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Biomedical subjects

J M Monaghan

Publications and source records attributed to J M Monaghan.

At least 55 records · Page 3Linked to original sources
PubMed1995

Drainage following radical hysterectomy and pelvic lymphadenectomy: dogma or need?

OBJECTIVE: To compare the incidence of lymphocyst formation and postoperative morbidity in patients drained or not drained following radical hysterectomy and pelvic lymph node dissection for cervical or endometrial malignancy. METHODS: A prospective study was undertaken of consecutive patients undergoing radical hysterectomy and pelvic lymphadenectomy at the Regional Department of Gynaecological Oncology, Gateshead, United Kingdom, between February 1992 and September 1994. A Piver type II procedure was performed with nonclosure of the vaginal cuff and pelvic peritoneum. Patients were randomized at the end of surgery to have either two suction drains inserted along the pelvic sidewalls or to have no drains inserted. The detection of lymphocysts was made by clinical examination and abdominal ultrasound scan performed 8 weeks postoperatively. RESULTS: Eight patients were excluded from the study when drains were deemed necessary to assess postoperative blood loss. Fifty-one were randomized to drains, and 49 to no drains. The detection of lymphocysts by ultrasound and clinical examination in the drained group (15.6 and 5.9%, respectively) was not significantly different from the group not drained (17.4 and 6.1%, respectively). There was no difference in postoperative morbidity in the two groups. CONCLUSION: There appears to be no advantage to the routine use of pelvic suction drainage following radical hysterectomy and pelvic lymphadenectomy.

Adult↗
PubMed1995

Laser vaporization and excisional techniques in the treatment of cervical intraepithelial neoplasia.

The CO2 laser proved to be a vital tool in the development of conservative therapy for the treatment of CIN in the 1980s. In conjunction with colposcopy, the laser has allowed many women to achieve the security of identified and treated CIN with the freedom to live their lives normally, including the achievement of pregnancies. The laser may be used either in the ablative (vaporization) or the cutting mode. This flexibility allows patients with unsatisfactory as well as satisfactory colposcopy to be managed. The results of treatment are universally excellent, with clearance rates of 96% being reported. Complications are rare both in the short and long term, most patients returning fully to normal activities within 4 weeks of therapy. Although the laser is being superceded to some extent by the advent of the loop diathermy technique, it will for years to come represent a valuable and useful tool in the treatment of CIN.

Carbon Dioxide↗
PubMed1995

The role of laparoscopic surgery in gynaecological oncology.

Minimal access surgery is here to stay in gynaecological oncology. Within the last three years, rapid strides have been made in applying minimal access surgical techniques to a wide range of gynaecological oncology procedures. The re-assessment of radical vaginal surgery has come largely because of the ease of accessing the pelvic lymph nodes using retroperitoneal and intraperitoneal techniques. An ability to assess the lymph nodes of the pelvis and the para-aortic region prior to definitive therapy is making management of many oncological conditions more logical. Question marks still arise over the place of minimal access surgery in ovarian cancer. A recent study by Professor Gunther Kinderman (Munich) in which, following a postal questionnaire, he identified an unacceptably high rate of laparoscopic interventions in invasive cancer with a parallel unacceptably high rate of metastatic disease, particularly in the port sites, has demonstrated a need for constant vigilance and careful assessment of the application of minimal access surgery in certain areas of oncology. Even while this chapter was in press, Professor Daniel Dargent has shown the possibility of carrying out assessment laparoscopically of the groin lymph nodes using a combination of minimal access surgery and plastic surgical techniques to remove fat. This technique when applied to sentinel node identification may revolutionize our assessment of the groin. Clearly this is an exciting time in gynaecological oncology and many and new inventive applications are being visualized by surgeons throughout the world. When this chapter is rewritten in two years time, inevitably, a considerable part of it will be altered. A glimpse of the future has been seen and we await the full vision with bated breath.

Female↗
PubMed1995

Insulin signaling in chick embryos exposed to alcohol.

Although insulin is known to be an important generator of regulatory signals during fetal growth and development, neither the immediate nor long-term effects of alcohol (ethanol) on insulin action are well understood. In the rat, fetal exposure to alcohol has been shown to be correlated with a subsequent abnormal response to a glucose load in the neonate and adult. Further, fetal hypoplasia secondary to maternal alcohol consumption is correlated with decreased placental glucose transport and with a lowering of the glucose levels in fetal tissues. However, the fetal effects of alcohol cannot be completely overcome by glucose/caloric supplementation, suggesting that factors other than glucose transport are involved. Using an embryonic chick model that negates the factors of maternal/placental metabolism and transport, the current study found that fetal alcohol exposure markedly increased insulin binding in developing tissue, but had little effect on the binding of the insulin-like growth factors. Competitive binding experiments revealed a marked increase in insulin receptor numbers, but no change in binding affinity as a result of the alcohol exposure. Basal uptake of 2-deoxyglucose by fetal tissue was lowered by alcohol exposure, but incubation with exogenous porcine insulin (1 x 10(-7) M) resulted in a significant increase in glucose uptake by the alcohol-exposed embryos. The increases in insulin binding and in insulin-dependent glucose uptake notwithstanding, exogenous insulin could not induce normal levels of ornithine decarboxylase activity in embryonic cells previously exposed to alcohol.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

Prognostic significance of lymph node variables in squamous cell carcinoma of the vulva.

BACKGROUND: In patients with squamous cell carcinoma of the vulva, lymph nodal, surgicopathologic variables have been studied rarely, although lymph node status is by far the most important prognostic factor. This study was designed to investigate surgicopathologic variables of lymph node metastases to evaluate their prognostic significance. METHODS: In 75 patients with inguinal and/or pelvic lymph node metastases from squamous cell carcinoma of the vulva, the following parameters were studied: size and location of the tumor, depth of invasion, grade, lymph-vascular space involvement (LVSI), local immune reaction, presence and degree of dystrophic changes in the surrounding skin, FIGO stage, number of positive lymph nodes, greatest dimension of the metastasis within the lymph node, percentage of lymph node replacement, number of lymph nodes with replacement greater than 50%, number of lymph nodes replaced completely by tumor, extracapsular spread, and active immunologic response within the lymph node. RESULTS: Among the variables related to the primary carcinomas, only size of the tumor and LVSI were correlated with survival (P < 0.003 and P < 0.02, respectively). On the contrary, all pathologic variables regarding the lymph nodes significantly influenced survival by univariate analysis. On multivariate analysis, extracapsular spread was the most significant independent prognostic factor (P < 0.0004), followed by FIGO stage (P < 0.03). For patients with only one positive lymph node, the most important prognostic factor was the greatest dimension of the metastasis within the lymph node (P < 0.01). CONCLUSIONS: These data, if confirmed in larger series, can contribute to a more accurate identification of low and high risk patients and, therefore, to a more appropriate employment of adjuvant therapies.

Adult↗
PubMed1994

Thrombocytosis as a prognostic factor in women with cervical cancer.

BACKGROUND: Thrombocytosis (a platelet count > 400 x 10(9)/l) is found frequently in association with malignant disease and recently has been suggested to be a poor prognostic indicator in patients with cervical cancer. The authors decided to see if these findings could be verified. METHODS: The pretreatment platelet counts of 643 women treated for cervical cancer between 1983 and 1992 were reviewed and correlated to each patient's age, stage of disease, histologic type, node status (when available), and outcome. Differences between groups were analyzed using the chi 2 test, and survival was compared using the log rank test on Kaplan-Meier life tables. RESULTS: The 5-year survival rate for patients with thrombocytosis was 57.1%, which was significantly worse than the 76.5% for those with normal platelet counts (P < 0.01). When adjusted for stage of disease, however, thrombocytosis failed to have a significant effect on patient survival. There was also no relation between thrombocytosis and the incidence of positive lymph nodes. CONCLUSION: Thrombocytosis was not found to be an independent prognostic factor in patients with carcinoma of the cervix in this series of 643 patients.

Adult↗
PubMed1994

Pelvic exenteration: a review of the Gateshead experience 1974-1992.

OBJECTIVE: To examine morbidity and survival among women treated by pelvic exenteration for gynaecological malignancy. DESIGN: Retrospective review by analysis of case records. SETTING: Department of Gynaecological Oncology, Queen Elizabeth Hospital, Gateshead, UK. SUBJECTS: Eighty-three consecutive patients referred from within the UK from 1974 to 1992 for initial treatment of advanced gynaecological malignancy or management of recurrent disease following unsuccessful initial therapy. RESULTS: Overall five year actuarial survival was 41%, falling to 36% at 10 years. Serious morbidity was low, and there were only three peri-operative deaths. CONCLUSIONS: For patients with limited options for treatment of advanced primary or recurrent cancer, exenteration offers a reasonable prospect of survival with good quality of life.

Actuarial Analysis↗
PubMed1993

The case for conservative management of "incomplete excision" of CIN after laser conization.

Three hundred thirteen laser cone biopsies were performed for cervical intraepithelial neoplasia (CIN) over a 4-year period. The mean age of the patients was 39.9 years and average cytology follow-up was just under 3 years. Six patients defaulted colposcopic review and were excluded from analysis. Of the 75 cases with CIN extending to the endocervical resection margin, 9 (12%) were found to have residual disease. Only 2 (3.6%) of 56 cases with CIN extending to the ectocervical margin had residual CIN detected. In the 176 cases in which the CIN lesion was excised completely there have been no cases of residual CIN. The overall detection of residual disease was 3.6%. Further surgery in those cases with CIN extending to the resection margin is excessive. These patients should be managed conservatively with regular cytological follow-up.

Adult↗
PubMed1993

Laparoscopic hysterectomy and cancer.

Laparoscopic hysterectomy with or without oophorectomy is a procedure which is now gaining popularity in the UK. It has been clearly demonstrated that this technique is superior to abdominal hysterectomy and oophorectomy via laparotomy, and often replaces this procedure. In cases where vaginal hysterectomy is likely to prove difficult or impossible in the hands of most surgeons, the laparoscopic route is of value. In those cases where dense pelvic adhesions or poor vaginal access exist, or where oophorectomy is co-indicated, laparoscopic surgery converts operation via laparotomy to a less invasive procedure, with consequent benefits in terms of both patient care and bed occupancy. In the case of malignant disease, laparoscopic hysterectomy and oophorectomy is a viable alternative to open abdominal hysterectomy, but great care must be taken that patients with malignant disease are not under-treated.

Fallopian Tube Neoplasms↗
PubMed1993

The Royal College of Obstetricians and Gynaecologists micro-invasive carcinoma of the cervix study: preliminary results.

OBJECTIVES: To determine how micro-invasive carcinoma of the cervix is diagnosed and treated in the United Kingdom. To record the frequency of the various pathological features which comprise the histological diagnosis of micro-invasion, and to assess their relevance to outcome. DESIGN: Prospective observational study. SETTING: Hospitals throughout the United Kingdom. SUBJECTS: Two hundred and eighty-six cases were submitted for entry into the study. Following independent review of the histological material 116 cases were excluded: 41 were not accompanied by histological slides for review, 55 had no evidence of invasive disease, 17 had invasive disease greater than FIGO Stage 1a, and three were adenocarcinomas. The remaining 170 cases were registered for the study but follow up was incomplete in 18. This report concerns the 152 women with complete follow up to 1991. RESULTS: The age of the 152 women ranged from 22 to 65 years (median 36 years). In 116 women (76%) the diagnosis was made by cone biopsy (cold knife, loop diathermy, or laser) or wedge biopsy, in 9 women (6%) the diagnosis was made by hysterectomy, and in 27 women (18%) punch biopsy suggested an invasive lesion and subsequent excisional treatment (including radical hysterectomy with node dissection in three) demonstrated micro-invasion. The depth of invasion was up to 3 mm in 142 women (93%) and 3.1 to 5 mm in 10 women (7%). Capillary-like space involvement was present in 12 women (8%). Treatment methods used were local cervical surgery in 79 women (52%), simple hysterectomy in 63 (41%), and radical hysterectomy in 10 (7%). There was only one known recurrence and death due to cervical carcinoma. CONCLUSION: There is no uniformity in the management of micro-invasive carcinoma of the cervix. The frequency of recurrence, lymph metastases, and death is low. Nonradical surgery appears to give satisfactory results.

Adult↗
PubMed1993

The Wallace technique of ureteroileal anastomosis and its use in gynecologic oncology: a study of 81 cases.

OBJECTIVE: To report the indications for surgery, morbidity, and results of treatment using the Wallace ileal conduit for supravesical urinary diversion. METHODS: Over a 15-year period (1977-1991), 81 patients, all with an underlying gynecologic malignancy requiring urinary diversion, had ileal conduit surgery performed at the Regional Department of Gynecological Oncology, Gateshead, England using the Wallace technique. Patient details stored in a computerized data base were reviewed retrospectively. RESULTS: Thirty-nine patients (48%) had received radiotherapy before conduit surgery. In 70% of cases, urinary diversion was performed as part of an exenterative procedure. Early postoperative complications occurred in 56% of cases and were mainly related to infection. Long-term complications included fistula (three), stoma retraction (three), loss of renal function (three), tumor metastases (two), and stoma herniation (one). There was one postoperative death secondary to septicemia. By 1991, 42 patients (52%) had died of their primary disease. CONCLUSION: We believe that for urinary diversion in the gynecologic oncology patient, the ileal conduit, in particular the Wallace technique, is the procedure of choice.

Adult↗
PubMed1992

Malignant melanoma of the vulva: a clinicopathologic study of 18 cases.

In a study of 18 patients diagnosed with vulvar malignant melanoma between 1975 and 1991, the effect of clinical and pathologic variables on the survival was evaluated. The overall 5-year survival rate was 28.6%. In 14 cases the tumor was retrospectively microstaged with use of Breslow depth and Chung levels. International Federation of Gynecology and Obstetrics (FIGO) stage and Breslow depth did not correlate well with survival. Positivity of groin lymph nodes at initial surgery was associated with an insignificant worsening in survival. An inverse correlation, although statistically not significant, was demonstrated between advancing Chung levels and survival. It is concluded that since the data with respect to microstaging of vulvar malignant melanoma is, as yet, still limited, great caution should be used in electing less aggressive surgery than radical vulvectomy and bilateral groin lymphadenectomy for patients with early-microstage localized disease.

Aged↗
PubMed1992

Histological incomplete excision of CIN after large loop excision of the transformation zone (LLETZ) merits careful follow up, not retreatment.

OBJECTIVE: To quantify and analyse the influence of a histological report of incomplete excision of CIN after LLETZ on frequency of detection of residual CIN. DESIGN: Review of a computerised database of sequential women treated by LLETZ. Initial follow-up was three months post-treatment. SETTING: The Colposcopy Clinic, Regional Department of Gynaecological Oncology, Queen Elizabeth Hospital, Gateshead, Tyne and Wear, UK. SUBJECTS: 721 women with CIN diagnosed histologically on LLETZ specimens. RESULTS: In spite of a first time treatment success rate of 95% at 3 months, only 56% of the women were reported to have complete histological excision of CIN. A report suggesting incomplete excision was more likely with more severe CIN, extensive lesions and involvement of the endocervical canal. Furthermore, 21% with residual CIN had apparent complete excision of CIN at LLETZ. CONCLUSIONS: A histological report of incomplete excision of CIN at LLETZ does not equate with residual disease. The high treatment success rate of LLETZ means that a report of incomplete excision should stimulate close colposcopic and cytologic follow-up to identify the small number of women with residual CIN after therapy.

Carcinoma in Situ↗