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Biomedical subjects

J D Trelford

Publications and source records attributed to J D Trelford.

16 recordsLinked to original sources
PubMed1992

Synchronous radiation and cytotoxic chemotherapy for locally advanced or recurrent squamous cancer of the vulva.

Between July 1987 and September 1991 a program of external beam radiation and synchronous, radiopotentiating chemotherapy was employed to treat 25 women with locoregionally advanced or locoregionally recurrent squamous cancer of the vulva. Of 18 previously untreated patients, 1 was Stage II, 10 were Stage III, 6 were Stage IVA, and 1 was Stage IVB. Reasons for patient referral for nonsurgical management included the presence of initially unresectable disease (5 patients), disease extent which would have necessitated partial or total exenteration if treated surgically (9 patients), disease extent predictive of inadequate surgical margins (less than 1 cm gross margin) if treated by less than exenterative surgery (8 patients), and severe comorbid illness precluding surgical management (3 patients). Complete clinical response was obtained in 16 of 18 previously untreated patients (89%) and in 4 of 7 patients with recurrent disease following vulvar surgery (57%). Of 20 patients achieving a complete clinical response, 3 patients have relapsed within the irradiated volume at 11, 38, and 48 months following completion of treatment. Fourteen patients remain alive and continuously cancer free from 2-52 months after completion of treatment (median follow-up 24 months). This experience suggests that initial management with radiation and chemotherapy may offer some patients with locally advanced squamous cancer of the vulva an alternative to exenterative surgery and may hold curative potential for some patients with surgically unresectable or medically inoperable disease.

Adolescent↗
PubMed1992

Formation of a vagina at the time of exenteration.

The formation of an artificial vagina at the time of exenteration has been described. Femoral gluteal flaps forming a tube suspended to the iliopectineal ligament appeared to give the most satisfactory results.

Adult↗
PubMed1992

20 year follow-up on microinvasive squamous carcinoma of the cervix.

MISC of the cervix is a potentially fatal disease if not properly classified and treated. Strict criteria for diagnosis are required to provide appropriate therapy. It is recommended that a radical approach be considered for those patients in whom the depth of invasion of the carcinoma is greater than 3 mm on cone biopsy and in all cases where vascular invasion is demonstrated. Confluency may not of itself be a reason for more radical therapy but is an indicator of the aggressiveness of the tumor. Vascular invasion is seen more frequently with increased depth of invasion but may be found with minimal infiltration and has a serious connotation. Further refinement of the definition of MISC of the cervix appears to be needed.

Adult↗
PubMed1992

Total exenteration, two or one ostomy.

Total exenterations require fecal and urinary diversions, necessitating ostomies in the anterior abdominal wall. This article was done to explore the possibility of extremely low anastomoses of the intestine to the anal stump, to reduce the number of ostomies to only one for the urinary diversion. Although technically feasible, the long term follow-up evaluation of these patients resulted in us having reservations concerning function.

Anal Canal↗
PubMed1979

The amnion in surgery, past and present.

The clinical application of the fetal membarnes has been under study for many years. An attempt is made to bring the reader up to date in this fascinating subject and to indicate practical employment of the membrane in modern medicine. The amnion and chorion are detailed separately where possible, particularly in the field of surgery.

Amnion↗
PubMed1978

Use of allograft amniotic membrane for control of intra-abdominal adhesions.

The authors have studied 60 rabbits to determine the effect and fate of allograft amniotic membranes (devoid of chorion) used in the intra-peritoneal cavity to control adhesions secondary to bowel perforation and bacterial contamination. The experimental animals revealed dramatic differences when compared to the control with major reduction in adhesions. Abscesses remained localized and contained. No untoward reactions were noted in the host. Violent immunologic rejection did not occur. The membranes gradually disintegrated and left little or no evidence of its presence. Important clinical applications are obvious.

Abdomen↗
PubMed1977

Complications following operation in the previously irradiated abdominopelvic cavity.

Twenty-three patients underwent 32 operations in a previously irradiated abdominopelvic cavity. The overall postoperative morbidity rate was 62% and the mortality rate was 6.2%. The data from this series do not support small bowel bypass as the only acceptable method of management of surgical radiation enteritis. Wide resection with primary anastomosis reduces the long-term morbidity of the "blind-loop syndrome", perforation and fistulization of the isolated loop, and does not have an increased mortality.

Abdomen↗
PubMed1977

Replacement of the peritoneum with amnion following pelvic exenteration.

An analysis was made of 24 patients undergoing pelvic exenteration. By chance, the patients are divided into two groups, 12 having the pelvic floor treated by the traditional means and 12 in whom amniotic membranes have been used. A statistically significant shortening of the hospital stay was experienced by those in the amnion group with a total lack of intestinal complications being related to the raw surface of the pelvis. A large number of recurrent or de novo carcinomas of the vagina following carcinoma of the cervix treated with radiation are identified. Two deaths in this series were related to complications of the small intestine.

Aged↗
PubMed1975

The effect of immunizing female rats with modified rat pituitary extract.

Immune reactions to a number of hormones have been induced, but information is lacking on the feasibility of inducing immune reactions to homologous gonadotropins. Female rats immunized with diazotized and tyrosylated rat pituitary extract containing gonadotropic activity and emulsified in complete Freund's adjuvant expressed various reproductive disturbances such as increased cycle length (7.0 days), increased number of sterile matings, reduced implantation in animals becoming pregnant, and reduced ability to carry fetuses to term. These effects were not exhibited by rats immunized similarly with diazotized or tyrosylated rat pituitary extract containing no detectable gonadotropic activity. Rats not becoming pregnant had a significantly higher antibody level to rat luteinizing hormone than did rats becoming pregnant. No significant elevation of rat follicle-stimulating hormone antibodies was noted. It is concluded that auto-immune reactions to gonadotropins can be induced and that very low levels of antibodies have a significant effect on reproduction.

Animals↗
PubMed1975

Implanted amniotic membrane as an autograft and as an allograft.

Detailed studies on autograft and allograft amniotic membranes implanted in the subcutaneous tissues to form tunnels are described. Autograft amniotic membranes appear to become permanent structures whereas allografts of this material, though accepted by the host for a longer time than most allografts, were eventually rejected. Serial histological studies were performed.

Amnion↗
PubMed1975

Amnion autografts, permanent structure.

Autografts of amniotic membrane were used to form tubes or conduits in lambs. These conduits survived for periods up to 9 months. The possibility of a clinical application has been explored.

Amnion↗
PubMed1975

Wound healing and the amniotic membrane.

The successful clinical application of the amniotic membrane as a surgical dressing is discussed as to the mode of healing. The amniotic membrane does not appear to be a permanent structure when used as an allograft.

Amnion↗