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Biomedical subjects

J M Monaghan

Publications and source records attributed to J M Monaghan.

At least 37 records · Page 2Linked to original sources
PubMed2000

A clinical review of borderline glandular cells on cervical cytology.

OBJECTIVE: To review the diagnoses and diagnostic pathway of women presenting with borderline glandular cells on cervical cytology. To outline the basis of clinical approach of these women. DESIGN: Retrospective review. POPULATION: Forty-three women referred to the hospital department over a 32-month period. METHODS: Review of the casenotes for the demographic data, previous cervical cytology and/or histology report, indication for the smear resulting in borderline glandular cells, colposcopic findings, diagnostic and/or treatment procedures, final diagnosis and current status. RESULTS: The average age was 36.7 years. Twenty-four women (56%) had clinically significant lesions: seven women (16%) presented with cancers, of which one was endometrial in origin, and 17 (40%) with intraepithelial neoplasia (CIN and cervical glandular intraepithelial neoplasia (CGIN)). Sixty-seven percent of all clinically significant lesions were of squamous origin. Thirty-seven had histological diagnosis, while six went on to cytological surveillance. Colposcopy was the most significant predictor for clinically significant lesions (P < 0.05). Punch biopsies and loop excisions were diagnostic when based on abnormal colposcopic findings. Brush cytology was appropriate follow up for asymptomatic, premenopausal women with no colposcopic abnormality. In addition, endometrial sampling was recommended in the peri- and postmenopausal women. CONCLUSION: Borderline glandular cells have a high incidence of clinically significant lesions. Immediate referral for colposcopy and assessment is strongly recommended in women with two borderline glandular smears to avoid delays in potential cancer diagnosis.

Adult↗
PubMed2000

Risk factors in stage III epithelial ovarian cancer: previous sterilisation is an adverse independent prognostic indicator.

OBJECTIVES: To determine whether past history of pelvic surgery is of prognostic significance in stage III epithelial ovarian cancer. METHODS: A retrospective review of 140 women with stage III epithelial ovarian cancer. RESULTS: Sixteen women had previously undergone pelvic surgery including eight sterilisations (6%), seven hysterectomies (5%) and one ovarian cystectomy (0.7%). Women with a past history of sterilisation were significantly younger (median age, 46 years) than women without a past history of sterilisation (median age, 63 years), and also significantly younger than women with a past history of hysterectomy (median age, 58 years). In addition, the sterilisation procedure was performed at a significantly younger age than the hysterectomy procedure (p=0.008). On multivariate analysis comparing previous pelvic surgery, previous malignancy, place of surgery, interval/secondary debulking, presence of concomitant tumour, performance of bowel surgery, histological grade, histological type, size of residual disease and age, all of the following were seen to be independent variables associated with outcome survival; previous sterilisation (p=0.0012), age (p=0.0074), histological type (p=0.025), histological grade (p=0.0017) and size of residual disease (p=0.0043). CONCLUSION: Past history of sterilisation appears to be an adverse independent prognostic indicator in women presenting with stage III epithelial ovarian cancer. To have developed ovarian cancer despite the protective effects of a sterilisation procedure against environmental factors might possibly suggest a predisposition to ovarian cancer in these women. Further studies are indicated to confirm the present results.

Adult↗
PubMed1999

Identification of sentinel lymph nodes in vulvar carcinoma patients with the aid of a patent blue V injection: a multicenter study.

BACKGROUND: The aim of this multicenter study was to investigate the feasibility and negative predictive value of sentinel lymph node detection with blue dye in vulvar carcinoma patients. METHODS: In patients with squamous cell carcinoma of the vulva without suspicious groin lymph nodes, patent blue V was injected intradermally shortly before surgery. Routine groin lymph node dissection and radical vulvectomy were performed. During the surgery, blue lymph vessels and lymph nodes were identified, and the blue lymph nodes were sent separately for histologic examination. The negative predictive value of the blue lymph nodes for the absence of metastases was assessed by histologic examination of the groin lymph node specimens. RESULTS: Fifty-one patients in whom 93 groin lymph node dissections were performed were entered. One or more blue lymph nodes were detected in only 52 groins (56%). Nine (17%) of these were tumor positive, and 6 blue lymph nodes were the only tumor positive lymph nodes in the specimen in which they were found. There were two false-negative blue lymph nodes. The negative predictive value was 0.953. CONCLUSIONS: It was shown in this multicenter study that sentinel lymph node detection in vulvar carcinoma patients with blue dye only is not feasible because its negative predictive value is too low. Further studies involving the use of a combination of radioactive labeled technetium and blue dye are warranted.

Adult↗
PubMed1999

Thrombocytosis in women with vulvar carcinoma.

Thrombocytosis (platelet count >400 x 10(9)/L) is frequently found in association with malignant disease. Although the pathogenesis of thrombocytosis in malignancy is currently unclear, it appears to be a poor prognostic factor in patients with lung, colon, breast, and cervical carcinoma. The current study was initiated to assess the incidence of thrombocytosis in vulvar carcinoma and to evaluate its prognostic significance for patients with vulvar carcinoma. The pretreatment platelet counts of 201 women treated for vulvar cancer were reviewed and correlated to the patient's age, stage of disease, node status, histologic type, and outcome. Differences between categories were analyzed by means of the ANOVA test, and survival was compared using the log-rank test on the Kaplan-Meier life table. Thrombocytosis was presented in 14.92% of patients with vulvar malignancies and in 15.46% of patients with squamous cell carcinoma of the vulva. No correlation was found between thrombocytosis and tumor size, incidence of lymph node metastases, or stage of the disease. The 5-year survival rate for patients with thrombocytosis was 89.29%, which was not significantly different from the 76.47% 5-year survival of patients with normal platelet counts (P = 0.586). When adjusted for age, histological differentiation, number of tumors, staging, incidence of nodal metastases, platelet count, hemoglobin, and white blood count, only the staging, number of tumors, and histological differentiation were associated with an unfavorable prognosis (P = 0.0001, P = 0.003, P = 0.03, respectively). Thrombocytosis was not found to be a prognostic factor in patients with carcinoma of the vulva in this series of 201 patients.

Adult↗
PubMed1999

Laparoscopic port-site metastasis of an early stage adenocarcinoma of the cervix with negative lymph nodes.

BACKGROUND: Port-site metastasis (PSM) following laparoscopic surgery for cancer is being increasingly recognized as a potential problem; the majority of cases appear following laparoscopy for a pelvic mass that subsequently proved to be malignant or in the case of a disseminated intraperitoneal disease. The rare cases of PSM following laparoscopy for endometrial and cervical cancer have all been associated with the presence of regional lymph node metastasis or disseminated disease in the peritoneal cavity. We present here a case report of PSM in the absence of spread beyond the primary tumor. CASE: A 48-year-old woman with stage IA1 adenocarcinoma of the cervix was treated with laparoscopically assisted vaginal hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic node dissection. The pathologic study revealed an endocervical adenocarcinoma confined to the cervix with negative lymph nodes. Nine months postoperatively, a cutaneous metastasis at the port-site was diagnosed. This was treated with wide local excision of the recurrence and the port-site track. Explorative laparotomy and para-aortic node sampling showed no evidence of recurrence elsewhere. CONCLUSION: This case emphasizes the risk for PSM in laparoscopic surgery performed for early stage disease.

Adenocarcinoma↗
PubMed1999

Decreasing estrogen in nonpregnant women lowers uterine myometrial type I nitric oxide synthase protein expression.

OBJECTIVE: Our purpose was to study the effect of estrogen on myometrial nitric oxide synthase. STUDY DESIGN: Twenty-four women were randomly assigned to treatment with gonadotropin-releasing hormone agonist or placebo for 8 weeks before hysterectomy, at which time samples of myometrium were collected and the serum levels of estrogen, nitrate, and nitrite measured. Myometrial nitric oxide synthase was measured with the arginine-citrulline assay. The levels of endothelial nitric oxide synthase and neuronal nitric oxide synthase were determined by Western blot analysis. RESULTS: Myometrial nitric oxide synthase was 88% calcium dependent but only partially calmodulin dependent. Women treated with gonadotropin-releasing hormone agonist had postmenopausal levels of estradiol and had significantly lower levels of myometrial neuronal nitric oxide synthase than those in the control group. Total, endothelial, and inducible nitric oxide synthase levels in the myometrium were unchanged, as were serum nitrite and nitrate levels. CONCLUSION: Neuronal nitric oxide synthase is regulated in the myometrium by estrogen. Myometrial nitric oxide synthase is not all calmodulin dependent; this may represent the activity of a novel nitric oxide synthase isoform.

Adult↗
PubMed1997

Determination of nitrite and nitrate in human serum.

A simple and effective assay for nitrite and nitrate in human serum has been developed using ion chromatography. Initial experiments using isocratic carbonate-bicarbonate elution with conductivity detection on a Dionex QIC system with an AS4A-SC column showed promise but were unsatisfactory because of co-elution problems with nitrite. Carbonate and chloride were investigated as eluents using a gradient system, and direct UV detection at 214 nm was used in place of conductivity detection. Dionex AS4A, AS9A, AS12, Nucleopac PA-100 and Carbopac PA-100 columns were compared for selectivity and resistance to overload. The final method, using a chloride concentration gradient, pH buffering and direct UV detection with a Carbopac PA-100 column, shows good resolution, does not suffer from chloride overload and is simple to use. The method is being used in an investigation of the role of nitric oxide in pre-eclampsia, a hypertensive disorder during pregnancy.

Chromatography, Ion Exchange↗
PubMed1997

Invasive cervical cancer after conservative therapy for cervical intraepithelial neoplasia.

BACKGROUND: Conservative outpatient therapy for cervical intraepithelial neoplasia (CIN) by ablative or excisional techniques is widely used. The main objective of this treatment is the prevention of invasive cervical cancer. We assessed the rate of invasive disease and the duration of the risk of developing invasive cervical cancer after such treatment. METHODS: Four UK centres have used life-table methods to analyse the long-term results of conservative treatment of CIN. We combined and updated data from these studies to investigate the rate of invasive disease after treatment and the duration of that risk. FINDINGS: The data comprised 44 699 woman-years of follow-up, with 2116 women under observation 8 years after treatment. 33 women developed invasive cancer, 14 of whom had microinvasion. The cumulative rate of invasion 8 years after treatment was 5.8 per 1000 women and the rate of invasive cancer during this period was 85 (95% CI 60-119) per 100,000 woman-years. The risk of developing cancer did not change throughout the 8 years of follow-up. INTERPRETATION: These data show that conservative outpatient therapy in women with CIN reduces the risk of invasive cancer of the cervix by 95% during the first 8 years after treatment. However, even with careful, long-term follow-up, the risk of invasive cervical cancer among these women is about five times greater than that among the general population of women throughout that period. Careful follow-up is essential for at least 10 years after conservative treatment of CIN.

Adult↗
PubMed1997

Prognostic value of preoperative squamous cell carcinoma antigen level in patients surgically treated for cervical carcinoma.

Preoperative evaluation of squamous cell carcinoma antigen (SCCa) was performed in 220 patients with surgically treated early-stage carcinoma of the cervix. The median duration of follow-up was 1.9 years. SCCa was significantly higher in tumors with a squamous element (P < 0.001). There was a squamous element in 171 tumors. SCCa was elevated (>2 ng/ml) in 21.6%. Significantly higher levels were associated with stage II disease (P < 0.001), tumors >4-cm size (P < 0.001), and lymph node metastases (P < 0.001). The positive predictive value for lymph node metastases at >2, >4, and >8.6 ng/ml SCCa is 51.4, 70.0, and 100% and the sensitivity is 58.1, 45.2, and 22.6%, respectively. Low SCCa is a poor predictor of absence of lymph node metastasis. The median SCCa for patients who developed tumor recurrence was greater than those who remained disease free (1.7 and 1.0 ng/ml, respectively, P = 0.009); however, in a multivariate analysis only lymph node metastasis and tumor size were of independent prognostic significance (P = 0.002 and P = 0.004, respectively). SCCa level >8.6 ng/ml is highly predictive of lymph nodal disease. There is no independent prognostic significance in patients with early-stage surgically treated cervical carcinoma.

Adenocarcinoma↗
PubMed1997

The hormonal receptor status of uterine carcinosarcomas (mixed müllerian tumours): an immunohistochemical study.

AIM: To investigate the role of oestrogen and progesterone receptor status in uterine carcinosarcomas (mixed Müllerian tumours) to see whether the receptors were identifiable, and if so whether they were of significance clinically. METHODS: 11 cases of uterine carcinosarcoma were identified from clinical and pathology records. An immunohistochemical method was used to demonstrate oestrogen and progesterone hormone receptors on paraffin embedded material, with suitable tissue controls, staining being recorded. RESULTS: 10 of 11 cases showed staining for one or both hormone receptors in normal tissue adjacent to tumour. In four carcinosarcoma cases, staining for one or both receptors was shown within the epithelial component (appearing to correlate with the degree of epithelial differentiation); two of these cases had staining within sarcomatous areas. Two of the three patients still alive had epithelial hormone receptor positivity. CONCLUSIONS: Receptors for oestrogen and progesterone were found in four of 11 cases of uterine carcinosarcoma, using paraffin embedded material. There may be an association between hormone receptor positivity and clinical outcome.

Aged↗
PubMed1997

Contact stress analysis of the tibial component of prosthetic knee implants.

The engineering problems associated with implantation into the human body of prosthetic knee implants and some of the outstanding issues facing engineering designers in this growing sector of orthopaedic medicine are described. The contact behaviour of polymeric tibial components was modelled using a stainless steel indentor in contact with an Araldite CT200 block which contained embedded strain gauges. The block was subjected to normal and sliding loads and the stresses in the block were evaluated using the strain data; the results were compared with results obtained from finite element analysis. The results are considered in the light of recent experience with non-conforming knee implants.

Biocompatible Materials↗
PubMed1997

Role of appendicectomy in the surgical management of ovarian cancer.

There is a paucity of literature on the role of appendicectomy in the staging and cytoreductive procedures for ovarian cancer. In this series of 129 patients with ovarian carcinoma over a period of 9 years. (June 1985-June 1995) at the Northern Regional Department of Gynaecological Oncology, Gateshead, appendicectomy was performed in 31 patients. 11/31 were found to have metastases to the appendix. The concept of appendicectomy of a macroscopically abnormal appendix to achieve optimum debulking is accepted. The need for a prospective evaluation of the histological findings from macroscopically normal appendices removed in the presence of clinically staged early and advanced disease is required to define the role of appendicectomy in this group of patients.

Appendectomy↗
PubMed1996

Less invasive surgery for gynecologic tumors.

The majority of cancers of the female genital tract are managed primarily by surgery in Western communities. Surgical techniques have developed during the 20th century with a tendency toward increasing radicality in order to deal with those cancers with a propensity for locoregional spread. On occasions during the past 100 years, individual surgeons have made efforts to tailor surgical practice to more appropriately deal with the true risks of spread. In recent times this search for more accurate tailoring has moved on apace and has coincided with the burgeoning interest in minimal access surgical techniques. This review is designed to cover the past year's developments in the quest toward less invasive surgery for gynecologic tumors. A major drawback to tailoring of surgical technique with its inevitable reduction in radicality for some patients is the risk of undertreating the cancer. The temptation for the less experienced or less skilled clinician to reduce radicality because such a move more closely matches his or her level of skill will result in poor results, with the risk that the surgical technique being given a bad name rather than the situation being recognized as a decision to use inappropriate therapy.

Carcinoma in Situ↗
PubMed1996

Recurrent stage IB cervical carcinoma: evaluation of the effectiveness of routine follow up surveillance.

OBJECTIVE: To study the effectiveness of follow up surveillance in detecting recurrent disease following radical hysterectomy for Stage IB cervical carcinoma. DESIGN: Retrospective analysis of clinical records using a computerised database. PARTICIPANTS: Six hundred and seventy-four patients with Stage IB carcinoma of the cervix underwent radical hysterectomy and lymph node dissection. INTERVENTIONS: Standard follow up surveillance consisted of clinical history and physical examination six weeks post surgery, and subsequently three monthly for the first year, six monthly for the second year, and yearly thereafter until 10 years post-treatment. RESULTS: Of the 674 patients, 112 (17%) developed recurrent disease. In only 29/112 (26%) was recurrent disease detected at the time of routine follow up visits. Nearly half of the patients (44%) were referred by their general practitioner between visits to the clinic because of suspicion of recurrent disease. CONCLUSION: Routine follow up surveillance is ineffective in detecting recurrent cervical carcinoma. Only one in four recurrences were detected at the time of a clinical visit.

Adult↗
PubMed1995

"Microinvasive" adenocarcinoma of the cervix implanting in an episiotomy scar.

Episiotomy scar tumor implantation arising from a cervical carcinoma is rare. This report details a patient who developed an episiotomy implant from a "microinvasive" adenocarcinoma of the cervix 5 months following vaginal delivery. The implant behaved as a primary focus for metastases to the inguinal lymph nodes. Despite subsequent treatment with chemotherapy and radiotherapy the patient succumbed to the disease. The case is the first reporting a poor outcome following an episiotomy scar implant from a primary cervical adenocarcinoma. The poor outcome highlights the controversy regarding the use of the term microinvasive with respect to glandular cervical lesions.

Adenocarcinoma↗