Biomedical subjects
Publications and source records attributed to J H Shepherd.
Two patients with bladder extrophy are presented. Both had had corrective surgery in childhood and subsequently presented with recurrent procidentia after a previously unsatisfactory repair operation. Both were treated by hysteroscaropexy (a new procedure) which is described in detail and when reviewed 12 months later were symptom-free with good genital tract support.
A prospective, randomized controlled study was made to measure the circulating levels of 13, 14-dihydro-15-keto-prostaglandin F (PGFM) in two groups of women having cervical cerclage early in the second trimester of pregnancy. One group of patients was given omnopon by intramuscular injection for 24 hours after operation and the other salbutamol by intravenous infusion. A significant rise in circulating PGFM was found in both groups after cervical cerclage and the magnitude of the rise was similar in the two groups; levels of PGFM in both groups had returned to the preoperative levels within 24 hours of operation. The levels of PGFM before and after operation showed no relation to the eventual outcome of the pregnancy, which was successful in 80 percent of patients.
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Vaginal suppositories of prostaglandin E2 constitute a highly efficient and acceptable method for inducing labor in patients with both favorable and unfavorable cervices. Both the failure of induction and consequent cesarean section rates can be dramatically reduced.
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Vaginal pessaries containing 3 mg of prostaglandin E2 were used to induce labour in 200 patients with variable induction features. Prostaglandin-induced labour was augmented where necessary by synthetic oxytocin. There was on failed induction. Only 23% of patients with favourable induction features and 53% of patients with unfavourable features needed oxytocin. There were no adverse fetal or maternal effects. The prostaglandin E2 pessary was as effective in inducing labour as 350 microgram extra-amniotic prostaglandin E2 in tylose in a comparable group of 200 patients in which there were 4 failed inductions.
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An attempt has been made to clarify the degree and control of production of the concentration gradient of sex-hormone-binding globulin (SHBG) between human mother and fetus. SHBG was measured by an improved ammonium sulphate precipitation method using 5 alpha-dihydrotestosterone as ligand. Maternal and fetal (cord blood) plasma SHBG was measured at delivery in twenty-three normal, four twin and one anencephalic pregnancies and in non-pregnant subjects. Comparison was also made with two macaque species, the rhesus monkey (M. mulatta) and the bonnet monkey (M. radiata), sampled shortly after delivery. In the human, a highly consistent gradient (mean 21-fold) was found between mother and fetus, which was independent of fetal sex and weight. Fetal but not maternal SHBG was significantly higher in the twin pregnancies. Maternal SHBG was 5-fold higher than in forty non-pregnant women, and fell with a half-life of 7-1 days immediately post-partium. In the two monkey species, SHBG with similar binding-characteristics exists but levels were 2-5-fold higher in the non-pregnant adult females than in women. In pregnancy, maternal SHBG levels were unchanged in the bonnet (nine observations) and fell markedly in the rhesus monkey (twenty-three observations) ; levels in the infants were comparably low in all three species, though more variable in the monkeys. In seven bonnet moneky mother-infant paris sampled again 2 or 2 weeks later, SHBG had risen mardedly (mean 6-1-fold) in the infants as has been shown previously in the human. The species differences in the non-pregnant females and the mothers may in part be related to species differences in oestrogen production. The macaque moneky appears suitable for studying further the mechanism of the neonatal SHBG rise, in which oestrogens cannot be implicated but thyroid hormones may be involved.
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INTRODUCTION: Women with epithelial ovarian cancer (EOC) are conventionally treated with primary cytoreductive surgery. For those with a low probability of optimal primary surgical debulking, an alternative management option is primary chemotherapy with delayed primary surgery. Selection criteria are required to identify women who may benefit from this approach. PATIENTS AND METHODS: Patient age, presence of ascites, preoperative serum CA-125 level, surgical procedures performed, postoperative residual disease, FIGO stage, and histology data were collected on 97 women with preoperative clinical evidence of advanced EOC. Univariate and multivariate analysis was performed to identify which preoperative factors predict disease that will be suboptimally debulked. Receiver-operator curves were constructed for CA-125 level as a predictor for residual disease. RESULTS: The best predictor of disease suboptimally cytoreduced was serum CA-125 level (OR = 22.76, 95% CI = 7.13-72.69). Other predictive factors included age over 60 years (OR = 3.16, 95% CI = 1.04-9.56) and clinical evidence of ascites (OR = 3.30, 95% CI = 1.03-10.62). The optimal cut-off for serum CA-125 as a predictor of suboptimal debulking was 586 IU (sensitivity 80.0%, specificity 88.5%, PPV 85.7%). CONCLUSION: Serum CA-125 level is a reliable component of the preoperative assessment of women with EOC.
OBJECTIVE: To report our incidence of soft tissue tumors at this site and to discuss various prognostic factors. METHODS: All patients with a diagnosis of vulvar soft tissue neoplasms were studied from a prospective database at the Royal Marsden Hospital between January 1985 and July 2001. RESULTS: Seventeen vulvar soft tissue neoplasms (11 malignant and six benign) were treated during this period. Leiomyosarcoma (n = 5) and aggressive angiomyxoma (n = 4) were the most frequent histologic types. According to the grade, there were four G3, three G2, three G1 and could not be assessed in one patient. Local recurrence occurred in six patients with sarcoma (three with high grade and one each with intermediate, low, and undetermined grade). In this group, five patients had negative microscopic margins and one patient had positive microscopic margins on excision. All three women with low-grade sarcomas are alive without evidence of disease. Three patients with aggressive angiomyxoma also had a local recurrence. CONCLUSION: Surgical excision is the primary treatment where possible. The grade of the tumor is an important predictor for local recurrence and outcome. Aggressive angiomyxoma is a local problem. Leiomyosarcoma and aggressive angiomyxoma are the most frequent histologic types.
We set out to study whether computerized tomography (CT) scanning of the vulva and the groin and groin ultrasound scanning (USS) alone or with fine needle aspiration cytology (FNAC) (USS/FNAC) influenced or could influence the surgical management of primary squamous cell carcinoma of the vulva (SCCaV). Forty-four patients underwent surgery for primary SCCaV following radiologic imaging by one or more modalities. Patient details included the clinical assessment of the carcinoma, radiologic findings, the operation performed, and whether the decision regarding the type and extent of surgery for the vulval carcinoma and, in particular, for the groin node dissection was or could be influenced by the radiologic findings. The age range was 38-87 years, with a median of 74 years. A total of 75 groin dissections were performed. Twenty-five of the 44 patients (56.8%) did not have groin node metastasis, 14 had unilateral metastasis (31.8%), and 5 (11.4%) had bilateral metastasis. All cases with histologically proven nodal status were analyzed to compare the preoperative imaging status with the histology. The calculated sensitivity, specificity, negative predictive value, and positive predictive value for CT were 58%, 75%, 75%, and 58%, for USS alone-87%, 69%, 94%, and 48%, and for USS-guided FNAC-80%, 100%, 93%, and 100%, respectively. There was no patient in whom surgical planning for the vulval carcinoma or the groin nodes was or could be altered by the CT findings. The data do not support the routine use of CT scanning in patients with primary SCCaV, either in assessment of the primary vulval carcinoma or in detecting groin nodal metastases. For the groin nodes, USS/FNAC is superior to CT in assessing disease status. In contrast to CT, USS/FNAC may have a useful clinical role in the management of the groin nodes in vulval carcinoma.
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Two or more epithelial ovarian cancers in close relatives, or ovarian cancer in conjunction with young-onset breast or colonic cancers, are suggestive of an inherited predisposition. Women in such families may have a 30-40% lifetime risk of developing ovarian cancer.