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Biomedical subjects

J H Shepherd

Publications and source records attributed to J H Shepherd.

At least 127 records · Page 7Linked to original sources
PubMed1986

Surgical procedures for ovarian cancer.

The management of 191 patients with ovarian cancer is presented. A significant proportion of these patients were initially seen (16%) or operated on (7%) by a general surgeon. The current surgical approach to this disease should be aggressive, and in 23% of these patients a non-gynaecological surgical procedure was required. Although chemotherapy is the main form of treatment following surgery, its chances of success are influenced by the amount of tumour left after surgery. The picture is not uniformly hopeless, and of 34 patients who subsequently underwent laparotomy to check the effectiveness of chemotherapy, 10 (29%) had no evidence of disease. Palliative surgery also has an important place in the management of this disease to provide comfort from disabling symptoms, and in some cases it may prolong life.

Adolescent↗
PubMed1985

Cisplatin combination chemotherapy versus chlorambucil in advanced ovarian carcinoma: mature results of a randomized trial.

A randomized study to compare the efficacy of combination chemotherapy (cisplatin, doxorubicin, cyclophosphamide: PACe) with chlorambucil (CB) in International Federation of Gynecology and Obstetrics (FIGO) stage III and IV ovarian carcinoma was conducted between May 1979 and October 1983. Patients failing initial CB were subsequently eligible for treatment with PACe. Eighty-nine patients were randomized and 85 were eligible for analysis; as of date, 72 of these patients have died. The majority of patients in this study had bulky residual disease after their initial laparotomy (76%). Complete response (CR) was documented by a second laparotomy after five cycles of combination therapy or 6 to 12 months alkylating agent therapy. The overall response rate (CR plus partial response [PR]) for the combination (PACe, 68%) was significantly higher (P = .0004) than that for the chlorambucil (CB, 26%). However, the median survival was not improved (PACe, 13 months; CB, 11 months) and the survival curves were not significantly different (log rank test P = .25). The results of this study are comparable to preliminary data reported from other similar randomized studies. PACe, as administered in this study, is not indicated as routine therapy in patients with bulky residual ovarian carcinoma.

Actuarial Analysis↗
PubMed1983

Abdominal wound closure using a nonabsorbable single-layer technique.

A continuous 1-layer abdominal closure using number 2 polypropylene was employed in 200 unselected consecutive patients. All the patients had lower midline incisions and were high-risk, and the majority (82%) had some form of gynecologic malignancy. A significant number had received preoperative radiotherapy (22.5%), another 18% were obese (over 90 kg), and 15% had undergone bowel surgery. The complete evisceration rate in the series was 0. A total of 17 (8.5%) wound infections occurred and 10 (5%) postoperative ventral hernias were seen over a 2-year period. Five of these were incisional and 5 were paraincisional; 1 of each required surgical repair. The method is simple, time-saving, and successful; it carries a low complication rate for patients at high risk for postoperative evisceration.

Abdomen↗
PubMed1982

Septic shock and the obstetrician/gynecologist.

Septic shock continues to be a serious problem with a mortality ranging from 11% to 82%, depending upon the cause, the time of diagnosis, and the type of treatment. The condition is seen in pregnant patients with postabortal or postpartal endometritis, chorioamnionitis, and pyelonephritis. In gynecology patients it is seen after severe pelvic infection and in immunosuppressed patients with gynecologic cancer. Prompt diagnosis, adequate monitoring and vigorous treatment are essential if deaths are to be reduced. Over the period July 1, 1959, to June 30, 1981, 91 patients were treated for septic shock with a mortality of 18%. Although medical treatment is important, the most important aspect of treatment for most patients is removal of the septic focus.

Abortion, Septic↗
PubMed1981

Steroid hormone regulation of ovalbumin and conalbumin gene transcription. A model based upon multiple regulatory sites and intermediary proteins.

Changes in rates of ovalbumin and conalbumin gene transcription and mRNA levels were monitored during an entire cycle of estrogen withdrawal and restimulation. Correlations of transcription rates with nuclear estrogen receptor levels in this experiment and in dose-response experiments reveal that conalbumin gene transcription is directly proportional to nuclear receptor levels, whereas ovalbumin gene transcription is related to receptor levels in a way that suggests cooperative interactions among receptors. Conalbumin mRNA accumulation and transcription are transiently inhibited by administration of progesterone to estrogen-stimulated chicks, whereas ovalbumin gene transcription is stimulated by this regimen. This puzzling observation can be rationalized if a single receptor binding site is involved in conalbumin gene regulation and multiple sites are involved in ovalbumin gene regulation. These ideas are combined with our recent observations that protein synthesis inhibitors and butyrate selectively, but reversibly, inhibit ovalbumin and conalbumin gene transcription. We describe a new hypothesis of how steroid hormones regulate egg white gene transcription in the chick oviduct.

Animals↗
PubMed1981

Prostaglandin vaginal suppositories: a simple and safe approach to the induction of labor.

The results of 1000 consecutive unselected cases of induction of labor for medical or obstetric reasons using prostaglandin E2 suppositories are presented. The overall rate of failed induction resulting in a cesarean section in those patients with an unfavorable cervix has fallen from 42 to 2.5%. Only 27% of the entire series required augmentation of labor with intravenous oxytocin, the range being from 9.9% of multigravidas with a favorable cervix to 42.4% of primigravidas with an unfavorable cervix. Both low- and high-risk pregnancies are suitable for induction by this method and trials of vaginal breech delivery and of uterine scars have been safely and successfully carried out. This method has now become routine for the induction of labor at the authors' institution. It has proved to be simple, safe, and highly acceptable to patients and obstetricians alike in all cases in which a simple amniotomy would not suffice.

Delivery, Obstetric↗
PubMed1980

Commitment of chick oviduct tubular gland cells to produce ovalbumin mRNA during hormonal withdrawal and restimulation.

Acute withdrawal of estrogen from chicks leads to a precipitous decline in egg white protein synthesis and egg white mRNAs in the oviduct. In this paper we explore the biochemical basis of this phenomenon as well as the capacity of the "withdrawn" tubular gland cells to be restimulated with steroid hormones. During withdrawal, the decline in ovalbumin mRNA was closely correlated with the decline in nuclear estrogen receptors. Within 2-3 d of estrogen removal a withdrawn state was established and then maintained, as defined by a 1,000-fold-lower level of ovalbumin mRNA and a 20-fold-lower level of nuclear estrogen receptors, relative to the estrogen-stimulated state. The number of active forms I and II RNA polymerases declined by 50% during this time. Histological examination of oviduct sections and cell suspensions, combined with measurements of DNA content, revealed that tubular gland cells persisted as a constant proportion of the cell population for 3 d after estrogen removal. Despite a 1,000-fold decrease in the content of ovalbumin mRNA, the ovalbumin gene remained preferentially sensitive to digestion by DNase I. When 3-d-withdrawn oviducts were restimulated with either estrogen or progesterone, in situ hybridization revealed that greater than or equal to 98% of the tubular gland cells contained ovalbumin mRNA. Induction by a suboptimal concentration of estrogen was correlated with a lower concentration of ovalbumin mRNA in all cells rather than fewer responsive cells.

Animals↗