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Biomedical subjects

J A Merrill

Publications and source records attributed to J A Merrill.

At least 19 recordsLinked to original sources
PubMed1988

Pathology of endometriosis.

In summary, endometriosis is a protean pathologic entity of uncertain nature and etiology, occurring commonly in the pelvis and rarely in remote sites. The lesions are characterized by gross and microscopic evidence of endometrium, past and present hemorrhage, inflammatory response, scarring, and dense adhesions. Electron microscopic evaluation suggests that early lesions are more common than appreciated, often retroperitoneal, and not clinically recognized. The diagnosis is established by the identification of microscopic foci of endometrium, although often the end stage reveals only hemosiderin-laden macrophages, foreign body giant cells, and proliferation of fibrous connective tissue. The presence of endometriosis alters the biology of the pelvic peritoneum in ways not universally agreed upon, but which undoubtedly influence the clinical manifestation of the disease.

Endometriosis↗
PubMed1988

Radiation dose and second cancer risk in patients treated for cancer of the cervix.

The risk of cancer associated with a broad range of organ doses was estimated in an international study of women with cervical cancer. Among 150,000 patients reported to one of 19 population-based cancer registries or treated in any of 20 oncology clinics, 4188 women with second cancers and 6880 matched controls were selected for detailed study. Radiation doses for selected organs were reconstructed for each patient on the basis of her original radiotherapy records. Very high doses, on the order of several hundred gray, were found to increase the risk of cancers of the bladder [relative risk (RR) = 4.0], rectum (RR = 1.8), vagina (RR = 2.7), and possibly bone (RR = 1.3), uterine corpus (RR = 1.3), cecum (RR = 1.5), and non-Hodgkin's lymphoma (RR = 2.5). For all female genital cancers taken together, a sharp dose-response gradient was observed, reaching fivefold for doses more than 150 Gy. Several gray increased the risk of stomach cancer (RR = 2.1) and leukemia (RR = 2.0). Although cancer of the pancreas was elevated, there was no evidence of a dose-dependent risk. Cancer of the kidney was significantly increased among 15-year survivors. A nonsignificant twofold risk of radiogenic thyroid cancer was observed following an average dose of only 0.11 Gy. Breast cancer was not increased overall, despite an average dose of 0.31 Gy and 953 cases available for evaluation (RR = 0.9); there was, however, a weak suggestion of a dose response among women whose ovaries had been surgically removed. Doses greater than 6 Gy to the ovaries reduced breast cancer risk by 44%. A significant deficit of ovarian cancer was observed within 5 years of radiotherapy; in contrast, a dose response was suggested among 10-year survivors. Radiation was not found to increase the overall risk of cancers of the small intestine, colon, ovary, vulva, connective tissue, breast, Hodgkin's disease, multiple myeloma, or chronic lymphocytic leukemia. For most cancers associated with radiation, risks were highest among long-term survivors and appeared concentrated among women irradiated at relatively younger ages.

Female↗
PubMed1987

(Sub)specialization in obstetrics and gynecology: results of a survey by the American Board of Obstetrics and Gynecology.

Survey of department chairmen (n = 113) and former fellows (n = 599) revealed that from 1974 to 1984 the mean number of full-time faculty doubled and the increase was in subspecialists (5.1 per department). More than 60% of departments report trained subspecialists in three areas and 92.9% in one or more areas. Twenty-two chairmen report zero laboratory research funding. Of former fellows, 82% are certified in obstetrics and gynecology; 44% are certified in a subspecialty; 86.3% have passed the subspecialty written examination. Employment is full-time faculty for 60.8% and full-time private practice for 16.1%. They devote 49.1% of professional time to the subspecialty and 15.9% to research, most of which is clinical; 56.6% spend no time in laboratory research. While 40.3% have submitted no research grant applications since completion of fellowship, of all grants submitted to the federal government, 63.5% were approved and 34.5% were funded. The mean number of papers published since fellowship is 7.8. The number of fellows graduating may meet estimated need. The initial objectives of this new certification are being achieved.

Certification↗
PubMed1986

Elevated serum alpha-fetoprotein associated with Sertoli-Leydig cell tumors of the ovary.

Two young girls are described who presented with amenorrhea, large ovarian masses, elevated serum alpha-fetoprotein (AFP), and signs of androgen excess. Whereas the findings of an ovarian mass and elevated serum AFP typically suggest an ominous diagnosis, ie, endodermal sinus tumor of the ovary, both of these patients were found at laparotomy to have Sertoli-Leydig cell tumors of the ovary. Unilateral oophorectomy rapidly led to undetectable AFP levels in both patients, and resumption of menses.

Adolescent↗
PubMed1981

Management of postmenopausal bleeding.

Postmenopausal genital bleeding is a symptom that requires thorough evaluation. In most cases the cause is benign. Nongenital and nonuterine causes will be found occasionally and should be managed accordingly. The principal thrust of management involves thorough history, examination, and interpretation of endometrial histology. The latter is especially necessary to exclude the most significant, but not most common, cause of postmenopausal bleeding, i.e., adenocarcinoma of the endometrium. Estrogen therapy contributes to postmenopausal bleeding and is usually contraindicated in such cases. Endometrial hyperplasia is considered a precursor lesion to endometrial carcinoma, but the incidence of progression is not great. Thus a scheme of conservative management that relies on repeat histologic examination of the endometrium to determine the biologic potential of endometrial hyperplasia is recommended. Although hospital D&C of the uterus is the traditional accepted method of evaluating the endometrium, there are persuasive reasons to consider suction endometrial biopsy as an appropriate alternative in most patients presenting with postmenopausal bleeding.

Biopsy↗
PubMed1977

Evaluation of abnormal cervical cytology.

The results from cytologic, colposcopic, and histologic studies in 376 patients are analyzed and compared to previous reports. Cytologic results correlated within 1 degree of the histologic diagnosis in only 67% of cases. Colposcopic impression correlated with the final histologic diagnosis in 78% of cases. Directed biopsies were exceedingly accurate (99.3%) when the entire transformation zone was visualized. When the entire zone was not visualized, 7 cases of invasive carcinoma were discovered among 59 cone biopsies. It is concluded that cytology should be used only as a screening tool and colposcopy as a directional aid in obtaining biopsies and defining the need for endocervical curettage. When the entire zone is visualized, directed biopsies are dependable and cone biopsies may be avoided. When the upper zone is not visualized and the endocervical canal is involved by significant dysplasia or carcinoma in situ as diagnosed by directed biopsies and/or endocervical curettage, cone biopsy is mandatory prior to definite therapy.

Biopsy↗