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Biomedical subjects

K D Hatch

Publications and source records attributed to K D Hatch.

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

Complications of combined radical hysterectomy-postoperative radiation therapy in women with early stage cervical cancer.

Fifty patients with cervical cancer were treated with radical hysterectomy and lymphadenectomy followed by postoperative radiation therapy for high risk factors (nodal metastases, lymphvascular space invasion, close or involved margins) at the University of Alabama at Birmingham Medical Center from 1969 to 1984. Fifteen (30%) of the patients treated had serious complications, 8 (16%) requiring an operation, and 1 (2%) dying as a result of treatment-related problems. This combined modality approach is associated with significant complications.

Adenocarcinoma↗
PubMed1989

Intraperitoneal chromic phosphate in ovarian cancer: risks and benefits.

Between March 1977 and December 1985, 59 patients were treated with intraperitoneal chromic phosphate at The University of Alabama Birmingham Hospitals and its affiliates. Twenty-seven patients received primary adjuvant therapy. Thirty-two patients were treated "secondarily" after tumor recurrence or after a "positive" second-look laparotomy. Associated morbidity was noted to be 12% with reoperation required in 7%. Early stage and grade tumors demonstrate a good prognosis. Little, if any, benefit was demonstrated in "secondary" therapy of advanced stage and grade tumors.

Chromium↗
PubMed1989

A randomized comparison of a rapid versus prolonged (24 hr) infusion of cisplatin in therapy of squamous cell carcinoma of the uterine cervix: a Gynecologic Oncology Group study.

In this study, 331 patients with advanced or recurrent squamous cell carcinoma of the cervix no longer amenable to control with surgery or radiotherapy were randomized to receive cisplatin 50 mg/m2 as either a continuous infusion over 24 hr or a more rapid infusion at a rate of 1 mg/min. Antiemetic therapy was standardized for the initial course of both regimens as metoclopramide 60 mg at the time of and at 3 and 6 hours after initiation of cisplatin. The overall frequency of objective regression of disease was 18%; the response rate in each regimen was essentially identical. The continuous infusion regimen was associated with a significantly greater percentage of patients who experienced no nausea and vomiting (34% versus 18%, P = 0.002). Other adverse effects included nephrotoxicity, peripheral neuropathy, myelosuppression, and ototoxicity. Both the frequency and severity of these were essentially the same for each regimen.

Adult↗
PubMed1989

Clinical and histopathologic factors predicting recurrence and survival after pelvic exenteration for cancer of the cervix.

Between September 1969 and January 1, 1986, 143 pelvic exenterations for recurrent cervical cancer were performed by the gynecologic oncologists at the University of Alabama at Birmingham. Of this group, 78 patients underwent total pelvic exenteration, 63 patients had anterior exenteration, and two had posterior exenteration. The overall operative mortality rate was 6.3%, mostly associated with total pelvic exenteration. The 5-year survival rates were 50% overall, 63% with anterior exenteration and 42% with total exenteration. Univariate and multivariate analyses were performed to identify clinical and histopathologic factors predictive of prolonged survival. Using three clinical factors (duration from initial radiation therapy to exenteration, size of the central mass, and presence of preoperative sidewall fixation), low-, intermediate-, and high-risk groups were constructed; the 5-year survival rates for these groups were 82, 46, and 0%, respectively. Inclusion of one histopathologic factor (margin status of the surgical specimen) added to the ability to predict 2- and 5-year survival rates. The best candidates for cure by pelvic exenteration were those with recurrent small (less than 3 cm), mobile central masses who were a year or longer from the time of their previous radiation therapy. Attempts to resect bulky pelvic recurrences that impinge on the pelvic sidewall, especially in the case of persistent or early recurrent disease (within 6 months), or continuation of exenterative procedures in women known to have nodal metastases or extrapelvic spread, are generally futile. For those women falling between the two extremes, sound clinical and operative judgment is imperative in regard to selecting the treatment offering the best quality of life.

Adenocarcinoma↗
PubMed1989

A randomized comparative trial of carboplatin and iproplatin in advanced squamous carcinoma of the uterine cervix: a Gynecologic Oncology Group study.

A total of 394 patients with advanced, measurable squamous carcinoma of the uterine cervix and no prior chemotherapy were randomized to therapy with either carboplatin or iproplatin. There were 23 patients ineligible for the study and 10 patients who were not evaluable; the remaining 361 patients were evaluable for response and adverse effects. Randomization was well balanced for age, performance status, and prior therapy. Both platinum analogs were given every 28 days with starting doses of 400 mg/m2 for carboplatin (340 mg/m2 if the patient underwent prior radiation) and 270 mg/m2 for iproplatin (230 mg/m2 if the patient underwent prior radiation). These doses are equivalent to cisplatin doses of 75 to 100 mg/m2. Hematologic toxicity was dose-limiting, among which thrombocytopenia was slightly more common than leukopenia. Gastrointestinal toxicity was also prominent with both agents; however, iproplatin was significantly more toxic than carboplatin (P less than .001). Renal, otic, and peripheral nervous system toxicities were absent or infrequent with both analogs. No electrolyte abnormalities were observed. The percentage of planned dosages that were actually administered was 100% of carboplatin doses and 85% of iproplatin doses (P less than .0001). The reduction in iproplatin dose was apparently due to gastrointestinal toxicity. Response rates were similar for both agents (15% for carboplatin, 11% for iproplatin) and appear to be inferior to those noted with the parent compound, cisplatin.

Adult↗
PubMed1988

Amplification of the c-myc proto-oncogene in cervical carcinoma.

Amplification without structural rearrangements of the c-myc proto-oncogene was found in 14 of 44 primary cervical neoplasms. There was no apparent correlation with stage of disease or degree of cellular differentiation. The prognostic significance of c-myc amplification cannot be determined from this study.

Adenocarcinoma↗
PubMed1988

Selective inhibition of c-myc expression by the ribonucleic acid synthesis inhibitor mithramycin.

Expression of the c-myc proto-oncogene has been shown to correlate with the rate of cellular proliferation and malignant transformation in a number of cell types. JEG-3 choriocarcinoma cells demonstrate c-myc transcript levels that are greater than those of nonmalignant trophoblastic tissue at any stage of gestation. Southern blot analysis documents c-myc gene amplification in JEG-3 cells, with a gene copy number of approximately 20. The methylation pattern and genomic structure of the amplified c-myc oncogene in JEG-3 choriocarcinoma cells are identical to those of normal placenta. Treatment of JEG-3 cells with mithramycin, a ribonucleic acid synthesis inhibitor, results in a dramatic decrease in c-myc expression relative to that of the c-Ha-Ras gene. The apparent selectivity of mithramycin for c-myc expression represents the only example, to date, of the selective pharmacologic modulation of oncogene expression.

Cell Line↗
PubMed1988

Melanosis of the cervix.

Benign and malignant melanotic cervical lesions are rare and require biopsy to rule out melanoma. Reported is a case of cervical melanosis, defined as benign epithelial pigmentation.

Adult↗
PubMed1988

Analysis of prognostic features in adenocarcinoma of the cervix.

Uncertainties regarding the clinical behavior and management of women with primary adenocarcinoma of the cervix persist. A series of 162 patients was evaluated with emphasis on histopathology, clinical features, treatment, and survival. Sixty-seven patients underwent radical hysterectomy alone, 65 patients underwent radiation therapy alone, while the remainder were treated with combined surgery and radiotherapy. When compared to a matched series of squamous cell carcinoma patients, no statistical differences in survival could be demonstrated. Clinical stage (P less than 0.001) and lesion size (P less than 0.001) were the most important prognostic factors for the entire series. Patients with adenocarcinoma of varied histologic patterns were compared to patients with adenosquamous lesions and no statistical difference in survival could be demonstrated. Multivariate analysis of those women with Stage I adenocarcinoma of the cervix identified risk groups based on tumor grade, lesion size, and patient age. Patients in the low risk group had a 5-year survival of 89.5% while patients in the intermediate and high risk groups had 5-year survival rates of 68.4 and 37.3%, respectively. In patients with Stage I well-differentiated lesions survival was excellent, independent of lesion size.

Adenocarcinoma↗
PubMed1988

Low rectal resection and anastomosis at the time of pelvic exenteration.

Twenty patients underwent a supra levator total pelvic exenteration with low rectal anastomosis for recurrent or persistent cervical carcinoma following radiotherapy. Fourteen (70%) had complete healing. Five of 9 patients with protective colostomies had complete healing while 9 of 11 without protective colostomies healed. Three of 7 patients with a rectal stump length of less than 6 cm healed while 11 of 13 whose rectal stump was 6 cm or greater experienced complete healing. Overall, 13 of the 20 patients are clinically free of disease and 8 (61%) of those enjoy life with excellent bowel continence. A low rectal anastomosis should be attempted in those patients undergoing a supralevator total pelvic exenteration.

Anastomosis, Surgical↗
PubMed1988

Secretory immune system of the female reproductive tract: I. Immunoglobulin and secretory component-containing cells.

We have investigated tissues from the female reproductive tract to determine whether the distribution of cells involved in the formation of secretory immunoglobulin A (IgA) molecules is analogous to that described for intestines, bronchus, and mammary and salivary glands. Fresh tissues from fallopian tube, ovary, uterus, and vagina were obtained, and sections were stained with fluorochrome-labeled polyclonal or monoclonal antibodies specific for IgG, IgA, IgA1, and IgA2 subclasses; IgM; secretory component; and J chain. Subepithelial plasma cells were identified in each specimen of fallopian tube, endocervix, ectocervix, and vagina. Approximately two-thirds of the immunoglobulin-positive cells contained IgA and J chain, indicating that they produced polymeric IgA. In comparison to tissues such as spleen and bone marrow, where IgA1-positive cells are produced, we found a high proportion of IgA2-positive cells in fallopian tube, cervix, and vagina. Epithelial cells in fallopian tube and endocervix contained secretory component. These data indicate that secretory IgA, which provides the first line of defense against invading pathogens, is produced locally in tissues of the female reproductive tract.

Antibodies, Monoclonal↗
PubMed1987

Patients with condyloma acuminatum exhibit decreased interleukin-2 and interferon gamma production and depressed natural killer activity.

Peripheral blood mononuclear cells were obtained from 20 untreated condyloma acuminatum patients and from an equal number of sex- and age-matched controls and assayed for cell surface antigen expression, natural killer activity, and lymphokine production. Patient peripheral blood mononuclear cells had significantly lower helper-to-suppressor T-cell ratios (Leu3/Leu2) (P less than 0.05) and significantly higher percentages of Leu 2+ Tac+ cells (activated suppressor/cytotoxic cells) (P less than 0.05) and Leu 2+ OKM1+ cells (suppressor cells) (P less than 0.01). Natural killer activity of condyloma acuminatum patients was significantly lower (P less than 0.05) than that of controls. Production of interleukin-2 and interferon gamma, but not interferon alpha, was significantly (P less than 0.01) decreased in condyloma acuminatum patients. There was an inverse correlation between the in vitro production of interleukin-2 and interferon gamma and the percentage of Leu 2+ OKM1+ cells (suppressor) (P less than 0.01). Thus, patients with condyloma acuminatum differ from controls by demonstrating decreased natural killer-cell activity, decreased production of lymphokines which enhance natural killer-cell activity (i.e., interferon gamma and interleukin-2), and an increased proportion of T cells with a suppressor phenotype.

Adult↗
PubMed1987

CA125 as a serum marker for poor prognosis in ovarian malignancies.

In cancer of the ovary, a tumor marker is much needed to assist the conventional methods for monitoring the disease course. All published reports of the CA125 serum immunoassay to date have indicated that rising or falling CA125 levels correlated with disease progression or regression in patients with ovarian malignancies. Our experience with CA125 at the University of Alabama at Birmingham shows that rising CA125 levels are highly suggestive of progressive disease. However, the significance of our findings with CA125 is that, contrary to other reports, falling CA125 levels are not a reliable indicator for regressive disease. Thus, falling CA125 levels are not clinically useful whereas rising CA125 levels may be interpreted as indicative of poor tumor response to therapy, and of the presence of persistent or recurrent disease either prior to second-look laparotomy or during post-treatment follow-up.

Antigens, Neoplasm↗
PubMed1987

The adverse effects of cervical cancer treatment on bladder function.

Bladder dysfunction is a recognized complication following radical hysterectomy, however, the effect of radiation alone or in combination with surgery on bladder function has received little attention. Thirty patients who underwent radical hysterectomy with postoperative whole pelvis radiation (RH + RT) were matched for age, stage of disease, and time interval since therapy, with 30 patients who had radical hysterectomy alone (RH) and 30 patients who were treated with pelvic radiotherapy (RT). Bladder function was assessed by symptoms and urodynamic evaluation. Altered bladder sensation and voiding problems were associated with surgery, and were more frequent after RH or RH + RT than RT (P = 0.002). fifty percent of RH patients voided by abdominal straining compared to 10% who had only RT. No greater problem was seen after RH + RT compared to RH. Urinary incontinence was present in 15% of patients prior to therapy. After treatment, incontinence requiring protection developed in 23% of RT patients, 26% of RH patients, and 63% of RH + RT patients. The severity of the incontinence was greater after RH + RT. Bladder neck and urethral function was similar in all groups, however, bladder compliance was reduced in RT patients and significantly (P = 0.0001) reduced after RH + RT compared to RH alone. This reduction was related to the bladder dose of external radiation and was a factor in the etiology of the urinary incontinence seen in RH + RT patients.

Adult↗
PubMed1987

Treatment of nonmetastatic gestational trophoblastic disease with oral methotrexate.

Fifteen patients with nonmetastatic gestational trophoblastic disease were treated solely with methotrexate given orally rather than intramuscularly. Remission, defined as a beta-human chorionic gonadotropin titer of less than 5 mIU/ml for 3 consecutive weeks, was attained in 13 (87%) of the 15 patients. Level of toxicity was acceptable. Patient comfort, convenience, and less time off work and in the physician's office are significant advantages to this efficacious, well-tolerated method of therapy.

Administration, Oral↗
PubMed1987

The short-term effect of radical hysterectomy on urethral and bladder function.

To investigate bladder neck and urethral function after radical hysterectomy, 21 patients were investigated before and 3 months after the operation. Each patient had an excretory urogram, CO2 cystoscopy, uroflowmetry, water cystometry and a urethral pressure profile, using a dual sensor microtransducer catheter, at rest and during stress. Postoperatively there was a significant reduction in urethral length and urethral closure pressure; however, pressure transmission ratios were maintained, indicating no loss of bladder neck support with stress. Of the six patients with pre-operative bladder neck weakness, two (33%) had stress urinary incontinence at the 3 months assessment. No patient with a normal pre-operative assessment developed this complication. Fifteen (71%) voided by abdominal straining and this manoeuvre emptied the bladder effectively. These data suggest that patients with pre-operative evidence of an incompetent bladder neck may be predisposed to develop stress urinary incontinence after radical hysterectomy because of a reduction in the urethral closure pressure.

Adult↗