Search PubMed⌕ Search

Biomedical subjects

J A Jordan

Publications and source records attributed to J A Jordan.

At least 73 records · Page 4Linked to original sources
PubMed1990

Invasive cervical cancer after laser vaporization for cervical intraepithelial neoplasia: a 10-year experience.

The treatment of cervical intraepithelial neoplasia by laser vaporization has been in progress at the Birmingham and Midland Hospital for Women since September 1977. In this interval, 3182 patients have been treated. Seven women have developed invasive cancer at intervals 4-34 months postlaser. The lesions diagnosed were stage Ia (3), Ib (1), IIb (1), IIIa (1), and IV (1). These case histories are presented. On retrospective assessment, there were contraindications to local destructive treatment in six of seven cases. This series emphasizes the need for thorough evaluation of patients before embarking on local destructive treatments and emphasizes the need for careful follow-up of treated patients.

Adult↗
PubMed1990

Carbon dioxide laser treatment for vulval papillomatosis (vulvodynia).

Genital papillomatosis accompanied by distressing vulval symptoms is often termed vulvodynia. Common presenting symptoms are vulvar burning, pruritus and dyspareunia. Sixteen patients with vulval papillomatosis (vulvodynia) have been treated by carbon dioxide laser therapy over a 4-year period. Initial responses at 6 weeks appeared encouraging but with follow-up it became apparent that the relapse rate was high, with a mean symptom-free interval of 4.6 months. Of the 16 patients treated, only three remain symptom free. In view of our findings, we recommend that laser therapy should not be offered as a primary procedure, if at all, for patients with vulval papillomatosis.

Adult↗
PubMed1989

Colposcopy services in the West Midlands region.

A survey of all 72 consultant gynaecologists in the West Midlands region was carried out to determine their views on colposcopy services. All districts provided a colposcopy service and 47 consultants practised colposcopy. The consultants differed considerably in their views on criteria for referring women for investigation after smears. All but one thought that a positive smear result was an indication for immediate referral but whereas 55 thought that women with one or more inflammatory smear should be referred, 17 did not believe this to be necessary. Sixty seven consultants thought a preoperative colposcopic assessment desirable, but 10 had to ration referrals because of limited resources. Four forms of treatment were used: 17 districts had a carbon dioxide laser, eight used low voltage diathermy loop excision, two had only a cold coagulator, and one used only cold cautery. There was widespread dissatisfaction with resources and about the increasing amount of time spent on the service at the expense of other work. Consultants were also concerned about the relevance of much of what was done to the aim of the screening programme--reducing mortality from cervical cancer. Although additional resources are needed in some districts, referral policies, indications for colposcopic assessment, training, choice of treatment, and the value of follow up need to be reviewed if the service is to be improved.

Adult↗
PubMed1989

The L protein of a VSV mutant isolated from a persistent infection is responsible for viral interference and dominance over the wild-type.

The dominance of a mutant isolated from a persistent infection (VSV-Pi) over wild-type vesicular stomatitis virus (wt-VSV) in mixed infections was described previously (J. A. Jordan and J. S. Youngner, 1987, Virology, 158, 407-413). In an attempt to identify the VSV-Pi gene product responsible for transcriptional interference, various combinations of purified VSV-Pi and wt-VSV transcribing core proteins were analyzed in an in vitro transcription assay and compared to homologous wild-type controls. The reconstitution studies revealed that the VSV-Pi RNA dependent-RNA polymerase (L protein) has a dominant activity which works in trans to inhibit wt-VSV transcription.

Animals↗
PubMed1989

Division of uterine adhesions (Asherman's syndrome) with the Nd-YAG laser.

Two women with Asherman's syndrome after postpartum curettage are presented. The diagnosis was confirmed by hysteroscopy. The adhesions were vaporized under hysteroscopic control, using a Nd-YAG laser (neodymium-yttrium-aluminium-garnet laser). The method was precise, caused minimal thermal injury and resulted in immediate return of regular menstrual cycles. The use of the Nd-YAG laser for Asherman's syndrome warrants further study.

Adolescent↗
PubMed1989

Vulval intraepithelial neoplasia--management and outcome.

Forty-six patients with a primary diagnosis of vulval intraepithelial neoplasia (VIN) have been managed over a 10-year period. The prevalence of VIN has increased and the age at presentation has decreased over the last decade; 59% of our patients had histological evidence of human papillomavirus infection. Pruritus was the commonest symptom at presentation (59%). Of the 46 patients 44 were treated by laser skinning vulvectomy, local excision or simple vulvectomy. Symptomatic relief was best achieved by local excision. Clinical and definitive relapse occurred more often in the laser-treated group. The median time to relapse was 38 months in the laser-treated group and 74 months in the surgically treated group (excision and simple vulvectomy). Two patients have not been treated and their disease has not progressed. The carbon dioxide laser almost certainly has a role in conservative management and although our data possibly do not reflect its full potential they demonstrate a need for a controlled prospective study.

Adolescent↗
PubMed1988

Radiotherapy in the management of vaginal intraepithelial neoplasia after hysterectomy.

Intravaginal radium was used to treat 11 patients who were found to have vaginal intraepithelial neoplasia (VAIN) following hysterectomy for cervical intraepithelial neoplasia. All were discovered by cytological follow-up, were colposcopically assessed and diagnosis was confirmed by histological examination before treatment. Nine of 10 patients questioned continue to enjoy satisfactory sexual intercourse after treatment but 6 of 8 premenopausal patients subsequently became oestrogen deficient and required hormone replacement therapy. No other significant morbidity has been observed. All remain cytologically and colposcopically free of disease after a median follow-up of 26 months. We conclude that radiotherapy is an effective treatment of VAIN following hysterectomy.

Adult↗
PubMed1987

Dominance of temperature-sensitive phenotypes. II. Vesicular stomatitis virus mutants from a persistent infection interfere with shut-off of host protein synthesis by wild-type virus.

The dominance of a mutant (VSV-PI) isolated from a long-term persistent infection over wild-type vesicular stomatitis virus (wt-VSV) is reported. This dominance has some important differences from and similarities to the dominance of conventional ts mutants studied previously (J. S. Youngner, D. W. Frielle, and P. Whitaker-Dowling, 1986, Virology 155, 225-235). Unlike the ts mutants representing complementation groups I and IV, coinfection with VSV-PI does not reduce the yield of infectious wt-VSV at either the permissive (37 degrees) or nonpermissive (39.5 degrees) temperatures. However, in double infections with wt-VSV and VSV-PI at 37 degrees, viral RNA synthesis patterns were converted to those of the RNA synthesis phenotype of VSV-PI: reduced mRNA transcription and enhanced replication of genomic RNA. In addition, VSV-PI which shuts off host protein synthesis very inefficiently was able to interfere in double infections with the ability of wt-VSV to rapidly shut off host protein synthesis. This finding suggests that the mutant virus is not just missing the factor(s) responsible for the inhibition of host protein synthesis but has a dominant activity which works in trans to interfere with the shut-off function of wt-VSV. Ultraviolet irradiation of VSV-PI was used to determine the target size of the interference function. The calculated value for the uv target size is equal to that of the viral genome. This suggests that either viral replication or the expression of the last gene on the viral genome (encoding the L protein) is required for interference by VSV-PI with the shut-off of host cell protein synthesis by wt-VSV.

Animals↗
PubMed1987

A retrospective review of adenocarcinoma-in-situ and glandular atypia of the uterine cervix.

Between 1978 and 1985, 19 cases of adenocarcinoma-in-situ and 12 cases of glandular atypia have been identified at the Birmingham and Midland Hospital for Women. In 19 cases an associated dysplastic squamous element was identified, 20 of 28 pre-diagnosis smears correctly predicted a glandular lesion, 5 of 17 colposcopically directed biopsies predicted the findings in a larger biopsy (cone biopsy or hysterectomy). Colposcopy provided no additional information with regard to diagnosis. Twelve of 13 patients managed by cone biopsy and 16 of 17 by abdominal hysterectomy have been treated successfully as defined by subsequent normal cytology.

Adenocarcinoma↗
PubMed1987

Negative cone biopsies after colposcopy and their prediction.

A retrospective study of 899 cone biopsies revealed significantly more cones containing no dysplastic epithelium in patients who had a prior colposcopic assessment compared with those who had not been so assessed. A case-control study of 48 'negative' cones, 47 cones containing intraepithelial neoplasia (CIN), 44 microcarcinoma containing cones and 27 occult Ib containing cones has allowed five variables to be identified which can predict the presence of dysplastic or neoplastic tissue in the cone specimen. These variables include a colposcopic suspicion of invasion; a positive or worse pre-cone smear; two severely dyskaryotic smears within a 12-month observation period, previous abnormal histology and previous treatment for CIN. Using these criteria, 44% of 'negative' cones could be avoided without overlooking any cases of microcarcinoma or occult carcinoma.

Adult↗
PubMed1987

Residual disease after cone biopsy: completeness of excision and follow-up cytology as predictive factors.

Residual disease was identified in the hysterectomy specimen in 19 of 65 patients (29%) previously found to have cervical intraepithelial neoplasia and in four of 19 (21%) found to have early stromal invasion on histologic examination of a cone biopsy. Residual disease was found in six of 34 cases (18%) of cervical intraepithelial neoplasia and zero of 12 cases of early stromal invasion after complete excision, and in 13 of 31 cases (42%) of cervical intraepithelial neoplasia and four of seven cases (57%) of early stromal invasion after incomplete excision by cone biopsy. Sixteen of 28 women (57%) with abnormal cytology after cone biopsy were found to have residual disease at the time of hysterectomy. In contrast, no residual disease was found in 35 patients who had no evidence of cytologic abnormality after the initial treatment. The finding of abnormal cytology after cone biopsy is shown to be a more useful prognostic indicator than histologic examination of excision margins. Therefore, we believe that a policy of expectant management, based on regular cytologic examination, is justified when histologic assessment has shown the lesion to extend to the line of excision.

Biopsy↗
PubMed1986

Management of postconization cervical stenosis by laser vaporization.

In 18 patients with symptomatic cervical stenosis after conization, laser vaporization of the stenotic segment was performed. Total relief of symptoms was achieved in 12 patients and partial relief in four. In seven cases there was no evidence of stenosis at follow-up, and in a further nine cases the degree of stenosis was less. In seven cases it was possible to visualize the squamocolumnar junction at follow-up. This had not been possible in any cases before the procedure. Vaporization using the carbon dioxide laser provides a useful conservative management technique for postconization stenosis.

Adult↗