Unexpected pathological findings in uterine prolapse: a 12-month audit.
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Female↗
Biomedical subjects
M E Paterson
Publications and source records attributed to M E Paterson.
The potential for adjuvant therapy in early-stage cervical cancer.
Adjuvant therapy may potentially improve prognosis in women with early-stage cervical cancer who are at high risk of relapse after primary therapy. Patients with lymph node involvement at surgery are at high risk of recurrence and may benefit from adjuvant therapy, but many patients are treated with radical radiotherapy. At present there is no method of accurately identifying patients at high risk of recurrence in the latter group. A retrospective analysis of 141 surgically managed cases with stage I/II a cervical cancer is presented. The study aims were to characterize patients at high risk of relapse, identify independent prognostic variables predicting for relapse and, using these variables, develop a model, that would accurately predict high-risk patients. Univariate analysis identified depth of invasion, substage, lymph node involvement, lymphatic and blood vessel invasion and tumour differentiation as significant prognostic variables. After stratification for depth of invasion, which did not conform to the proportional hazards assumption implicit in the Cox model, Cox regression analysis showed substage, lymphatic and vascular invasion and histological tumour type to be independent prognostic variables. Using these variables, classification models were constructed that would be applicable to patients treated with either surgery or radiotherapy. Applying the models to 110 cases with greater than 18 months follow-up, 11/18 (61%) and 11/19 cases (58%) predicted as being at high risk of relapse have developed recurrence. Highly active chemotherapy is now available for this disease. We have demonstrated that combined bleomycin, ifosfamide and cisplatin (BIP) is one of the most active regimens in this disease. BIP produces cytoreduction in around 70% of patients with recurrent and primary advanced disease. Responses are achieved rapidly and acute radiotherapy toxicity is not enhanced by giving chemotherapy prior to radical local radiotherapy. A multicentre, prospective randomized trial testing the role of BIP as adjuvant therapy in patients with positive nodes at radical hysterectomy is now in progress. A complementary study testing the role of adjuvant chemotherapy in high-risk patients treated with radical radiotherapy is in preparation.
Adenocarcinoma↗
Prevention and treatment of endometrial disease in climacteric women receiving oestrogen therapy.
The treatment regimens are described in 74 patients with endometrial disease among 850 climacteric women receiving oestrogen therapy. Cystic hyperplasia was associated with unopposed oestrogen therapy without progestagen. Two courses of 21 days of 5 mg norethisterone daily caused reversion to normal in all 57 cases of cystic hyperplasia and 6 of the 8 cases of atypical hyperplasia. 4 cases of endometrial carcinoma referred from elsewhere demonstrated the problems of inappropriate and unsupervised unopposed oestrogen therapy and the difficulty in distinguishing severe hyperplasia from malignancy. Cyclical low-dose oestrogen therapy with 7--13 days of progestagen does not seem to increase the risk of endometrial hyperplasia or carcinoma.
Adenocarcinoma↗
The effect of menopausal status and sequential mestranol and norethisterone on serum cholesterol, triglyceride and electrophoretic lipoprotein patterns.
The serum cholesterol, triglycerides and electrophoretic lipoprotein patterns of 35 postmenopausal women, who subsequently received sequential mestranol and norethisterone, were compared with those of 35 premenopasual women of the same age and weight. The postmenopausal women had a significantly higher level of serum cholesterol (p less than 0.01) than the premenopausal women, and a significant reduction (p less than 0.001) occurred in this group after two months of therapy. There was no significant difference in level of serum cholesterol between the premenopausal group and the postmenopausal group receiving sequential mestranol and norethisterone for two months. The serum triglycerides were not significantly higher in the postmenopausal group but there was a significant increase (p less than 0.001) after two months of therapy. The marked alteration in lipid levels at the menopause may in part account for the great increase in coronary artery disease in postmenopausal women but whether these changes are reversible by giving hormone therapy remains speculative.
Adult↗
The aetiology and outcome of abruptio placentae.
A series of 193 cases of abruptio placentae in a hospital population of 35,217 is described. This is an incidence of 0.55%. In the series both age and parity, but not pre-eclampsia or anaemia, are significant associated factors. The recurrence rate of abruptio placentae was 5.6%. There were no maternal deaths and the perinatal mortality was 35%. Epidural analgesia does not abolish the pain of the abruptio placentae in spite of abolishing the pain of labour.
Abruptio Placentae↗
Relations between bleeding pattern, endometrial histology, and oestrogen treatment in menopausal women.
Vacuum curettage was performed on 348 women who had received various regimens of oestrogen treatment for an average of 9.7 months for climacteric symptoms. In 62 cases (18%) the specimens were unsatisfactory for histological assessment; among the remainder, however, they showed a normal endometrium in 257 cases (90%), cystic hyperplasia in 21 (7%), adenomatous hyperplasia in 7 (2%), and endometrial adenocarcinoma in one. Cyclical unopposed oral oestrogen treatment (98 cases) was associated with a 12% incidence of endometrial hyperplasia, but among those given an additional five-day course of progestogen in each cycle (37 cases) the incidence was only 8%. No case of hyperplasia occurred among 102 women taking regimens including 10 or 13 days of progestogen. Among women treated with subcutaneous oestradiol implants and monthly five-day courses of oral progestogen (50 cases) there was a 28% incidence of hyperplasia including the one case of carcinoma, though some of those with hyperplasia may not have taken the full course of progestogen. Regular withdrawal bleeding during treatment was associated with a lower incidence of endometrial hyperplasia (6%) than unscheduled breakthrough bleeding (28%), but the one patient with carcinoma had experienced regular bleeding only.The risk of developing endometrial carcinoma from oestrogen treatment may be reduced by avoiding the use of unopposed oestrogen regimens, the addition of more than five days' treatment with a progestogen, and recognising that a regular bleeding response to oestrogen is no guarantee of a healthy endometrium.
Climacteric↗
A survey of 100 patients who had laparoscopic ventrosuspensions.
The technique for and results of 100 laparoscopic ventrosuspensions are described; patients were followed for an average of 40 months and in all but 11 the uterus was anteverted at the end of the follow-up period. The presenting symptoms of dyspareunia, dysmenorrhoea or sacral backache were almost always improved as a result of the operation.
Adolescent↗