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Biomedical subjects

D E Townsend

Publications and source records attributed to D E Townsend.

At least 91 records · Page 5Linked to original sources
PubMed1980

Vaginal intraepithelial neoplasia: Biologic aspects and treatment with topical 5-fluorouracil and the carbon dioxide laser.

A review of 41 evaluable patients was made in order to study vaginal intraepithelial neoplasia (VAIN) and to investigate new methods of treatment. Colposcopic examination of the vagina revealed white epithelium alone in 20 patients and white epithelium associated with vascular punctation in 15. No lesion had a vascular mosaic pattern. Most patients had multifocal disease located in the vaginal apex. Iodine staining was positive in six patients with negative colposcopic examinations. Twenty-four patients had severe dysplasia or carcinoma in situ, and 17 had minimal or moderate dyplasia. Associated genital disease occurred in 17 patients with antecedent cervical or vulvar squamous neoplasia, and six additional patients had coexistent lesions. The chronology of vaginal disease that appeared after treatment of cervical neoplasia suggests a persistent but decreasing likelihood of the development of VAIN with the passage of time. In patients followed without therapy, six had spontaneous remission of disease. Treatment was successful in 12 of 15 patients with topical 5-fluorouracil and in nine of 10 patients with the carbon dioxide laser. The advantage of these methods of treatment for patients with VAIN relative to surgical procedures and radiation therapy are considered.

Adult↗
PubMed1980

An analysis of "long-term" follow-up results in patients with cervical intraepithelial neoplasia treated by cryotherapy.

Two thousand eight hundred thirty-nine patients who had been treated by cryotherapy for cervical intraepithelial neoplasia (CIN) in nine different institutions were followed longitudinally after three negative Papanicolaou smears to ascertain the risk of recurrence. The cumulative risk of developing CIN after successful cryotherapeutic management of CIN was 0.41% at year 5, 0.44% at year 10, and 0.44% at year 14. There was no significant difference in risk between patients originally treated for CIN 1, CIN 2, or CIN 3.

Carcinoma↗
PubMed1980

Fertility and outcome of pregnancy in women exposed in utero to diethylstilbestrol.

Fertility and outcome of pregnancy were examined in women participating in the National Cooperative Diethylstilbestrol Adenosis (DESAD) Project. We compared 618 subjects who had prenatal exposure to DES with 618 control subjects. Fertility, measured in terms of pregnancies achieved, did not differ between the women exposed to DES and the controls. An increased risk of unfavorable outcome of pregnancy was associated with DES exposure (the relative risk of any unfavorable outcome of pregnancy was 1.69; P less than 0.001). Speculation on biologic mechanisms that might produce this difference is premature, since additional data about these subjects must be collected. Among DES-exposed women who became pregnant, 81 per cent had at least one full-term live birth.

Abnormalities, Drug-Induced↗
PubMed1979

Nuclear DNA and histologic studies of genital lesions in diethylstilbestrol-exposed progeny. II. Intraepithelial glandular abnormalities.

This study has analyzed the nuclear DNA content of intraepithelial glandular lesions in diethylstilbestrol (DES)-exposed offspring. The endocervical cells and endometrial-tubal cells present in the vaginal adenosis and pericervical collars had a euploid distribution. However, greater proliferative activity was found among the endometrial-tubal cells. In the cells of vaginal adenosis of a postpartum woman without a confirmed history of maternal exposure to DES, a polyploid pattern was found, indicating that endometrial-tubal cells underwent hyperplastic changes under the influence of hormonal stimulation. In an atypical adenosis derived from endometrial-tubal cells, an aneuploid pattern was found. Based on these findings, it is suggested that endometrial-tubal cells have a greater proliferative potential than endocervical cells.

Adult↗
PubMed1979

Vaginal epithelial changes in young women enrolled in the National Cooperative Diethylstilbestrol Adenosis (DESAD) project.

Initial clinical findings are reported for the 3339 young women enrolled in the Diethylstilbestrol Adenosis (DESAD) project. Changes in the vaginal mucosa (VEC--vaginal epithelial changes), which were detected by colposcopy or iodine staining, occurred in 34% of 1275 participants identified by review of prenatal records 59% of participants who themselves requested entry into the project, and 65% of participants referred by a physician. Analysis of data on the 298 women who were identified by record review and whose prenatal records contained complete information about drug exposure indicated that VEC is most closely associated with the timing of the onset of intrauterine exposure to diethylstilbestrol (DES), total dose, and length of exposure. Frequency of VEC was also found to decrease with age. No instances of severe dysplasia, carcinoma in situ, invasive squamous cell adenocarcinoma, or clear cell carcinoma were observed among the women identified by record review.

Adenocarcinoma↗
PubMed1978

Cryosurgery.

Explore the source record for details and available documents.

Cryosurgery↗
PubMed1978

Comparison of histologic and colposcopic findings in DES-exposed females.

A study was undertaken to evaluate the histologic alterations associated with two of the most abnormal colposcopic findings, mosaicism and punctation, that are commonly found in the vaginas and cervices of young women who have been exposed prenatally to diethylstilbestrol (DES). Four-fifths of 215 biopsy specimens from 171 exposed subjects with mosaicism or punctation disclosed metaplastic squamous epithelium, the presence of which is thought to reflect the repair of vaginal adenosis and cervical ectropion. Hyperkeratosis was observed in one-fifth of the specimens and was more frequent in lesions colposcopically graded I than II. Mild dysplasia was encountered in only one specimen. The findings indicate that the presence of squamous cell dysplasia cannot be predicted by the finding of Grade I or II mosaicism or punctation in the DES-exposed female despite the fact that these abnormal colposcopic patterns are associated with dysplasia in about 10% of cases when encountered in the cervix of the unexposed woman.

Colposcopy↗
PubMed1977

Clinical and laboratory correlates of molar pregnancy and trophoblastic disease.

From January 1, 1970 to July 1, 1976, 128 women had hydatidiform moles evacuated at the Los Angeles County-University of Southern California Women's Hospitals. Of the 121 patients with follow-up, persistent trophoblastic disease (TD) was diagnosed in 32 (26.4 per cent). Remission was achieved in all treated patients. The frequency of TD was significantly increased in pregnancies large for dates (47.8 per cent), with a uterus greater than 20 weeks' gestational size (45.0 per cent) or with theca-lutein cysts greater than 5 cm. in diameter (50.0 per cent). A normal regression curve for serum beta-human gonadotropin as measured by radioimmunoassay has been constructed as an aid to the early recognition of postmolar TD (invasive mole and choriocarcinoma).

Adult↗
PubMed1977

Management of carcinoma in situ of the vulva.

Concern about multicentricity and occult invasion has led authorities to recommend total vulvectomy in the management of carcinoma in situ of the vulva (VCIS). Of these considerations, only occult invasion has sufficient import to contraindicate a more conservative therapeutic approach. VCIS is being diagnosed with increasing frequency in young women for whom the deforming and sexually crippling effects of vulvectomy are especially repugnant. Because of its distinctive success in localizing preinvasive and early invasive squamous neoplasia of the cervix, colposcopy and directed biopsy were employed in evaluating all patients seen in our vulva clinic since 1971. Of 27 consecutive patients considered to have VCIS, 24 were treated either by local excision, skinning vulvectomy, topical 5-fluorouracil (5-FU), or cryosurgery. In no instance was occult invasion missed on pretreatment evaluation, and only one patient has developed a new in-situ lesion following conservative surgical therapy. Topical 5-FU therapy was unsuccessful in six of six cases. These results demonstrate that total vulvectomy for VCIS can be replaced successfully with more conservative operations.

Adult↗
PubMed1977

Pelvic celiotomy in the obese patient.

We have responded to the challenge of surgery in the overweight patient by promoting it to an area of special interest. These individuals should not be deprived of good medical care although their obesity makes the physician's task more arduous and increases the risk of a poor result. With the use of intensive preoperative preparation, including prophylactic antibiotics and heparinization, a modified operative technique, and an active recovery regimen, a more sanguine view toward the surgical care of obese women can be taken.

Adult↗
PubMed1977

Mixed mesodermal sarcoma of the ovary.

Three cases of mixed mesodermal sarcoma (MMS) are reported and a review of 90 cases from the English literature is presented. All cases were analyzed with regard to clinical features, prognosis, and therapeutic efficacy. The histogenesis of these rare tumors is discussed and a new classification of ovarian sarcomas is proposed. MMS usually afflicts the postmenopausal women and occurs more often in the nulliparous female. The disease is usually advanced (Stage III) when diagnosed and thus provides a difficult challenge to any postoperative therapy.

Adolescent↗
PubMed1976

Gravlee jet irrigator. Efficacy in diagnosis of endometrial neoplasia.

The Gravlee jet irrigator was used in 556 women with abnormal uterine bleeding. The irrigator failed to demonstrated endometrial adenocarcinoma in 14 of 25 patients. In ten of these 14, the specimens were found to be unsatisfactory. Twenty-six percent (16 of 61) of those patients with unsatisfactory specimens had a proliferative endometrial lesion. The false-negative rate in diagnosing endometrial cancer with an adequate specimen was 27% (4 of 15). Forty-eight of 61 cases of hyperplastic endometrial lesions were not diagnosed by means of jet irrigation. The irrigation failed to detect premalignant endometrial lesions and was not sufficiently reliable to exclude endometrial carcinoma when a satisfactory negative specimen was obtained.

Adenocarcinoma↗
PubMed1976

Impact of cephalosporin prophylaxis on conization-vaginal hysterectomy morbidity.

A prospective, randomized, double-blind evaluation of Loridine-Keflex prophylaxis in a homogeneous group of 32 patients undergoing sequential cervical conization and vaginal hysterectomy is reported. There was no infectious or febrile morbidity in the 18 oatuebts receuvubg abtubuitucs, Morbidity occurred in six of 14 patients receiving placebos (P is less than 0.05). Antibiotic prophylaxis and conization-hysterectomy morbidity are discussed.

Adult↗
PubMed1976

Histopathologic spectrum of vaginal adenosis and related changes in stilbestrol-exposed females.

A total of 98 colposcopically directed biopsies were obtained from the vagina, cervix, and cervicovaginal ridge (hood) of 80 young women believed to have had intrauterine exposure to stilbestrol (DES). Specific investigation of the patient's medical records corroborated the history of maternal stilbestrol administration in 36 patients (45%), while in the remainder the drug history was regarded as presumptive since medical records were unavailable for review. The findings did not differ significantly in those biopsies taken from patients with confirmed or presumptive drug histories. Histologic evidence of vaginal adenosis was detected in vaginal biopsies from 43 patients. In 30 cases (70%) benign Müllerian-type glandular epithelium was in the superficial vaginal wall, residing on the mucosal surface and/or in the lamina propria. The glandular epithelium predominantly was of endocervical type, but in six instances it resembled endometrial or fallopian tubal epithelium. The glands were accompanied by varying degrees of squamous metaplasia in 22 cases. When extensive the metaplasia produced transformation zones similar to those seen in the normal cervix. Vaginal biopsies of adenosis from the other 13 patients (30%) revealed squamous metaplasia without demonstrable glands due to complete transformation of all antecedent glandular epithelium by squamous metaplasia. Our studies indicate that squamous metaplasia is a component of major importance in the natural history of adenosis and that the concept of adenosis should be broadened to include those examples comprised exclusively of metaplastic epithelium. In such examples metaplasia is identified by the immaturity and poor glycogenation of the squamous cells and their accompanying squamous pegs which often contain residual gland openings or squamous "eddies." Similar findings were present in biopsies of seven cervicovaginal ridges and in cervical biopsies from 37 patients, except for the absence of endometrial or tubal type glands in the latter site. Although no adenocarcinomas were detected, six patients had squamous dysplasia of the vagina and/or cervix. In no case were premalignant or dysplastic changes of glandular cells found. Our findings support the thesis that stilbestrol-associated adenosis represents anomalous embryologic localization of the original squamocolumnar junction in the vagina rather than in the cervix. It is closely related to so-called cervical "erosions." The development of squamous metaplasia accounts for modifications in the clinical and histologic appearances by producing transformation zones which then may be subject to the same oncogenic stimuli for squamous neoplasia as are their counterparts in the cervix.

Adolescent↗