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Biomedical subjects

W A Peters

Publications and source records attributed to W A Peters.

53 records · Page 3Linked to original sources
PubMed1984

Autopsy findings in patients with uterine sarcoma.

Autopsy findings were reviewed in 22 patients treated for uterine sarcoma at the University of Michigan Hospitals. Included are 11 mixed mesodermal tumors, 6 endometrial stromal sarcomas, and 5 leiomyosarcomas. Only one patient died with disease limited to the pelvis. Forty-five percent of the patients died with disease limited to the pelvis and abdomen. The most common site of the disease above the diaphragm was the lung. Lymph nodes were involved in 59% of our patients. There were no obvious differences in the patterns of spread between the tumor types.

Combined Modality Therapy↗
PubMed1984

Subcellular localization of the large subunit of Mo1 (Mo1 alpha; formerly gp 110), a surface glycoprotein associated with neutrophil adhesion.

Mo1 alpha (formerly gp 110) is a neutrophil glycoprotein whose deficiency is associated with abnormalities in several neutrophil functions, including defects in adherence, chemotaxis, and phagocytosis. Examination of whole cells and subcellular components by the use of both immunological and electrophoretic techniques demonstrated that Mo1 alpha was located primarily in the specific granules but that a small portion was present in the plasma membrane, where it is exposed to the extracellular environment and can bind to anti-Mo1 antibody. During degranulation, Mo1 alpha is translocated from the specific granules to the plasma membrane, resulting in a 5-10-fold increase in the surface expression of this glycoprotein. These findings plus previous work suggest that plasma membrane-associated Mo1 alpha is needed for a normal interaction between neutrophils and underlying surfaces, and raise the possibility that the increase in surface adhesiveness of neutrophils that have discharged their specific granules might be due in part to the increase in the amount of Mo1 alpha in the plasma membranes of these degranulated cells.

Animals↗
PubMed1984

Prognostic features of sarcomas and mixed tumors of the endometrium.

A retrospective study of 103 patients with endometrial sarcomas treated at the University of Michigan Hospital includes 47 mixed homologous tumors, 32 mixed heterologous tumors, 21 pure homologous sarcomas (endometrial stromal sarcoma), and three pure heterologous sarcomas (rhabdomyosarcomas). Clinical characteristics appeared similar among the four patient groups. Fourteen percent of the patients had received previous pelvic irradiation. Twenty-nine percent of the patients with a clinical stage I or II tumor had extrauterine disease discovered at surgery. Extent of the tumor at the time of surgery strongly correlated with outcome, and only two patients with extrauterine disease were long-term survivors. Life table survival probability at five years was 58% with surgical stage I, 33% with surgical stage II, 13% with surgical stage III, 0 with surgical stage IV, and 5% in patients referred with recurrence. Risk factors predicting treatment failure were analyzed separately in surgical stages I and II using Cox model analysis. There was no difference in risk for treatment failure between pure endometrial stromal sarcoma, mixed homologous sarcoma, or mixed heterologous sarcoma. The strongest factor correlating with a poor outcome was deep myometrial invasion (P less than .001). An adverse trend was detected in those patients with previous pelvic irradiation, with advancing patient age, and with increasing uterine size, although these differences did not reach statistical significance. Neither the presence of heterologous tumor elements nor cervical involvement were found to be adverse prognostic factors.

Actuarial Analysis↗
PubMed1983

Repair of vaginal prolapse after hysterectomy.

Forty-one women with primary or recurrent prolapse of the vagina following either vaginal or abdominal hysterectomy were treated with a vaginal operation. The retroperitoneal approach of utilization of the perirectal fascia to support the vault of the vagina is described and illustrated. This technique may also be used in selected patients to prevent this complication after vaginal hysterectomy and repair.

Adult↗
PubMed1983

The selective use of vaginal hysterectomy in the management of adenocarcinoma of the endometrium.

Vaginal hysterectomy was performed in 56 patients with Stage I adenocarcinoma of the endometrium who were selected because of obesity or major medical problems that placed the patient at high risk for morbidity and death with an abdominal operation. Seventy percent of the patients were hypertensive and 29% were diabetic. The median weight for the 56 patients was 211 pounds. Ten patients who were age 40 or younger were included, and all showed signs of polycystic ovary syndrome. This subgroup of patients was significantly more obese, with a median weight of 331 pounds. Adjuvant radiation therapy was used in 32 of the 56 patients. There was one postoperative death from a pulmonary embolus, but there were few other major complications. The actuarial survival probability was 94% for all patients. With grade 1 tumors, the 5-year survival rate was 98%; with grade 2 tumors, it was 78%; and with grade 3 tumors, it was 84%. Although we do not recommend that vaginal hysterectomy become routine, it has cure rates comparable to those with abdominal hysterectomy and should be considered in patients who are a poor surgical risk, particularly patients with grade 1 tumors.

Adenocarcinoma↗
PubMed1983

Dermatomyositis and coexistent ovarian cancer: a review of the compounding clinical problems.

Although the nature of the relationship of dermatomyositis and malignancy is debated, the clinical implications of their coexistence is considerable. This review details the clinical and laboratory diagnostic features of the dermatomyositis (DM). Two case reports serve to focus on the unique management problems faced by the gynecologic oncologist when DM is associated with ovarian malignancy. Cricopharyngeal achalasia, an unusual aberration of DM, complicated the course of both patients.

Adenocarcinoma↗
PubMed1983

Radiotherapeutic alternatives to standard management of adenocarcinoma of the endometrium.

Primary radiotherapy as an alternative management for adenocarcinoma of the endometrium was chosen for 117 patients treated at the University of Michigan Medical Center and University of Virginia Medical Center. Cases were selected for radiation because of contraindications to surgery (52.2%) or by protocol for disease outside the endometrium (47.8%). An overall 5-year actuarial survival rate of 49.6% was attained for all stages, with 55% 5-year survival for disease limited to the uterus or cervix. Stage and grade were the most significant risk factors. The addition of external-beam irradiation did not improve local failure rates or survival. Heyman's uterine packing technique was slightly more successful than uterine "line sources" in controlling local disease (P = 0.08). Treatment-related mortality (0.8%) and morbidity (6.8%) were minimal. Surgery, whenever possible, remains the "best standard therapy" but the radiotherapeutic alternative is of significant benefit for those deemed nonsurgical candidates.

Actuarial Analysis↗
PubMed1983

Contribution of endocervical curettage in evaluating abnormal cervical cytology.

A review of 540 patients evaluated by the Gynecologic Colposcopy Clinic for abnormal cervical cytology revealed that 372 (68.9%) had cervical intraepithelial neoplasia (CIN), microinvasive carcinoma, or frank invasive carcinoma. The repeat cytologic smear taken before biopsy was falsely negative in 26.4%. An endocervical curettage was obtained in 52.5% of patients with an adequate colposcopy who had a neo-plastic lesion and was positive in 17.9% of those sampled, including six patients with no lesion found on the ectocervix. An endocervical curettage was obtained in 88.5% of patients with an inadequate colposcopy who had a neoplastic lesion, and was positive in 48.7%. All patients with an inadequate colposcopy not having an endocervical curettage underwent conization of the cervix. Twelve patients (2.2%) were ultimately found to have invasive or microinvasive carcinoma. A positive endocervical curettage and an inadequate colposcopy were both correlated with a final diagnosis of invasion. The contribution of endocervical curettage to the outpatient work-up of abnormal cervical cytology is substantial and it should be performed in all patients in whom cone biopsy is not planned.

Adenocarcinoma↗
PubMed1983

Pregnancy following urinary diversion.

Five pregnancies were cared for in four patients who had undergone ureterosigmoid anastomosis or ileal conduit urinary diversions. The most common complication of pregnancy was urinary tract infection, ranging from asymptomatic bacteriuria to pyelonephritis. Significant obstruction of the diverted urinary tract failed to occur during gestation or delivery. Laboratory and radiographic studies demonstrated maintenance of baseline renal function. Offspring delivered showed appropriate growth for gestational age without associated anomalies. The authors' data and a review of the literature suggest that vaginal delivery is safe, and cesarean section may be reserved for obstetric indications. Pregnancy is not contraindicated after urinary diversion.

Bacteriuria↗
PubMed1982

Expression of a chronic granulomatous disease-like defect by fluoride-exhausted neutrophils.

Neutrophils incubated with 20 mM F- express a respiratory burst without degranulating or performing phagocytosis. After 60 min of F- treatment, the burst is exhausted and cannot be restarted. Neutrophils so treated have a microbicidal defect similar to that of chronic granulomatous disease (CGD): they kill Str. mitis at a nearly normal rate, but show a marked impairment in the destruction of S. aureus. They differ from CGD neutrophils in that they also display a defect in motility. This defect, however, is not so severe as to seriously impair their ability to kill bacteria by mechanisms that are independent of endogenously generated microbicidal oxidants.

Blood Bactericidal Activity↗
PubMed1981

The O2--producing enzyme of human neutrophils. Further properties.

The enzyme responsible for the respiratory burst in human neutrophils is a membrane-bound oxidase that catalyzes the reduction of oxygen to O2- at the expense of a reduced pyridine nucleotide. We describe further properties of the solubilized oxidase. The rates of O2- production and NADPH consumption are consistent with the stoichiometry: 2 O2 + NADPH leads to 2 O2- + NADP The enzyme is highly specific for oxygen, failing to reduce several artificial electron acceptors including ferricyanide. FAD, an essential cofactor, binds tightly to the enzyme, as indicated by a Km of 61 nM. A requirement for a free --SH group is suggested by a 2-fold increase in activity in the presence of low concentrations of dithiothreitol; the higher dithiothreitol concentrations lead to inhibition. The solubilized enzyme is highly unstable, losing one-half its activity after 1 h at room temperature. Loss of activity is accelerated 2- to 3-fold by salts and EDTA. The substrate analog 2',5'-ADP is similar to other salts in its effect on the inactivation rate. ATP, on the other hand, causes loss of activity in seconds, raising the possibility that ATP is a physiological regulator of the catalytic activity of the enzyme.

Cations, Divalent↗
PubMed1981

Arrangement of the respiratory burst oxidase in the plasma membrane of the neutrophil.

Evidence was obtained regarding the way the O-2-forming NADPH oxidase of human neutrophils is arranged within the plasma membrane. O-2 production by particles from zymosan-activated human neutrophils rose two- to threefold when the particles were assayed in the presence of appropriate concentrations of Triton X-100. The portion of activity revealed by the detergent was not affected by treating the particles with trypsin or with p-chloromercuribenzene sulfonate, a nonpenetrating sulfhydryl reagent, but the activity detectable in the absence of detergent was abolished by these treatments. O-2 production by phagocytic vesicles was not augmented by detergent, and was almost entirely eliminated by tryptic digestion of the vesicles regardless of whether or not detergent was present during the assay. These results suggest that the O-2-forming oxidase is embedded in the plasma membrane with a portion extending into the cytoplasm and the rest buried in the lipid bilayer. It is proposed that the pyridine nucleotide-binding site is located on the cytoplasmic extension and the oxygen binding site is on the intramembranous portion of the enzyme.

4-Chloromercuribenzenesulfonate↗
PubMed1980

Selection of the primary operative procedure for stress urinary incontinence.

Four hundred twenty-one women were treated by an initial operative procedure for stress urinary incontinence. The patients were divided into three groups on the basis of the degree of relaxation of the anterior vaginal wall on clinical examination. Patients classified as grade O treated by vesicourethral suspension had a 98% success rate at 2 years. Similar patients treated by vaginal operation had only a 48% success rate at 2 years. In grades I and II either the vesicourethral suspension or the vaginal operations resulted in success rates in the 85% to 90% range. Chain cystourethrograms were obtained in 171 patients, but they were not predictive of success or failure for the vaginal operations. Improved results may be obtained by individualizing the choice of the operative procedure based on the anatomic findings with the vaginal procedures used for those patients with significant anterior vaginal wall relaxation.

Female↗
PubMed1979

Cervical cerclage: twenty years' experience.

During a 20-year period, 40 pregnancies were managed in 32 patients with a diagnosis of an incompetent cervix, a ratio of 1:775 deliveries. Diagnosis before development of symptoms produced a 92% fetal salvage, with 68% reaching 36 weeks of gestation. Development of symptoms before cerclage resulted in only a 40% fetal salvage. Fetal salvage was reduced in cases where membranes bulged beyond the cervix, the cervix was more than 3 cm dilated, or the gestational age was greater than 26 weeks at the time of suture placement. No difference was noted between the Shirodkar and McDonald procedures. Major complications included uterine rupture in three patients and acute chorioamnionitis in two. Because of complications, treatment is contraindicated based on history alone or where close follow-up is not available.

Adolescent↗
PubMed1979

Ovarian hemorrhage in patients receiving anticoagulant therapy.

During a 10-year period, five laparotomies were performed on three patients for hemorrhage from nonneoplastic ovarian lesions that occurred while the patients were on anticoagulant therapy. The patients were stabilized with blood transfusions, given medication to reverse the anticoagulants and underwent immediate surgery. Nineteen similar patients have been reported on previously. During the brief follow-up a 31% incidence of recurrent hemorrhage was observed in those patients continued on anticoagulants postoperatively. All physicians caring for women on anticoagulants should be on the alert for this life-threatening complication.

Adult↗