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Biomedical subjects

G W Morley

Publications and source records attributed to G W Morley.

At least 55 records · Page 3Linked to original sources
PubMed1988

Stage IB carcinoma of the cervix with lymph node metastases.

From January 1, 1946, through January 1, 1986, at the University of Michigan, 60 patients were treated with Stage IB (FIGO) carcinoma of the cervix with lymph node metastases. Clinical variables were examined with regard to long-term survival. Prognostically significant variables were (1) highest level of lymph node involvement and (2) tumor histology. Patients with common iliac or periaortic node involvement had an actuarial survival at 5 years of 14%; 5-year survival for patients with only pelvic node involvement (external iliac, hypogastric, or obturator) was 68%. Patients with adenocarcinoma or adenosquamous histology had an actuarial survival at 5 years of 16%; 5-year survival for patient with squamous cell carcinoma was 71%. Overall survival for all patients with lymph node involvement was 61%. For patients undergoing radical hysterectomy as primary treatment, postoperative adjuvant radiotherapy did not significantly improve survival.

Actuarial Analysis↗
PubMed1988

Vaginal reconstruction in gynecologic oncology.

The improved prognosis for patients with gynecologic malignancies has resulted in an increased concern for their sexual function. Vaginal reconstruction plays an integral role in this rehabilitation. The care of these patients at the University of Michigan is reviewed and their treatment is described. Fifty-one patients were treated with split-thickness skin graft vaginoplasty. Seven repeat vaginoplasties were required, for a total of 58 procedures. Fifty patients were assessed postoperatively, and 47 (94%) ultimately had a satisfactory outcome. Three of the 50 patients had an unsatisfactory final outcome; two had recurrent malignancy and the third patient did not comply with the proposed dilator regimen. Four patients developed fistulas. The split-thickness skin graft provides an acceptable outcome when used for vaginal reconstruction in the patient with a gynecologic malignancy.

Adolescent↗
PubMed1988

The prognosis and treatment of stage I adenocarcinoma of the cervix.

A review of 125 patients with stage I adenocarcinoma of the cervix is reported. The subtypes included endocervical (60), adenosquamous (38), papillary (15), clear cell (nine), and mucoid (three). The cumulative 5-year survival was 60%, and was significantly related to the following: tumor differentiation--well-differentiated 80%, moderately differentiated 69%, poorly differentiated 41%; lymph node status--nodes positive 28%, nodes negative 82%; the amount of residual disease present in the cervix after radical hysterectomy; and the interval from the previous pelvic examination. Survival was not significantly influenced by histologic subtype, patient age, number of positive lymph nodes, or tumor size beyond 3 cm. Treatment included radical hysterectomy with or without bilateral salpingo-oophorectomy, radiation therapy, radiation therapy with hysterectomy, and hysterectomy followed by radiation therapy. The best cumulative 5-year survival (93%) was found in patients treated by radical hysterectomy without bilateral salpingo-oophorectomy, whereas the poorest survival (18%) was in those treated by standard hysterectomy followed by radiation therapy. Ovarian conservation seems to be an acceptable alternative to bilateral salpingo-oophorectomy in the young patient undergoing radical hysterectomy.

Adenocarcinoma↗
PubMed1988

Gland cell carcinoma (adenocarcinoma) of the cervix.

A review of 203 patients with adenocarcinoma of the cervix treated at the University of Michigan Medical Center from 1970-1985 is reported. The following subtypes were identified: endocervical, 94 (46%); adenosquamous, 67 (33%); papillary, 21 (11%); clear cell, 16 (8%); and mucoid, five (4%). The distribution by stage of disease included stage I, 125 (62%); stage II, 40 (20%); stage III, 25 (12%); and stage IV, 13 (6%). One patient was lost to follow-up. Overall, 107 patients (53%) died from disease. The cumulative 5-year survival rate varied significantly according to the following: stage of disease--stage I 60%, stage II 47%, stage III 8%, stage IV 0%; tumor grade--well-differentiated 75%, moderately differentiated 57%, poorly differentiated 29%; lymph node status--negative nodes 79%, positive nodes 12%; patient age--less than 40 years 65%, 40-60 years 46%, over 60 years 30%; and interval from previous pelvic examination--within 1 year 65%, 1-3 years 41%, beyond 3 years 36%. The histologic subtype did not significantly influence survival. Treatment strategies should be directed at high-risk groups as defined by the stage of disease, tumor differentiation, and lymph node status.

Adenocarcinoma↗
PubMed1988

Prognostic features of carcinoma of the fallopian tube.

One hundred fifteen women with carcinoma of the fallopian tube were examined in this retrospective review. A third of the patients were nulliparous and 37% had evidence of old pelvic inflammatory disease. The most common symptoms were bleeding, pain, and/or vaginal discharge. Prognostic factors that predicted death from tumor were the presence of extratubal disease at initial surgery and the bulk of residual tumor left after the initial surgery. With disease limited to the fallopian tube, the depth of invasion of the tubal wall was correlated with the risk of treatment failure. Among patients with disease limited to their fallopian tubes, there was no statistically significant improvement in survival with the addition of either pelvic irradiation or single-agent chemotherapy. Among women with extrapelvic disease, survival improved significantly with the use of cis-platinum-containing multiagent chemotherapy.

Adult↗
PubMed1987

Surgical incision for cesarean section.

Ninety-seven women undergoing cesarean section were delivered through a muscle-cutting Maylard or a Pfannenstiel abdominal incision. In these two similar groups of women, the mean Maylard incision length was significantly greater (18.3 +/- 4.5 cm) than that of the Pfannenstiel incision (14.0 +/- 2.1 cm), with no difference in operative morbidity. Difficulty with infant delivery was significantly less frequent with both the Maylard and Pfannenstiel when the incision was at least 15 cm in length. These results suggest that cesarean delivery is performed optimally with an adequate surgical incision, and that the Maylard incision is a safe option which should be strongly considered when risk factors (eg, macrosomia, twins) demand maximal surgical exposure for nontraumatic abdominal delivery.

Abdominal Muscles↗
PubMed1987

Outpatient management of small bowel obstruction in terminal ovarian cancer.

A technique for home gastric decompression and hydration was developed for use in patients with terminal ovarian cancer and bowel obstruction. In three of four patients undergoing a standard gastrostomy the results were unsatisfactory, requiring reintubation. The two most recent patients on whom the technique was used were able to leave the hospital within two weeks despite their bowel obstruction.

Ambulatory Care↗
PubMed1987

Role of needle biopsy in the investigation of gynecologic malignancy.

Three methods were used to investigate and evaluate patients with primary and persistent/recurrent pelvic malignancy in the gynecologic oncology services at two medical centers. The 22-gauge Chiba needle was utilized with fluoroscopic guidance to perform fine needle aspiration (FNA) of pelvic and paraaortic lymph nodes that appeared abnormal on lymphangiography (LAG). The Tru-cut needle was used to obtain tissue samples from beneath the surface epithelium of the cervix, vaginal vault and parametrium. A disposable, hand-held syringe and 20-gauge needle were used to aspirate supraclavicular and inguinal lymph nodes and cul-de-sac nodules. One hundred thirty-eight patients were evaluated, with positive results in 66 (47.8%). Surgical exploration was used to further investigate 16 negative results that did not correlate with LAG and/or clinical presentation. The sensitivity and predictive value of a negative result for the three methods was Chiba needle FNA/LAG, 62.1% and 65.6%; Tru-cut needle biopsy, 94.4% and 93.5%; and hand-held syringe and needle, 87.5% and 66.7%, respectively. All three techniques proved to be safe, uncomplicated and rapid methods of assessing gynecologic tumor spread. Positive results from these techniques can often replace surgical exploration, with a considerable savings in patient morbidity and hospitalization, and permit additional treatment to proceed without delay. Negative results still require surgical validation.

Biopsy, Needle↗
PubMed1987

Claudication as a rare symptom of recurrent cervical carcinoma.

Diagnosis of recurrent cervical cancer can be very difficult in the heavily irradiated pelvis. Sciatica and lymphedema are well-known symptoms of disease recurrent to the side wall. The isolated symptom of claudication is reported as an early sign of recurrence. Two patients are presented in whom claudication was the only early presenting symptom. This symptom in a patient with a history of a gynecologic malignancy should lead to an evaluation for recurrent cancer as well as the routine vascular studies.

Adenocarcinoma↗
PubMed1987

Simultaneous measurement of DNA content and detection of surface antigens of cervicovaginal cells by flow cytometry.

A method is described by which the measurement of the DNA content and the light scatter and the detection of a cervical carcinoma-associated antigen (CCA) of squamous epithelial cells can be simultaneously accomplished by flow cytometry (FCM). Cervicovaginal cellular samples obtained from 30 patients were analyzed by this method. Cell populations with an abnormal DNA content or with the presence of CCA were detected in 20 samples, 18 of which contained dysplastic cells as detected by routine cytologic screening. The remaining ten cases, which were interpreted as cytologically normal by routine screening, were also interpreted as normal by FCM analysis.

Antigens, Neoplasm↗
PubMed1987

Radical hysterectomy as surgical salvage therapy for gynecologic malignancy.

Fourteen patients with recurrent or second primary gynecologic malignancies after pelvic irradiation underwent radical hysterectomy as surgical salvage therapy. Six patients had microscopic regional metastatic disease at the time of surgery. All of these patients died of recurrent tumor. Overall disease-free actuarial survival at five years was 27%; excluding patients with regional metastatic disease, five-year survival was 54%. Complications requiring subsequent major surgical intervention occurred in 29% of patients. There appears to be a limited role for radical hysterectomy as surgical salvage therapy in patients with centrally limited invasive disease after pelvic irradiation.

Adult↗
PubMed1987

An assessment of pathologic features and treatment modalities in ovarian tumors of low malignant potential.

Sixty-eight patients with epithelial ovarian tumors of low malignant potential treated at the University of Michigan Medical Center were reviewed for clinical and pathologic features related to recurrence or death. The ovarian tumor of low malignant potential represented 12.6% of all ovarian cancers and 22% of all serous or mucinous tumors. Thirty-four patients were stage I (50%), 13 were stage II (19%), 17 were stage III (25%), two patients could not be staged, and two patients developed ovarian tumor of low malignant potential in a residual ovary. The risk of recurrence was significantly related to stage III disease (P = .023), high nuclear atypia (P = .020), and high grade (P = .017); and was unrelated to capsular status, the presence of psammoma bodies, nucleoli, cribriform pattern, stratification, cystadenofibroma, tumor size, or spillage at surgery. Therapy in all stages included observation, chemotherapy, or radiotherapy. There was one recurrence in 47 patients with stages I-II, and 11 recurrences in 17 patients with stage III disease. The ovarian tumor of low malignant potential carries an extremely favorable prognosis in stage I and II regardless of therapy. Radiotherapy appeared to extend disease-free survival in stage III disease, and future randomized studies should consider this treatment modality.

Adult↗
PubMed1987

Squamous cell carcinoma of the neovagina.

Congenital absence of the vagina is very rare, with one method of treatment being the split-thickness skin graft vaginoplasty. This is the ninth reported instance of carcinoma arising in the neovagina and is apparently related to the type of tissue transplanted. The optimal therapy for this malignancy remains to be defined. A review of previously reported patients plus this patient suggests that reliance on radiotherapy as the primary means of treatment may result in a high percentage of failures.

Adolescent↗
PubMed1986

Prognostic features of vulvar melanoma: a clinicopathologic analysis.

We studied 19 cases of vulvar melanoma to determine significant clinical and histologic prognostic predictors. The average follow-up time was 32 months. Fourteen patients died of melanoma, four patients are alive with no evidence of melanoma, and one patient is alive with residual melanoma. All disease-free survivors had clinical stage I disease and a maximum tumor thickness of 1.3 mm. The average mitotic count in this group was 5.5 per 10 high power fields (HPF) and 50% of the tumors were superficial spreading melanomas. All survivors were treated by radical vulvectomy with bilateral inguinal lymph node dissection. Of the nonsurvivors, four (28.5%) were clinical stage I, five (36%) were clinical stage II, four (28.5%) were clinical stage III, and one (7%) was clinical stage IV. The average tumor thickness for nonsurvivors was 9.5 mm (range 2.6-18 mm) and the average mitotic count was 13.3/10 HPF. Only three (21%) tumors from nonsurvivors were superficial spreading melanomas; the majority were nodular melanomas. The statistically significant prognostic predictors were clinical stage of disease and tumor thickness. Tumor type (i.e., superficial spreading, nodular, or acral lentiginous) correlated with tumor thickness and was indirectly related to prognosis. The mitotic count was also a useful prognostic feature.

Adult↗
PubMed1985

Microinvasive carcinoma of the vagina: a distinct clinical entity?

Six patients with superficially invasive squamous carcinoma of the vagina are described. All had less than 2.5 mm of invasion as measured from the surface, lacked involvement of the lymph-vascular spaces, and arose within a field of carcinoma in situ. Three of the six had previously been treated for carcinoma of the cervix. The patients with microinvasive carcinoma had a median age 10 years younger than that of patients with Stage I carcinoma of the vagina. Treatment of the six patients has been by partial or total vaginectomy. With follow-up of 51 to 172 months, there have been no recurrences. More experience is needed to define microinvasive squamous carcinoma of the vagina and to determine the optimal treatment for these lesions.

Adult↗
PubMed1985

Carcinoma of the vagina. Factors influencing treatment outcome.

A 33-year review from the University of Michigan Medical Center of 86 cases of primary carcinoma of the vagina included 68 squamous carcinomas, 13 adenocarcinomas, and 5 small cell carcinomas. There was a 26% incidence of prior cervical carcinoma and a 21% incidence of prior pelvic radiation therapy. The median interval between the diagnosis of invasive cervical and vaginal carcinoma was 20 years. Survival was strongly correlated with stage. There was no association between survival and involvement of a particular vaginal segment or the amount of vaginal surface area involved with tumor. Irradiation was the most frequently employed primary therapy for vaginal carcinoma. Local control was correlated with the mid-tumor irradiation dose, with predictable control obtained only with doses above 7500 rad. The use of interstitial therapy should facilitate local control without increasing the complication rate.

Adenocarcinoma↗
PubMed1985

Primary sarcoma of the adult vagina: a clinicopathologic study.

Combination chemotherapy has dramatically improved the results of treatment for embryonal rhabdomyosarcoma of the vagina in children, but little attention has been directed toward vaginal sarcomas in adults. This report of 17 cases of primary sarcoma of the adult vagina includes ten leiomyosarcomas, four mixed mesodermal tumors, one undifferentiated sarcoma, one stromal sarcoma, and one neurofibrosarcoma. The leiomyosarcomas, mixed mesodermal tumors, and the stromal sarcoma were morphologically similar to their uterine counterparts. Thirty-five percent of the patients had received pelvic irradiation for carcinoma of the cervix. Three of four patients treated by pelvic exenteration are alive and disease free after 84 to 161 months of observation. All 13 patients who received other forms of primary therapy died of recurrence. The pelvis was the first site of recurrence in all treatment failures and the only site of failure in 50%.

Adenocarcinoma↗