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Biomedical subjects

R J Stock

Publications and source records attributed to R J Stock.

At least 19 recordsLinked to original sources
PubMed2000

Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix.

PURPOSE: To determine whether the addition of cisplatin-based chemotherapy (CT) to pelvic radiation therapy (RT) will improve the survival of early-stage, high-risk patients with cervical carcinoma. PATIENTS AND METHODS: Patients with clinical stage IA(2), IB, and IIA carcinoma of the cervix, initially treated with radical hysterectomy and pelvic lymphadenectomy, and who had positive pelvic lymph nodes and/or positive margins and/or microscopic involvement of the parametrium were eligible for this study. Patients were randomized to receive RT or RT + CT. Patients in each group received 49.3 GY RT in 29 fractions to a standard pelvic field. Chemotherapy consisted of bolus cisplatin 70 mg/m(2) and a 96-hour infusion of fluorouracil 1,000 mg/m(2)/d every 3 weeks for four cycles, with the first and second cycles given concurrent to RT. RESULTS: Between 1991 and 1996, 268 patients were entered onto the study. Two hundred forty-three patients were assessable (127 RT + CT patients and 116 RT patients). Progression-free and overall survival are significantly improved in the patients receiving CT. The hazard ratios for progression-free survival and overall survival in the RT only arm versus the RT + CT arm are 2.01 (P =.003) and 1.96 (P =. 007), respectively. The projected progression-free survivals at 4 years is 63% with RT and 80% with RT + CT. The projected overall survival rate at 4 years is 71% with RT and 81% with RT + CT. Grades 3 and 4 hematologic and gastrointestinal toxicity were more frequent in the RT + CT group. CONCLUSION: The addition of concurrent cisplatin-based CT to RT significantly improves progression-free and overall survival for high-risk, early-stage patients who undergo radical hysterectomy and pelvic lymphadenectomy for carcinoma of the cervix.

Adult↗
PubMed1995

Lack of magainin-like activity in human cervical tissue.

PROBLEM: The cervix plays an integral role in innate immunity of the human reproductive tract. Magainins are antimicrobial and spermicidal peptides recently described in human submandibular glands. We investigated the human cervix for magainin-like peptides. METHOD: Histologic sections of frozen and paraffin embedded cervical tissue from nine subjects were separately incubated with two rabbit, polyclonal, anti-magainin antibodies (CB-2 and CB-7) to investigate for magainin-like activity in the human cervix. RESULTS: There was no specific staining of cervical columnar cells within the endocervical canal or in the endocervical crypts. Magainin-like immunoreactivity in the human submandibular gland confirmed previous observations. CONCLUSION: Antigen related to magainin-like peptides were not discovered in the human cervix.

Animals↗
PubMed1994

Evaluation and comparison of histopathologic grading systems of epithelial carcinoma of the uterine cervix: Gynecologic Oncology Group studies.

The subjects of this study are 445 patients with advanced cervical cancer treated by standardized radiation therapy. Upon entry into one of two Gynecologic Oncology Group (GOG) protocols, original pathologic diagnoses and histologic tumor descriptions for each patient were compared with separate evaluations made by a consensus opinion of two GOG pathologists. A review diagnosis using grade, cell type, and the Stendahl scoring system was then made by the first author (R.J.S.) without knowledge of the prior diagnoses. Of the original pathologists' diagnoses, 21% did not include grade or cell type. There was little agreement among the different pathologists as to the use of either specific grade or cell type. Histologic grade, irrespective of the pathologists making the diagnosis, had no correlation to prognosis. The Reagan and Wentz large-cell keratinizing (LCK) cell type, when applied by the author to tumors with any form of squamous keratinization present, identified a group of patients with a poorer prognosis, although not independently of other prognostic factors. The Stendahl scoring system identified a number of patients with both a poorer and better prognosis. This was statistically significant and independent of other risk factors. A major limitation, however, was the number of patients evaluable because of inadequate biopsy material in 23.6% of the study group.

Adult↗
PubMed1993

Primitive neuroectodermal tumor arising in an ovarian mature cystic teratoma: immunohistochemical and electron microscopic studies.

The occurrence of a malignant neuroectodermal tumor in a mature cystic teratoma is extremely rare. Five cases of ovarian primitive neuroectodermal tumors (PNET) or neuroepitheliomas have been reported. In two, the tumor was adjacent to foci of a mature teratomatous element. We present the immunohistochemical profile and electron microscopic study of an ovarian mature cystic teratoma with PNET or malignant neuroepithelioma. The transition between the mature neural elements and the malignant PNET presents a model for monodermic neuroepithelial differentiation and explains the histogenesis of this unusual tumor.

Adult↗
PubMed1992

Patterns of failure of bulky-barrel carcinomas of the cervix.

OBJECTIVE(S): This retrospective study was conducted to analyze the hypothesis that radiation therapy followed by extrafascial hysterectomy would improve survival in patients with bulky-barrel cervical carcinomas. STUDY DESIGN: Forty-three patients with bulky-barrel carcinomas of the cervix were treated over a 14-year period. The majority of these were treated with approximately 4000 cGY external beam, followed by brachytherapy, followed by extrafascial hysterectomy. RESULTS: Forty-seven percent of all patients are dead of disease; 2.3% are alive with disease. Of the total patients, 35% had diseased paraaortic nodes, and 80% of these are dead of disease. Of the patients dead of disease, 80% had distant metastases. Delayed complications included: vesicovaginal fistulas (n = 3), surgery for bowel obstruction (n = 3), rectovaginal fistula (n = 1), and vaginal vault necrosis (n = 3). CONCLUSION: These data do not support an improvement in survival of patients with bulky-barrel-shaped lesions treated with irradiation plus adjunctive hysterectomy.

Adult↗
PubMed1991

Persistent tubal pregnancy.

Persistent tubal pregnancy may be manifest by either acute symptoms or a persistent or rising beta-hCG titer following conservative surgery. This condition is a relatively new complication, related to the recent practice of conservative surgical management of tubal pregnancy. Much has been written on the identification and possible therapy for this condition but little is known about its pathophysiology. Eight cases of persistence were studied, as well as three cases of failed conservative procedures. In nine instances, the surgeon had concentrated appropriately on the maximally dilated portion of the tube, which contained the blood clot and aborted products of conception. Unfortunately, the implantation site was located medially, toward the uterus. Ways of avoiding this complication include medial exploration or possibly the use of mesosalpingeal injection of vasopressin. An understanding of the natural history of the pathologic process might also be valuable in the management of cases of "persistence" identified solely by a continuing beta-hCG titer.

Female↗
PubMed1991

Tubal pregnancy. Associated histopathology.

Endometrial histologic characteristics are of little value in predicting ectopic pregnancy. The growing tubal gestation does not have any unique characteristics as far as the maternal-fetal tissue interface is concerned. The placentation is relatively superficial, and the growth is intraluminal. Tubal rupture occurs as a result of progressive tubal distention with focal hemorrhagic necrosis. Persistence is a reflection of incomplete evacuation combined with the noncyclic shedding of the tubal epithelium. The evacuated implantation site and conservative surgical incisions are not directly related to the recurrence of ipsilateral tubal pregnancies. The most common histologic finding related to tubal pregnancy is that of prior tubal disease.

Embryo Implantation↗
PubMed1990

Histopathology of fallopian tubes with recurrent tubal pregnancy.

Fifteen fallopian tubes in which a previous ipsilateral eccyesis was managed by conservative surgical techniques were examined. The condition of the tube relative to the previous surgical management and the resolution of the previous implantation sites were correlated with the recurrent tubal pregnancy. All previous incisions were identified and all were well-healed, except for one fistula. Residual histologic evidence was present in only five of 16 previous implantation sites. The recurrent eccyeses were related to previous surgical management in only three women, two after anastomosis and one because of inadvertent obstruction of the tube. The cases of tubal obstruction and tuboperitoneal fistula formation were thought to reflect a lack of understanding of the pathologic changes associated with tubal pregnancy during conservative surgery. The previous tubal incision sites were all remarkably well-healed regardless of whether they were primarily closed or left open, and independent of location. Infundibular or fimbrial "milk-outs" were without histologic evidence of damage. The underlying tubal disease (chronic salpingitis, follicular salpingitis, or salpingitis isthmica nodosa) seems to be the major factor identified that is associated with, and probably the cause for, the recurrent tubal gestation.

Adult↗
PubMed1989

A quantitative study of fluorescein isothiocyanate-dextran transport in the microcirculation of the isolated perfused rat liver.

Hepatic extraction of solutes depends on microvascular angioarchitecture, hemodynamics and solute concentrations. These factors may contribute to the heterogeneity observed in solute transport and uptake in the hepatic lobules. However, predictions of liver extraction based on black-box models require assumptions about these factors and the microvascular transport mechanisms involved. Consequently, the purpose of this study was to investigate solute transport and uptake by hepatocytes. Livers from male Sprague-Dawley rats were perfused at physiological flowrates and portal pressures on the stage of an in vivo microscope using a low-hematocrit Ringer solution. A bolus of fluorescein isothiocyanate-dextrans (17,900, 39,000, 65,600 or 156,900 MW), which are considered inert fluid-phase markers, was injected into the portal vein. Fluorescein isothiocyanate fluorescence, as a measure of solute concentration, was video recorded in periportal or centrivenular regions of the lobules. Spatial and temporal fluorescence data, measured in sinusoids and hepatocytes, were fit to one-dimensional transport models to determine estimates for an intracellular effective diffusion coefficient and for hepatocyte permeability. The calculated effective diffusion coefficients were 2.5 times larger for dextrans less than 66,000 MW, but were not different between the periportal and centrivenular regions. Also, the values did not show the inverse log-log molecular weight dependency for dextrans seen in other microvascular tissues.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

Mammographic localization and biopsy: the experience of a gynecologic oncology group.

From 1976 through 1986, two hundred eighty or 9% of all breast biopsies performed by a private gynecologic oncology group were for mammographically suspicious but occult breast lesions. Sixteen percent were found to be malignant. There has been improvement in mammographic techniques, and localization procedures have evolved to the current use of hooked-wire needles, which allow for the excision of smaller amounts of tissue and use of outpatient surgery facilities. Recently, the cancers encountered have been more often carcinoma in situ rather than invasive lesions. With the current increase in mammographic screening, there needs to be a continuing evolution in diagnostic modalities.

Adult↗
PubMed1989

Current management of non-squamous carcinoma of the cervix.

The incidence of non-squamous carcinoma of the cervix, relative to squamous cell carcinoma, seems to have been increasing over the past 15 years, and adenocarcinomas currently constitute 10 to 18% of cervical cancers. Uncertainties regarding the clinical behavior and management of women with non-squamous cervical cancer persist. Certain cell types and grade of adenocarcinomas play a role in prognosis and treatment selections. Treatment via irradiation or radical surgery for Stage I, small, garden variety cervical adenocarcinomas will result in excellent survival. Conversely, survival may be poor in early stage non-squamous lesions if they are of high grade or of certain cell types, such as adenosquamous carcinoma. Patients with advanced cancers of other organ systems can now achieve an increase in progression-free interval with neoadjuvant chemotherapy or concomitant irradiation/chemotherapy. Such treatments might also benefit patients with non-squamous cervical cancers.

Adenocarcinoma↗
PubMed1988

The changing spectrum of ectopic pregnancy.

There was a 3.7-fold increase in ectopic pregnancies over the last 21 years, with the occurrence rate among blacks remaining higher than for white patients. The average age of patients with ectopic pregnancies has not changed. A history of ectopic pregnancy or tubal surgery is now found in 25% of patients with ectopic pregnancies. The traditional etiologic factors have remained about the same.

Adult↗
PubMed1987

Differential staining techniques in amniotic fluid cytology diagnosis of neural tube defects: a prospective study of 129 pregnancies.

In order to assess the utility of amniotic fluid cytology in the diagnosis of neural tube defects (NTDs), we performed a prospective study of 129 pregnancies selected for maternal age or history of prior congenital defects or multiple stillbirths. Amniotic fluid obtained between the 16th and 22nd weeks of gestation was cytocentrifuged and stained with hematoxylineosin (H&E), Papanicolaou, and Diff-Quik. Chromosomal analysis, amniotic fluid alpha fetoprotein (AFP) level, and eventual pregnancy outcome were recorded for each case. The AFP levels were normal in 128 cases, including two closed NTDs (meningomyelocele and encephalocele). Three patients had abnormal chromosomal studies: two with 47,XXX and one with trisomy 21. Of these 128 cases, 16 had inadequate cytologic preparations; the remainder, including the five aforementioned patients, showed predominantly squamous cells, amnion cells, and minicells. Other cell types, including genito-urinary cells, umbilical cord cells, respiratory cells, and macrophages, were also present in smaller numbers. One case exhibited a large population of small, darkly staining neural cells and large macrophages. The AFP in this case was markedly elevated, and the fetus was noted to be anencephalic. We found the H&E to be the preferred stain for both cytologic detail and minicell preservation; however papanicolaou was better for bloody specimens. Amniotic fluid cytology may provide a rapid and inexpensive method of confirming the diagnosis of open NTDs.

Amniotic Fluid↗
PubMed1987

Recurrent carcinoma in situ of the vagina following split-thickness skin graft vaginoplasty.

A patient who developed squamous cell carcinoma in situ in a split-thickness skin graft neovagina is presented. This is the third reported case in the English literature of a patient previously treated for carcinoma in situ of the vagina who later developed an identical lesion in the graft. Management of this neoplasm is discussed, and follow-up for patients with neovaginas is emphasized.

Carcinoma in Situ↗
PubMed1987

Hysterography in patients with suspected uterine cancer: radiographic and histologic correlations and clinical implications.

The present study correlated the hysterographic and nonradiation-affected uterine histologic findings in 91 patients with suspected uterine cancer. Hysterography helped diagnose correctly a benign or malignant lesion, and helped identify the correct primary site of a malignant lesion in 11 patients. In 65 patients with a final diagnosis of endometrial carcinoma, all five cases of true endocervical involvement were identified, 69% were determined to have either no residual tumor or no myometrial invasion, and 88% were predicted correctly to have a myometrial invasion of greater than one-half. Prediction of the volume, distribution, and point of maximum invasion permitted the uterus to be opened so as to permit the best histologic assessment of the depth and extent of the lesion.

Biopsy↗