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Biomedical subjects

D Cavanagh

Publications and source records attributed to D Cavanagh.

At least 145 records · Page 8Linked to original sources
PubMed1990

Role of pH in syncytium induction and genome uncoating of avian infectious bronchitis coronavirus (IBV).

Syncytium formation induced in Vero cells by IBV-Beaudette was optimal at pH 6.7 and absent at pH 7.5. Reduction of IBV-Beaudette replication by ammonium chloride, which raises the pH in endosomes, further indicated that uncoating of the virus genome probably occurred within the acidic environment of endosomes. However, this would not appear to apply to all IBV strains, since one was unaffected by the drug. It would appear that some strains of IBV have the capacity to fuse with the plasma membrane at neutral pH, thereby leading to genome uncoating at that site. Other strains of IBV might also uncoat at the plasma membrane when the extracellular environment is slightly less than pH7.

Ammonium Chloride↗
PubMed1990

Molecular basis of the variation exhibited by avian infectious bronchitis coronavirus (IBV).

IBV serotype-specific, virus neutralising (VN) antibody is induced by the S1 subunit of the spike (S) glycoprotein. A Portuguese isolate (Port/322/85) is considered to be an in vivo recombinant. VN tests showed that it belongs to the Massachussetts (Mass) serotype. Correspondingly, the sequence of S1 and S2 was extremely similar to that of older Mass isolates. However, the matrix (M) glycoprotein and upstream gene sequences were atypical of these Mass strains and more closely resembled other serotypes isolated in Europe. The recombination event had occurred within the sequence between the M and S genes (corresponding to mRNA 3) or near the 3' terminus of the S2 gene.

Amino Acid Sequence↗
PubMed1990

Interstitial radiotherapy for the treatment of advanced or recurrent vulvar and distal vaginal malignancy.

From March 1, 1985 to April 30, 1988 10 patients with locally advanced primary or recurrent vulvar or distal vaginal malignancy were managed with interstitial radiotherapy with or without teletherapy. One patient died of complications of a total pelvic exenteration for radionecrosis 8 months after completion of radiotherapy. The remaining nine patients were alive at a mean follow-up of 28 months (14 to 50 months). Recurrent disease developed within a bed of severe radionecrosis in two patients at 13 and 47 months after completion of radiotherapy. The remaining seven patients have remained without evidence of recurrent disease. Of the 10 total patients severe radionecrosis developed in six at a median of 8.5 months (6 to 26 months) after radiotherapy. We conclude from our data that the use of interstitial needles, mainly combined with external radiotherapy, for the treatment of locally advanced primary or recurrent vulvar and introital malignancy is highly effective but also highly morbid.

Adult↗
PubMed1990

Invasive carcinoma of the vulva. Changing trends in surgical management.

Four hundred fifteen patients who had invasive carcinoma of the vulva were treated with primary surgery from July 1, 1955, through June 30, 1989. Three hundred seventy-six (90%) of the patients had squamous carcinoma. Two hundred fourteen patients (52%) had radical vulvectomy with inguinofemoral lymphadenectomy. Twenty-four patients (6%) underwent radical vulvectomy with pelvic exenteration for advanced disease, and 55 patients (13%) had nonradical operations. The remaining 122 patients (29%) underwent radical vulvectomy, inguinofemoral lymphadenectomy, and pelvic lymphadenectomy. The primary morbidity was associated with lymphedema (8.6%) and groin wound breakdown (54%). No intraoperative deaths occurred among the 415 patients treated surgically, but there were 17 deaths (4%) within 28 days of operation. The absolute 5-year survival rate was 85% in patients with negative inguinofemoral lymph nodes and 39% when these lymph nodes were positive for metastatic carcinoma. The overall absolute 5-year survival rate was 67%.

Adult↗
PubMed1990

Experience with the EndoPap device for the cytologic detection of uterine cancer and its precursors: a comparison of the EndoPap with fractional curettage or hysterectomy.

Cytologic assessment of the endometrium with the EndoPap sampler was compared with curettage or hysterectomy in 249 women with symptoms. The sensitivities for the detection of primary corpus cancer and hyperplasia were 0.90 (59/66) and 0.58 (18/31), respectively. All six cases of atypical endometrial hyperplasia were detected by the EndoPap device. Malignant EndoPap cytologic findings were present in 4 of 10 patients with a primary adnexal malignancy and normal endometrial histologic findings. Ninety-two percent of primary uterine cervical cancers were detected by EndoPap cytologic sampling. The specificity for the cytologic diagnosis of benign conditions was 0.93. EndoPap cytologic sampling has a reasonably high sensitivity for the detection of uterine cancers and preinvasive endometrial lesions with a high risk of progression to carcinoma. Further evaluation as to its usefulness in a screening program for uterine and adnexal cancers in postmenopausal women should be considered.

Adult↗
PubMed1990

Morbidity and survival patterns in patients after radical hysterectomy and postoperative adjuvant pelvic radiotherapy.

Morbidity and survival patterns were reviewed in 50 patients who underwent radical hysterectomy, pelvic lymphadenectomy, and adjuvant postoperative pelvic radiotherapy for invasive cervical cancer. Ninety percent of the patients were FIGO stage IB, and 10% were clinical stage IIA or IIB. Indications for adjuvant radiotherapy included pelvic lymph node metastasis, large volume, deep stromal penetration, lower uterine segment involvement, or capillary space involvement. Seventy-two percent of the patients had multiple high-risk factors. An average of 4700 cGy of whole-pelvis radiotherapy was administered. Ten percent of the patients suffered major gastrointestinal complications, 14% minor gastrointestinal morbidity, 12% minor genitourinary complications, one patient a lymphocyst, and one patient lymphedema. Of the five patients with major gastrointestinal morbidity, all occurred within 12 months of treatment. Three patients required intestinal bypass surgery for distal ileal obstructions and all are currently doing well and free of disease. All of the patients who developed recurrent disease had multiple, high-risk factors. The median time of recurrence was 12 months. All patients recurred within the radiated field. Actuarial survival was 90% and disease-free survival 87% at 70 months. It is our opinion that the morbidity of postoperative pelvic radiotherapy is acceptable, and benefit may be gained in such a high-risk patient population.

Adenocarcinoma↗
PubMed1990

Use of local flaps for primary anal reconstruction following perianal resection for neoplasia.

Perianal resection for neoplasia is associated with a significant risk for subsequent fecal incontinence. This report describes primary reconstruction of the anus using local skin flaps in nine patients who had undergone resection of perianal tissue for neoplasia. Seven patients had invasive cancer, and two patients had carcinoma in situ with a preoperative suspicion of invasive cancer. In all nine patients a portion of the external anal sphincter was excised during surgery. Bilateral rhomboid flaps were used in five patients, and four patients had advancement of local full-thickness skin flaps. All nine patients had a satisfactory anatomic result and were ultimately fecally continent.

Adult↗
PubMed1990

Treatment of advanced gynecologic malignancies with intraarterial chemotherapy and accelerated fractionation radiation therapy: a preliminary report.

The results of a pilot study employing the administration of intraarterial chemotherapy and accelerated fractionation radiotherapy for advanced gynecologic malignancies are reported. The protocol consisted of three treatment sessions every 3 to 4 weeks. Each session consisted of bilateral or unilateral catheterization of the hypogastric artery with the infusion of cisplatin 100 mg/m2 on Day 1 and 2-deoxy-5-fluorouridine (FUDR) 300 mg/m2 on Day 2. An accelerated fractionation schedule of external-beam radiation was begun on Day 1 consisting of 200 rads twice daily for 4 days (1600 rads per session). Eight patients entered the protocol, and seven completed external-beam radiotherapy. Five completed three intraarterial sessions, and three, two sessions. Five of seven evaluable patients had a complete local response. Local control was sustained fom 6 to 24 months in four patients. Complications included three sensorimotor neuropathies, one clinically insignificant catheter-related thrombosis, and three clinically significant radiation injuries. This multimodality treatment for locally advanced gynecologic tumors appears feasible with modification, and continued work exploring this approach is encouraged.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

Successful therapy of metastatic embryonal carcinoma coexisting with gonadoblastoma in a patient with 46,XY pure gonadal dysgenesis (Swyer's syndrome).

A case of gonadoblastoma associated with metastatic embryonal carcinoma occurring in a phenotypic female with 46,XY pure gonadal dysgenesis is presented. Two years after treatment with surgery and combination chemotherapy the patient is disease free. This is the third reported case and first reported cure in the English-language literature over the past 25 years. Current management is reviewed.

Adolescent↗
PubMed1990

Detection of endometrial carcinoma: clinical judgement versus histologic examination.

Dilatation and curettage (D&C) is routinely performed on patients with postmenopausal bleeding. The tendency is to rely on the results of the D&C rather than clinical judgment if the diagnosis is benign. In four of our patients treated with total abdominal hysterectomy, endometrial carcinoma was diagnosed even though earlier histologic examination with D&C had shown benign disease. All patients were 60 years of age or older. Three of the four patients had postmenopausal bleeding, and one patient had a Papanicolaou test that indicated an unexplained abnormality. All patients were obese (weighing more than 250 lb) and hypertensive. Other high-risk factors included diabetes mellitus in three and an elevated tumor marker antigen (CA125) in one. Frozen sections of tissue taken at D&C revealed no malignancy and failed to explain the postmenopausal bleeding. Rather than relying on these results, we assessed the high-risk factors and performed total abdominal hysterectomy immediately on all four patients. The results confirmed endometrial carcinoma. Immediate abdominal hysterectomy saved the patients additional anesthesia and delay in diagnosis.

Adenocarcinoma↗
PubMed1990

Tuboovarian abscess in postmenopausal women.

A retrospective review was done on all patients at Tampa General Hospital with a surgically confirmed tuboovarian abscess between March 31, 1983, and April 30, 1988. Patients were grouped according to their menopausal status. Sixty-three were identified. Fifty-four were premenopausal and nine postmenopausal. The median ages of the two groups (26 and 52, respectively) were significantly different. The premenopausal patients had a significantly lower median parity and were significantly more likely to have a prior history of gonorrhea and/or pelvic inflammatory disease. The postmenopausal patients were significantly more likely to have contributing medical problems and to have concomitant genital tract pathology. Such pathology, found in 13% of the premenopausal patients, consisted mainly of large leiomyomata uteri. In 3 (33.3%) of the postmenopausal patients there was a strong preoperative suspicion of a coexisting pelvic abscess originating in the genital tract. Two of the patients developed septic shock shortly before surgery. Concomitant pelvic pathology was present in six patients (66.7%), with four of them having genital tract malignancies. An attempt at early recognition and surgical management of tuboovarian abscess is important in postmenopausal women. There is little to be gained by delaying surgical treatment, and the patient is at significant risk of deterioration. In addition, surgical exploration appears to be vital to the recognition and treatment of concomitant pelvic malignancy or other pathologic conditions that may be contributing to the abscess.

Abscess↗
PubMed1989

Whole-abdomen radiation as a second-line therapy for epithelial ovarian cancer.

Whole-abdomen irradiation was delivered to 11 patients with persistent epithelial ovarian cancer after chemotherapy. Ten of the eleven patients have recurred and subsequently died of disease. The median time to recurrence was 5.5 months. All 10 recurrences were within the irradiated field. All 6 patients with microscopic disease at second-look laparotomy recurred. Four of the five patients with minimal residual disease (less than or equal to 5 mm) at second-look laparotomy recurred. One patient is alive with no evidence of recurrence at 14 months. Four patients developed small bowel obstruction, three of which were associated with recurrence. During therapy, 4 patients developed significant enteritis and 5 patients developed significant bone marrow suppression. All 11 patients completed radiation therapy, although in 4 there were interruptions of 1 to 3 weeks. Whole-abdomen irradiation does not appear to be an effective second-line regimen for epithelial ovarian cancer, even in the presence of microscopic or minimal residual disease.

Abdomen↗
PubMed1989

Treatment of recurrent and metastatic endometrial cancer with cisplatin, doxorubicin, cyclophosphamide, and megestrol acetate.

The combination of cisplatin, doxorubicin, cyclophosphamide, and megestrol acetate was used to treat 15 patients with recurrent and metastatic endometrial cancer. Four patients had a complete response and one patient had a partial response, yielding a total response rate of 33%. Five patients had stable disease. The median survival for the whole group was 38 weeks. The median survival for responders was 60 weeks, and that for nonresponders was 21 weeks. The median progression-free survival for the whole group was 17 weeks. The median progression-free survival for responders was 32 weeks, and that for patients with stable disease was 25 weeks. The toxic reactions noted were primarily nausea, vomiting, and myelosuppression. The combination of cisplatin, doxorubicin, cyclophosphamide, and megestrol acetate has modest effectiveness in the treatment of metastatic or recurrent carcinoma of the endometrium.

Aclarubicin↗
PubMed1989

Use of Vicryl mesh in the reconstruction of the pelvic floor following exenteration.

Thirteen patients underwent reconstruction of the pelvic floor following pelvic exenteration using polyglactin 910 (Vicryl) mesh with omentum. One patient developed a conduit leak in the early postoperative period and one patient developed an enterocutaneous fistula at the time of recurrence. There were no other gastrointestinal or urinary tract complications. Six patients developed significant postoperative pelvic infections, four of which manifest as abscesses below the mesh. Vicryl mesh with omentum appears to be a reasonable method for reconstruction of the pelvic floor following exenteration. The postoperative infectious morbidity in this series is concerning, however.

Abscess↗
PubMed1989

Carcinoma of the vulva involving the perianal or anal skin.

From January 1, 1985, to December 31, 1987, 58 patients underwent radical vulvar surgery for primary squamous cell carcinoma of the vulva. Twenty-four (41%) of the tumors involved the perianal or anal tissues. Nineteen patients had FIGO stage III disease and five patients had stage IV disease. Nineteen of the 24 patients underwent radical excision of their tumors, without colostomy. Two of the 19 excisions included resection of the majority of the anus, and both patients were subsequently left with severe fecal incontinence. In 8 patients the resection involved partial removal of the external and sphincter. Four of these patients developed persistent postoperative fecal incontinence. In the remaining 9 patients the resection involved partial removal of the anal skin, but with the external anal sphincter intact. One of these patients had postoperative fecal incontinence which was unchanged from her preoperative state. In conclusion, carcinoma of the vulva involving perianal tissue can be resected in most cases with adequate preservation of external anal sphincter function. If the sphincter is damaged during the operation, there is a significant risk for subsequent fecal incontinence.

Adult↗
PubMed1989

Ovarian management at the time of radical hysterectomy for cancer of the cervix.

Ovarian management at the time of radical hysterectomy for cervical cancer was reviewed retrospectively over a 7-year period. All patients had early-stage cancer except three who had stage IIB disease. Approximately 80% of patients had squamous cancer and 20% adenocarcinoma or adenosquamous carcinoma. The mean age was 44, and 24% of patients were 35 or younger. Ninety-nine patients had their ovaries removed. None of the ovaries contained metastatic disease including 22 patients with adenocarcinoma or adenosquamous carcinoma. Of the 17 patients with retained ovaries 14 had transposition into the paracolic gutters. Only one of the 14 patients with transposed ovaries developed symptoms of ovarian failure. No patients with retained ovaries developed metastatic disease or required reoperation secondary to new ovarian pathology. It is our opinion that normal ovaries can be preserved in young women at the time of radical hysterectomy for early cervical cancer regardless of histologic type.

Adenocarcinoma↗
PubMed1989

Concomitant radiation therapy and chemotherapy in the treatment of advanced squamous carcinoma of the lower female genital tract.

Twenty-three consecutive patients with advanced squamous carcinoma of the lower female genital tract were entered into a pilot study to determine the response rate and toxicity of a combination of intravenous cisplatin and 5-fluorouracil given concomitantly with radiation therapy. Twenty (87%) of the patients had a complete clinical response. Two patients (9%) had a partial response and one (4%) had stable disease. Nine (45%) of the complete responders have recurred with a median time to recurrence of 4 months. Seven (35%) had some component of local recurrence. The complete responders who have not recurred have been followed a median of 17 months. The acute toxicity was generally mild and there was no life-threatening acute complications. Three patients developed significant late complications. The response rate in this study was very high. The responses were usually prompt and dramatic, but often not sustained.

Adult↗