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Biomedical subjects

G W Morley

Publications and source records attributed to G W Morley.

At least 37 records · Page 2Linked to original sources
PubMed1991

The effects of early removal of indwelling urinary catheter after radical hysterectomy.

Radical hysterectomy has long been a primary mode of therapy for selected gynecologic malignancies. The lower urinary tract is an area associated with complications following this procedure. Lack of satisfactory reflex micturition and urinary retention, diminished bladder sensation, infection, and fistula formation are common adverse sequelae. Prolonged indwelling catheterization is a cornerstone of postoperative management after radical hysterectomy. An alternative regimen consisting of early postoperative catheter removal, with a strict voiding schedule, and intermittent self-catheterization (ISC) for postvoid residuals (PVR) was prospectively investigated. Intermittent self-catheterization was initiated only if the PVR 12 hr after catheter removal was greater than 75 ml. Twenty-six patients who underwent radical hysterectomy were studied. Catheters were removed between the fifth and ninth postoperative day. Eighteen patients (69%) had PVRs less than 75 ml at 12 hr and were successfully managed with a strict voiding schedule only. Eight patients (31%) had 12-hr PVRs greater than 75 ml and were managed with a strict voiding schedule and ISC until the PVR was less than 75 ml for two consecutive voids. These patients were evaluated with fluorourodynamics and none had an abnormal study. Compared to 25 historical control patients, study group median indwelling catheter duration was less (6.0 days compared to 30.0 days) with no increase in postoperative complications. On the basis of these data, early removal of indwelling urinary catheters after radical hysterectomy appears to be an acceptable alternative to long-term catheterization.

Catheters, Indwelling↗
PubMed1991

Squamous cell carcinoma of the vulva: prognostic factors influencing survival.

One hundred seventy-two cases of patients with squamous cell cancer of the vulva treated at the University of Michigan Medical Center from 1975 to 1988 are reported. The mean age was 66 years with a range of 21 to 101 years. The distribution by stage included Stage I, 65; Stage II, 44; Stage III, 50; and Stage IV, 13 patients. Groin node dissections performed on 145 patients showed negative nodes, 58%; unilateral positive nodes, 28%; and bilateral positive nodes, 14%. The distribution of patients with positive nodes was influenced by stage: Stage I, 14%; Stage II, 23%; Stage III, 72%; Stage IV, 92%. The overall cumulative 5-year survival was 71% and this was significantly influenced by stage of disease: Stage I, 94%; Stage II, 91%; Stage III, 36%; Stage IV, 26%. Stages I/II and III/IV were combined for analysis. In Stages I/II, survival was significantly influenced by tumor grade while size, patient age, and lymph node status did not influence survival. In Stage III/IV, survival was significantly influenced by tumor size, node status, and number of positive nodes while grade, patient age, and tumor location did not influence survival. Squamous cell cancer of the vulva is effectively treated with radical surgery but advanced-stage disease with regional metastases significantly alters survival.

Adult↗
PubMed1991

Full-thickness skin graft vaginoplasty for treatment of the stenotic or foreshortened vagina.

Vaginal stenosis or foreshortening following surgery or radiation therapy can lead to dyspareunia. This report concerns the successful use of full-thickness skin grafts taken from the flank overlying the iliac crest to treat vaginal stenosis or foreshortening. The operation consists of incising the involved area and creating a space which will become the recipient site. An elliptical piece of full-thickness skin harvested from the area overlying the iliac crest is cleared of underlying fat, trimmed to fit the recipient site, and sutured in place. Vaginal packing is used to keep the graft against the recipient bed. Ten patients have been treated successfully with this technique, without significant complications or sequelae. Follow-up from 6 weeks to 42 months showed excellent postsurgical vaginal capacity in all patients. Similarly, excellent functional results were achieved in eight patients, with distinct improvement in the remaining two. This procedure is a useful addition to the gynecologic surgeon's armamentarium.

Adult↗
PubMed1991

A comparison of adenocarcinoma and squamous cell carcinoma of the cervix.

A comparison and survival analysis of 203 patients (21%) with adenocarcinoma and 756 (79%) with squamous cell cancer of the cervix for the time period 1970-1985 is reported. The mean number of new cases of adenocarcinoma (N = 12) remained the same, while squamous cell cases decreased from 57 to 32. The clinical features were compared; oral contraceptive usage, node status, diabetes, and symptoms of bleeding were not related to cell type. Nulliparity was more frequent in patients with adenocarcinoma, whereas obesity and smoking were more frequent in patients with squamous cell cancer. Survival in stage I was significantly influenced by the cell type. Patients with stage I squamous cell disease had a 90% 5-year survival, compared with 60% for adenocarcinoma (P less than .0001). Other features that influenced survival included node status (P = .001), poor differentiation of tumor histology (P = .001), diabetes (P = .001), and Papanicolaou smear interval (P = .001). Patients undergoing radical hysterectomy were analyzed separately, and adenocarcinoma cell type significantly influenced survival (P = .0008). Patients with stage II squamous cell disease had a 62% survival, compared with 47% for adenocarcinoma (P = .01); patients with stage III squamous cell disease had a 36% survival, compared with 8% for adenocarcinoma (P = .002). The percentage of adenocarcinoma has increased because of the decreased number of patients with squamous cell disease. Stage-for-stage survival is significantly decreased for patients with adenocarcinoma as opposed to squamous cell disease.

Adenocarcinoma↗
PubMed1990

Invasive cervical cancer treated initially by standard hysterectomy.

Ninety-two patients with invasive cervical cancer initially treated by standard hysterectomy were evaluated for features related to survival. The cell type included squamous cell (64) and adenocarcinoma (28). Posthysterectomy therapy included radiation therapy (78), pelvic lymphadenectomy (3), and radical parametrectomy (1). Hysterectomy was initially performed for the following indications: invasive lesion missed on cone biopsy, 17; hemorrhage at cone biopsy, 2; bleeding, 16; abnormal cytology, 13; presumed endometrial cancer, 9; known cancer, 7; pelvic relaxation, 5; planned therapy, 3; fibroids, 3; adnexal mass, 2; chronic discharge, 1; pyometra, 1; postpartum endometritis, 1. The cumulative 5-year survival for all patients was 68%, for squamous cell 80%, and for adenocarcinoma 41% (P = 0.0001). On postoperative evaluation 84 patients had presumed Stage I and 7 had parametrial involvement (Stage II). Patients with Stage I disease were then examined separately by cell type. Fifty-seven patients with squamous cell disease had cumulative 5-year survival of 85%. Radiation therapy in the immediate postoperative period produced a survival of 88%, compared to observation only with a 69% survival (P = .10). Patients with squamous cell disease and more than 50% cervical invasion had a 75% survival compared to a 96% survival for those with less than 50% (P = .02). The presence of disease at the surgical margins, grade, age, and increase in radiation therapy did not influence survival. Twenty-seven patients with presumed Stage I adenocarcinoma had a cumulative 5-year survival rate of 42%. Survival was significantly influenced by tumor grade (P = .018) and the amount of postoperative radiation therapy (P = .03), while age, amount of residual tumor, and presence of tumor at surgical margins did not influence survival. Patients with invasive squamous cell carcinoma treated by standard hysterectomy and postoperative radiation therapy have a prognosis similar to those treated initially by either radical surgery or radiation therapy. Patients with adenocarcinoma appear to have a significantly decreased survival when compared to patients with squamous cell disease and their prognosis is related to tumor grade and the amount of postoperative pelvic radiation.

Adenocarcinoma↗
PubMed1990

Urinary incontinence following radical vulvectomy.

Although incontinence has been reported after radical vulvectomy, its relationship to operative technique, anatomy, and treatment has not been defined. Twenty-one patients having vulvectomies for vulvar cancer were prospectively evaluated preoperatively and postoperatively with urodynamic function studies. A portion of the urethra was removed in four patients undergoing radical vulvectomy, and 14 had a vulvectomy excision that came within 1 cm of the distal urethra. Six patients (28%) developed a change of continence, with three developing total incontinence, two stress incontinence, and one urge incontinence. All four patients who had a portion of the urethra excised developed stress or total incontinence. The other two patients with incontinence (one total, one urge) had the vulvectomy excision that came close to the urethra. No patient had a change in continence when surgery did not involve or come close to the urethra. When the four patients with a distal urethral resection were compared with patients in whom the urethra was not excised, there was a significant decrease postoperatively in functional urethral length (P less than .0001), anatomical urethral length (P less than .0001), and distal urethral pressure transmission ratios in Q3 (P = .004), Q4 (P = .02), and Q5 (P = .005); but no difference in urethral support (Q-tip test), flow rates, residual urine, bladder capacity, maximal urethral pressure, resting closure pressure, or squeeze pressure. Histologic examination of urethral specimens demonstrated that a portion of the compressor urethrae muscle was often excised. Radical vulvectomy by itself does not cause incontinence, but it would appear that removal of a portion of the urethra increases the chance of incontinence.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1990

The surgical management of recurrent squamous cell carcinoma of the vulva.

Thirty-four patients with recurrent/persistent squamous cell carcinoma of the vulva were treated at the University of Michigan Medical Center from 1975-1988. At follow-up, 19 patients (56%) were free of disease and 15 were dead of disease. Three patients developed a "bridge" recurrence, one patient each with original stages I, II, and IV. Two of these patients were free of disease and one patient died of disease. Ten patients had metastatic disease to the groin lymph nodes at the time of recurrence, and all of these patients are dead of disease. Therapy for the recurrence consisted of five radical vulvectomies (80% survival), four pelvic exenterations (25% survival), and 25 wide radical excisions (56% survival). The lymph node status was highly significant in predicting outcome, with zero of ten patients remaining free of disease when the lymph nodes were involved and 19 of 24 free of disease when the lymph nodes were uninvolved (P less than .0001). Factors that did not influence survival included the institution where the initial surgery was performed and the interval from initial therapy to recurrence. Twenty patients received their initial therapy at the University of Michigan and 12 (60%) were free of disease. Fourteen patients were referred from outside institutions for their recurrence and seven (50%) were free of disease. Nineteen patients had a recurrence within 2 years and nine were free of disease, ten patients recurred between 2-10 years of whom seven were free of disease, and five patients recurred after 10 years with three free of disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma, Squamous Cell↗
PubMed1989

Identification of prognostic factors and risk groups in patients found to have nodal metastasis at the time of radical hysterectomy for early-stage squamous carcinoma of the cervix.

In a retrospective study conducted at the University of Alabama at Birmingham, the University of Michigan, and the Mayo Clinic, 185 patients with previously untreated FIGO stage IB and IIA squamous cell carcinoma of the cervix were found to have nodal metastasis at the time of radical hysterectomy and pelvic lymphadenectomy. Of these patients, 103 received adjuvant pelvic irradiation. Cancer recurred in 76 patients; the median time to recurrence was 3.1 years. The prognostic significance of patient age, clinical stage, lesion diameter, number and location of nodal metastases, and use of adjuvant radiation therapy was determined by multivariate analysis. Only patient age (P = 0.0006), lesion diameter (P less than 0.0001), and number of nodal metastases (P = 0.0004) were noted to be significant factors in determining overall survival. Rates of recurrence were also related to these factors. Employment of these significant variables led to identification of four risk groups. In general, patients with small cervical lesions (diameter less than 1 cm) and no more than two nodes with metastases fell into the low-risk category; those patients with large cervical lesions (diameter greater than 4 cm) and more than two involved nodes fell into the high-risk category. All other patients were categorized into intermediate-risk groups. Ten-year survival was 92% in the low-risk group (n = 13), 70% in the low-intermediate-risk group (n = 66), 56% in the high-intermediate-risk group (n = 66), and 13% in the high-risk group (n = 20). This risk group classification identifies subgroups of early-stage cervical carcinoma patients found to have nodal metastasis at the time of radical hysterectomy that warrant appropriately selected adjuvant therapy.

Carcinoma, Squamous Cell↗
PubMed1989

Value of adjuvant whole-pelvis irradiation after Wertheim hysterectomy for early-stage squamous carcinoma of the cervix with pelvic nodal metastasis: a matched-control study.

In a retrospective study, 185 patients with previously untreated stage IB or IIA (International Federation of Gynecology and Obstetrics) squamous cell carcinoma of the cervix were found to have pelvic nodal metastasis at the time of Wertheim hysterectomy and bilateral pelvic lymphadenectomy. Of these patients, 103 received adjuvant whole-pelvis irradiation and 82 received no adjuvant therapy. Median dose of pelvic irradiation was 5000 cGy. Among the irradiated patients, in 75% the dose was 5000 cGy or greater. Matching irradiated and nonirradiated patients according to stage, tumor size, and number and location of positive nodes yielded 60 pairs. Mean length of follow-up was 3.9 years for the 60 irradiated patients and 5.8 years for the non-irradiated patients. Kaplan-Meier overall and cancer-specific survival estimates for the two groups were not significantly different (P greater than 0.30). During the follow-up period, 21 surgery-only patients and 22 patients treated with adjuvant radiotherapy had recurrence, but adjuvant radiotherapy decreased the proportion of recurrences occurring in the pelvis alone--27% compared with 67% in the surgery-only group (P = 0.01).

Adult↗
PubMed1989

Small cell carcinoma of the vagina with neuroendocrine features. A report of three cases.

Three patients were treated for primary small cell carcinoma of the vagina. The light microscopic features were similar to those of small cell carcinoma of the lung, cervix and endometrium. Electron microscopy revealed occasional cytoplasmic, neurosecretory-type granules and cytoplasmic processes, features consistent with neuroendocrine cells. Radiotherapy appears to provide local control, but widespread disease at presentation or early metastases suggest the use of adjuvant chemotherapy in the initial management of the neoplasm.

Adult↗
PubMed1989

Pelvic exenteration, University of Michigan: 100 patients at 5 years.

One hundred patients undergoing pelvic exenteration (total 69, anterior 13, posterior 18) at the University of Michigan Medical Center from 1964-1984 are reported. All patients were followed for at least 5 years or until time of death. The overall cumulative survival was 66% at 3 years and 61% at 5 years. The age of the patients ranged from 21-74 years (median 53). The type of pelvic neoplasm included squamous cell of the cervix, 57; adenocarcinoma of the cervix, nine; squamous cell carcinoma of the vulva, 12; squamous cell carcinoma of the vagina, eight; vaginal sarcoma, four; adenocarcinoma of the vagina, one; adenocarcinoma of the endometrium, four; uterine sarcoma, four; and adenocarcinoma of the ovary, one. The cumulative 5-year survival was significantly related to the presence of metastatic disease to the regional lymph nodes (8% 3-year and 0% 5-year survival), time interval from primary diagnosis to exenteration (within 1 year 44%, 1-10 years 60%, and over 10 years 95%), and cell type (squamous cell 68%, sarcoma 62%, and adenocarcinoma 26%). Patients with squamous cell carcinoma of the cervix (N = 57) had a cumulative 5-year survival of 73%, compared with nine patients with adenocarcinoma of the cervix, who had a 22% 5-year survival. No significant difference in survival existed for the type of exenteration, original stage of squamous cell cervical carcinoma, size of recurrent squamous cell lesion, or age of the patient. Early or late complications occurred in 49 patients. Two patients died in the postoperative period. Small-bowel obstruction was the most common complication seen in this series.

Adenocarcinoma↗
PubMed1989

The role of pelvic exenteration for sarcomatous malignancies.

Pelvic exenteration, although performed most frequently for recurrent squamous cell carcinoma of the cervix and vagina, has been used in selected patients with pelvic sarcoma. Nine patients with various histologic types of sarcoma treated by pelvic exenteration are reported. During this 23-year time period, 46 patients with sarcoma were evaluated for possible exenteration. Patients with embryonal rhadomyosarcoma (sarcoma botryoides) were excluded because these pediatric tumors are now treated with less radical operative procedures, plus radiation and chemotherapy. Six patients had exenteration as primary treatment, and three patients had exenteration as secondary treatment. Four patients developed recurrent disease (mean 5.2 months), and all four died of disease. Five patients were alive at 5 and 10 years, for an absolute survival of 55%. All three patients with mixed mesodermal tumors died of recurrent disease, compared with 83% survival for patients with other sarcoma types. Pelvic exenteration may play a limited but important role in the therapy of pelvic sarcoma.

Adult↗
PubMed1989

Primary melanoma of the vagina: a clinicopathologic analysis.

Primary melanoma of the vagina is a rare tumor associated with a poor prognosis. The clinical and pathologic features of 15 patients treated at the University of Michigan Medical Center and Bowman Gray School of Medicine are reviewed. The presenting symptom of bleeding was noted in 80% of the patients. The cumulative 5-year survival was 17.4%. Two patients survived more than 5 years. All melanoma tumors were of the nodular type, 66% were located in the lower one-third of the vagina, and all patients were found to have invasion greater than 3 mm at the time of diagnosis. The majority of recurrences were located in the pelvis, with the lung being the most common metastatic site. Data from the literature were incorporated with these patients' data in a meta-analysis. Tumor thickness (6 mm or less) significantly (P = .015) affected the disease-free interval. Tumor size (less than 3 cm) significantly (P = .024) influenced survival, whereas age, stage, tumor location, and tumor thickness did not. There was no significant difference in survival among patients treated by surgical resection, irradiation, or surgical resection plus irradiation. The type of surgery, whether radical or conservative, also did not influence survival. One patient had a complete response to high-dose irradiation fractions (greater than 400 cGy), and this form of irradiation in conjunction with surgical resection is presented as a treatment option.

Aged↗
PubMed1989

The second-look operation and surgical reexploration in ovarian tumor of low malignant potential.

Patients at the University of Michigan Medical Center who were reoperated on for either operative staging, suspected disease, or a second-look procedure with the diagnosis of ovarian tumor of low malignant potential are reported. At the time of initial surgery, 29 patients were thought to have benign disease based on visual inspection of the ovarian mass, and seven patients had a frozen-section report of benign disease. Fifteen patients underwent restaging operation, and disease was found in seven patients. One patient remained as stage Ia, one patient was upstaged to stage Ib, and five patients were upstaged to either stages II or III. Thirteen patients underwent 22 operations for suspected disease. Malignancy was encountered in 19 of these 22 operations. A second-look operation was performed on 20 patients, and 17 of these were negative. All patient with original stages I or II disease had negative second-look operations, whereas three of the eight patients with stage III disease had positive second-look operations. Reexploration for staging in the ovarian tumor of low malignant potential will yield a reasonable number of positive results, whereas the second-look operation in early-stage disease has a very low yield.

Adult↗
PubMed1988

The management of vaginal melanoma.

Between 1964 and 1987 ten patients with vaginal melanoma were treated at The University of Michigan Hospital. Five of the six patients who underwent radical surgery had adequate information concerning the first site of relapse, and in four of these five, pelvic sites or locoregional lymph nodes were the first sites of recurrent disease. One of these patients developed a 17-cm pelvic recurrence, which responded with a 75% reduction in size 3 months after completion of radiotherapy given in high individual fractions (400 cGy X 11). Three patients were managed with local resection, and all developed recurrent locoregional disease. One patient presented with metastatic disease. We conclude that locoregional control of vaginal melanoma is difficult to achieve with surgery alone. We hypothesize that preoperative radiotherapy to the pelvis (500 cGy X 6 given 3 days a week to the whole pelvis with subsequent consideration for a vaginal boost field) may improve the poor rate of locoregional control of vaginal melanoma that is seen when surgery alone is used.

Aged↗
PubMed1988

Sacrospinous ligament fixation for eversion of the vagina.

During the period from January 1, 1974, through June 30, 1987, 100 patients were treated with a sacrospinous ligament suspension of the vaginal apex at the University of Michigan Medical Center. Fifty-seven patients had a posthysterectomy complete vaginal prolapse; 38 patients, an incomplete vaginal prolapse; and five, a posthysterectomy enterocele. Fifty-one patients had had an abdominal hysterectomy and 49 a vaginal hysterectomy previously. Almost half of the patients had had at least one attempt at surgical correction of the prolapse and three patients had had four previous procedures. The immediate postoperative complications were not unexpected. Febrile morbidity responding to appropriate therapy was the most common complication. There was no surgical mortality. Seventy-one of the 78 patients were operated on greater than or equal to 1 year ago and were the subjects of the review. Sixty-four of the patients (90%) had complete symptomatic relief after operation. Ten of these patients had some asymptomatic laxity of the vaginal walls and nine others had satisfactory support but vaginal stenosis or symptoms of stress urinary incontinence after operation. Four patients developed cystoceles and three others had recurrent vaginal prolapse. The vaginal approach to the treatment of eversion of the vagina has many advantages, as reported. The surgical goals described were attained; therefore, use of the sacrospinous ligament fixation procedure as a therapeutic procedure only is defended. The surgical technique is described. Finally, the sacrospinous ligament fixation of vaginal vault prolapse should assume high priority in our therapeutic regimen.

Adult↗
PubMed1988

Pelvic irradiation for stage II ovarian carcinoma.

Over a 20-year period, 34 patients with FIGO stage II ovarian carcinoma were treated with postoperative pelvic irradiation at the University of Michigan. Complications of radiation treatment were minimal. The overall actuarial disease-free 5-year survival was 53%. This was not significantly different for substages IIA, IIB, or IIC. Patients with well-differentiated tumors had a significantly better survival than patients with moderate or poorly differentiated tumors (P less than 0.05). The implications for managing stage II ovarian carcinoma are discussed.

Abdomen↗