPS. At the time of this report, the patient was scheduled for total hysterectomy with promising results. Conclusion: Given the infrequency of ASPS, pathological evaluation is or utmost importance in order to establish an accurate diagnosis. When presenting as a primary tumor, complete excision is fundamental in the treatment.
Gynecologic Oncology, Jun 1, 2017
The Journal of maternal-fetal medicine, 2000
To investigate the role of subspecialization in maternal-fetal medicine (MFM) on the frequency of... more To investigate the role of subspecialization in maternal-fetal medicine (MFM) on the frequency of a trial of labor in term pregnancies with breech presentation. We conducted a retrospective study of 332 singleton pregnancies > or =37 weeks with nonfootling breech presentation that delivered over a 6-year period (1994-1998) at a university-based, tertiary care hospital. Patients were divided into two groups based on whether the delivery was attended by an MFM or non-MFM obstetrician-gynecologist. Demographic and clinical data were compared between groups and outcome variables included whether the patient had an attempt at vaginal delivery, cesarean delivery after a labor attempt, or vaginal breech delivery. The frequency of labor attempt (OR 1.4, 95% CI 0.9-2.3), vaginal breech success rate (OR 0.6, 95% CI 0.3-1.5), and overall cesarean rates (OR 0.9, 95% CI 0.5-1.7) were similar between groups. Using discriminant function analysis, only nulliparity (R2 = 1.6%, F = 6.0, P = 0.005) and birthweight (R2 = 2.0% F = 6.4, P = 0.01) were associated with trial of vaginal delivery. Subspecialization in MFM had no impact on the frequency of trial of labor in the term pregnancy with a breech presentation.
International Journal of Gynecological Cancer, Jul 1, 2004
The rate of groin breakdown after radical wide vulvar excision and inguinal lymphadenectomy for v... more The rate of groin breakdown after radical wide vulvar excision and inguinal lymphadenectomy for vulvar cancer remains significant despite conservative surgical approaches. An 86-year-old Latin American woman underwent wide radical excision and bilateral inguinal lymphadenectomy for vulvar cancer. The postoperative course was complicated by bilateral groin wound separation and high output lymphorrhea. The patient responded to the application of a gelatin matrix-thrombin tissue sealant (FloSeal) to the bases of each groin with resolution in lymphorrhea and formation of granulation tissue. The application of a gelatin matrix-thrombin tissue sealant (FloSeal) may be a viable treatment in the management of groin breakdown in selected patients when conventional therapy produces suboptimal results.
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Papers by Veronica Schimp