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Biomedical subjects

G W Morley

Publications and source records attributed to G W Morley.

At least 19 recordsLinked to original sources
PubMed2003

Nanoscale solid-state quantum computing.

Most experts agree that it is too early to say how quantum computers will eventually be built, and several nanoscale solid-state schemes are being implemented in a range of materials. Nanofabricated quantum dots can be made in designer configurations, with established technology for controlling interactions and for reading out results. Epitaxial quantum dots can be grown in vertical arrays in semiconductors, and ultrafast optical techniques are available for controlling and measuring their excitations. Single-walled carbon nanotubes can be used for molecular self-assembly of endohedral fullerenes, which can embody quantum information in the electron spin. The challenges of individual addressing in such tiny structures could rapidly become intractable with increasing numbers of qubits, but these schemes are amenable to global addressing methods for computation.

Journal Article↗
PubMed1998

Synthetic graft placement in the treatment of fascial dehiscence with necrosis and infection.

OBJECTIVE: The objective of this study was to describe the use of synthetic grafts in repairing fascial dehiscence complicated by fascial necrosis and infection after obstetric and gynecologic operations. STUDY DESIGN: A retrospective review of the operating room records at Hutzel Hospital (Detroit, Mich) was performed to find all cases of fascial dehiscence repaired during a 6-year period between January 1, 1991, and December 31, 1996. Patients with partial or complete disruption of the fascia with evidence of fascial necrosis and infection were included in this study. Demographic information; the initial surgical procedure, including type of incision; suture material; use of synthetic graft and closure technique for repair of dehiscence; postoperative complications, microbiologic results; antibiotic therapy; subsequent operations; length of hospital stay; and late complications were recorded. RESULTS: During the study period 52 patients underwent repair of fascial dehiscence; 36 of these had concurrent fascial necrosis and infection, including 4 women with necrotizing fasciitis. Eighteen patients were from the obstetric service and 18 were from the benign or cancer gynecology service. Ninety-one bacterial isolates were recovered from the infected wounds. Extensive fascial resection precluded closure without tension in 18 cases and necessitated synthetic graft placement to prevent evisceration. Graft materials included polypropylene (11 cases) and polyglactin (7 cases). Late complications of graft placement included extrusion of the graft in 3 patients and incisional hernia in 1. CONCLUSIONS: Extensive fascial débridement with resection prevents primary closure of wound dehiscence. Synthetic grafts permit primary closure of large fascial defects and can be used with extensive débridement in the presence of infection.

Abdominal Muscles↗
PubMed1997

Total colpocleisis for vaginal eversion.

OBJECTIVE: This report describes a technique for total colpocleisis performed on women with posthysterectomy vaginal eversion and presents the outcome of this surgery. STUDY DESIGN: Thirty-three women, aged 51 to 94 years (78.1 +/- 8.8, average +/- SD) with vaginal eversion were treated with total colpocleisis. Twenty-four women had previously undergone a total of 40 operations for prolapse, and many had a massive prolapse with scarring and ulceration. Five women had stress incontinence, and an additional 12 had poor urethral support without stress incontinence. In association with colpocleisis, 14 had suburethral plication of the endopelvic fascia; two, needle suspensions; and one, a pubovaginal sling. Three had a perineorrhaphy. RESULTS: Operations lasted from 30 to 205 minutes (101 +/- 33.4, average +/- SD), and the estimated blood loss ranged from 20 to 750 ml (206 +/- 171, average +/- SD). No operative complications occurred. Postoperatively, congestive heart failure developed in two women and one had pneumonia; all illnesses resolved with appropriate therapy. There were no complications at the operative site. Average follow-up was 35 (+/-48) months. All women were initially cured of the vaginal eversion. Recurrent eversion developed in one woman 1 year after surgery and was successfully treated with repeat colpocleisis. Of five women with preoperative stress incontinence, four were cured and one lost to follow-up. No new stress incontinence occurred. CONCLUSION: Total colpocleisis is an effective operation for the treatment of vaginal eversion in selected situations. When defective urethral support is corrected at the time of the operation, postoperative incontinence is not usually a problem.

Aged↗
PubMed1996

Treatment of uterine and vaginal prolapse.

As stated earlier, we as gynecologic surgeons are going to see more of these problems as we experience the increased longevity of our patients. With the patients best interest in mind, it is suggested that one inexperienced in the performance of the sacrospinous ligament suspension should serve a tutorial with one who had considerable experience with this procedure. Contrariwise, the colpectomy followed by a total colpocleisis is so straightforward that my teaching is, "See one; do one; teach one!"

Female↗
PubMed1995

[100 years radical abdominal operation of cervix carcinoma: in memory of Wertheim's predecessors].

1895 was a crucial year in the course of the development of abdominal radical surgery for effective treatment of cervical cancer. In March of 1895, Ries presented the rationale of modern radical hysterectomy and was the first to call for systematic removal of pelvic lymph nodes. Independently, Clark in Baltimore, Rumpf in Berlin, and Latzko in Vienna performed the first radical hysterectomies. This article is dedicated to the memory of the contributions by these four pioneers of surgical gynecology presented in 1895.

Europe↗
PubMed1995

Treatment of refractory ovarian carcinoma with paclitaxel and cisplatin after treatment failure with single-agent paclitaxel.

The clinical response to paclitaxel and cisplatin was evaluated in fifteen patients with refractory epithelial ovarian cancer who failed to respond to treatment with single agent paclitaxel. Patients received combination chemotherapy every 3 weeks with both 135 mg/m2 (9) or 175 mg/m2 (6) of paclitaxel and 50 mg/m2 (2), 75 mg/m2 (4) or 100 mg/m2 (9) of cisplatin. There was 1 complete clinical response, with 2 partial clinical responses for an overall response rate of 20%. The progression free interval was 6+ months for the complete responder and 9.5+ months for the partial responders. Overall five (33%) patients experienced an improvement in clinical response over that seen with paclitaxel alone, and 5 patients have died. Improvement in clinical response with combination chemotherapy compared to paclitaxel alone was positively associated with the cisplatin dose; while disease progression and death were inversely associated with the paclitaxel dose. Addition of cisplatin to paclitaxel may be useful in the treatment of patients who fail to respond to paclitaxel alone.

Adult↗
PubMed1994

Microinvasive squamous cell carcinoma of the cervix.

The International Federation of Gynecologists and Obstetricians (FIGO) definition of microinvasive carcinoma of the cervix changed recently. We clinically reviewed our treatment of superficially invasive cancer of the cervix in light of those changes. The review covered all patients treated at the University of Michigan from 1970 to 1985 who had stage I squamous cell carcinoma of the cervix, with the Society of Gynecologic Oncologists (SGO) and new FIGO criteria for microinvasion used. Using SGO criteria, 43 patients were treated as follows: total abdominal hysterectomy (32), total vaginal hysterectomy (7), radical hysterectomy (2) and cone biopsy (2). One patient, who had multifocal disease with a maximum depth of 1.5 mm, developed a recurrence and died of the disease. A review of 345 patients considered to have stage IB disease under SGO criteria showed 30 patients who were reclassified as having stage IA2. All these patients were treated with radical surgery and survived, and all had negative lymph nodes. Radical surgery for patients with more than microinvasion according to SGO criteria provides excellent survival rates. Radical therapy may also be indicated for multifocal lesions.

Adult↗
PubMed1993

Prognostic factors in advanced stage squamous cell cancer of the cervix.

BACKGROUND: This study was undertaken to review prognostic factors for advanced squamous cell cancer of the cervix. METHODS: A clinicopathologic review of patients diagnosed with advanced stage squamous cell cancer of the cervix was performed at the University of Michigan Medical Center, Ann Arbor, Michigan, from 1970-1985. RESULTS: All patients had squamous cell disease and were divided according to the following stages: Stage IIIa (4), Stage IIIb (113), Stage IVa (32), and Stage IVb (26). The cumulative 5-year survival was as follows: Stage IIIa (50%), Stage IIIb (37%), Stage IVa (14%), and Stage IVb (4%). Prognostic features for Stage IIIb disease showed that the intravenous pyelogram status significantly predicted cumulative 5-year survival (P = 0.00001). When the intravenous pyelogram was normal, 47% survived. When ureteral obstruction was present without renal failure, 29% survived, and when renal failure occurred, all patients were dead of disease by 16 months. The lymph node status significantly influenced cumulative 5-year survival (P = 0.004). When lymph nodes were negative, 47% survived. When three or fewer were positive, 44% survived. When more than three were positive, 11% survived. When pelvic lymph nodes were positive and paraaortic node status was determined, 25% survived when paraaortic lymph nodes were negative, while 8% survived when these were positive (P = 0.06). Factors that did not influence 5-year survival included one or both sidewall involvement (P = 0.77), tumor grade (P = 0.23), diabetes (P = 0.92), hypertension (P = 0.85), and obesity (P = 0.47). The diagnosis of Stage IVa disease was made by the presence of fistula at initial presentation (n = 8), cystoscopy (n = 21), and sigmoidoscopy (n = 1). One patient developed a treatment-related vesicovaginal fistula when bladder involvement was diagnosed by cystoscopy. All 18 patients who presented with renal failure (Stage IIIb, 9; Stage IVa, 9) were analyzed as a group, and only 1 patient survived. The median survival in 15 patients who underwent nephrostomy was 8 months, range 1-36 months. Ten of 15 patients (66%) were dead of disease within 1 year. Three patients refused renal bypass, and these three patients died at 1, 2, and 3 months, respectively. CONCLUSIONS: Advanced stage disease represents a significant challenge, and when ureteral obstruction or renal failure is present, the prognosis is markedly decreased.

Adult↗
PubMed1993

Radical vulvectomy. The decision for the incision.

BACKGROUND: An analysis of survival and complications related to the type of radical vulvectomy operation performed is reported. METHODS: Clinical records and pathology reports were reviewed for the time period 1975-1989. The operation, complications, and site of recurrent disease were recorded. RESULTS: The following types of surgical vulvectomies were used: radical vulvectomy (28 cases), the technique with three separate incisions (42 cases), and en bloc radical vulvectomy (94 cases). There was no significant difference in survival between the patients receiving en bloc radical vulvectomy or three separate incisions when analyzed by stage of disease. The following numbers of local/regional recurrences occurred among patients receiving the following treatment regimens: radical vulvectomy, seven; the technique with three separate incisions, six; and en bloc radical vulvectomy, five. Three patients treated by the separate-incision technique had a bridge recurrence. Complications were more frequent in those receiving the en bloc technique compared with those receiving the technique with three separate incisions: wound breakdown, 64% versus 38%, respectively (P = 0.005); wound infection, 20% versus 12%, respectively (P = 0.4); wound cellulitis, 21% versus 14%, respectively (P = 0.4); and lymphocyst formation, 28% versus 14%, respectively (P = 0.08). Drain placement or prophylactic antibiotics did not reduce wound infection or wound breakdown significantly. The most common sites of metastatic disease were the lungs and subcutaneous tissues of the leg. Hypercalcemia occurred in four patients, with the sites of metastatic disease being the subcutaneous tissue of the thigh (three patients) and pubic bone (one patient). CONCLUSIONS: The technique with three separate incisions provides satisfactory survival results with less morbidity compared with the en bloc technique of radical vulvectomy.

Carcinoma, Squamous Cell↗
PubMed1993

Primary treatment of stage III ovarian carcinoma with sequential chemotherapy and whole abdominal radiation therapy.

A prospective phase II clinical treatment trial of 13 patients with previously untreated optimal surgically resected (< or = 1 cm stage III ovarian carcinoma was conducted at the University of Michigan Hospitals. The treatment regimen after surgical resection consisted of chemotherapy followed by whole abdomen and pelvic radiation therapy. Chemotherapy consisted of four cycles of 50 mg/m2 cisplatin and 1000 mg/m2 cytoxan. This was followed by whole abdomen radiation therapy with a planned total dose of 30 Gy to the whole abdomen and then a 20-Gy boost to the pelvis. Six of 13 patients received a paraaortic radiation boost. There was minimal acute toxicity, but delayed toxicity was encountered with 38% of patients developing a bowel obstruction. Nine patients had reassessment laparotomy: 5 second-look laparotomies and 4 laparotomies for bowel obstruction. Two of these 9 patients died of septic complications after surgery. Nine patients died with disease, 1 patient is alive with advanced disease, and only 3 patients are alive with no evidence of disease. Actuarial 3-year survival and progression-free interval was 26 and 20%, respectively. Primary treatment consisting of sequential chemotherapy and whole abdomen radiation in the dose and scheme utilized did not improve the survival over what could be expected utilizing one of these treatments alone. It was associated with increased delayed toxicity.

Abdomen↗
PubMed1992

Pelvic exenteration for the treatment of vulvar cancer.

BACKGROUND: Advanced vulvar cancer can be treated by pelvic exenteration. METHODS: A clinical review of patients treated by exenteration surgery for vulvar cancer was performed. RESULTS: From 1950 through 1989, 19 patients underwent pelvic exenteration for advanced or recurrent squamous cell cancer of the vulva. The mean age was 53 years (median, 50 years; range, 40-74 years). The cumulative 5-year survival was 60%. Fourteen patients had posterior exenteration; 2 had anterior exenteration; and 3 had total exenteration. The survival was significantly influenced by lymph node status. When lymph nodes were not involved, 10 of 14 patients survived, whereas all 5 patients with lymph node involvement died of disease (P = 0.002). When exenteration was performed as primary therapy, 7 of 11 patients survived, whereas 3 of 8 survived when exenteration was performed for recurrent disease (P = 0.4). The extent of vulvar involvement did not influence survival (P = 0.99). There was no mortality, but ten patients had complications, including vesicovaginal fistula (three); stomal hernia (two); abscess (one); stress urinary incontinence (one); deep venous thrombosis (one); conduit leak (one); enterocutaneous fistula (one); and small intestinal obstruction (one). CONCLUSIONS: Acceptable survival for advanced or recurrent vulvar cancer can be achieved with pelvic exenteration, but the presence of metastatic disease to lymph nodes markedly decreases survival.

Adult↗
PubMed1992

A comparison of staging systems for squamous cell carcinoma of the vulva.

A review of 172 patients with squamous cell cancer of the vulva treated at the University of Michigan Medical Center from 1975-1989 was performed to compare the 1988 FIGO Staging System to the 1970 FIGO Staging System. The stage distribution according to the 1970 FIGO Staging System was stage I, 65; stage II, 44; stage III, 50; and stage IV, 13. The cumulative 5-year survival under the old system was stage I, 94%; stage II, 91%; stage III, 36%; and stage IV, 26%. The distribution changed under the 1988 FIGO system to stage I, 58; stage II, 36; stage III, 49; stage IVA, 16; and stage IVB, 13. The cumulative survival also changed to stage I, 94%; stage II, 89%; stage III, 71%; stage IVA, 19%; and stage IVB, 8%. The new FIGO stage distribution shifted for the worse due to the influence of positive lymph nodes found at the time of surgery. The survival was then analyzed for death from all causes. This was markedly decreased when compared to the cumulative corrected survival. This relates to the high number of other primary malignancies and the age of the patients. Among these 172 patients, other primary malignancies included squamous cell cancer of the cervix (11), squamous cell cancer of the vagina (2), endometrial cancer (3), squamous cell cancer of the lung (2), colon cancer (3), and others (6). An additional 5 patients died from myocardial infarction within 2 years of diagnosis. The new 1988 FIGO Staging System provides for better discrimination of survival between stages than the 1970 FIGO Staging System.

Carcinoma, Squamous Cell↗
PubMed1992

The prognosis and management of cervical cancer associated with pregnancy.

OBJECTIVE: We sought to evaluate the prognosis of patients with stage IB cervical cancer related to pregnancy. METHODS: We reviewed 53 patients from the University of Michigan diagnosed with cervical cancer related to pregnancy between 1960-1989. Patients with stage IB disease were compared with a control group less than 46 years old to determine whether pregnancy influenced survival. RESULTS: The mean age of the patients was 30.5 years (range 22-45). The number of patients treated by 5-year periods decreased from a high of 17 during 1965-1969 to a low of three during 1985-1989. The following cell types and stages were treated: squamous cell stages IA (four), IB (35), and IIB (six); adenocarcinoma stages IB (five) and IIB (two); and small-cell stage IIB (one). The 35 patients with stage IB disease had a cumulative 5-year survival of 83%. Positive lymph nodes were present in eight of 24 patients. There was no significant difference in 5-year survival according to the time of therapy (P = .45): Ten second-trimester patients had 90% survival, five third-trimester patients had 75% survival, and 20 postpartum patients had 75% survival. Eighteen of 21 patients treated by radical hysterectomy survived: three of four treated at term, five of five treated in the second trimester, and ten of 12 treated postpartum. Seven of 12 patients treated by radiation therapy survived: one of one treated at term, five of six treated in the second trimester, and one of five treated postpartum. When we compared these patients with 170 nonpregnant women less than 46 years old with stage IB squamous cell cancer, pregnancy did not adversely influence survival (P = .13). CONCLUSIONS: The number of patients diagnosed with invasive cervical cancer related to pregnancy has decreased. Survival is not altered by pregnancy for stage IB disease.

Adenocarcinoma↗
PubMed1991

Radical hysterectomy versus radiation therapy for stage IB squamous cell cancer of the cervix.

Three hundred forty-five patients with Stage IB squamous cell carcinoma of the cervix were treated at the University of Michigan Medical Center from 1970 to 1985. The overall cumulative 5-year survival rate was 89% and the mean age was 44.6 years. In 213 patients undergoing radical hysterectomy the cumulative 5-year survival rate was 92%; 14 patients were explored for radical hysterectomy that was not performed due to high risk features and their survival rate was 50%. Ninety-seven patients underwent radiation therapy as initial treatment and had a 5-year survival rate of 86%. There was no significant difference when radiation therapy was compared with radical hysterectomy (P = 0.098). The survival rates for lesions 3 cm or smaller were 94% for radical hysterectomy and 88% for radiation therapy. When the lesion was larger than 3 cm, the survival rates were 82% with radical surgery and 73% with radiation therapy. Metastatic disease to lymph nodes was present in 26 of the 213 patients undergoing radical hysterectomy. When 1 to 3 nodes were involved 16 of 19 patients survived and when 4 to 10 nodes were involved 3 of 7 patients survived. The addition of radiation therapy did not influence survival. Complications were similar in both treatment groups. Fistulas occurred in 4 of 213 patients undergoing radical hysterectomy and 1 of 111 undergoing radiation. Second surgery for a complication was required in 6 of 213 patients undergoing radical hysterectomy and 7 of 111 undergoing radiation. Survival and complication rates in early stage squamous cell carcinoma of the cervix are equal with either radical surgery or radiation therapy.

Adult↗
PubMed1991

Stage IB squamous cell cancer of the cervix: clinicopathologic features related to survival.

Three hundred forty-five patients with stage IB squamous cell carcinoma of the cervix were treated at the University of Michigan Medical Center from 1970 through 1985. The overall cumulative 5-year survival was 89%. The clinical characteristics included mean age 44.6 years, nulliparity 10%, married 93%, obese 38%, hypertension 32%, diabetes mellitus 5%, smoking 54%, symptoms of bleeding 68%, positive cytologic smear 83%. Lymph nodes were diseased in 45 of 261 (17%) with 26 unilateral (10%) and 19 bilateral (7%). Tumor differentiation showed: grade 1, 112 (33%); grade 2, 144 (42%); grade 3, 86 (25%). Factors that did not influence survival included age, presence or absence of positive cervical cytologic smear, the interval from previous papanicolaou smear, hypertension, smoking history, patient's blood type, and transfusion at radical hysterectomy. In all patients survival was significantly influenced by the following features: tumor classified as well differentiated (95%) or poorly differentiated (82%); tumor size less than 3 cm (91%) or greater than 3 cm (76%); negative lymph nodes (93%) or positive lymph nodes (61%). When three or fewer lymph nodes were involved, the survival was 79% compared with 33% when four or more lymph nodes were involved. In 213 patients undergoing radical hysterectomy the cumulative 5-year survival was significantly influenced by the amount of residual cervical disease: no residual disease, 100%; less than 50% penetration, 96%; greater than 50% penetration, 83%. Involvement of the lower uterine segment reduced survival to 73% compared with 95% when the lower segment was uninvolved. One hundred seventeen patients without angiolymphatic invasion had a 97% cumulative 5-year survival whereas 70 patients without disease in the lymph nodes but with angiolymphatic invasion had an 88% cumulative 5-year survival rate. A Cox model, multiple proportional hazard analysis was performed for all patients, and the factors that influenced survival included tumor grade, tumor size, presence of metastatic disease in the lymph nodes, and diabetes mellitus. In patients undergoing radiation therapy, the tumor grade and size were significant factors in survival. In patients undergoing radical hysterectomy, survival was influenced by the depth of cervical penetration and lower uterine segment involvement whereas the tumor grade, tumor size, patient's age, and removal of ovaries were not significant.

Adolescent↗