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Biomedical subjects

J M Malone

Publications and source records attributed to J M Malone.

At least 73 records · Page 4Linked to original sources
PubMed1989

Advanced ovarian cancer: urinary tract resection as a part of cytoreductive surgery.

Maximum surgical effort to minimize residual tumor following primary surgery has been shown to increase mean survival in patients with epithelial ovarian cancer. From September, 1983 to November, 1987, 22 patients underwent resection of the urinary tract as a part of cytoreductive surgery. Seven patients underwent partial cystectomy, four underwent partial cystectomy with ureteroneocystotomy, five patients underwent ureteroneocystotomy while an additional four patients underwent ureteroureteral anastomosis. One patient underwent primary transverse colon conduit while another underwent a similar procedure after developing urinary leakage. All anastomoses were protected with indwelling stents while the urinary bladder was drained with an indwelling Foley catheter for ten days. Both patients requiring conduits had undergone prior radiation therapy in addition to chemotherapy. Nine major and two minor complications occurred in seven patients. One patient died six weeks postoperatively after concurrent hepatic resection. Optimal cytoreduction was possible in 59% of the patients, and was associated with a mean survival of 15.2 months. Optimal cytoreduction including resection of the urinary tract was associated with longer survival and acceptable morbidity and it appears to be justified in patients with ovarian cancer.

Adenocarcinoma↗
PubMed1988

Canine model for surgical correction of chronic venous hypertension.

A chronic model of venous hypertension was created by iliofemoral venous ligation in the left hindlimb of eight greyhounds (right limb control). Prior to ligation, immediately postligation (T0), and at 2, 4, 6, and 15 weeks postligation (T2-T15), bilateral hindlimb venous pressures were measured at rest. At T2-T15, exercise pressures were measured for 5 min after hindlimb muscle contraction induced under sedation by tetanic (20 sec, 50 Hz, 8 mA) stimulus (S30-S300 sec). Resting and exercise pressures were significantly higher in the ligated hindlimb at all time intervals (resting, P less than 0.001 at T0, T2, T4, T6, and P less than 0.025 at T15; exercise, P less than 0.001 for S30-S300 at T2-T15). In five of the animals at 15 weeks, a cross-femoral venous bypass (CFB) with adjacent adjuvant arteriovenous fistula (AVF) was constructed using autologous external jugular vein. Venous pressures were measured at 2 and 6 weeks post-CFB both at rest and after tetanic muscle stimulation. At 2 weeks, venous pressure in the ligated limb was significantly higher than that in control only after exercise (P less than 0.025 at S30-S120; P less than 0.05 at S150-S180; NS at S240-S300). At 6 weeks, venous pressures were not significantly different at rest or with exercise. All five grafts were patent at 6 weeks. Three of five dogs then successfully underwent ligation of the AVF. At 2 weeks post-AVF ligation there was no difference in resting or exercise venous pressure in the ligated limb compared to control. At 6 weeks post-AVF ligation only two dogs remained for monitoring and in these there was no trend toward venous hypertension in the ligated hindlimb. Graft patency was maintained despite AVF ligation.

Animals↗
PubMed1988

Recurrent cervical carcinoma after radical hysterectomy.

The characteristics of recurrent carcinoma following radical hysterectomy and pelvic lymphadenectomy for cervical carcinoma are not well known. Disease recurrence was noted in 27 of 249 patients (11%) with stage IB cervical carcinoma who were treated with a primary surgical approach between January 1962 and December 1984. Fourteen recurrences (52%) occurred within 1 year of surgery, and 24 (89%) within 2 years. Patients with pelvic node metastases or adenocarcinoma had a significantly higher recurrence rate than did patients with negative nodes (33% vs 8%) or with squamous carcinoma (22% vs 8%). Seventeen patients (63%) had disease recurrence in the pelvis or vulva and 12 of these patients had recurrences within 1 year. Eight patients developed asymptomatic pelvic or vulvar recurrences, and all were diagnosed within 1 year. Ten patients (37%) developed recurrences outside the pelvis and 8 of these experienced recurrence after 1 year. Successful treatment after recurrence was independent of clinical or histopathologic parameters except site of recurrence. Eight of 15 patients (53%) who were treated with irradiation for a recurrence in the pelvis or vulva are free of disease 10 to 126 months (median, 48 months) after recurrence. Since irradiation can aid in salvaging patients with recurrent cervical carcinoma confined to the pelvis following radical surgery, clinical vigilance for this site of recurrence is emphasized.

Adenocarcinoma↗
PubMed1988

Debulking surgery for ovarian cancer with the Cavitron Ultrasonic Surgical Aspirator (CUSA)--a preliminary report.

The Cavitron Ultrasonic Surgical Aspirator (CUSA) can be used to fragment and aspirate tissue precisely. The CUSA was utilized as an adjunctive procedure to standard operative techniques to optimally debulk 11 women with advanced epithelial carcinoma of the ovary. No significant intraoperative or postoperative complications were encountered. It is suggested that this technique may be safely attempted in combination with the standard surgical techniques for debulking nonfibrous ovarian tumors or may allow removal of nonfibrous tumor masses which cannot be resected safely utilizing the standard surgical techniques. The authors found the CUSA's efficiency was limited in dense and fibrotic tissue. On the basis of our experience with this small number of patients, we believe this technique deserves further study.

Antineoplastic Agents↗
PubMed1988

Pregnancy, human papillomavirus and cervical intraepithelial neoplasia.

Human papillomavirus (HPV) has been implicated in the development of cervical intraepithelial neoplasia (CIN). To test the hypothesis that the known relationship between HPV and CIN might be modified by the altered immune status of pregnancy the cytologic, colposcopic and histologic findings in 176 pregnant and 515 nonpregnant patients referred to a colposcopy clinic were prospectively compared. No difference between the two groups was found regarding the frequency with which CIN and HPV were detected cytologically, colposcopically and histologically. Confidence intervals for the probability of CIN in the presence of HPV for the two groups were calculated. At the 80% confidence interval the two groups were reassuringly similar. Pregnancy did not alter the relationship of CIN to HPV. Despite the relatively small size of our study population, it is unlikely that a larger study would demonstrate a difference. Interestingly a 3% cervical carriage rate of HPV in pregnancy was demonstrated. What, if any, effect this has upon the unborn child is unknown at this time.

Adult↗
PubMed1988

Hemodynamics of revascularization for iliofemoral venous occlusion: a short-term canine model.

A short-term canine model of lower extremity venous hypertension was created to study the hemodynamics of crossfemoral venous bypass grafts (CFB). Specifically, the hemodynamic effects of bypass conduit diameter and adjunctive arteriovenous fistulas (AVFs) were investigated. Unilateral hind limb venous hypertension was produced by iliofemoral venous ligation in six groups of five greyhounds each. Group I had venous ligation alone. CFBs were constructed in the remaining five groups: group II, 3 mm bypass conduit alone; group III, 3 mm bypass plus sequential AVF; group IV, 3 mm bypass plus caudad AVF; group V, 3 mm bypass plus cephalad AVF; group VI, 6 mm bypass conduit alone. Venous hypertension was significantly reduced by CFB (group II, p less than 0.025; group VI, p less than 0.001); increasing the diameter of the bypass conduit from 3 to 6 mm produced significantly greater graft flow (p less than 0.05), while completely relieving venous hypertension. Addition of adjunctive AVFs significantly augmented graft flow (p less than 0.001) but tended to aggravate ipsilateral venous hypertension (group III, p less than 0.01; group IV increase, NSS; group V, p less than 0.001). During the 4 hours of pressure monitoring, venous hypertension diminished significantly (p less than 0.05) with the sequential AVF but not with the other AVF. We conclude that (1) AVFs may be required for adequate graft flow if a small-diameter (3 mm) bypass conduit is used to relieve venous hypertension; (2) adjunctive AVFs aggravate venous hypertension; (3) sequential AVFs seem to be the most hemodynamically efficacious; (4) AVFs may not be necessary if a large, isodiametric (6 mm) conduit is used.

Anastomosis, Surgical↗
PubMed1988

Gastrointestinal bleeding after aortic surgery. The role of laparotomy to rule out aortoenteric fistula.

The frequency and causes of gastrointestinal (GI) bleeding occurring after aortic surgery were evaluated retrospectively to determine the incidence of aortoenteric fistula (AEF) in relation to other causes and to place in perspective the role of laparotomy for the diagnosis of AEF. Two hundred fifty-three patients in whom aortic prostheses have been inserted were observed for a mean of 46 months. Seventy-four bleeding episodes occurred in 21% of patients between 1 and 108 months after surgery (mean 29 months). Only one AEF appeared that was associated with GI bleeding, for an incidence of 1.4% of bleeding episodes and 0.4% of grafts inserted. No diagnostic workup for GI bleeding was performed for 20 of the 74 episodes and no AEFs were noted in this group during a mean follow-up of 28 months. Diagnostic evaluation was done for the remaining 54 episodes. No cause for bleeding was identified in 16 patients and no AEF developed in this group during a mean follow-up of 26 months. A potential bleeding site was identified in 38 patients, of whom 30 had intrinsic GI lesions and no subsequent evidence of AEF during a mean follow-up of 28 months. Laparotomy for a suspected AEF was recommended for the remaining eight episodes in eight patients and was performed in six patients. An AEF was seen in one patient with abnormality found on preoperative CT scanning; an intrinsic GI lesion was identified in three patients; and no pathologic condition was found in the remaining two (negative laparotomy rate, 33%).(ABSTRACT TRUNCATED AT 250 WORDS)

Aorta, Abdominal↗
PubMed1988

Diagnosis of recurrent cervical carcinoma after radical hysterectomy.

A standard surveillance program for cervical carcinoma patients treated with radical hysterectomy is reviewed. Between 1962-1984, 249 patients with stage IB cervical carcinoma treated with radical hysterectomy and pelvic lymphadenectomy were entered in the surveillance program. Of the 27 patients (11%) diagnosed with recurrent carcinoma, 17 (63%) were identified by clinical history, 22 (81%) by physical examination, five (18%) by vaginal cytology, six (22%) by chest radiography, and eight (30%) by renal contrast imaging. Combined clinical history and physical examination identified 24 patients (89%) with recurrent carcinoma. Disease recurrence was detected by vaginal cytology in one asymptomatic patient with a normal examination. The recommended surveillance procedures for patients with cervical carcinoma after radical hysterectomy include clinical history, physical examination, and vaginal cytology. Chest radiography and renal contrast imaging should be reserved for symptomatic patients.

Cytodiagnosis↗
PubMed1988

Transcutaneous oxygen and carbon dioxide pressure monitoring to determine severity of limb ischemia and to predict surgical outcome.

Transcutaneous oxygen and carbon dioxide pressure (PO2 and PCO2) foot monitoring was compared with ankle Doppler-derived systolic pressure regarding their respective abilities to discriminate the severity of limb ischemia before vascular reconstruction and to predict surgical outcome early in the postoperative period. Transcutaneous PO2 (tcPCO2), foot-chest tcPO2 index, transcutaneous PCO2 (tcPCO2), foot tcPO2/tcPCO2 index (tcPO2/tcPCO2), ankle Doppler systolic pressure (AP), and ankle-brachial pressure index (ABI) were determined in 89 revascularized limbs. The measurement of tcPO2 and foot-chest tcPO2 was found to be more sensitive to degrees of severity of limb ischemia and more closely associated with the outcome of revascularization than AP and ABI. TcPCO2 and tcPO2/tcPCO2 were not useful in assessment of the vascular patient undergoing reconstructive surgery. Before operation, tcPO2 less than or equal to 22 torr and foot-chest tcPO2 less than or equal to 0.46 indicate severe limb ischemia requiring urgent revascularization. After operation, tcPO2 less than or equal to 22 torr and foot-chest tcPO2 index less than or equal to 0.53 indicate that revascularization is likely to fail. We conclude that tcPO2 monitoring, as a metabolic test of actual tissue perfusion, is a more reliable indicator of preoperative limb ischemia and postoperative outcome of revascularization than hemodynamic, Doppler-derived pressure tests.

Aged↗
PubMed1988

The necessity for long-term antibiotic therapy with positive arterial wall cultures.

The results of treatment after excision of infected arterial grafts were analyzed as a function of aortic/arterial wall cultures and duration of antibiotic therapy in 33 patients. Four patients died during surgery and 29 patients were observed for periods ranging from 2 weeks to 76 months. Negative arterial wall cultures (NAwC) were found in 16 patients, three of whom died of multiple-organ failure and sepsis but none of whom had aortic/arterial disruption/hemorrhage. Positive arterial wall cultures (PAwC) were found in 13 patients, seven of whom received short-term, broad-spectrum antibiotics for less than 10 days (PAwC-STA) and six of whom received long-term culture-specific antibiotic therapy (intravenous therapy for 6 weeks and oral therapy for 6 months) (PAwC-LTA). Five of seven patients in the PAwC-STA group died of aortic disruption or hemorrhage, one patient had severe hemorrhage caused by disintegration of a saphenous vein patch over the common femoral artery, and one patient had a recurrent aortoenteric fistula. There were 10 episodes of arterial disruption/hemorrhage in those seven patients. All episodes of aortic/arterial disruption/hemorrhage occurred in the PAwC-STA subgroup (seven of seven patients) and none occurred in the PAwC-LTA subgroup (none of six patients) (0.005 less than p less than 0.001). The incidence of aortic/arterial disruption/hemorrhage was significantly different between overall PAwC (7 of 13 patients) vs NAwC (none of 16 patients) (0.005 less than p less than 0.001) and NAwC-STA (none of 16 patients) vs PAwC-STA (seven of seven patients) (0.001 less than p less than 0.0005).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1987

Prognostic factors in stage II endometrial carcinoma.

The rarity of Stage II endometrial carcinoma and variable treatment modalities have made the evaluation of prognostic factors difficult. Clinical, surgical, and pathologic characteristics were evaluated in 64 patients treated with whole pelvic irradiation and intracavitary radium followed by hysterectomy at The University of Texas M.D. Anderson Hospital and Tumor Institute from January 1965 to December 1983. Comparison of 5-year actuarial survival rates revealed the following statistically significant categories: age, grade, depth of myometrial invasion, disease extent at surgery including lymph node metastases, and pelvic cytology. Race, weight, and cell type were not significant prognostic factors. Evaluation of prognostic factors at surgery includes pelvic and para-aortic lymph node biopsies, omental biopsy, pelvic cytologic washings, and biopsy of any suspicious tissues. Patients with adverse prognostic factors are candidates for trials with adjuvant therapy.

Actuarial Analysis↗
PubMed1987

Intrahepatic infusional therapy for metastatic ovarian carcinoma.

Twenty-four women with ovarian carcinoma that had metastasized to the liver were treated with intrahepatic infusional therapy. No consistent drug regimen was used. There were no complete responders; however, 33% had a partial response. All responses were noticed after the first course of therapy. The median length of response was 6.3 months. The median survival from the time of the first hepatic infusion was 7.5 months for all patients. In this series, there were two treatment-related deaths, one secondary to the chemotherapy, the other to improper catheter placement. Because of the multiplicity of chemotherapy regimens employed, no definite conclusions can be made concerning the efficacy of intrahepatic infusional therapy for metastatic ovarian carcinoma. It is suggested that its future use be restricted to patients with disease limited to the liver and who are being treated according to a study protocol.

Adolescent↗
PubMed1987

Prospective comparison of noninvasive techniques for amputation level selection.

This study prospectively compared the following tests for their accuracy in amputation level selection: transcutaneous oxygen, transcutaneous carbon dioxide, transcutaneous oxygen-to-transcutaneous carbon dioxide, foot-to-chest transcutaneous oxygen, intradermal xenon-133, ankle-brachial index, and absolute popliteal artery Doppler systolic pressure. All metabolic parameters had a high degree of statistical accuracy in predicting amputation healing whereas none of the other tests had statistical reliability. Amputation site healing was not affected by the presence of diabetes mellitus nor were the test results for any of the metabolic parameters.

Adult↗
PubMed1987

The impact of multiple operations on the importance of arterial wall cultures.

The present study reviewed arterial culture data from 172 patients undergoing major vascular reconstructions between July 1, 1977, and Dec. 31, 1984. Prosthetic graft infection was documented in 0 of 97 cases (0%) with negative arterial cultures but in six of 75 cases (8%) with positive arterial cultures (chi 2 = 5.84; 0.01 less than p less than 0.025). The data were reanalyzed after the patients were subdivided into two groups on the basis of the numbers of operations: group I (132 patients)--a culture obtained at initial vascular reconstruction--and group II (40 patients)--a culture obtained at a subsequent vascular reconstruction. Positive arterial cultures had no predictive value for graft infection among patients in group I (1 of 57 cases vs. 0 of 75 cases; chi 2 = 0.019), whereas the presence of positive arterial cultures was associated with a significant increase in the incidence of graft infection in group II patients (5 of 18 cases vs. 0 of 22 cases; chi 2 = 4.68; 0.025 less than p less than 0.05). For group I patients, we believe that neither routine arterial culture nor long-term antibiotic therapy for patients with positive arterial cultures is indicated. For group II patients we recommend that routine arterial cultures should be obtained; perioperative antibiotics should be continued until definitive arterial culture information is available; and positive arterial cultures should be treated with a short course of high-dose intravenous antibiotics. Thereafter, long-term treatment of positive arterial cultures with oral antibiotics, although not statistically validated, is probably appropriate.

Arteries↗
PubMed1987

Stage IB cervical carcinoma treated with radical hysterectomy and pelvic lymphadenectomy: role of adjuvant radiotherapy.

A retrospective review of 194 patients with stage IB cervical carcinoma treated with radical hysterectomy between January 1977 and December 1984 revealed 30 patients (15%) with pelvic node metastases. Twenty patients with pelvic node metastases received postoperative radiotherapy and ten patients did not. Five of 20 patients who received adjuvant radiotherapy had recurrence, compared with five of ten patients who did not receive radiotherapy. No pelvic recurrences occurred in the adjuvant radiotherapy group compared with two in the no radiotherapy group. Only one serious complication occurred in a patient receiving radiotherapy. Adjuvant postoperative radiotherapy may reduce pelvic recurrences and improve survival in patients with pelvic node metastases treated with radical hysterectomy and pelvic lymphadenectomy.

Adenocarcinoma↗
PubMed1987

Ureteral assessment after radical hysterectomy.

Postoperative intravenous pyelography was performed in 233 patients with stage IB cervical carcinoma treated with radical hysterectomy and pelvic lymphadenectomy between January 1962 and December 1985. Four patients developed symptoms of ureteral injury, two (0.8%) ureteral fistulae, and one (0.4%) stricture and obstruction due to recurrent carcinoma. No ureteral injuries were observed in 229 asymptomatic patients. A 5.2% incidence of transient severe ureteral dilatation occurred in asymptomatic patients, but resolved within a median of 94 days. A significant urinary tract anomaly was observed in 3.4% of preoperative pyelograms. All of these anomalies were apparent at surgery and presented no intraoperative difficulties. Three patients (1.3%) sustained intraoperative ureteral transections, which were diagnosed and repaired without sequelae. In patients with early cervical carcinoma having primary operative treatment, the role of routine preoperative and postoperative intravenous pyelography is questionable.

Adult↗