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Biomedical subjects

H M Shingleton

Publications and source records attributed to H M Shingleton.

At least 73 records · Page 4Linked to original sources
PubMed1984

Ureteral strictures and fistulae following radical hysterectomy.

Three hundred patients have undergone radical hysterectomy and pelvic node dissection at The University of Alabama in Birmingham (UAB). Uretero-vaginal fistulae occurred in four (1.3%). None of these were associated with recurrent carcinoma. Two occurred because of intraoperative trauma and two were unexplained. Ureteral strictures occurred in 13 (4.3%). Three were early (within 3 months) and were due to benign causes. Ten were late (after 3 months) and were due to recurrent cancer. Thirty-two patients received whole pelvis radiation therapy for positive pelvic nodes or positive margins. None of these developed uretero-vaginal fistulae. Two developed ureteral obstruction and recurrent cancer was the etiology. Four patients received postoperative vaginal ovoids for positive vaginal margins. None developed a fistulae, but two developed ureteral obstruction secondary to recurrent cancer. Two patients received both whole pelvis and vaginal ovoid irradiation. No fistulae occurred, but one developed ureteral obstruction from recurrent cancer. Recurrent cancer causing ureteral obstruction was a serious finding as only 2 of 10 patients have been salvaged.

Antineoplastic Agents↗
PubMed1984

Peritoneal cytology in patients with squamous cell carcinoma of the cervix.

The importance of peritoneal cytology was investigated in 163 patients with squamous cell carcinoma of the cervix. Of 116 patients undergoing primary evaluation and treatment 3 (2.5%) had abnormal cytology. No abnormal specimens were found in 77 patients undergoing radical hysterectomy. Five (10.6%) of forty-seven patients evaluated and treated for posttreatment recurrence had abnormal cytology. All eight patients with abnormal cytology had other poor prognostic factors and are dead of cancer. The relevance of abnormal cytology is discussed.

Ascitic Fluid↗
PubMed1984

Lower extremity edema due to deep vein thrombosis in patients with recurrent cervix cancer.

Seven patients with recurrent cervix cancer and concurrent lower extremity edema and pain were studied with contrast venography. Five patients (83%) were proven to have deep venous thrombosis. Significant objective and subjective response to therapeutic intravenous heparinization was obtained in all patients with DVT. The low morbidity and high rate of efficacy of treating this problem should encourage the physician to investigate this problem, in order to offer palliation.

Adult↗
PubMed1983

Hemodynamic parameters following pelvic exenteration.

Hemodynamic parameters were prospectively studied in 31 patients who underwent pelvic exenteration. With the use of a thermistor-tipped pulmonary artery catheter, hemodynamic parameters were calculated during the intraoperative and acute (less than 48 hours) postoperative interval. The mean operative time was 5.5 +/- 0.8 hours, and volume replacement (mean, 21.6 ml/kg/hr) consisted of crystalloid, colloid, and blood. Postoperative urine production (mean, 1.9 ml/kg/hr) was maintained with crystalloid (mean, 2.5 ml/kg/hr), colloid (0.2 ml/kg/hr), and blood (0.4 ml/kg/hr). Despite individual variations, the important parameters of cardiovascular function were maintained in the physiologic range. No patient developed cardiovascular or respiratory failure. We believe that the lack of perioperative morbidity and mortality was related, in substantial part, to this type of cardiovascular monitoring, which allows for the prompt diagnosis of potential problems and enables the physician to make appropriate interventions to correct these problems.

Adult↗
PubMed1983

Gastrointestinal complications associated with pelvic exenteration.

Between October, 1969, and August, 1981, 125 pelvic exenterations were performed by gynecologic oncologists at the University of Alabama in Birmingham. One hundred twenty patients underwent an exenterative procedure that required urinary diversion and a gastrointestinal anastomosis. Gastrointestinal complications accounted for 60% of all nonmalignant indications for reoperation after exenteration. The common factor in the majority of gastrointestinal complications was the presence of an anastomosis in previously irradiated small bowel. Other preoperative factors, such as significant medical disease, previous laparotomy, or malnutrition, had little apparent effect on the rate of gastrointestinal complications. Avoidance of a small bowel anastomosis by means of a colon conduit, use of an omental pedicle to bring new blood supply into the pelvis, and hyperalimentation have reduced the risk of small bowel obstruction and fistula to 2.2%, while alteration in surgical technique has decreased the rectovaginal fistula rate to 5.3%.

Adult↗
PubMed1983

The role of percutaneous nephrostomy in gynecologic oncology.

Percutaneous nephrostomy can provide rapid relief of renal failure due to ureteral obstruction by contiguous spread of cervical malignancy. A series of 26 percutaneous nephrostomies placed in 14 patients with cervical cancer, using only local anesthesia and ultrasound or fluoroscopic guidance is presented. Twelve patients experienced no complications, one developed pyelonephritis which cleared rapidly with antibiotics, and one suffered a hematoma managed by surgical nephrostomy. Three of six previously untreated patients and one of eight patients with recurrent disease survived over a year. A single exenterated patient was stented when anuria developed after surgery to correct a conduit leak. This patient survives at 1.5 years with no evidence of recurrence. Indications for percutaneous nephrostomy, anticipated benefits, and the decision-making process involved in determining who to stent is reviewed.

Acute Kidney Injury↗
PubMed1983

Tumor recurrence and survival in stage IB cancer of the cervix.

Clinical records of 371 women with carcinoma of the cervix, Stage IB, treated in the decade 1969-1979 were reviewed. Cancer recurred in 67 women (18.1%). A group of 171 patients treated by radiation, including 25 who were surgically staged prior to treatment, was compared to 200 patients treated by radical abdominal hysterectomy and pelvic node dissection, including 35 who had postoperative whole pelvis radiation. A multifactorial analysis included time to recurrence, site of recurrence, treatment for recurrence, and survival after recurrence. Pathology review and clinicopathological correlation included tumor configuration, histologic type, size of tumor in greatest dimension, and rate of node metastases in patients undergoing either radical hysterectomy or surgical staging procedures. Lesion size was found to be the most accurate predictor of disease-free survival; this was true whether the patient was treated by surgery or radiation and was not significantly affected by the tumor histology. Nodal metastases were associated with increasing size of lesions and predicted high recurrence rates. Node metastasis rates were not affected by the histology of the tumor.

Female↗
PubMed1983

Regeneration of cervical epithelium after laser vaporization.

The process of reepithelialization after laser vaporization of normal cervical squamous epithelium was examined using light and electron microscopy. Tissue specimens were obtained from seven patients at time intervals ranging from seven to 16 days after laser vaporization. Immature squamous epithelium appeared at the edge of the laser crater between seven and 14 days, and by 14 to 16 days, the immature epithelium covered the entire crater area. The observations made in this study concur with those of other studies of the healing process of squamous epithelium, whereby immature cells from the surrounding undamaged epithelium migrate into the damaged area, eventually differentiating into a full thickness of epithelium.

Biopsy↗
PubMed1982

Urinary diversion in patients undergoing pelvic exenteration.

Between October, 1969, and April, 1981, gynecologic oncologists at the University of Alabama Medical Center in Birmingham have performed 119 pelvic exenterations. One hundred fifteen of these patients had a concurrent supravesical urinary diversion. Fifty-six patients (48.7%) had an anterior exenteration and 59 patients (51.3%) had a total exenteration. An ileal segment was used as a conduit in 97 patients while the segment of transverse colon was used in 16 patients. Two patients had sigmoid conduits. Eighty-five patients (73.9%) had the intestinal anastomosis and conduit constructed with gastrointestinal staplers. Stapler use shortened the mean operating time for the exenterative procedure by approximately 30%. No increase in postoperative gastrointestinal complications was noted. Urinary diversion preformed as part of a pelvic exenteration has been associated with short- and long-term complications. The use of ureteral stents and the gastrointestinal staplers shortens the procedure without predisposing the patient to major urologic complications. The use of a segment of unirradiated bowel (transverse colon) in conjunction with these techniques constitutes the preferred method of supravesical urinary diversion in patients undergoing a pelvic exenteration.

Colon↗
PubMed1982

Correlation of perioperative morbidity and conization to radical hysterectomy interval.

Between October 1969 and December 1980, radical hysterectomies were performed on 311 patients at the University of Alabama Medical Center in Birmingham. The hospital records of these patients were reviewed for perioperative morbidity. One hundred twenty-two patients (39.2%) had had previous cold knife conization. The conization to radical hysterectomy interval varied between 48 hours and 8 weeks. An analysis of the perioperative morbidity was performed comparing patients with to those without prior conization. Previous cervical conization, regardless of the interval, was not associated with increased hospital stay, operative time, blood loss, or febrile morbidity in patients undergoing radical hysterectomy. These findings suggest that a radical hysterectomy may be safely performed after cervical conization, regardless of the intervening interval.

Abscess↗
PubMed1981

Adenocarcinoma of the cervix. I. Clinical evaluation and pathologic features.

A series of 137 patients with primary adenocarcinoma of the cervix is presented with emphasis on clinical and histologic features. Adenocarcinoma has several distinct histologic patterns that may occur in a pure form but often occur (44%) in combinations of two or more patterns. Mixtures of adenocarcinoma and squamous cell carcinoma occur in one third of the patients and squamous intraepithelial neoplasia occurs in one tenth. Transmission electron microscopy is helpful in classifying poorly differentiated tumors. Preliminary recurrence/survival data suggest that the identification of patterns and subpatterns has no prognostic significance, nor is there evidence that adenocarcinoma (or adenosquamous carcinoma) metastasizes earlier, metastasizes more frequently, or is more radioresistant. For most patients, treatment may be the same as that for squamous cell carcinoma but a few selected patients with bulky central lesions may benefit from combined therapy consisting of whole-pelvis irradiation and conservative hysterectomy.

Adenocarcinoma↗
PubMed1981

Impact of a colposcopy satellite clinic.

A community educational program and the introduction of a colposcope in Decatur, Alabama, led to a dramatic decrease in the relative percent of patients evaluated by conization after a positive Pap smear, and a corresponding increase in the relative percent of colposcopic evaluations. The percent of negative or dysplastic tissue diagnoses from conization was reduced from 78% before the colposcopy program to 61% after the program. It was estimated that the colposcopy program resulted in an 81% reduction in the number of conizations and that colposcopy used in lieu of conization resulted in a substantial reduction in both morbidity and cost.

Adolescent↗
PubMed1981

Cervical intraepithelial neoplasia associated with exposure to diethylstilbestrol in utero: a clinical and pathologic study.

The anatomic, colposcopic, cytologic, and histologic findings of the cervix in 300 women exposed to diethylstilbestrol (DES) in utero are reported. Structural cervical abnormalities were found in 51.7% of these patients and an abnormal colposcopic examination was present in 50.6%. The initial interpretation of the pathologic specimens revealed that 26.6% of patients had cytologic or histologic evidence of cervical dysplasia. A uniform pathologic review demonstrated that 10.8% of the cytologic specimens and 37.5% of the histologic specimens had been overread by the initial pathologist. A correlation of the review cytology and histology revealed that the Papanicolaou smear sensitivity for the prediction of abnormal histology was 83.9% and specificity was 86.3%. The probability of an atypical cytologic finding predicting an abnormal histologic pattern was highly significant (P less than .00001). Colposcopic and structural cervical abnormalities were not predictive of an abnormal histologic diagnosis. Of the 18 patients (6%) with histologic evidence of mild-moderate dysplasia, 12 have been followed with no treatment, and cytologic and colposcopic examination has been normal. Marked dysplasia-carcinoma in situ was found in 14 patients (4.7%). Their therapy is summarized. These data strongly suggest that women exposed to DES may be followed safely with Papanicolaou smears and colposcopic examinations provided that both cytopathologists and colposcopists are cognizant of the metaplastic changes in the DES progeny that distinguish them from patients with cervical intraepithelial neoplasia (CIN) who were not exposed to DES. Biopsy should be performed only if indicated by cytologic atypia, colposcopic evidence of advanced CIN, or the presence of an invasive lesion.

Adolescent↗
PubMed1981

Cryosurgery of cervical intraepithelial neoplasia.

Nine hundred sixty-eight patients with cervical intraepithelial neoplasia (CIN) were evaluated with colposcopy and treated with cryosurgery; 722 had a pretreatment diagnosis of CIN I or II and 246 had CIN III. Of those patients available for 2 follow-up smears, histologically proved persistence of CIN was found in 10% of patients with CIN I and II and 20% of patients with CIN III. Recurrent disease was detected in 3.2 and 3.8%, respectively. No patients had a recurrence after 5 negative Papanicolaou smears. One patient had invasive carcinoma 30 months after treatment. Failure of patients to return for follow-up was a significant problem. When the present results were compared to those published in the literature, cryosurgery was found to be less effective than conization in treating CIN III.

Carcinoma, Squamous Cell↗