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D M Luesley

Publications and source records attributed to D M Luesley.

At least 37 records · Page 2Linked to original sources
PubMed1996

The effect of directed biopsy on the atypical cervical transformation zone: assessed by digital imaging colposcopy.

OBJECTIVE: To determine the effect of directed punch biopsy trauma on the natural history of atypical cervical transformation zones. DESIGN: A prospective randomised clinical trial. SETTING: Academic Unit colposcopy clinics in Birmingham. PARTICIPANTS: One hundred and eighty women attending the colposcopy clinics were recruited over an 18 month period, of which 161 were eligible for analysis. METHODS: Three-way randomisation of patients into 1. no biopsy, 2. central biopsy and 3. peripheral biopsy groups. Quantitative assessment of the change in surface area and severity of cervical intra-epithelial neoplasia (CIN) lesions in each group measured six weeks apart using digital imaging colposcopy. RESULTS: No significant difference in change in lesion size (P = 0.40) was noted in the three treatment groups. Results suggest that the severity of the lesion was underestimated by the peripheral biopsy. CONCLUSIONS: The results of this study suggest that directed punch biopsy trauma does not have a significant effect on the immediate natural history of CIN. No statistically significant differences were found in lesion size whether biopsy was employed or not. In addition, the site of biopsy had no influence on the outcome. It appears, therefore, that tissue trauma from punch biopsy and the subsequent inflammatory and wound healing processes do not modify the course of CIN. The regressive changes observed after punch biopsy in previous natural history studies are probably not a result of the initial inflammatory response to biopsy trauma and subsequent re-epithelialisation with normal cells, but may result from processes that continue long after tissue repair is completed.

Adolescent↗
PubMed1996

Management of lichen sclerosus and intraepithelial neoplasia of the vulva in the UK.

Women with vulval intraepithelial neoplasia (VIN), lichen sclerosus (LS) and Paget's disease are referred either to gynaecologists or to dermatologists. We have ascertained the caseloads, referral patterns and treatment modalities used in the two specialties. A postal questionnaire was sent to 540 consultant gynaecologists and 225 consultant and senior registrar members of the British Association of Dermatologists. 350 gynaecologists and 161 dermatologists returned completed questionnaires. The workload of LS and Paget's disease was evenly distributed, with 54% of dermatologists and 58% of gynaecologists seeing more than six cases of LS per annum and less than 1% seeing more than five cases of Paget's disease. 92% of responding gynaecologists saw at least one case of VIN per year whereas 43% of dermatologists saw no cases. Patients with VIN and Paget's were referred to gynaecologists for treatment by 66% of dermatologists. Both groups are equally prepared to treat LS. Indications for treatment of VIN and LS were suspicion of invasion and symptoms. Local excision of VIN is the treatment of choice by both gynaecologists and dermatologists. LS is predominantly treated with topical steroids but gynaecologists also use topical oestrogen and testosterone. The great majority of responders favoured establishing a national register to study the outcome of vulval lesions.

Carcinoma in Situ↗
PubMed1995

Intradural lipoma presenting in pregnancy.

Progressive peripheral neuropathy is an unusual condition in pregnancy requiring specialist opinion to identify the possible underlying pathology. The case presented is that of a patient with cervical intradural lipoma and worsening neurological symptoms, treated surgically at the time of caesarean section. This rare disease and its management are discussed.

Adolescent↗
PubMed1995

Management of low grade lesions: follow-up or treat?

CIN has arbitrarily been divided into three categories (1, 2 and 3) and recently a revised classification of high and low grade lesions has been suggested. Whatever classification is used, there appears to be a high level of inter- and intraobserver variability in diagnosing the grade of CIN, particularly at the minor end of the spectrum. Punch biopsy diagnoses are undoubtedly associated with both underdiagnosis and overdiagnosis of lesions, depending on the size of the lesion and the site of the worst colposcopic abnormality chosen for such investigation. The consensus is that high grade lesions should be treated once diagnosed. The dilemma of treatment of low grade lesions is more vexed and is hampered by the lack of reliable data on progression, persistence and regression rates. Local circumstances must be taken into consideration and if surveillance is not possible, then all cases of CIN should be treated. However, if women are prepared to undergo surveillance, this may be offered with certain safeguards. At present we would suggest treatment of those being observed if they continue to have an abnormality persisting for 2 years or if the lesion worsens in grade or size. It may be that the size of the lesion is of major importance in its progressive potential. The overall impact of screening programmes must be to do more good to the population than harm and the optimal management of low grade lesions is uncertain in this context.

Biopsy↗
PubMed1995

Modern image capture and data collection technology.

Computer data collection technology is intended to facilitate patient management and clinic administration. The systems should be devised for ease of usage and careful consideration should be given to the core set of data required and the task to be performed by the system. Security of data is important, and it must cover not only the inadvertent access to confidential data, but also must stop corrupt data from entering the system. Audit is becoming increasingly important, and the ability to achieve this should be inbuilt into any data collection system. A staged introduction of these systems is suggested without trying to achieve too much at the initial attempt. Adaptability is important so that as new technologies are introduced, the old systems should not be made redundant. Eventually it should be possible to achieve the goals set, and include fields for image capture of the colposcopic findings, which although not an essential requirement for such systems, is certainly a desirable one.

Colposcopes↗
PubMed1994

Intervention debulking surgery in advanced epithelial ovarian cancer.

OBJECTIVE: To study whether intervention debulking surgery improves survival in patients with advanced ovarian cancer who have bulky (> 2 cm) residual disease after primary surgery. DESIGN: A prospective multicentre randomised study. SETTING: Hospitals in the West Midlands. SUBJECTS: Ovarian cancer patients with bulky residual disease after primary surgery who are considered well enough to receive cis-platinum based chemotherapy and further surgery. METHODS: Eligible patients were randomised to receive combination chemotherapy alone or combined with intervention debulking surgery. MAIN OUTCOME MEASURE: Survival was assessed using product limit method and log-rank test. RESULTS: Seventy-nine patients were entered into the study. Thirty-seven patients were randomised to intervention debulking surgery, 25 (67%) of whom underwent intervention debulking surgery, which was performed a median of 13 weeks after primary surgery. The median survival for the intervention debulking surgery group was 15 months (95% CI 10-20 mo) and that of those randomised to chemotherapy alone, which was 12 months (95% CI 8-16 mo), were not significantly different (hazard ratio = 0.71; 95% CI 0.44-1.13). CONCLUSION: Intervention debulking surgery may not improve survival in patients with advanced ovarian cancer.

Adult↗
PubMed1994

Digital imaging colposcopy, image analysis and quantification of the colposcopic image.

OBJECTIVE: To investigate the use of a digital imaging system for colposcopy, its use for image analysis and quantification of the colposcopic features that may predict histological outcome as defined by large loop excision of transformation zone. DESIGN: Prospective programme study of all patients undergoing colposcopy for cytological abnormalities. SETTING: Dudley Road Hospital, Birmingham. SUBJECTS: Fifty consecutive patients having cytological and colposcopic abnormality treated with large loop excision of transformation zone formed the study group. MAIN OUTCOME MEASURES: Pretreatment and colposcopic features correlated with histological diagnosis of excised transformation zone. RESULTS: Index cytology and current smoking status are the most important variables for prediction of histological diagnosis. Other important variables are focality of lesion, surface pattern, intercapillary distance and degree of acetowhiteness. CONCLUSION: Digital imaging colposcopy allows image capture, processing and objective analysis. This methodology holds advantages for basic and clinical research, teaching, diagnostics and clinical audit. The system can act as a quality control tool for colposcopy units. This system should prove invaluable for further quantitative studies, for natural history studies and for those patients with deferred treatment of their cytological and colposcopic abnormalities. The statistical models described may be incorporated into the system and can aid the colposcopist in management of the woman with abnormal cervical cytology and colposcopic abnormality.

Adolescent↗
PubMed1993

Pregnancy outcome after large loop excision of the cervical transformation zone.

OBJECTIVE: Our purpose was to determine whether large loop excision of the cervical transformation zone affects the outcome of pregnancy after 20 weeks' gestation. STUDY DESIGN: In a retrospective case control study 40 women who had undergone large loop excision of the cervical transformation zone and were subsequently delivered at Dudley Road Hospital were identified between January 1989 and January 1992. Eighty controls were identified and matched for age, parity, and ethnic group from women delivered immediately before and after index cases. Variables included maternal performance in labor and smoking habits and perinatal outcome. Maternal factors analyzed included pregnancy gestation, length of the first and second stages of labor, use of oxytocin, analgesia, mode of delivery, estimated blood loss, whether labor was spontaneous or induced, and if preterm spontaneous rupture of membranes occurred. Perinatal outcome measures included whether the infant was liveborn, fetal weight, the presence of fetal abnormalities, and admission to the neonatal unit. RESULTS: Women delivered after large loop excision of the cervical transformation zone had infants of significantly lower birth weight than did controls. They were also significantly more likely to have admitted to smoking on admission. CONCLUSION: Previous studies investigating pregnancy outcome after local destructive methods of treating cervical intraepithelial neoplasia have been generally reassuring. However, in this study women who were delivered after large loop excision of the cervical transformation zone had significantly smaller infants. Although this may be related to the characteristics of women who have cervical intraepithelial neoplasia (for example, their smoking habits), larger adequately controlled studies should be performed before colposcopists can be justified in adopting a liberal attitude to treating all women with abnormal smears.

Adult↗
PubMed1993

The West Midlands epithelial ovarian cancer adjuvant therapy trial.

In a multicentre prospective randomized controlled trial, single agent cisplatinum was compared with whole abdomino-pelvic moving strip radiotherapy in the management of Stage IC-III epithelial ovarian cancer patients who had no macroscopic residual disease after primary surgery. Over a 6-year period 40 eligible patients were recruited, 15 of whom had Stage III disease. The overall 5-year survival was 60% with no significant survival difference between the treatment groups. Acute toxicity was common in both arms and six (11%) patients experienced significant long term disability.

Chemotherapy, Adjuvant↗
PubMed1993

Abnormal cervical cytology following large loop excision of the transformation zone: a case controlled study.

OBJECTIVES: To determine factors that may predict cytological outcome at 6 months following large loop excision of transformation zone (LLETZ) for cervical intra epithelial neoplasia (CIN) and to investigate the outcome in women with continuing cytological abnormality. DESIGN: Case controlled retrospective study. SETTING: Dudley Road Hospital, Birmingham and Midland Hospital for Women. SUBJECTS: Fifty-eight women with abnormal follow up cytology and a control group of 116 women. MAIN OUTCOME MEASURES: The relation between pretreatment and treatment factors and cytological outcome, and the relation between cytology and histology in women who had biopsies for persistent abnormal cytology. RESULTS: Univariate and stepwise logistic regression analysis showed that the number of sectors of atypical transformation zone (lesion size) and the excision margin status of the large loop excision specimen are of prognostic importance for the prediction of cytological abnormality at the 6 month follow up visit. Sixteen women have undergone further cervical biopsy. Of the five cases of persistent CIN, four had cytological changes showing moderate or severe dyskaryosis. Of the 11 women with koilocytosis or normal histology, 10 had mild dyskaryosis or borderline changes on their follow up cytology. CONCLUSION: Lesion size and excision margin status are important correlates of follow up cytology when treating patients for CIN with LLETZ. All women with abnormal cervical cytology at follow up should undergo colposcopic assessment. Excision biopsy is indicated if follow up cytology shows moderate or severe dyskaryosis, especially if still present 12 months after treatment.

Age Factors↗
PubMed1992

A prospective study of conization of the cervix in the management of cervical intraepithelial glandular neoplasia (CIGN)--a preliminary report.

OBJECTIVE: To assess the efficacy of cervical conization as primary management of cervical intraepithelial glandular neoplasia (CIGN). DESIGN: A multicentre prospective cohort study. SETTING: CRC Clinical Trials Unit, Birmingham. SUBJECTS: 84 women registered with the Unit between May 1986 and January 1989. After excluding 33 women, 51 who had been managed in accordance with the described protocol and had the presence of CIGN confirmed by central review of diagnostic histopathological material were included in the study. INTERVENTION/PROTOCOL: Women with CIGN diagnosed on a cervical cone specimen were managed in accordance with a specific protocol: (a) women with negative cone margins were managed conservatively and followed up with regular cervical cytological and colposcopic examinations; (b) women with involved cone margins were managed by hysterectomy. MAIN OUTCOME MEASURES: Presence or absence of CIGN at cone margins, results of cervical cytological examinations following conization, results of histopathological assessment of any surgical specimens taken after initial cone biopsy. RESULTS: Of the 51 women with confirmed CIGN, managed by conization, 14 (27%) were aged 30 or less and 15 (29%) were nulliparous. Thirty five women who had a cone biopsy showing margins free of CIGN have been managed by conization alone. After a median follow-up period of 12 months there is no apparent residual CIGN or invasive disease in this group. Thirteen women have had further surgical procedures (according to protocol) and two have had a hysterectomy for benign gynaecological disorders. Eight further procedures were carried out because the original cone biopsy had margins involved with CIGN, and only one of them was found to have residual CIGN. The other five procedures were carried out solely because of abnormal cytology, only one of them had a diagnosis of CIN 1. A total of 10 women had cytological abnormality following cone biopsy, one had CIGN, one had CIN 1 and a third had CIN 3. CONCLUSIONS: Our preliminary data suggests that when a diagnosis of CIGN is made upon a cone biopsy, further surgery is unnecessary in those women in whom the margins of the cone specimen are free of disease. Cytological and colposcopic follow up, including cytological sampling of the endocervical canal, is recommended for these women.

Adult↗
PubMed1992

Is stage I epithelial ovarian cancer overtreated both surgically and systemically? Results of a five-year cancer registry review.

OBJECTIVE: To review the incidence of Stage I epithelial ovarian carcinoma in the West Midlands region and to identify prognostic factors that have a significant effect on survival. DESIGN: A retrospective review of all Stage I ovarian cancer patients registered from 1.1.80 to 31.12.84. SETTING: West Midlands Regional Cancer Registry. POPULATION: 457 patients with Stage I ovarian cancer--373 with epithelial ovarian carcinoma. MAIN OUTCOME MEASURES: Survival at censor date of 30.6.89. RESULTS: 28% developed recurrent disease, and the overall 5-year survival of the group was 70%. Univariate analysis of all possible prognostic factors showed that stage, adjuvant chemotherapy, histological grade and type, surgical rupture of the tumour, intact capsule histologically, clinical finding of ascites and the performance of peritoneal washings were significantly associated with survival. Adequate surgical staging as defined by FIGO was not significantly associated with survival. A multivariate analysis based on the Cox proportional hazard model identified histological grade, adjuvant chemotherapy, patient age and peritoneal washings as having independent prognostic effects. Surprisingly adjuvant chemotherapy and peritoneal washings had negative effects on survival. CONCLUSIONS: Although a retrospective review has limitations, it would appear that adequate surgical staging and adjuvant chemotherapy confer no benefit in terms of survival in Stage I disease.

Adolescent↗