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Biomedical subjects

R W Holloway

Publications and source records attributed to R W Holloway.

11 recordsLinked to original sources
PubMed1995

An evaluation of Groshong central venous catheters on a gynecologic oncology service.

One hundred ten women with gynecologic malignancies underwent 116 subclavian vein Groshong catheter insertions at the bedside under local anesthesia and intravenous sedation. Three (2.6%) additional patients had unsuccessful insertions because of an inability to access the subclavian vein or thread the guidewire. Fluoroscopy was not used. There was one delayed pneumothorax and no insertion-related infections. The 111 single-lumen catheters used primarily for the administration of chemotherapy are the subject of this report. The mean age of patients was 60 (range 13 to 89) years and their average Gynecologic Oncology Group performance score was 1.1 (range, 0 to 3). Diagnoses include 74 ovarian, 19 cervical, 13 uterine, and 5 other gynecologic malignancies. Hyperalimentation was administered in 16 (14%) patients. Grade IV neutropenia occurred in 57 (51%) patients and 44 (40%) received granulocyte colony-stimulating factor during therapy. The average lifespan of catheters was 247 (range, 37 to 703) days, and 39 (35%) women died from disease with their catheter in situ at a mean time of 288 days. Thirty-seven (33%) catheters were removed after completion of chemotherapy at an average time of 239 (range, 78 to 448) days. As of 1/1/94, 22 patients continued to use their catheters at a mean of 313 (range, 182 to 509) days. The remaining 13 (11.7%) catheters were removed due to complications (7 episodes of bacteremia, 3 tunnel infections, 2 catheter migration/thromboses, and 1 catheter laceration). Twenty episodes of fever in 17 (15.3%) patients were evaluated with blood cultures in the absence of a tunnel infection. None of the 10 culture negative cases resulted in catheter removal, whereas 7 of 10 patients with bacteremia had catheters removed. Exit site infections occurred in 23 (21%) patients and were resolved with local measures and oral antibiotics. The risk of exit site cellulitis was 3.3% per month. When compared to placement of permanent central venous access devices at our institution in the operating room or radiology suite, bedside placement of Groshong catheters resulted in a savings of $1448 and $231 per case, respectively.

Adolescent↗
PubMed1992

The efficacy and safety of the cytobrush during pregnancy.

The safety and efficacy of abrasive cytology, using the cytobrush, were evaluated in 300 pregnant patients. When compared to conventional cytology obtained with a cotton-tipped applicator there was no difference in adverse pregnancy events. Smear adequacy (containing endocervical cells) was statistically (P less than 0.01) and clinically increased from 21 to 86%. The use of abrasive cervical cytology was associated with a twofold increase in the incidence of abnormal smears.

Adult↗
PubMed1991

Identification of human papillomavirus type 16 in primary and recurrent cervical cancer following radiation therapy.

Formalin-fixed, paraffin-embedded tissue blocks from 13 women with cervical carcinoma that recurred following radiation therapy were evaluated for the presence of human papillomavirus (HPV) by in situ hybridization using ribonucleic acid 35S-labeled probes for HPV types 6, 11, 16, and 18. Ten of thirteen patients also had pretreatment biopsies from their primary tumors available for analysis. HPV 16 was detected in both primary and recurrent lesions in 4 women. In 1 case, HPV was detected in the primary tumor and not in the recurrence. HPV 16 was also present in three recurrent cancers from which primary lesions were not available for probing. Radiation therapy did not alter the hybridization signal strength or pattern, suggesting that the HPV genome copy number was not significantly affected. The persistence of HPV 16 in recurrent cervical carcinoma is consistent with the theory that HPV plays a role in maintaining the malignant state.

Adult↗
PubMed1991

Surgical staging of uterine cancer: an analysis of perioperative morbidity.

Surgical staging documented extrauterine disease in 27.9% of 168 patients with apparent early-clinical-stage uterine cancer. An analysis of operative time (78 +/- 21 min), blood loss (332 +/- 160 cc), and surgical site infection risks (4.7%) indicated little additional risk of lymphadenectomy. The long-term risk of lymphocyst (1.3%) or lymphedema (0.7%) was small. The histologic information obtained from staging was utilized to rationally guide the need for adjunctive teletherapy. The overall risk of recurrence (median follow-up, 26 months) with surgical Stage I disease was 2.6%.

Combined Modality Therapy↗
PubMed1991

Surgical aspects of cervical cancer.

Surgery maintains an important role in the diagnosis and treatment of premalignant as well as early invasive and recurrent cervical cancer. Although the indications for and benefits of surgical staging remain to be determined, specific procedures frequently are necessary to manage treatment-related complications. The authors review the indications, morbidity, and outcome of these procedures.

Carcinoma in Situ↗
PubMed1990

The use of in situ hybridization to show human papillomavirus deoxyribonucleic acid in metastatic cancer cells within lymph nodes.

Southern blot hybridization has been used to identify human papillomavirus types in both primary tumors and lymph node metastases. However, this technique requires fresh-frozen tissue and is incapable of localizing deoxyribonucleic acid sequences to specific cell types in the tumor sample. In contrast, in situ hybridization precisely locates viral sequences within tumor cells while preserving cellular architecture. Further, in situ hybridization requires only small samples of formalin-fixed, paraffin-embedded tissues. Five lymph nodes (from four patients) containing metastatic cervical squamous tumor cells (identified with hematoxylin and eosinophil staining) were analyzed with in situ hybridization techniques with human papillomavirus type 16 deoxyribonucleic acid probes labeled with sulfur 35. The primary cervical cancer from all four patients had been shown to contain human papillomavirus type 16 sequences by Southern blot. Three specimens from two patients clearly showed the presence of human papillomavirus type 16 sequences within the nuclei of metastatic tumor cells, whereas two specimens were nondiagnostic most likely as a result of the small volume of cancer relative to the size of the lymph node. This information indicates that it is the tumor cells themselves that contain viral deoxyribonucleic acid and provides additional evidence linking human papillomavirus with cervical carcinogenesis.

Autoradiography↗
PubMed1990

Hysterectomy with extended surgical staging and radiotherapy versus hysterectomy alone and radiotherapy in stage I endometrial cancer: a comparison of complication rates.

Extended surgical staging (ESS) has been added to total hysterectomy and bilateral salpingo-oophorectomy (TAHBSO) in patients with clinical Stage I endometrial cancer in order to better define patterns of metastatic spread and the response to treatment. Adjuvant radiotherapy has a demonstrated efficacy in decreasing central recurrence in Stage I disease. The combined use of radical surgery and pelvic radiotherapy for cervical cancer patients results in an increased incidence of complications. This study compares major complication rates in Stage I endometrial cancer patients who underwent either TAHBSO with ESS or TAHBSO alone followed by adjuvant external beam radiotherapy (RT). Records of 52 patients with clinical stage I endometrial cancer were reviewed. Thirty-two patients underwent TAHBSO plus ESS and 20 patients had TAHBSO alone. All patients received postoperative, whole pelvis external radiotherapy. Four patients suffered complications potentially related to treatment which required rehospitalization, and all 4 were in the group which had undergone ESS. A comparison of complication rates between the ESS + RT group (4/37 or 10.8%) and TAHBSO + RT group (0/20) suggested a trend toward significance (P less than 0.10). Treatment protocols using extended surgical staging prior to adjuvant radiotherapy in Stage I endometrial cancer should examine complications potentially related to this combination, to further define treatment risks and benefits.

Adult↗
PubMed1989

Monitoring the course of cervical carcinoma with the squamous cell carcinoma serum radioimmunoassay.

Serum samples were collected from 611 gynecologic patients for measurement of squamous cell carcinoma antigen levels using the Abbott Laboratories squamous cell carcinoma antigen radioimmunoassay kit. Sixteen of 83 patients (19.3%) with cervical dysplasia and 72 of 135 (53.3%) with primary or recurrent cervical carcinoma had levels above 2.4 ng/mL. In contrast, only seven of 373 women (1.9%) without genital tract squamous cell intraepithelial neoplasia or carcinoma had squamous cell carcinoma antigen levels above 2.4 ng/mL. Fifty-six patients with cervical cancer were followed for correlation of squamous cell carcinoma antigen levels to disease course, and 20 had persistent or recurrent disease after therapy; rising squamous cell carcinoma antigen levels predicted disease in 15 of these 20 patients with recurrence (13 of 15 with elevated pre-treatment levels and two of five with normal pre-treatment levels). Rising squamous cell carcinoma antigen levels preceded the clinical detection of disease in ten patients by a mean of 4.6 months (range 2-7.5 months); in the remaining five, squamous cell carcinoma antigen levels were elevated only when disease recurrence was documented. Although measurement of squamous cell carcinoma antigen levels is not a sensitive screening method for cervical cancer (sensitivity 53.3%), the test has good specificity (94.3%); the majority of patients with false-positive elevations had other genital tract squamous cell neoplasias. The squamous cell carcinoma antigen assay may be a useful aid for monitoring the disease course of cervical carcinoma.

Antigens, Neoplasm↗
PubMed1988

Melanosis of the cervix.

Benign and malignant melanotic cervical lesions are rare and require biopsy to rule out melanoma. Reported is a case of cervical melanosis, defined as benign epithelial pigmentation.

Adult↗