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Biomedical subjects

W N Thornton

Publications and source records attributed to W N Thornton.

At least 19 recordsLinked to original sources
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↗
PubMed1979

Ectopic pregnancy: current clinical trends.

During the 16 year period ending in November, 1978, 191 cases of ectopic pregnancy were managed at the University of Virginia Hospital. The overall incidence was 1/126 deliveries but during the last 3 years of the study the incidence was 1/60 deliveries. Only 56 patients have had a subsequent conception. Thirteen have had a recurrent ectopic implantation. Only 36 women (23.7% of those available for follow-up) have had subsequent term pregnancies. Ectopic pregnancy continues to be a major gynecologic problem and the potential for subsequent fertility is poor.

Adult↗
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↗
PubMed1977

Progesterone production by an ovarian granulosa cell carcinoma.

A patient with a progesterone-producing granulosa cell carcinoma is the basis of this report. Seven years after initial surgical therapy pelvic masses were palpated. At laparotomy the recurrence of tumor was confirmed, and many nonresectable metastases were discovered on the surface of the liver and on the mesentery of the bowel. An exceedingly high plasma progesterone level of 6270 pg/ml was obtained in the postoperative period. During 12 months of single agent chemotherapy with melphalan, serial plasma progesterone assays declined to 310 pg/ml. Complete tumor regression was subsequently confirmed by laparoscopy. Evaluation of progesterone levels in patients with granulosa cell tumors is recommended to determine the incidence of this finding and to further assess its value in following response to therapy.

Aged↗
PubMed1976

Thrombotic thrombocytopenic purpura associated with pregnancy.

Thrombotic thrombocytopenic purpura (TTP), a disorder of unknown etiology, appears to be a syndrome often associated with infectious, vascular, or autoimmune diseases. When it occurs in pregnancy, TTP can mimic other gestational complications. Two patients with TTP associated with pregnancy form the basis of this report. On patient is the second person known to have survived longer than 2 years after concurrent TTP and pregnancy. This patient had underlying glomerulonephritis and was treated with corticosteroids and heparin. The other patient, in whom an underlying disease process was not identified, was treated unsuccessfully with most of the recommended therapeutic modalities. Patients with concurrent TTP and pregnancy have the same prognosis as nonpregnant patient with TTP. Both groups have a prolonged survival rate of only 10 per cent. Primary treatment should consist of corticosteroids and inhibitors of platelet aggregation. If a rapid response does not occur, splenectomy is indicated. Care must be taken to recognize the pregnancy complicated by TTP, a circumstance which appears to occur more frequently than past reports have indicated.

Adolescent↗
PubMed1976

Actinomycosis of the female genital tract.

Four cases of actinomycosis involving the uterus and adnexal structures are reported. In 2 cases the infection was transmitted from a ruptured appendix. Ascending actinomycosis involving the endometrium and resulting in adnexal abscesses was associated with the use of an IUD in 2 patients. This infection should be suspected in any patient who develops a pelvic abscess with an IUD in place. Culture and histologic examination of tissue removed with the IUD may be a means of early diagnosis. The nature of these infections became apparent only after serious complications developed. Each patient required several surgical procedures. The diagnosis remained unsuspected until repeated laboratory examinations detected the fungus. The difficulty encountered identifying Actinomyces israeli indicates the infection is often undetected. Gallium scans were helpful in localizing occult abscesses in 2 patients.

Abscess↗
PubMed1975

Puerperal inversion of the uterus.

Acute puerperal inversion of the uterus is an uncommon but potentially fatal obstetric complication. In the 15 year period ending December 31, 1974, 11 inversions have been managed at the University of Virginia Hospital. All were recognized immediately and manually replaced and there was no significant postpartum morbidity. Successful management appears to depend largely upon prompt recognition, which can be achieved by routine postpartum examination of the vagina and cervix and manual exploration of the uterus.

Adult↗
PubMed1970

Diurnal variation of spontaneous uterine activity in nonpregnant primates (Macaca mulatta).

Diurnal variations in the average intrauterine pressure and in the average frequency of contraction were demonstrated in four nonpregnant rhesus monkeys. Uterine activity is lowest between 0400 and 0700 hours and highest between 1400 and 1700 hours. There is statistically significant correlation between uterine activity and diurnal variation in core temperature.

Analysis of Variance↗