Biomedical subjects

J T Soper

Publications and source records attributed to J T Soper.

At least 91 records · Page 5Linked to original sources

PubMed1990

Expression of epidermal growth factor receptor and HER-2/neu in normal and neoplastic cervix, vulva, and vagina.

Monoclonal antibodies were used to localize immunohistochemically epidermal growth factor receptor and HER-2/neu in normal and neoplastic frozen tissue samples from the lower genital tract of women. In squamous epithelia of the cervix, vulva, and vagina, epidermal growth factor receptor and HER-2/neu both were expressed most strongly by basal keratinocytes. Expression of both of these cell surface molecules decreased as cells underwent differentiation toward the mucosal surface. In contrast, both epidermal growth factor receptor and HER-2/neu were expressed throughout the entire thickness of the epithelium by undifferentiated squamous cells in squamous metaplasia, raised condyloma, and carcinoma in situ. In 34 squamous cancers of the cervix, vulva, and vagina, all malignant cells were found to have moderate to heavy staining for epidermal growth factor receptor. Staining of 33 of these cancers for HER-2/neu was light, although one patient who presented with distant metastases had heavy staining for HER-2/neu. These data suggest that although overexpression of HER-2/neu in squamous cancers of the lower genital tract is a rare event, it may be associated with aggressive biologic behavior.

Adenocarcinoma↗

PubMed1990

A controlled trial of two low-dose heparin regimens for the prevention of postoperative deep vein thrombosis.

Venous thromboembolism is a serious complication following gynecologic surgery and is particularly common in patients with malignancy. A previous study of subcutaneous low-dose heparin given as one dose preoperatively and every 12 hours postoperatively failed to show a benefit in gynecologic oncology patients. In the present study, two more intense regimens of low-dose heparin were evaluated. Three hundred four patients were assigned randomly to receive no prophylaxis (controls), subcutaneous heparin 5000 units 2 hours before surgery and every 8 hours postoperatively (low-dose heparin) (regimen I), or 5000 units heparin subcutaneously every 8 hours preoperatively (between two and nine doses) and every 8 hours postoperatively (regimen II). All patients had thromboembolism surveillance with the fibrinogen uptake test and clinical evaluation. Eighty-four percent had a malignancy. Thromboemboli were diagnosed in 19 of 103 control patients, ten of 104 regimen I patients, and six of 97 regimen II patients, a statistically significant difference (P less than .008). When compared with the control group, the study groups had no evidence of increased bleeding complications or alteration of laboratory coagulation indicators.

Female↗

PubMed1990

Computed tomography-guided fine-needle aspiration of retroperitoneal lymph nodes in gynecologic oncology.

Computed tomography-guided fine-needle aspiration was performed on 30 retroperitoneal lymph nodes in 29 patients with gynecologic cancer. There were no serious complications. Review of the cytologic material demonstrated malignant cells in 83% of the aspirates. Because the predictive value of a positive aspirate approaches 100%, therapy for metastatic disease can be initiated in these patients with the need for an open biopsy. Among five aspirates in which malignant cells were not seen, the cellularity of the specimen appeared to be the critical factor determining the predictive value of the aspirate. Whereas neither of two patients with negative aspirates of adequate cellularity has developed recurrent disease, two of three patients with hypocellular negative aspirates have. Because a hypocellular negative aspirate from a retroperitoneal lymph node may not be a true reflection of disease status, either repeat aspiration or open biopsy is advisable.

Adenocarcinoma↗

PubMed1990

Preoperative serum tumor-associated antigen levels in women with pelvic masses.

Preoperative sera were assayed for tumor-associated antigens CA 125, TAG 72, and CA 15-3 in 100 women with pelvic masses. Serum CA 125 levels were elevated above 65 U/mL in 83% of 42 patients with ovarian malignancies, in 58% of 12 patients with nonovarian malignancies, and in 17% of 46 patients with benign pelvic masses. Elevations of TAG 72 and CA 15-3 levels occurred less frequently in all groups of patients. Serum CA 125 levels distinguished most effectively between patients with malignant pelvic masses and those with benign pelvic masses, having a sensitivity of 78% and a specificity of 83% at a threshold level of 65 U/mL. When comparing 33 patients with epithelial ovarian carcinomas to 46 patients with benign masses, the CA 125 level alone yielded a sensitivity of 88% with a specificity of 83%. Coordinate elevations of CA 125 (above 65 U/mL) and TAG 72 (above 10 U/mL) or CA 15-3 (above 30 U/mL) distinguished ovarian epithelial carcinomas from benign masses with a sensitivity of 73% and a specificity of 98%, which improved to 81 and 100%, respectively, among patients over 50 years of age. Given the marked increase in specificity observed with this panel of three serum tumor-associated antigens, use of multiple markers might facilitate screening for ovarian carcinoma and appropriate referral of patients with pelvic masses for cytoreductive operations.

Antigens, Tumor-Associated, Carbohydrate↗

PubMed1990

A comparison of symptomatology, physical examination, and vaginal cytology in the detection of recurrent cervical carcinoma after radical hysterectomy.

To evaluate our surveillance program for recurrent cervical carcinoma, we reviewed patients who underwent radical hysterectomy for International Federation of Gynecology and Obstetrics (FIGO) stages IB and IIA cervical cancer. The study group consisted of 203 women followed at Duke University Medical Center exclusively who had at least 2 years of regular surveillance. Thirty-one (15%) developed recurrence. For the detection of recurrent tumor, vaginal cytology had a sensitivity and specificity of 13 and 100%, pelvic or general physical examination 58 and 96%, and the presence of suspicious symptoms 71 and 95%, respectively. Ninety-four percent of all patients with recurrent tumor had at least one abnormal surveillance index. Three of 31 patients (10%) with recurrent tumor were treated successfully with secondary therapy. Two recurrences were detected by vaginal cytology exclusively. Even though vaginal cytology is not sensitive and may not be cost-effective, we conclude that it is the technique most likely to detect recurrent tumor while it is localized and potentially curable.

Female↗

PubMed1990

Methotrexate in advanced endometrial carcinoma. A phase II trial of the Gynecologic Oncology Group.

Thirty-three patients with advanced or metastatic endometrial carcinoma were entered in a Phase II trial utilizing methotrexate, 40 mg/m2 intravenously on a weekly basis. Almost all patients had prior total abdominal hysterectomy and almost two-thirds prior pelvic irradiation. No patient had prior chemotherapy. There was one complete and one partial response, for a complete and partial response rate of 6% (95% confidence intervals for a response of 1.7 to 19.6%). Toxicity was mild, with major adverse effects being nausea and vomiting and myelosuppression. One death may have been drug related. Methotrexate displays minimal clinical activity in patients with advanced or recurrent endometrial carcinoma who have received no prior chemotherapy.

Adult↗

PubMed1989

Immunohistochemical expression of CA 125 in endometrial adenocarcinoma: correlation of antigen expression with metastatic potential.

Immunohistochemical localization of CA 125 using murine monoclonal antibody OC 125 was performed on fresh frozen tissue from 44 endometrial adenocarcinomas and 26 benign endometria. Immunohistochemical evaluation incorporated both intensity and distribution of staining (CA 125 HSCORE). Thirty-seven cancers (84%) and 23 benign endometria (88%) expressed immunohistochemically detectable CA 125. Staining was confined to epithelial cells and was present both on the cell membrane and in the cytoplasm. Among the 44 endometrial cancers, CA 125 HSCORE did not correlate with histological grade, depth of myometrial invasion or estrogen/progesterone receptor levels. Following surgical staging, 13 patients (30%) were found to have extrauterine metastatic disease. The median CA 125 HSCORE of patients with metastatic disease (2.25) was significantly higher than that of patients with disease confined to the uterus (0.6) (P less than 0.001). In addition, high CA 125 HSCORE also correlated with the presence of lymph node metastasis (P less than 0.001). The results of this study suggest that high CA 125 expression by endometrial adenocarcinomas is associated with increased metastatic potential.

Adenocarcinoma↗

PubMed1989

Epidermal growth factor receptor expression in normal and malignant endometrium.

Epidermal growth factor receptor expression in fresh-frozen uterine tissues was studied with the use of monoclonal antibody 528, which recognizes an epitope on the external domain of the epidermal growth factor receptor. Immunohistochemically detectable epidermal growth factor receptor was seen in all uterine cell types in 19 of 20 normal uteri. Staining of endometrial glands and endometrial stromal cells was consistently greater than that of myometrium, and no variation in intensity or distribution of staining was seen during the menstrual cycle. Immunohistochemically detectable epidermal growth factor receptor was found less frequently in endometrial adenocarcinomas than in normal endometrium (p less than 0.01). Thirteen of 40 endometrial adenocarcinomas (32.5%) did not express detectable receptor. Epidermal growth factor receptor expression did not correlate with histologic grade, depth of myometrial invasion, estrogen-progesterone receptor status, the presence of extrauterine metastases, or the development of recurrent disease.

Adenocarcinoma↗

PubMed1989

Immunohistochemical expression of TAG-72 in normal and malignant endometrium: correlation of antigen expression with estrogen receptor and progesterone receptor levels.

TAG-72 is a tumor-associated antigen that is expressed by secretory endometrium and most endometrial adenocarcinomas. We used immunohistochemical techniques to quantitate expression of TAG-72, estrogen receptor, and progesterone receptor in 21 normal endometria and 44 endometrial adenocarcinomas. In normal cycling endometrial glands, TAG-72 expression was related inversely to expression of receptors for estrogen and progesterone. This suggests that TAG-72 expression in normal endometrium may be hormonally regulated. Ninety-one percent of endometrial adenocarcinomas expressed immunohistochemically detectable TAG-72. The magnitude of TAG-72 expression did not correlate with other known prognostic factors in endometrial cancer such as histologic grade, depth of myometrial invasion, surgical stage, or steroid receptor status. The production of TAG-72 by most endometrial adenocarcinomas may represent nonspecific expression by cells that have dedifferentiated.

Adult↗

PubMed1989

Pelvic exenteration: factors associated with major surgical morbidity.

Sixty-nine women underwent pelvic exenteration at Duke University Medical Center from 1970 through 1987. The operative mortality rate was 7.2% with a trend toward a reduction during the course of the study. One or more serious gastrointestinal or genitourinary surgical complication occurred in 26 (38%) patients and 20 (29%) required reoperation for these complications. There was a trend (P less than 0.1) toward an increase in surgical complications among patients who received prior radiation therapy and those requiring urinary diversion, with a decrease among those who underwent gracilis flap pelvic reconstruction. Patients with sigmoid or ileal conduits had a significantly higher incidence of severe surgical complications than those with transverse colon conduits or posterior exenteration alone (P less than 0.05). Those in whom an ileal conduit was constructed without gracilis flap pelvic reconstruction had significantly more surgical morbidity compared to those who underwent pelvic reconstruction or received a transverse colon conduit (P less than 0.05). Multiple changes in technique since 1978 including (1) the routine use of surgical staplers for bowel resection and anastomosis, (2) the introduction of the transverse colon conduit, and (3) the use of gracilis flap for pelvic reconstruction have combined to produce a significant (P less than 0.05) decrease in life-threatening surgical complications.

Adult↗

PubMed1989

Conservative surgical management of superficially invasive stage I vulvar carcinoma.

Fifty patients with stage I squamous cell carcinoma of the vulva were treated by means of wide local excision and either unilateral or bilateral superficial inguinal lymphadenectomy. Depth of invasion per se was not an exclusionary criterion; however, 36 of 37 patients for whom depth of invasion could be assessed had tumors invasive to a maximum depth of 5 mm. Factors investigated included recurrences and survival in addition to the early and delayed morbidity associated with this operative approach. Recurrent intraepithelial or minimally invasive cancer was documented in six patients, five of whom were treated successfully by a subsequent wide local excision following initial surgery. Only one patient died of recurrent carcinoma 16 months following surgery. The morbidity with this operation was appreciably less than that generally reported with more extensive operations commonly employed in the management of vulvar cancer and is recommended for management of patients with early invasive disease.

Adult↗

PubMed1989

A prospective randomized comparison of methotrexate, dactinomycin, and chlorambucil versus methotrexate, dactinomycin, cyclophosphamide, doxorubicin, melphalan, hydroxyurea, and vincristine in "poor prognosis" metastatic gestational trophoblastic disease: a Gynecologic Oncology Group study.

In 1981, the Gynecologic Oncology Group initiated a prospective randomized study in which patients with poor-prognosis gestational trophoblastic disease received either standard MAC chemotherapy (methotrexate, dactinomycin, and chlorambucil) or the modified CHAMOMA regimen (methotrexate, dactinomycin, cyclophosphamide, doxorubicin, melphalan, hydroxyurea, and vincristine). The protocol was closed in May 1986 because the modified CHAMOMA regimen was significantly more toxic and possibly less effective. There were 42 patients entered, with 22 receiving MAC and 20 receiving modified CHAMOMA. There have been six deaths due to disease in the modified CHAMOMA group and none in the MAC group. Five MAC failures and one modified CHAMOMA failure have been rescued by surgery and/or chemotherapy. All six of the patients who died on the modified CHAMOMA regimen had developed disease following a previous term pregnancy, but none had prior chemotherapy. All seven patients who were treated for gestational trophoblastic disease after term pregnancy in the MAC group were cured of disease. With the modified CHAMOMA regimen, 44% of patients had life-threatening hematologic toxicity, as compared with only 9% of the MAC patients. Thus, the standard MAC regimen appears to be at least equally effective and much less toxic than the modified CHAMOMA regimen, indicating a more favorable therapeutic index.

Adult↗

PubMed1989

Endometrial cancer: histologic correlates of immunohistochemical localization of progesterone receptor and estrogen receptor.

Progesterone and estrogen receptor localization, using monoclonal anti-receptor antibodies JZB39 and H222, was studied in 105 endometrial adenocarcinomas. Immunohistochemical evaluation incorporated both intensity and distribution of staining. Both anti-progesterone receptor and anti-estrogen receptor localized in the nucleus of target cells. Significant levels of progesterone receptor and estrogen receptor were seen localized in stromal and myometrial elements that diverged from the malignant epithelial component. Analyses of endometrial adenocarcinomas with anti-progesterone receptor and anti-estrogen receptor antibodies correlated with histologic differentiation. The ability to define divergent receptor populations in stromal and myometrial elements versus malignant epithelial elements indicates that immunohistochemical assay of progesterone and estrogen receptor provides information complementary to that from conventional quantitative ligand binding assays.

Adenocarcinoma↗

PubMed1989

Reactivity of epidermal growth factor receptor monoclonal antibodies with human uterine tissues.

Two monoclonal antibodies (29.1 and 528), which were raised against the epidermal growth factor receptor, were used to evaluate expression of epidermal growth factor receptor in frozen uterine tissue with immunohistochemical techniques. Monoclonal antibody 29.1 stained only vascular endothelium and glandular epithelium in patients who were blood type A. This staining pattern is consistent with the previously reported blood type A specificity of this antibody. Monoclonal antibody 528, which recognizes a peptide determinant is thought to be specific for the epidermal growth factor receptor, stained both endometrial glands and endometrial stromal cells heavily. Faint staining was also seen in myometrium in most cases. This marked difference in expression of epidermal growth factor receptor between endometrium and myometrium contrasts with results of prior biochemical studies in which tissue homogenates were used. No variation in intensity of staining was seen between proliferative and secretory endometrium with the use of either antibody.

ABO Blood-Group System↗

PubMed1989

Short gracilis myocutaneous flaps for vulvovaginal reconstruction after radical pelvic surgery.

The short gracilis myocutaneous flap derives its blood supply from terminal branches of the obturator artery, and the vascular pedicle derived from the medial femoral circumflex artery is sacrificed. Twenty-one short gracilis myocutaneous flaps were used for vulvovaginal reconstructions in 11 patients undergoing radical pelvic surgery: bilateral flaps in nine patients for neovaginal construction after pelvic exenterations, bilateral flaps in one patient for vulvovaginal reconstruction after radical vulvovaginectomy, and a unilateral flap in one patient for vulvovaginal reconstruction after radical vulvectomy with partial vaginectomy. Major complications consisted of bilateral flap necrosis occurring in one patient who had received preoperative irradiation to the vulva and groin combined with chemotherapy. Minor degrees of necrosis (less than 5%) and/or separation of vaginal suture lines occurred in five patients without marked loss of the flaps. Vaginal caliber and depth are excellent in ten patients (91%) after follow-up of 1-22 months. The short gracilis flap is an excellent alternative to the more bulky gracilis flap, which derives its blood supply from perforating branches of the femoral artery. Based on our experience, the short gracilis flap provides adequately vascularized tissue for vulvovaginal reconstruction in patients after radical pelvic surgery, but should not be used in patients who have received extensive groin irradiation.

Adult↗

PubMed1988

Percutaneous nephrostomy in gynecologic oncology patients.

Percutaneous nephrostomies were used in 34 patients with ureteral obstruction caused by gynecologic diseases. Group 1 consisted of 12 patients with untreated cervical carcinoma; group 2 consisted of six patients with recurrent cervical carcinoma; group 3 consisted of seven patients with complications of urinary conduits, and group 4 consisted of eight patients with a variety of malignant and benign gynecologic diseases causing ureteral obstruction. One perinephric hematoma and one perinephric abscess (4%) occurred during primary percutaneous nephrostomy diversion of 53 renal units. One (3%) percutaneous nephrostomy-related death caused by sepsis was observed in 34 patients. Only four (12%) patients with significant intrinsic renal disease did not have effective normalization of renal function by percutaneous nephrostomy. Percutaneous nephrostomies allow rapid and reliable urinary diversion without the morbidity and mortality of operative techniques. Percutaneous nephrostomy should be considered for relief of ureteral obstruction in patients with untreated cervical carcinoma who may enjoy prolonged palliation or cure, in patients with complications of previous urinary conduits as a temporizing method of urinary diversion, and in patients with benign or chemotherapy-sensitive pelvic malignancies causing ureteral obstruction. The use of percutaneous nephrostomy in patients with recurrent carcinoma of the cervix should be individualized on the basis of expectations for prolonged functional palliation.

Female↗

PubMed1988

Absorbable synthetic mesh (polyglactin 910) for the formation of a pelvic "lid" after radical pelvic resection.

Isolation of the abdominal contents from the denuded, potentially infected pelvis after radical pelvic surgery has been advocated. Of the many materials evaluated, omentum is usually chosen. In six patients in whom omentum was unsuitable, we have substituted polyglactin 910 (Vicryl, Ethicon, Sommerville, New Jersey) mesh to form a pelvic "lid." In these patients, omentum was either densely adherent in the upper abdomen because of prior surgery or was removed as part of surgical treatment for recurrent cancer. Vicryl mesh formed a "lid" across the true pelvis. No gastrointestinal complications occurred in these patients. Four patients developed pelvic infections that resolved after surgical drainage and antibiotic therapy. No patients developed peritonitis above the pelvis. No chronic infections have been found in more than 12 to 48 months of follow-up. In this preliminary experience, Vicryl mesh appears to be useful for the formation of a pelvic "lid" after exenterative pelvic surgery when the omentum is unavailable.

Absorption↗

PubMed1988

Absorbable synthetic mesh (910-polyglactin) intestinal sling to reduce radiation-induced small bowel injury in patients with pelvic malignancies.

Absorbable synthetic mesh (910-polyglactin) was used to create an intestinal sling in six patients undergoing surgical staging of pelvic malignancies prior to radiation therapy. All patients had effective compartmentalization of small intestine out of the pelvis which persisted throughout the duration of radiation therapy. None of the patients developed complications related to the intestinal sling. This technique is well tolerated and has the potential to minimize chronic small intestinal complications caused by radiation therapy for pelvic malignancies.

Aged↗