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Biomedical subjects

W G Watring

Publications and source records attributed to W G Watring.

At least 19 recordsLinked to original sources
PubMed1991

A randomized trial of three methods of obtaining Papanicolaou smears.

The relationship between technique of obtaining Papanicolaou smears, presence of endocervical cells, and rate of cervical neoplasia was studied by comparing an endocervical and ectocervical nylon brush (Bayne brush), Ayre spatula plus endocervical brush, and spatula plus cotton-tipped swab in a randomized, prospective trial involving 11,061 patients. Eligible patients had a cervix and were not pregnant. Clinic records of patients with abnormal cytology were reviewed to determine the pathologic diagnosis. Whether pathology was defined as including condyloma, dysplasia, and cancer; dysplasia and cancer; moderate dysplasia, severe dysplasia, and cancer; or just severe dysplasia and cancer, no significant difference was found in the rates of pathology between the three techniques. Endocervical cells were identified in 89.5% of smears obtained with the Bayne brush, in 91.5% with the spatula plus endocervical brush, and in 71.1% with the spatula plus cotton-tipped swab (P less than .001). Among smears obtained with the spatula plus swab, the rate of any pathology was higher in smears that contained endocervical cells than in smears in which endocervical cells were absent (2.0 versus 0.6%; P = .009). After correction for the influence of age, there remained predictive value with the presence of endocervical cells. Once corrected for the influence of age, the rate of pathology and abnormal cytology in smears obtained with the spatula plus brush or the Bayne brush was not dependent upon the presence of endocervical cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

A comparison of the Papanicolaou smear and the cervigram: sensitivity, specificity, and cost analysis.

A total of 3271 gynecology patients between the ages of 18-50 years were screened for cervical intraepithelial neoplasia and invasive cervical cancer by simultaneous Papanicolaou smears and cervigram, a noninvasive photographic method recently introduced for screening. The accuracy of each screening test, when positive or suspicious, was evaluated independently and the results compared with colposcopically directed biopsy results. The cervigram was significantly more sensitive than the Papanicolaou smear (P less than .001), whereas the Papanicolaou smear was significantly more specific than the cervigram in detecting cervical intraepithelial neoplasia (P less than .001). Cost analysis integrating sensitivity and specificity with cost per procedure indicated a greater yield of cervical intraepithelial neoplasia with the cervigram than with the Papanicolaou smear, by 3.7:1 case per dollar.

Adolescent↗
PubMed1986

Use of tracheloscopy and directed biopsy for evaluating cervical involvement in endometrial carcinoma.

Accurate assessment of cervical involvement in endometrial carcinoma (stage II) is often difficult. The value of tracheloscopy as a possible method for improving accuracy was assessed. One hundred one patients with endometrial carcinoma were studied; 28 were suspected of having cervical involvement on endocervical curettage, and 26 were evaluable. Only five patients were documented to have cervical involvement using tracheloscopy. This finding suggests that there is general overtreatment of patients with false-positive endocervical curettage. However, a definitive statement concerning the incidence of stage II disease in the series cannot be made because many patients received traditional preoperative radiation therapy, which may have eradicated intracervical disease missed by tracheloscopy, therefore falsely confirming stage 1 disease on history from subsequent hysterectomy specimens.

Adult↗
PubMed1984

Residual tumor following radiotherapy for locally advanced carcinomas of the uterine cervix. Prognostic significance.

Over a five-year period from 1977 to 1982, 120 patients with locally advanced carcinomas of the uterine cervix were surgically staged by lymphadenectomy and laparotomy. Radiotherapy was then administered according to the pelvic extent of disease, and all patients underwent extrafascial total hysterectomy with adnexectomy at ten weeks after completing radiation therapy. The presence or absence of residual tumor in the hysterectomy specimen appeared to be an important prognostic factor in treatment success or failure. Patients with no residual tumor were found to have an excellent prognosis. Those with residual tumor clear of the resection margins were at risk for distant metastases. Only one survivor was noted in the group of patients in whom the margins of resection were involved with tumor, nearly all of these patients dying from local recurrences. Major operative morbidity in the series was minimal, and consisted of a single ureterovaginal fistula, which required urinary diversion.

Adenocarcinoma↗
PubMed1983

Ovarian carcinoma: management of stress in patients and physicians.

A discussion of the management of ovarian cancer invariably involves the problems of death and dying faced by the patient, her family, and her physician. This paper attempts to deal with the general fears, anxieties, and problems of terminality, and also places attention on specific issues involved in living with the ongoing disease and its treatments. Focus is on the effects of the disease on the woman's self-image, on her family and relationships, on life outside the hospital, and on her relationship with her attending physician. Specific problems relating to the periods of (1) diagnosis, (2) operative management and treatment, and (3) terminality are discussed. Understanding the psychosocial realities of the patient provides the physician with added insights into methods to assist the patient in adaptation and coping with this ultimately fatal disease.

Adult↗
PubMed1982

The value of "routine tests" in the staging evaluation of gynecologic malignancies: a cost effectiveness analysis.

The value of tests employed in the clinical staging of patients with carcinomas of the cervix and endometrium has been examined in a retrospective review of 739 consecutive patients seen at Tufts-New England Medical Center. The yield of positive results of the barium enema (0%) and proctosigmoidoscopy (0.8%) in carcinoma of the cervix suggests that some of these studies may be omitted in asymptomatic patients with early disease on pelvic examinations. Similarly, for carcinoma of the endometrium, the yields from barium enema (0.9%) cytoscopy (0.9%) and proctosigmoidoscopy (0.6) are low. It is concluded that optimal patient care (with respect to morbidity and costs) may be provided without routinely performing these studies in staging asymptomatic patients with cervical and endometrial carcinomas.

Barium Sulfate↗
PubMed1980

Use of thyroid supplements in relation to the risk of breast cancer.

We conducted a case-control study to determine whether the use of thyroid supplements increases the risk of breast cancer. We compared 659 women with breast cancer and 1,719 control subjects. The rates of use of thyroid supplements were 9.1% and 8.7%, respectively (age-standardized rate ratio, 1.0; 95% confidence interval, 0.7 to 1.3). There was no evidence of an association when women known to be at increased risk for breast cancer (eg, nulliparae) were examined, even when thyroid supplements were taken for more than 15 years. Overall, there were no grounds to suggest that the long-term use of thyroid supplements increases the risk of breast cancer.

Adult↗
PubMed1980

Recent and past use of conjugated estrogens in relation to adenocarcinoma of the endometrium.

It has been suggested that the reported association between estrogen use and endometrial cancer may have been biased because estrogens provoke uterine bleeding in women with otherwise asymptomatic disease. To evaluate this hypothesis we compared 149 patients with endometrial cancer and 402 control subjects with other conditions with reference to the time when they had last used conjugated estrogens. In women who had last used conjugated estrogens two or more years previously and who had taken them for at least five years, the rate-ratio estimate was 3.3 (95 per cent confidence interval, 1.4 to 8.0) relative to women who had never used them. Uterine bleeding, and hence the diagnosis of otherwise asymptomatic cancer, cannot be attributed to estrogen use that ceased in the distant past. Our results suggest that such use has a residual effect on the risk of endometrial cancer; this effect is not accounted for by biased selection of cases according to estrogen use.

Adenocarcinoma↗
PubMed1980

Prognosis and treatment of endometrial cancer.

An understanding of the patterns of spread and prognostic factors influencing survival is necessary to develop rational treatment programs for patients with endometrial cancer. The most important risk factors include the stage of tumor, status of pelvic lymph nodes, depth of myometrial penetration, tumor grade, cell type, and patient age. Because of the inherent inaccuracies of staging based on pelvic examination and the inability to assess the status of lymph nodes or myometrial penetration clinically, errors in management often result when radiation therapy is delivered prior to operation. Therefore, a rationale is offered for primary operative management of patients with Stage I disease, with consideration of adjunctive radiation therapy following operation based on extend of disease and a thorough evaluation of the high-risk factors. It is suggested that patients with more advanced stages of disease be considered for pretreatment operative evaluation. Data are presented which refute theoretical objections to this approach.

Adenocarcinoma↗
PubMed1980

Treatment of vulvar intraepithelial neoplasia (VIN) with local bleomycin.

Surgical management of vulvar intraepithelial neoplasia has resulted in frequent failure or poor patient acceptance. Bleomycin (NSC 125066-Blenoxane, Bristol Laboratories), with its activity against squamous neoplasms, provides an ideal drug for use in the medical management of this disease. Twelve patients were treated with topical and/or intradermal bleomycin. None of those treated topically and only 2 of 10 treated intradermally showed an improvement with this therapy. At the same time 5 of 12 patients progressed to invasive disease. This poor response rate suggests that this form of therapy should not be used with this disease.

Administration, Topical↗
PubMed1979

Pretreatment lymphangiography and operative evaluation in carcinoma of the cervix.

Ninety-five patients with cervical carcinoma who were not candidates for definitive operation underwent initial lymphatic and 24-hour nodal phase lymphangiography and lymphadenectomy prior to radiation therapy. Operation by a transperitoneal or extraperitoneal approach consisted of bilateral pelvic and periaortic lymphadenectomy, exploratory laparotomy, and intraperitoneal biopsies as indicated by the findings. Radiation therapy was modified to include proved sites of metastases. Intestinal injuries followed transperitoneal operation and radiation therapy but were uncommon in patients in whom exploration was done by the extraperitoneal route. Eighteen patients (19%) had unsuspected metastases to common iliac or periaortic lymph nodes identified at operation. The characteristics of the primary tumor and the interpretation of the lymphangiogram provided an inaccurate basis on which to modify treatment. As further studies confirm the risk of disseminated disease in those patients with metastases to common iliac and the periaortic lymph nodes, future treatment plans might incorporate adjuvant chemotherapy or immunotherapy in addition to extended-field irradiation.

Evaluation Studies as Topic↗