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Biomedical subjects

J B Wheelock

Publications and source records attributed to J B Wheelock.

32 records · Page 2Linked to original sources
PubMed1985

Uterine sarcoma: analysis of prognostic variables in 71 cases.

The histories of 94 patients with a diagnosis of uterine sarcoma, treated from 1962 to 1982, at the Medical College of Virginia Hospital were reviewed. Histologic features were studied by one of the authors (V.S.), and cases that did not meet strict pathologic criteria were rejected. The 71 patients with uterine sarcoma accepted for this study had a survival rate of 22.5% from 1 to 11 years. Survival rates were similar for leiomyosarcoma, mixed mesodermal tumor, and endometrial stromal sarcoma. Clinical staging had some predictive value, since 45 patients with Stage I disease had a 27% survival rate, and 26 patients with Stages II, III, and IV disease had only a 12% survival rate (p less than 0.05). The type of treatment had no demonstrable effect on final outcome but did influence the recurrence patterns. Chemotherapy (used in 25 patients) was neither of benefit when used as adjuvant therapy nor effective in prolonging survival in patients with recurrence (mean survival, 5.4 months).

Adult↗
PubMed1985

Prolapsed fallopian tube masquerading as adenocarcinoma of the vagina in a postmenopausal woman.

A postmenopausal patient with vaginal prolapse of the fallopian tube presented with an erroneous diagnosis of adenocarcinoma of the vaginal apex. Failure to consider fallopian tube prolapse in the differential diagnosis of vaginal adenocarcinoma led to an upper vaginectomy and subsequent complication of a ureterovaginal fistula. The differential diagnosis of adenocarcinoma of the vagina in the postmenopausal patient and the management of vaginal prolapse of the fallopian tube are discussed.

Adenocarcinoma↗
PubMed1985

Partial trachelectomy in the elderly patient with abnormal cytology.

Because of an unsatisfactory colposcopic examination, cold knife conization of the cervix is frequently required for the evaluation of postmenopausal patients with abnormal cervical cytology. With advancing age, the cervix atrophies and retracts so that conization becomes increasingly difficult and results in a tissue specimen that is frequently inadequate. Dissatisfied with the results of the standard conization procedure, the authors performed partial trachelectomy in 26 elderly patients with atrophic, retracted cervixes. The operative complications were acceptable. Twelve of the 26 patients (46%), including four with severe dysplasia and carcinoma in situ (CIS) and eight with invasive carcinoma, received additional therapy. Eleven of 14 patients (78%) with cervical intraepithelial neoplasia (CIN) had clear surgical margins; ten of these required no further therapy. The authors conclude that partial trachelectomy may be preferable to conization for the evaluation of elderly women with small, atrophic cervixes. It provides a specimen of sufficient length, so as to reduce the incidence of positive surgical margins and to decrease the need for additional therapy if no invasive neoplasia is found. The technique of partial trachelectomy is described.

Aged↗
PubMed1985

Endocervical curettage after cryotherapy for cervical intraepithelial neoplasia.

Two hundred forty-five patients were studied prospectively to determine the value of endocervical curettage (ECC) in the follow-up of patients having undergone cryotherapy for cervical intraepithelial neoplasia (CIN). Patients at high risk of treatment failure were divided into three groups: (I) CIN grade 3 lesions confined strictly to the ectocervix (86 patients), (II) CIN grade 1-3 lesions involving the endocervix to a depth of up to 5 mm and a negative ECC prior to cryotherapy (64 patients), and (III) CIN grade 1-3 lesions confined to the ectocervix or extending into the endocervix to a depth of up to 5 mm and a positive ECC (27 patients). A fourth group, 68 patients with CIN grade 1 and 2 lesions confined to the ectocervix, was considered to be at low risk of treatment failure and served as controls. All the patients had satisfactory colposcopy. ECC was performed at 6 and 12 months after cryotherapy. Recurrent or persistent CIN was diagnosed in 19 of 245 patients (8%) and was found in group I (6 of 86, or 8%), II (6 of 64, or 9%), III (3 of 27, or 11%) and IV (4 of 68, or 6%). The rates of treatment failure did not differ significantly between the various groups (p greater than 0.1). ECC was positive in 4 of 19 (21%) of the cryotherapy failures (group I, 1 of 6; II, 2 of 6; III, 1 of 3; IV, 0 of 4). In two cases of a positive follow-up ECC, cervical cytology was also positive.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

The CO2 laser for recurrent and therapy-resistant condylomata acuminata.

The medical records of 48 patients who underwent laser vaporization of therapy-resistant or recurrent condylomata acuminata were studied with regard to history of immunosuppression, location of original lesion, type and duration of therapy, and whether magnification devices were used prior to or during therapy. The genitalia of the patients' sexual partners were examined in all cases in which the condylomata recurred after initial control of the lesions with conventional methods. In 46 of the 48 cases, possible reasons for the failure of conventional therapy could be found: unresponsive to chemical therapy (11 patients); reinfection by the sexual partner (4); immunosuppression (8); several factors (6); and incomplete eradication of the lesion (20). Thirty-eight of the 48 patients (79%) were treated successfully with one-time laser ablation of the lesions. Six patients with recurrent condylomata after laser therapy underwent a second laser treatment, and four of the six patients (total, 87%) have remained free of disease. The laser appears to be an effective method of treatment for recurrent or persistent condylomata acuminata provided that (1) the patient is not immunosuppressed, (2) the potentially infected sexual partner is examined and treated, if necessary, and (3) the external genitalia, including the anus, vagina and cervix, are carefully examined colposcopically to rule out the persistence of small lesions.

Adolescent↗
PubMed1985

Cis-platinum, doxorubicin, and methotrexate treatment for recurrent cervical cancer.

A combination of cis-platinum, doxorubicin (Adriamycin), and methotrexate was used to treat 28 patients with recurrent cervical cancer. Seven patients achieved a partial response with a median duration of ten months. Two patients achieved a complete response with a median duration of 14 months. The overall response rate was 32%. Ten patients with stable disease had a median progression-free interval of 4.5 months. Toxicity was acceptable.

Adenocarcinoma↗
PubMed1984

CT of the normal and abnormal parametria in cervical cancer.

To evaluate CT criteria for differentiating a cervical cancer confined to the cervix from a lesion that invades the parametria, 16 patients with newly diagnosed, untreated cervical cancer were studied with CT. Twenty-five parametria were confirmed by radical hysterectomy, transvaginal parametrial fine-needle aspiration cytology, or excretory urography. In eight tumor-free parametria, CT findings indicating confined tumor were: (1) smooth, well defined cervical margins; (2) lack of prominent parametrial soft-tissue strands; (3) no parametrial soft-tissue mass; and (4) preservation of the periureteral fat plane. The simultaneous occurrence of these four findings was seen in six of eight tumor-free parametria and in no tumor-infiltrated parametria. In 17 tumor-positive parametria, CT findings associated with parametrial tumor invasion were: (1) irregularity or poor definition of the lateral cervical margins; (2) prominent parametrial soft-tissue strands; (3) obliteration of the periureteral fat plane; and (4) an eccentric parametrial soft-tissue mass. The latter two findings were seen only in tumor-positive parametria. Irregularity of the cervical margins and prominent parametrial strands were seen most commonly with parametrial tumor invasion, but were also occasionally seen with parametrial inflammation. On the basis of the criteria developed in this report, CT may be used as an adjunct to the physical examination in differentiating stage I cervical cancer from more advanced disease in selected patients.

Adnexa Uteri↗
PubMed1984

Ineffectiveness of scalp hypothermia in the prevention of alopecia in patients treated with doxorubicin and cisplatin combinations.

Eleven patients were studied to determine the effectiveness of scalp hypothermia in the prevention of chemotherapy-induced hair loss. Scalp hypothermia was induced by the Kold Kap. The cytotoxic regimen used consisted of either cisplatin, doxorubicin, and cyclophosphamide or cisplatin, doxorubicin, and methotrexate given at monthly intervals. All 11 patients required a wig by the end of the fifth course of chemotherapy because of severe hair loss. Ten of the 11 patients (91%) had severe hair loss by the end of the second course of chemotherapy. These results suggest that scalp hypothermia as used in this study is ineffective in preventing chemotherapy-induced alopecia in patients treated with cisplatin and doxorubicin drug combinations in doses commonly used for treatment of gynecologic malignancies.

Alopecia↗
PubMed1984

Primary carcinoma of the Bartholin gland: a report of ten cases.

During the interval 1962 through 1982, ten patients, having a mean age of 49.5 years, were treated for primary carcinoma of the Bartholin gland at the Medical College of Virginia. In all cases, a primary surgical therapeutic approach was selected, which included radical vulvectomy with bilateral inguinal-femoral node dissection in nine cases. Of the patients followed from eight months to 9.5 years, 50% are alive and well without evidence of recurrent disease. Histologic assessment of lymph nodes demonstrated metastatic involvement in five of nine cases (55%) with four of five patients dead of their disease. The most common histologic pattern was squamous cell carcinoma. The most common presenting complaint was a painless mass. Radical surgery is appropriate as standard primary therapy, whereas the role of radiation appears less clear.

Adult↗
PubMed1983

Pregnancy and maternal proximal focal femoral deficiency. A case report.

Proximal focal femoral deficiency is a rare form of disproportionate dwarfism. This case report illustrates the common complications associated with it: ambulatory difficulty, abdominal and back pain and absolute cephalopelvic disproportion. The common findings of pelvic contraction in disproportionate dwarfs generally requires delivery by cesarean section.

Adult↗
PubMedDate not supplied

Significance of atypical cervical cytology in pregnancy.

To ascertain the significance of squamous atypia encountered during routine Papanicolaou smear screening in pregnancy, we reviewed our experience with 76 pregnant women seen during a 4-year period. All were evaluated with repeat cytology and colposcopy during pregnancy and again postpartum. Colposcopic examination during pregnancy revealed a normal transformation zone without evidence of intraepithelial neoplasia in 46 women. In six of these women, repeat cytology was interpreted as cervical intraepithelial neoplasia (CIN) grade 1. In 30 women, an abnormal transformation zone was identified--14 with a negative repeat cytology. In five women, the transformation zone was interpreted as compatible with CIN 2 or CIN 3. Colposcopically directed biopsies were performed in 31 women, in all but two postpartum. Of the 76 women, human papilloma virus or CIN was identified on biopsy in 16 women (21%). We propose that an isolated report of atypical squamous cells on cervical cytology obtained at the initial prenatal visit does not warrant colposcopic evaluation during pregnancy, unless a repeat cytology suggests CIN. Repeat cytology and evaluation to exclude infections and inflammatory lesions is appropriate. However, if a subsequent cytology is abnormal, postpartum colposcopy and colposcopically directed biopsies seem appropriate, since the prevalence of HPV or CIN was 21%.

Carcinoma in Situ↗