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Biomedical subjects

E E Partridge

Publications and source records attributed to E E Partridge.

At least 55 records · Page 3Linked to original sources
PubMed1994

LLETZ is an acceptable alternative to diagnostic cold-knife conization.

Large loop excision of the transformation zone (LLETZ) provides a pathologic specimen similar to a cold-knife cone (CKC) biopsy of the cervix. One hundred twenty women with indications for a cone biopsy were evaluated with LLETZ to determine if this procedure is an acceptable alternative to traditional cold-knife conization of the cervix. All patients had LLETZ performed in the clinic under local anesthesia. An average of 2.1 slices was required to remove the transformation zone. Coagulation artifact interfered with histologic diagnosis in only 1.8% of specimens. The number of slices taken during the LLETZ procedure significantly correlated with the amount of heat artifact in the pathology specimen (P = 0.02) and interfered with the ability of the pathologist to determine complete excision of dysplasia (P = 0.03). LLETZ is an acceptable alternative to diagnostic CKC and can offer a substantial cost savings. To facilitate histopathologic interpretation, every effort should be made to minimize the number of slices and to maintain orientation of the LLETZ specimen. Endocervical curettage performed after LLETZ can identify a group of patients who are at high risk for CIN recurrence.

Adolescent↗
PubMed1994

Appraisal of the modalities used to evaluate an initial abnormal Papanicolaou smear.

OBJECTIVE: To examine the efficacy of the different modalities used to evaluate an initial abnormal Papanicolaou smear. METHODS: The study population comprised 214 nonpregnant women referred with a Papanicolaou smear diagnosis of cervical intraepithelial neoplasia. Each patient was evaluated by a repeat Papanicolaou smear, colposcopy, and colposcopically directed cervical biopsies. Immediate loop excision was performed to remove the entire transformation zone in all patients. Kappa statistics were calculated to determine agreement among the modalities, and logistic regression was used for determining relative risks (RR). RESULTS: There was 53% agreement between the initial and repeat Papanicolaou smears. When low-grade squamous intraepithelial lesion (SIL) was diagnosed by Papanicolaou smear, there was 89% agreement with the colposcopic impression. However, a colposcopic impression of high-grade SIL was found in only one-third of the women diagnosed with high-grade SIL by Papanicolaou smear. A comparison of the histology of the cervical biopsy and the loop specimen revealed 57% agreement. Univariate analysis indicated that each modality was able to predict the RR of high-grade dysplasia in the loop specimen at a statistical significance level of .05. A colposcopic impression of high-grade dysplasia conferred an RR of 7.43 (95% confidence interval [CI] 2.17-25.49) for high-grade dysplasia in the loop specimen. An initial Papanicolaou smear diagnosis of high-grade SIL did not contribute to the multivariate model for calculating the risk of high-grade dysplasia, as the RR was 1.6 (95% CI 0.68-3.81). CONCLUSION: Patients with an initial Papanicolaou smear showing low-grade SIL would benefit from a repeat Papanicolaou smear and colposcopically directed biopsies before proceeding with loop diathermy. In contrast, patients with a colposcopic impression of high-grade dysplasia combined with high-grade SIL on Papanicolaou smear appear to be candidates for immediate loop excision.

Adolescent↗
PubMed1993

Diet and endometrial cancer: a case-control study.

A case-control study of 168 cases with endometrial cancer and 334 controls was conducted in Birmingham, Alabama, between June 1985 and December 1988. Cases were identified at the University of Alabama Hospital and in a private practice; controls were selected from among women who attended the University optometry clinic. A food frequency questionnaire that evaluated the intake of 55 nutrients and 116 foods was obtained for 103 cases and 236 controls. Logistic regression was used to evaluate the effect of diet on endometrial cancer after adjustment for total calories, age, race, education, obesity, smoking status, age at menarche, number of pregnancies, age at menopause, diabetes, hypertension, and use of exogenous estrogens. High intake of certain micronutrients was associated with a decreased risk of endometrial cancer: the odds ratio for subjects in the upper tertile versus those in the lower tertile was 0.4 for both carotene and nitrate (95% confidence interval (CI) 0.2-0.8 and 0.2-0.9, respectively). There also was an inverse association between endometrial cancer and protein consumption (trend test; p = 0.002), and a moderate direct association with cholesterol intake (OR = 1.9, 95% CI 0.9-3.7) when terms for both these macronutrients were included in a logistic model. Total intake of animal and vegetable fat were not associated with endometrial cancer. More frequent consumption of several vegetables and certain dairy products was associated with a statistically significant decreased risk of endometrial cancer. These results suggest that diet plays an important role in the etiology of endometrial cancer.

Carotenoids↗
PubMed1993

The validity and significance of substages of advanced ovarian cancer.

No studies to date have evaluated the validity of the new FIGO substaging of advanced epithelial ovarian cancer nor assessed the importance of substage in relation to other elements such as age at diagnosis, debulking surgery, and second-look laparotomy. The purpose of this study was to determine the significance of these factors. One hundred sixty-seven patients with Stage III ovarian cancer were restaged according to the 1988 FIGO criteria (6% Stage IIIa, 15.6% Stage IIIb, and 78.4% Stage IIIc). The mean age at diagnosis was 40.5 for Stage IIIa, 51 for Stage IIIb, and 62 for Stage IIIc (P = 0.0001). Median survival was 2.5 years for patients age < 60 and 1.4 years for those age > or = 60 (P = 0.0001). Median survival for patients undergoing TAH/BSO was 2.06 years, bowel resection 1.39 years, and biopsy only 1.38 years (P = 0.0003). Only 61 of 131 Stage IIIc patients underwent second-look laparotomy. Seven of nine Stage IIIa, 6 of 17 Stage IIIb, and 14 of 61 Stage IIIc patients had negative second-look laparotomies (P = 0.004). Only 4 of the 14 patients with Stage IIIc and 8 of 13 Stage IIIa/b patients are alive after negative second look (P = 0.37). Median survival for Stage IIIa patients has not been reached and for Stages IIIb and IIIc was 2.29 years and 1.33 years, respectively (P = 0.0001). These data confirm the prognostic validity of FIGO substages for Stage III. The age differential by substages suggests that the natural history of Stage III disease is progressive over several decades. The appropriateness of aggressive cytoreductive surgery and second-look laparotomy must be reevaluated using the new FIGO staging system.

Adult↗
PubMed1993

The rhomboid transposition flap for repair of the perineal defect after radical vulvar surgery.

A detailed account is given of experience at a single institution with the rhomboid transposition flap used to repair the perineal defect after surgery for carcinoma of the vulva. In 13 of 15 assessable cases, the flaps healed completely or had insignificant separation of a segment of the flap. In 2 cases, more major breakdown occurred in association with infection, but in both cases, satisfactory healing occurred without further surgery. In 14 cases, passage of a speculum and inspection of the vagina was possible at follow-up and only 1 patient experienced introital stenosis.

Adult↗
PubMed1993

The Groshong catheter as an intraperitoneal access device in the treatment of ovarian cancer patients.

With the development of new intraperitoneal treatments in ovarian cancer, safe and convenient access to the peritoneal cavity is now required. This report reviews the University of Alabama at Birmingham's experience with the Groshong catheter as an intraperitoneal access device. The Groshong was easily inserted intraperitoneally in 20 ovarian cancer patients and used to deliver 81 courses of intraperitoneal therapy over 2310 patient-days. There were no catheter-related complications during treatment and only one exit site infection after catheter removal. Further investigation of the Groshong catheter as a novel intraperitoneal access device appears warranted.

Antineoplastic Agents↗
PubMed1993

Ureteroarterial fistulae in exenteration patients with indwelling ureteral stents.

Ureteroarterial fistulae (UAF) are a rare complication of prolonged ureteral stenting. To date only three patients have been reported who have developed UAF after pelvic exenteration. This report presents two additional patients with UAF following exenteration and prolonged ureteral stenting. Rapid diagnosis with pelvic arteriography and retrograde ureteral angioplasty balloon catheter placement is discussed, and successful management with femoral artery embolization and bypass surgery is reviewed.

Adult↗
PubMed1993

A case-control study of endometrial cancer in relation to cigarette smoking, serum estrogen levels, and alcohol use.

OBJECTIVES: The purpose of this study was to evaluate the effect of cigarette smoking and alcohol use on the risk of endometrial cancer. The impact of smoking on serum estrone, estradiol, and androstenedione levels also was examined. STUDY DESIGN: This hospital-based case-control study included 168 women with endometrial carcinoma and 334 control women. RESULTS: Women who were current smokers had a lower risk of endometrial cancer than did women who did not smoke (relative rate 0.69; 95% confidence interval 0.40-1.19), whereas women who were exsmokers and women who had never smoked had similar rates (relative rate 0.83; 95% confidence interval 0.46-1.48). There was little overall association between serum estrogen levels and cigarette smoking, although estradiol levels in overweight control subjects were lower among women who were current smokers than among women who had never smoked. Androstenedione levels were slightly higher among women in the control group who smoked than among women in the control group who did not smoke, but the difference was not statistically significant (p = 0.28, two-tailed). Alcohol use was unrelated to endometrial cancer in this study. CONCLUSIONS: The study provides additional support for the hypothesis that smoking is inversely related to endometrial cancer. The inverse smoking association with endometrial cancer may be more directly related to higher serum androstenedione levels than to lower serum estrogen levels except, perhaps, among overweight women.

Adult↗
PubMed1993

Staging ovarian cancer diagnosed during laparoscopy: accuracy rather than immediacy.

Immediate staging and debulking of an unsuspected ovarian malignancy detected at the time of diagnostic laparoscopy is appropriate when personnel knowledgeable in these procedures are available. However, when assistance is unavailable, termination of the diagnostic laparoscopy and timely referral is acceptable. This report reviews techniques to preoperatively distinguish a benign from a malignant adnexal mass, steps to evaluate an adnexal mass during laparoscopy, and ovarian cancer staging procedures.

Diagnosis, Differential↗
PubMed1993

Radical hysterectomy in the treatment of patients with bulky early stage carcinoma of the cervix uteri.

This study was done to assess the role of radical hysterectomy in patients with bulky (greater than or equal to 4 centimeters) early stage carcinoma of the cervix uteri. Of 48 patients with bulky carcinoma of the cervix uteri undergoing Type III radical hysterectomy between 1970 and 1987, 46 patients were Stage 1B and two were Stage 2A. Pathologic estimate of the dimensions of the lesion ranged from 4 x 3 to 9 x 11 centimeters. Fourteen patients had evidence of pelvic node metastasis and one patient had evidence of microscopic metastasis to the para-aortic nodes. Twelve patients received adjunctive radiation therapy for findings of nodal metastasis or tumor near or at the surgical margin. There were recurrences in 19 patients, 13 of which were isolated to the pelvic area. Of the patients with isolated pelvic recurrences, five were salvaged with secondary treatment. The overall five year survival rate was 73.6 percent and the ten year survival rate was 60.6 percent. Radical hysterectomy and lymphadenectomy seems to have equal efficacy and morbidity rates when compared with radiation therapy or the combination of extrafascial hysterectomy and radiation therapy in the treatment of patients with bulky early stage carcinoma of the cervix uteri.

Adenocarcinoma↗
PubMed1992

Second-look laparotomy and salvage therapy: a research modality only?

Two hundred twelve patients who underwent second-look laparotomy as part of their treatment for epithelial ovarian cancer were evaluated. Factors associated with positive second looks were initial stage, tumor grade, age, and residual disease (P less than 0.05). One factor not of significance was whether adjuvant therapy was platinum based. Initial stage only was associated with recurrence after a negative second look (P less than 0.001). When controlled for volume of disease no difference in survival between various salvage therapies could be demonstrated. Survival between patients with recurrence after negative second look and patients with microscopic residual disease was similar even though the former group was not treated until recurrence (P = 0.75). Second-look laparotomy does not improve survival with currently existing salvage modalities and should primarily be confined to those patients willing to participate in research protocols evaluating new second-line therapy.

Adult↗
PubMed1992

The prognostic implications of low serum CA 125 levels prior to the second-look operation for stage III and IV epithelial ovarian cancer.

Second-look laparotomy is performed to evaluate response to chemotherapy and to determine the need for additional treatment. The relationship between absolute levels of serum CA 125 less than 35 u/ml and disease status at second-look operation was evaluated in 95 patients with advanced-stage epithelial ovarian cancer. Eighty-six patients had Stage III disease and nine patients had Stage IV cancer. Residual tumor was documented at second-look laparotomy in 52 (55%) of the patients studied. Forty-nine percent of the 82 patients with serum CA 125 values less than 20 u/ml had residual disease. In contrast, 12 of 13 (92%) patients with serum CA 125 values of 20-35 u/ml had residual tumor at second-look laparotomy. All patients with serous cystadenocarcinomas and serum CA 125 values of 20-35 u/ml had residual tumor, and two-thirds of these cases had grossly visible disease. The positive predictive value of a serum CA 125 level of 20-35 u/ml was 0.92. These data suggest that second-look laparotomy should be deferred in patients with advanced-stage ovarian cancer until serum CA 125 values are less than 20 u/ml.

Adult↗
PubMed1992

A matched comparison of single and triple incision techniques for the surgical treatment of carcinoma of the vulva.

Thirty-two patients with invasive squamous cell carcinoma of the vulva (SCC) undergoing radical vulvectomy or radical local excision with bilateral superficial groin node dissection using a triple incision technique (TI) were matched for new FIGO stage, lymph node status, size of lesion, and site of lesion with patients with SCC undergoing traditional radical vulvectomy with en bloc bilateral groin (but not pelvic) node dissection using a single incision (SI) technique. Average operative time (134 min: 191 min), blood loss (424 ml: 733 ml), and hospital stay (9.7 days: 17.2 days) were significantly less in the TI group. After SI 6/32 (19%) patients and after TI 1/32 (3%) patients experienced complete breakdown of the groin wounds. There was no significant difference in overall survival (P = 0.56) or disease-free survival (P = 0.53) between the two groups. There was no significant difference in survival between the two groups by lesion size or by FIGO (1989) stage. Disease recurred in six patients after SI compared with seven after TI (P = 0.75). There were no skin bridge recurrences in the TI group. Two patients in each group had isolated vulvar recurrences and all four were successfully treated by local excision. These data indicate that outcome following TI surgery is essentially equal to that of SI in early-stage disease but major morbidity is much reduced.

Adult↗
PubMed1992

5-fluorouracil and low-dose leucovorin in the treatment of recurrent squamous cell carcinoma of the cervix. A phase II trial of the Gynecologic Oncology Group.

Twenty-eight patients with recurrent squamous carcinoma of the cervix not amenable to cure by further surgery or radiation therapy were entered into a Phase II trial utilizing i.v. leucovorin 20 mg/m2 followed by 5-fluorouracil 425 mg/m2 administered daily for 5 days every 4 weeks for the first two courses and then every 5 weeks. One patient never received therapy, and three are inevaluable for response; therefore, 27 patients were evaluable for toxicity and 24 for response. Twenty-three patients had received prior radiotherapy, and 16 had received prior chemotherapy. There was one partial response 4.2% (95% confidence intervals for a response of 0 to 21%). Although toxicity was acceptable with 11 of 27 (41%) grade 3 or 4 leukopenia, 1 of 27 (4%) grade 3 thrombocytopenia, and 3 of 27 (11%) grade 3 or 4 gastrointestinal toxicity, this dose schedule of 5-fluorouracil and leucovorin has minimal activity in recurrent squamous carcinoma of the cervix.

Adult↗
PubMed1992

Effect of deoxyribonucleic acid ploidy status on survival of patients with carcinoma of the endometrium.

This retrospective study was performed to determine the clinical usefulness of deoxyribonucleic acid (DNA) ploidy and the amount of DNA in the nucleus of the tumor cell on the prognosis of patients with carcinoma of the endometrium. Five year follow-up study was obtained for 121 patients. Flow cytometric analysis was used to determine tumor cell ploidy from paraffin-embedded specimens. Patients were grouped according to ploidy, clinical stage and grade and whether or not they received postoperative radiation. The data were subjected to a Cox proportional hazards regression analysis, and only ploidy status and clinical stage were significantly associated with survival time. Of the 121 patients observed, 44.6 per cent were aneuploid and 55.4 per cent, euploid. Preliminary chi-square analysis indicated a strong survival advantage to those patients with euploid endometrial carcinoma. The over-all five year survival rate for patients with aneuploid tumors was 53.7 per cent, as opposed to 80.6 per cent for patients with euploid tumors (p less than 0.01). Eighty-seven patients were Stage I, 39 aneuploid, 48 euploid. The five year survival rate for patients with Stage I aneuploid was 71.8 versus 85.4 per cent for those who were euploid. Twenty-one patients were Stage II; seven aneuploid and 14 euploid. The five year survival rate for aneuploid patients was 14.3 versus 85.7 per cent for euploid patients. The over-all five year survival rate for those with Stage I and II was 85.5 per cent euploid and 63.0 per cent aneuploid, p less than 0.05. Patients with Stage III or IV had poor outcome regardless of ploidy status. These data show that patients with euploid Stage I and II carcinoma of the endometrium have a significant survival advantage over patients with aneuploid tumors. We, therefore, believe that ploidy status may be used to facilitate the determination of prognosis in carcinoma of the endometrium.

Adenocarcinoma↗
PubMed1991

Endometrial cancer, obesity, and body fat distribution.

A case-control study was undertaken to evaluate the roles of obesity and body fat distribution in the etiology of endometrial cancer. The study also included an evaluation of the associations of serum estrone, estradiol, and androstenedione with obesity, body fat distribution, and endometrial cancer risk. The study included 168 cases and 334 control subjects identified at an optometry clinic. A strong, positive relationship between overall obesity and endometrial cancer was found. The relative rate of endometrial cancer for women in the upper 90th percentile of a body mass index compared to those below the median was estimated as 5.5 with 95% confidence limits of 3.2-9.6. There was no association between endometrial cancer and the waist to hip ratio, an index of upper versus lower body fat distribution. A statistical test of trend across the four quartiles of the waist to hip ratio yielded a P value of 0.45 after adjustment for confounding by the body mass index. On the other hand, there was a statistically significant, independent positive effect of a high subscapular to tricep skinfold ratio, a measure of central versus peripheral obesity, on endometrial cancer risk. The relative rates of endometrial cancer for the second, third, or fourth quartile compared to the first quartile of this index were 1.5, 1.9, and 2.7, respectively (P = 0.007), after adjustment for the body mass index. Serum estrone and estradiol, but not androstenedione, were statistically significantly correlated with the body mass index among control subjects (r = 0.37 and 0.40 for estrone and estradiol, respectively). On the other hand, each of the sex hormones was uncorrelated with the waist to hip ratio after adjustment for body mass. The correlations between each of the three hormones and the subscapular to tricep skinfold ratio among controls were weak and were not statistically significant (0.10, 0.10, and 0.14 for estrone, estradiol and androstenedione, respectively). Cases had statistically significantly higher mean serum estrogen and androstenedione levels than did controls and these elevations did not simply reflect a higher prevalence of obesity among them. The findings are equivocal with respect to fat patterns and endometrial cancer. We suggest that future epidemiological studies of cancer and body fat distribution more carefully distinguish among the various types of fat patterns.

Adipose Tissue↗
PubMed1991

Primary surgical therapy of ovarian cancer: how much and when.

From July 1975 through December 1985, 328 patients with ovarian malignancies were treated. Of these, 302 had epithelial invasive malignancies and constitute the study group. The impact of the operative procedure, findings, and subsequent treatment is evaluated. Patients who underwent extensive debulking procedures such as bowel resection and peritoneal stripping did not have improved survival compared with those patients who did not undergo these procedures and yet had residual disease remaining (P = 0.7 and P = 0.34). Reoperating patients felt to be unresectable at the time of referral did not increase survival over reoperating patients after an attempt at chemotherapeutic reduction (P = 0.34).

Female↗