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Biomedical subjects

H W Jones

Publications and source records attributed to H W Jones.

At least 73 records · Page 4Linked to original sources
PubMed1995

Transrectal and transperineal sonography during guided intrauterine procedures.

Transrectal sonography was used to provide intraoperative guidance for dilatation and curettage and placement of intrauterine tandem apparatus in 20 patients in whom the external cervical os could not be visualized adequately. Transrectal sonography was found to be useful in providing guidance for these procedures and at the same time helped avoid uterine perforation. This method also was used during cerclage placement in two patients who had undergone several conizations. Transperineal sonography was used in three patients whose area of abnormality was best approached transperineally. These cases included transvaginal biopsy of a metastatic trophoblastic tumor and one guided aspiration of a perirectal abscess after pelvic exenteration. The potential advantages and pitfalls in the intraoperative use of transrectal and transperineal sonography for guided intrauterine procedures are discussed and illustrated.

Abscess↗
PubMed1994

Prognostic significance of ureteral obstruction in primary cervical cancer.

OBJECTIVES: To evaluate the prognostic significance of ureteral obstruction in women with cervical cancer and the result of aggressive urinary diversion. METHODS: The clinical history and X-rays of 52 women with Stage III and IV cervical cancer seen at Vanderbilt University between 1981 and 1991 were retrospectively reviewed. RESULTS: Twenty-nine (55.8%) of these patients had unilateral [15] or bilateral [14] ureteral obstruction. There was no statistically significant difference in the survival of patients whether or not ureteral obstruction was present. Ten of fourteen women with bilateral ureteral obstruction and 4 of the 15 patients with unilateral obstruction underwent urinary diversion by percutaneous nephrostomy [9] or retrograde ureteral catheterization [5]. Complications were few. Although patients who underwent urinary diversion had somewhat better survival, it was not statistically significant. CONCLUSIONS: Some patients with ureteral obstruction due to advanced cervical cancer can be salvaged by prompt, aggressive urinary diversion, but large trials are needed to validate this approach.

Adult↗
PubMed1994

Reconstruction of the external genitalia in females with bladder exstrophy.

OBJECTIVES: A very characteristic genital anomaly accompanies bladder exstrophy in females. This includes anterior displacement and narrowing of the vagina and separation of the clitoris into two distinct bodies. The authors have had a relatively large experience with correction of this rare genital anomaly. From this experience, it began to appear that certain procedural details were associated with improved outcomes. The objective of this article was to review this experience and detail the reconstruction of the external genitalia in these patients. METHODS: All cases of bladder exstrophy in females presenting from January 1, 1970 to December 31, 1992 were reviewed. A total of eight patients who underwent surgical correction of the external genitalia were included. Data was obtained regarding urologic treatment, associated anomalies, corrective gynecologic procedures, complications and subsequent course. RESULTS: Corrective gynecologic surgery included enlargement of the vaginal orifice in all eight patients. Five patients had reapproximation of the bifid clitoris. Three patients performed postoperative dilatation therapy. Postoperatively, one patient experienced dyspareunia requiring a repeat procedure to enlarge the vaginal orifice. No patient had complications related to pelvic organ prolapse. CONCLUSIONS: Care should be taken not to extend the perineal incision too far posteriorly in reconstruction of the external genitalia in females with bladder exstrophy. Failure to do so may further predispose the patient to uterine prolapse. Post-operative dilator therapy may be an important adjunctive technique.

Adolescent↗
PubMed1994

Fertilization and in vitro development of cryopreserved human prophase I oocytes.

OBJECTIVE: To determine the potential for in vitro maturation, fertilization, and cleavage after cryopreservation of immature, prophase I human oocytes. DESIGN: Immature oocytes obtained in excess of the number required by the patient were randomized and cryopreserved at the prophase I stage or cultured as control. After thawing and maturation in vitro, test and control oocytes were inseminated with husband's sperm and evaluated for fertilization and cleavage in vitro. SETTING: In vitro fertilization program. PATIENTS: Consenting patients undergoing controlled ovarian hyperstimulation for the purposes of IVF. MAIN OUTCOME MEASURES: Rates of maturation to metaphase II, fertilization, and cleavage were compared between control and cryopreserved oocytes. RESULTS: Upon thaw, 58.5% (72/123) of prophase I oocytes were viable. Control oocytes demonstrated a 74.8% (98/131) maturation rate to metaphase II, a 56.5% (52/92) fertilization rate, and an 11.5% (6/52) blastocyst rate. Cryopreserved oocytes showed a 83.3% (60/72) rate of maturation, a 57.7% (30/52) fertilization rate, and a 3.3% (1/30) blastocyst rate. No significant differences were noted between any of these parameters. CONCLUSIONS: These results demonstrate that prophase I oocytes from stimulated IVF cycles are able to survive cryopreservation and resume meiosis to achieve full nuclear maturation post-thaw. In addition, cryopreserved oocytes retain the same capacity for fertilization and development as control oocytes.

Adult↗
PubMed1994

Assisted hatching in the treatment of poor prognosis in vitro fertilization candidates.

OBJECTIVE: To access the effect of augmenting IVF with assisted hatching in the treatment of poor-prognosis patients. DESIGN: Thirty-three poor-prognosis IVF patients were treated with assisted hatching and were compared with 43 control subjects without assisted hatching. SETTING: Center for Reproductive Medicine, Swedish Medical Center, Englewood, Colorado. PARTICIPANTS: Seventy-six women undergoing IVF with a poor prognosis for pregnancy. Poor prognosis was defined as Elevated day 3 FSH level; age > or = 39 years; and multiple prior IVF failures. MAIN OUTCOME MEASURES: Pregnancy and implantation rates per embryo. RESULTS: The incidence of ongoing pregnancy in the assisted hatching group was 64% compared with 19% in the control group. Implantation rate per embryo transferred was 33% in the assisted hatching group versus 6.5% in the control group. CONCLUSIONS: These results demonstrate that assisted hatching, when applied to poor-prognosis patients, improves embryonic implantation and pregnancy rates.

Adult↗
PubMed1994

Selenium deficiency, reversible cardiomyopathy and short-term intravenous feeding.

We report the case of a patient with Crohn's disease receiving short-term postoperative parenteral nutrition supplemented with trace elements who nevertheless became selenium deficient with evidence of a cardiomyopathy. This was fully reversible with oral selenium supplementation. Current parenteral feeding regimes may not contain enough selenium for malnourished patients.

Adult↗
PubMed1993

Advanced ovarian carcinoma diagnosed during pregnancy in a patient with human immunodeficiency virus infection.

Many malignancies appear to occur with increased frequency and aggressive patterns of spread in patients seropositive for human immunodeficiency virus (HIV). The relationship between HIV infection and cervical neoplasia suggests that these patients present with more advanced disease and demonstrate poor response to therapy. To date, there have been no reported cases of ovarian cancer with concomitant HIV infection. We describe a young, gravid woman with an advanced ovarian carcinoma diagnosed at the time of delivery. Following poor response to cytoreductive surgery and initial chemotherapy, she was found to be HIV-seropositive. She received multiple chemotherapeutic regimens and experienced significant complications associated with her treatment and HIV infection. She progressively deteriorated and died within 13 months of diagnosis. Based on these findings and experience with other HIV-associated malignancies, it is apparent that the conventional approach to therapy is inadequate to treat the advanced and more aggressive form of disease seen in women infected with HIV.

Adult↗
PubMed1993

Recent activity in ultrasonic tomography.

During the past two decades there have been significant developments in many aspects of acoustical imaging techniques for various applications. One aspect of this development has been the application of ultrasonic tomography to medical imaging and diagnosis instrumentation, and also to non-destructive evaluation of materials, to oceanographic systems for measurements of such factors as temperature and currents etc, and to seismic exploration. This paper reviews the theoretical and practical work in acoustical tomography to the present time.

Acoustics↗
PubMed1993

Significantly enhanced pregnancy rates per cycle through cryopreservation and thaw of pronuclear stage oocytes.

OBJECTIVE: To examine the results of a 5-year trial using cryopreservation to limit multiple pregnancy and optimize overall pregnancy per cycle. DESIGN: Retrospective clinical evaluation of pregnancy rates (PRs) per cycle after freezing pronuclear stage human oocytes. SETTING: Tertiary care academic center. PATIENTS: Six hundred seventeen patients treated in 776 IVF-ET cycles from January 1987 to December 1991 (less oocyte donation cycles). MAIN OUTCOME MEASURE: Pregnancy rate per cycle after transfer of pre-embryos developed from thawed pronuclear stage oocytes. RESULTS: Three thousand seven hundred thirty-one oocytes were frozen. Of these, 2,039 were thawed. One thousand three hundred seventy-seven survived thawing (68%), and 1,370 were transferred after passing through syngamy to at least the first cleavage (68%). Of patients with thawing, 359 of 401 (90%) (449 of 505 cycles [89%]) received intrauterine transfer. One hundred thirty-three separate clinical pregnancies were established from 128 different cycles (128/449; 29%); 5 cycles had two thaws, each of which resulted in pregnancy. This PR is less than the overall fresh PR observed in patients who had excess pronucleate oocytes frozen (279/776; 36%) but is remarkably similar when adjusted for the number of pre-embryos transferred per cycle. The age of the patient at the time of cryopreservation and the number of quality of pre-embryos ultimately available for transfer were important factors in the establishment of pregnancy. The mode of ovarian stimulation and duration of cryostorage did not prove meaningful. CONCLUSIONS: Cryopreserved pronucleate oocytes that survive freezing, thawing, and progress through syngamy demonstrate a similar potential for implantation and pregnancy when compared with fresh conceptuses, the cumulative effect of which is an enhanced total PR per cycle.

Cell Survival↗
PubMed1993

CAPE/PALE salvage chemotherapy for Hodgkin's disease patients relapsing within 1 year of ChlVPP chemotherapy.

BACKGROUND: Patients with advanced Hodgkin's disease failing to achieve complete remission with chemotherapy or developing disease progression within 1 year have a poor prognosis with salvage chemotherapy. PATIENTS AND METHODS: Twenty-five patients fulfilling the above criteria after failing treatment with ChlVPP (chlorambucil, vinblastine, procarbazine and prednisolone) or its variant were treated with a new salvage regimen CAPE/PALE (cyclophosphamide, adriamycin, prednisolone, etoposide and lomustine), given for 6 courses at three weekly intervals. RESULTS: Thirteen of the 25 patients (52%) achieved complete remission. After a minimum follow-up period of 38 months five of these patients remained free from disease progression. This regimen was very well tolerated. CONCLUSIONS: CAPE/PALE produces results comparable to other salvage regimens in Hodgkin's disease. New strategies are however required for this patient group.

Adult↗