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Biomedical subjects

D E Townsend

Publications and source records attributed to D E Townsend.

At least 19 recordsLinked to original sources
PubMed1992

Synchronous radiation and cytotoxic chemotherapy for locally advanced or recurrent squamous cancer of the vulva.

Between July 1987 and September 1991 a program of external beam radiation and synchronous, radiopotentiating chemotherapy was employed to treat 25 women with locoregionally advanced or locoregionally recurrent squamous cancer of the vulva. Of 18 previously untreated patients, 1 was Stage II, 10 were Stage III, 6 were Stage IVA, and 1 was Stage IVB. Reasons for patient referral for nonsurgical management included the presence of initially unresectable disease (5 patients), disease extent which would have necessitated partial or total exenteration if treated surgically (9 patients), disease extent predictive of inadequate surgical margins (less than 1 cm gross margin) if treated by less than exenterative surgery (8 patients), and severe comorbid illness precluding surgical management (3 patients). Complete clinical response was obtained in 16 of 18 previously untreated patients (89%) and in 4 of 7 patients with recurrent disease following vulvar surgery (57%). Of 20 patients achieving a complete clinical response, 3 patients have relapsed within the irradiated volume at 11, 38, and 48 months following completion of treatment. Fourteen patients remain alive and continuously cancer free from 2-52 months after completion of treatment (median follow-up 24 months). This experience suggests that initial management with radiation and chemotherapy may offer some patients with locally advanced squamous cancer of the vulva an alternative to exenterative surgery and may hold curative potential for some patients with surgically unresectable or medically inoperable disease.

Adolescent↗
PubMed1992

Proline transport in Staphylococcus aureus: a high-affinity system and a low-affinity system involved in osmoregulation.

L-Proline enhanced the growth of Staphylococcus aureus in high-osmotic-strength medium, i.e., it acted as an osmoprotectant. Study of the kinetics of L-[14C]proline uptake by S. aureus NCTC 8325 revealed high-affinity (Km = 1.7 microM; maximum rate of transport [Vmax] = 1.1 nmol/min/mg [dry weight]) and low-affinity (Km = 132 microM; Vmax = 22 nmol/min/mg [dry weight]) transport systems. Both systems were present in a proline prototrophic variant grown in the absence of proline, although the Vmax of the high-affinity system was three to five times higher than that of the high-affinity system in strain 8325. Both systems were dependent on Na+ for activity, and the high-affinity system was stimulated by lower concentrations of Na+ more than the low-affinity system. The proline transport activity of the low-affinity system was stimulated by increased osmotic strength. The high-affinity system was highly specific for L-proline, whereas the low-affinity system showed a broader substrate specificity. Glycine betaine did not compete with proline for uptake through either system. Inhibitor studies confirmed that proline uptake occurred via Na(+)-dependent systems and suggested the involvement of the proton motive force in creating an Na+ gradient. Hyperosmotic stress (upshock) of growing cultures led to a rapid and large uptake of L-[14C]proline that was not dependent on new protein synthesis. It is suggested that the low-affinity system is involved in adjusting to increased environmental osmolarity and that the high-affinity system may be involved in scavenging low concentrations of proline.

Biological Transport↗
PubMed1991

Vasopressin and operative hysteroscopy in the management of delayed postabortion and postpartum bleeding.

Two women, one with refractory postabortion hemorrhage and the other with refractory postpartum hemorrhage, were managed with vasopressin, operative hysteroscopy, and a dilute vasopressin pack. Both patients had been treated by standard methods (i.e., dilation and curettage) and both were being prepared for a surgical intervention procedure. It was decided in both cases to try to slow the bleeding by injection of vasopressin paracervically and then performance of operative hysteroscopy. In both cases, the injection of dilute vasopressin paracervically when coupled with operative hysteroscopy was quite effective in determining the cause of the bleeding and was instrumental in avoiding major operative procedures.

Abortion, Induced↗
PubMed1991

Vasopressin pack for treatment of bleeding after myoma resection.

In 17 women with refractory bleeding after myoma resection a dilute vasopressin pack was applied. Twenty units of vasopressin was diluted with 30 ml normal saline solution. A 1-inch new gauze pack was soaked in the dilute vasopressin and packed into the uteri of patients with bleeding from the beds of resected submucous myomas. The pack was left in place for no more than an hour. In none of the cases was there bleeding after the removal of the pack nor were there any side effects that could be attributed to the vasopressin.

Administration, Intravaginal↗
PubMed1990

"Rollerball" coagulation of the endometrium.

Menorrhagia was the primary complaint of 50 patients treated by "rollerball" electrocoagulation of the endometrium. All the patients in this series had failed surgical (D & C) and/or medical therapy and all had refused hysterectomy. The electrocoagulation was performed on an outpatient basis. Complications have been minimal with follow-up varying from 6-22 months. Amenorrhea was achieved in ten of the 25 women who were followed for at least 12 months. An additional ten patients have had monthly spotting and five have had light bleeding. None of the patients noted a return of their menorrhagia. In the other 25 patients bleeding could not be evaluated, as all received medroxyprogesterone after their ablation. The preliminary results suggest that "rollerball" electrocoagulation is a safe, economical, and effective method of eliminating or reducing menorrhagia.

Combined Modality Therapy↗
PubMed1979

Nuclear DNA and histologic studies of genital lesions in diethylstilbestrol-exposed progeny. II. Intraepithelial glandular abnormalities.

This study has analyzed the nuclear DNA content of intraepithelial glandular lesions in diethylstilbestrol (DES)-exposed offspring. The endocervical cells and endometrial-tubal cells present in the vaginal adenosis and pericervical collars had a euploid distribution. However, greater proliferative activity was found among the endometrial-tubal cells. In the cells of vaginal adenosis of a postpartum woman without a confirmed history of maternal exposure to DES, a polyploid pattern was found, indicating that endometrial-tubal cells underwent hyperplastic changes under the influence of hormonal stimulation. In an atypical adenosis derived from endometrial-tubal cells, an aneuploid pattern was found. Based on these findings, it is suggested that endometrial-tubal cells have a greater proliferative potential than endocervical cells.

Adult↗
PubMed1979

Vaginal epithelial changes in young women enrolled in the National Cooperative Diethylstilbestrol Adenosis (DESAD) project.

Initial clinical findings are reported for the 3339 young women enrolled in the Diethylstilbestrol Adenosis (DESAD) project. Changes in the vaginal mucosa (VEC--vaginal epithelial changes), which were detected by colposcopy or iodine staining, occurred in 34% of 1275 participants identified by review of prenatal records 59% of participants who themselves requested entry into the project, and 65% of participants referred by a physician. Analysis of data on the 298 women who were identified by record review and whose prenatal records contained complete information about drug exposure indicated that VEC is most closely associated with the timing of the onset of intrauterine exposure to diethylstilbestrol (DES), total dose, and length of exposure. Frequency of VEC was also found to decrease with age. No instances of severe dysplasia, carcinoma in situ, invasive squamous cell adenocarcinoma, or clear cell carcinoma were observed among the women identified by record review.

Adenocarcinoma↗
PubMed1978

Cryosurgery.

Explore the source record for details and available documents.

Cryosurgery↗
PubMed1978

Comparison of histologic and colposcopic findings in DES-exposed females.

A study was undertaken to evaluate the histologic alterations associated with two of the most abnormal colposcopic findings, mosaicism and punctation, that are commonly found in the vaginas and cervices of young women who have been exposed prenatally to diethylstilbestrol (DES). Four-fifths of 215 biopsy specimens from 171 exposed subjects with mosaicism or punctation disclosed metaplastic squamous epithelium, the presence of which is thought to reflect the repair of vaginal adenosis and cervical ectropion. Hyperkeratosis was observed in one-fifth of the specimens and was more frequent in lesions colposcopically graded I than II. Mild dysplasia was encountered in only one specimen. The findings indicate that the presence of squamous cell dysplasia cannot be predicted by the finding of Grade I or II mosaicism or punctation in the DES-exposed female despite the fact that these abnormal colposcopic patterns are associated with dysplasia in about 10% of cases when encountered in the cervix of the unexposed woman.

Colposcopy↗
PubMed1977

Clinical and laboratory correlates of molar pregnancy and trophoblastic disease.

From January 1, 1970 to July 1, 1976, 128 women had hydatidiform moles evacuated at the Los Angeles County-University of Southern California Women's Hospitals. Of the 121 patients with follow-up, persistent trophoblastic disease (TD) was diagnosed in 32 (26.4 per cent). Remission was achieved in all treated patients. The frequency of TD was significantly increased in pregnancies large for dates (47.8 per cent), with a uterus greater than 20 weeks' gestational size (45.0 per cent) or with theca-lutein cysts greater than 5 cm. in diameter (50.0 per cent). A normal regression curve for serum beta-human gonadotropin as measured by radioimmunoassay has been constructed as an aid to the early recognition of postmolar TD (invasive mole and choriocarcinoma).

Adult↗
PubMed1977

Management of carcinoma in situ of the vulva.

Concern about multicentricity and occult invasion has led authorities to recommend total vulvectomy in the management of carcinoma in situ of the vulva (VCIS). Of these considerations, only occult invasion has sufficient import to contraindicate a more conservative therapeutic approach. VCIS is being diagnosed with increasing frequency in young women for whom the deforming and sexually crippling effects of vulvectomy are especially repugnant. Because of its distinctive success in localizing preinvasive and early invasive squamous neoplasia of the cervix, colposcopy and directed biopsy were employed in evaluating all patients seen in our vulva clinic since 1971. Of 27 consecutive patients considered to have VCIS, 24 were treated either by local excision, skinning vulvectomy, topical 5-fluorouracil (5-FU), or cryosurgery. In no instance was occult invasion missed on pretreatment evaluation, and only one patient has developed a new in-situ lesion following conservative surgical therapy. Topical 5-FU therapy was unsuccessful in six of six cases. These results demonstrate that total vulvectomy for VCIS can be replaced successfully with more conservative operations.

Adult↗
PubMed1977

Pelvic celiotomy in the obese patient.

We have responded to the challenge of surgery in the overweight patient by promoting it to an area of special interest. These individuals should not be deprived of good medical care although their obesity makes the physician's task more arduous and increases the risk of a poor result. With the use of intensive preoperative preparation, including prophylactic antibiotics and heparinization, a modified operative technique, and an active recovery regimen, a more sanguine view toward the surgical care of obese women can be taken.

Adult↗
PubMed1977

Mixed mesodermal sarcoma of the ovary.

Three cases of mixed mesodermal sarcoma (MMS) are reported and a review of 90 cases from the English literature is presented. All cases were analyzed with regard to clinical features, prognosis, and therapeutic efficacy. The histogenesis of these rare tumors is discussed and a new classification of ovarian sarcomas is proposed. MMS usually afflicts the postmenopausal women and occurs more often in the nulliparous female. The disease is usually advanced (Stage III) when diagnosed and thus provides a difficult challenge to any postoperative therapy.

Adolescent↗