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Biomedical subjects

H M Shingleton

Publications and source records attributed to H M Shingleton.

At least 55 records · Page 3Linked to original sources
PubMed1986

Radioimmunoassay of free beta-subunit of human chorionic gonadotropin as a prognostic test for persistent trophoblastic disease in molar pregnancy.

A new radioimmunoassay system was established with a monoclonal antibody (1E5) that distinguishes the free beta-subunit of human chorionic gonadotropin in the presence of intact human chorionic gonadotropin, showing only 0.23% cross-reactivity with the intact human chorionic gonadotropin molecule and virtually no cross-reactivity with other glycoprotein hormones or their beta-subunits. Serum samples, taken at initial diagnosis from nine patients with hydatidiform mole and spontaneous remission and 12 patients with subsequent progression to persistent trophoblastic disease, were assayed for free and total levels of the beta-subunit of human chorionic gonadotropin. The assay results were expressed as a ratio of nanograms of free beta-subunit per 1000 mIU of total beta-subunit. Eight of nine patients with mole and spontaneous remission had a ratio value less than 4 whereas 10 of 12 patients with subsequent persistent disease had a ratio value greater than 4. Statistical analysis with chi 2 showed a highly significant correlation of high ratios with eventual progressive disease (p = 0.0009). This study suggests that excessive production of the free beta-subunit of human chorionic gonadotropin may identify patients with a high likelihood of developing persistent trophoblastic disease.

Chorionic Gonadotropin↗
PubMed1986

Lymph node metastasis in cancer of the cervix: a preliminary report.

Accurate assessment of lymph node metastasis in cervical cancer is imperative to treatment plan. A histologic sampling method is suggested in which surgically excised lymph nodes are dissected at multiple levels before paraffin embedding. This approach proves to be a more sensitive procedure than the current bisection method in detecting metastasis.

Female↗
PubMed1986

Isolated abdominal wound recurrence of an endometrial adenocarcinoma confined to a polyp.

An unusual case of Stage IB moderately well-differentiated endometrial adenocarcinoma that was confined to a polyp and recurred only in the abdominal wound is presented. Eighteen months following complete excision, local electron beam therapy, and the institution of hormonal therapy, the patient is alive and without other evidence of recurrence. The mechanisms of metastasis in this case are discussed.

Abdominal Neoplasms↗
PubMed1986

The effect of beta-adrenergic stimulation on the bladder and urethra following radical hysterectomy.

The effect of two beta-adrenergic stimulating agents on bladder and urethral function was assessed in 16 patients 3 weeks after radical hysterectomy for carcinoma of the cervix. Urodynamic evaluation was performed before and after inhalation of metaproterenol by metered dose inhaler in 10 patients and injection of 0.25 mg of terbutaline sc in 6 patients. Although no change was observed following administration of metaproterenol, a significant decrease in maximum urethral pressure and urethral closure pressure, and a significant increase in volume of urine voided was found after administration of terbutaline. These results suggest that beta-sympathomimetic agents may benefit those patients with bladder dysfunction following radical hysterectomy.

Adrenergic beta-Agonists↗
PubMed1986

Closed suction pelvic drainage after radical pelvic surgical procedures.

Thirty-four women had short-term, low-pressure, closed suction pelvic drainage after radical gynecologic surgical procedures. Mean collected fluid losses were significantly higher after radical hysterectomy (25.3 ml/kg) when compared with abdominal hysterectomy (10.7 ml/kg) and lymphadenectomy. There was no correlation between the volume of pelvic drainage and patient's age, patient's weight, duration of operation, or amount of blood loss. The fluid contents resembled serum and were rarely culture positive. Short-term (5-day) drainage was not associated with lymphocysts.

Adult↗
PubMed1986

Endometrial adenocarcinoma after in utero diethylstilbesterol exposure.

The association of cervicovaginal adenocarcinoma and in utero diethylstilbesterol exposure is well known. There is concern that offspring exposed in utero may be predisposed to develop other malignancies as well. Presented is a case of endometrial adenocarcinoma occurring in this clinical setting. To the best of the authors' knowledge this association has not been reported previously.

Adenocarcinoma↗
PubMed1986

Diethylstilbestrol in pregnancy: an update.

Several decades ago, diethylstilbestrol (DES) was considered efficacious in improving pregnancy outcome. Later data did not support this, and the exposed mothers and offspring have suffered from a variety of problems attributed to the drug. Knowledge of these problems is essential in dealing with these patients.

Adenocarcinoma↗
PubMed1986

Study of superficially invasive carcinoma of the cervix.

A detailed histologic study has been completed on 125 patients with squamous cell carcinoma of the cervix invading to a depth no greater than 5 mm. Depth of invasion was 3 mm or less in 73% and 3.1 to 5 mm in 27%. The median width was 4.8 mm (range 0.08 to 20 mm). Most of the lesions were multifocal (82%); the number of invasive foci correlated well with increasing width and depth of invasion. Lymphvascular space invasion was found in seven patients, none of whom had lymph node metastases, although in one a single focus of carcinoma was present in the parametrium. Therapy consisted of radical hysterectomy and pelvic lymphadenectomy in 55% of the women, including 43 patients with lesions invading less than 3 mm. There was tumor metastatic to lymph nodes in only one of 69 patients with dissected nodes (1.4%). The mean follow-up time was 5.0 years; there was one recurrence (cervical intraepithelial neoplasia only). This study and a survey of the recent literature imply that tumor pattern, width, and confluence can be ignored in lesions invading to 5 mm, and that the most important factor to consider in therapy planning is depth of invasion. The following guidelines are proposed. In lesions without lymphvascular space invasion, those invading the stroma to no more than 3 mm may be treated with a total abdominal or vaginal hysterectomy. In lesions invading between 3 and 5 mm, a total abdominal hysterectomy and a pelvic lymphadenectomy seem adequate therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Corpus and cervix cancer: a nutritional comparison.

Nutritional parameters of patients with cervical cancer and endometrial cancer were prospectively evaluated. Analysis of anthropometric assessments that were abnormal in as many as 52% of patients indicated little difference between organ sites in mean values or percentage of patients with abnormal values. Biochemical parameters included serum albumin, total iron-binding capacity, copper, zinc, and creatinine height index. An abnormal value was present in as many as 60% of patients. Multiple abnormal values were more likely to be present in patients with endometrial cancer. Abnormal vitamin levels were more commonly present in patients with cervical cancer. When compared to control values, levels of plasma folate, beta carotene, and vitamin C were significantly lower in patients with cervical cancer. Patients with endometrial cancer had significantly lower levels of beta carotene and vitamin C. Analysis of surgical complications suggested a correlation with specific nutritional deficits.

Adult↗
PubMed1985

Nutritional status of patients with untreated cervical cancer. I. Biochemical and immunologic assessment.

A prospective nutritional evaluation of 78 patients with untreated cervical cancer was undertaken. Stage-related abnormal anthropometric measurements were present in 60% of patients. Abnormal biochemical nutritional measurements were found in 67% of patients. Thirty percent of these patients were anergic to usual skin test antigens. The overall incidence of protein-calorie malnutrition was 12.5%; however, the risk was stage-related. Measured parameters were usually adversely affected following a surgical procedure. Although surgical complications were few, the implications of these findings as to the appropriate method and timing of nutritional assessment as well as the possible benefit from nutritional support in malnourished patients with cervical cancer are discussed.

Adult↗
PubMed1985

Nutritional status of patients with untreated cervical cancer. II. Vitamin assessment.

Prospective vitamin assessment was undertaken in 78 patients with untreated cancer of the uterine cervix. At least one abnormal vitamin level was present in 67% of patients while individual levels were abnormal in as many as 38% of patients. Significantly lowered levels of plasma folate, vitamin A, and vitamin C were present. Although most of these vitamins did not correlate with other parameters of protein-calorie malnutrition, the possible preventative and treatment effects of these vitamins require additional investigation.

Avitaminosis↗
PubMed1985

Role of endocervical curettage in colposcopy.

Two-thousand three-hundred and four patients with abnormal cervical cytology were evaluated by colposcopy, cervical biopsy, and endocervical curettage. The endocervical curettage was more accurate than the cervical biopsy in 1.2% of patients with satisfactory colposcopic examinations, 15.7% of patients with unsatisfactory examinations, and 30.5% of patients with no lesions observed. The endocervical curettage contained neoplastic epithelium in all 15 of the patients with invasive cancer and in seven patients it was the only diagnostic parameter that indicated invasion. The information from the endocervical curettage, when correlated with the cervical cytology, colposcopic findings, and cervical biopsy, eliminated the need to do a diagnostic conization in 76% of patients with unsatisfactory examinations and 79% of patients with no lesion identified. It is recommended that the endocervical curettage be a part of every colposcopic examination.

Adult↗
PubMed1985

Pelvic fibromatosis: an unusual gynecologic tumor.

Pelvic fibromatoses are only unusually encountered in gynecologic practice, but then consistently create a diagnostic and therapeutic challenge. The reported patient typifies the difficulties encountered in surgical excision. A discussion of theories of etiology and management options follows.

Adult↗
PubMed1985

Identification of histopathologic risk groups in stage IB squamous cell carcinoma of the cervix.

This study was undertaken to identify histopathologic risk factors in 100 women with stage IB squamous cell carcinoma of the cervix treated surgically. Histologic factors included maximum depth of stromal invasion, presence of lymph-vascular invasion, mitotic activity, nature of the tumor-stromal borders, plasma cell-lymphocyte stromal response, histologic grade, and metastases to regional lymph nodes. Using a multifactorial analysis, the maximum depth of stromal invasion was found to be the most important prognostic indicator (P less than .0001). The depth of invasion also correlated significantly with the presence of nodal metastases (P less than .0001), lymph-vascular space invasion (P = .0003), and "spreading" versus "pushing" borders (P = .0315). The number of mitoses, grade of tumor, or plasma cell-lymphocyte stromal response did not correlate significantly with depth of stromal invasion. Lymph-vascular involvement, although present in 59% of the patients, did not significantly affect survival. Depth of stromal invasion and lesion diameter were combined to constitute three risk groups: Patients with small size cervical tumors (less than 2 cm), regardless of depth of stromal invasion, as well as patients with intermediate size lesions (2.1 to 3 cm) with stromal invasion less than or equal to 1.5 cm, constituted a low-risk group; the intermediate-risk group was comprised of those patients with cervical lesions between 2.1 and 3 cm in size and deep stromal invasion (greater than 1.5 cm), as well as those patients with large cervical lesions (greater than 3.0 cm) and stromal invasion less than or equal to 1.5 cm.2+ (greater than 3 cm) and deep stromal invasion (greater than 1.5 cm).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

The use of ultrasound and computed tomography scanning in the management of gynecologic cancer patients.

The contribution of abdominal-pelvic computed tomography (CT) and ultrasound scanning to the management of gynecologic malignancy patients was assessed retrospectively in 62 scans that were performed immediately preceding laparotomy. A total of 55.5% CT and 71.4% ultrasound scans were found to be helpful. Diagnostic problem areas included the detection of lymph node metastases, peritoneal implants, omental metastases, and parametrial extension. An additional 75 scans performed in patients not undergoing laparotomy were received to assess any alteration in management resulting from the scans. It is concluded that clinicians should be more discriminating in their requests for scanning procedures and that appropriate communication between the clinician and the radiologist may avoid unproductive scans.

Evaluation Studies as Topic↗