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Biomedical subjects

P Kelehan

Publications and source records attributed to P Kelehan.

13 recordsLinked to original sources

Variations in immunohistochemical detection of p53 protein overexpression in cervical carcinomas with different antibodies and methods of detection.

Immunocytochemical detection of p53 protein products in paraffin sections is possible with a number of antisera, monoclonal and polyclonal. Few corroborative results amongst different laboratories have been published due to variations in the antibodies, the fixation protocols, and the immunocytochemical methods applied. Antigen unmasking methods employing microwaves or proteolytic enzymes add to the disparity in the percentage of positive cases reported. In this study, paraffin sections of 55 cases of cervical carcinoma were immunostained with monoclonal antibodies p53-DO7 and p53-1801 (a) without section pretreatment, (b) with pronase digestion, and (c) with microwave antigen retrieval in citric acid buffer. Specimens fixed in buffered formalin required antigen unmasking to show positive staining. Pronase digestion caused false-negative immunostaining. Microwave pretreatment with p53-DO7 yielded 100 per cent positivity for p53 proteins but only 7/55 cases with more than 50 per cent positive cells. Monoclonal antibody p53-DO7 detected more positive cases than p53-1801. Immunostaining with antibodies to p53 proteins must be interpreted cautiously as variations in fixation, antibodies, and section pretreatment will significantly affect results.

Antibodies, Monoclonal

The echogenic thalamus in hypoxic ischaemic encephalopathy.

This paper reports 16 term infants in whom an echogenic thalamus was identified on cranial ultrasonography. Fourteen of the patients suffered severe birth asphyxia. The prognostic significance of this finding and the underlying pathogenesis is assessed.

Asphyxia Neonatorum

Septic pelvic thrombophlebitis: an unusual treatable postpartum complication.

Septic pelvic thrombophlebitis is an uncommon but serious postpartum complication occurring in about 1 in 2,000 pregnancies, characterized by pain, antibiotic resistant fever and tachycardia. In about 50% of cases a pelvic mass is present which is usually right-sided (especially when the ovarian vein is involved). It is estimated to cause 18 maternal deaths per million pregnancies in the United States. Use of contrast enhanced CT scanning and a trial of heparin therapy increases the diagnostic certainty. It is particularly important because surgical management which may otherwise be suggested because of a spiking fever and a mass seems to be associated with a poorer prognosis than does conservative management.

Adult

En bloc radical vulvectomy and lymphadenectomy with modifications of separate groin incisions.

A new modification of radical vulvectomy and lymphadenectomy through separate groin incisions involves dissection of the intervening skin bridge and allows an en bloc dissection. The results in 26 women treated with this technique are compared with those of seven treated with separate incisions without an en bloc dissection. All 33 women had squamous carcinoma of the vulva and were treated between 1985-1989. The incidence of advanced disease was high, with nodal metastases present in 52% of cases. Dissection of the tissue beneath the skin bridge did not alter the morbidity of the procedure in terms of the incidence of wound infection, number of units of blood transfused, or duration of hospitalization. The only case of an isolated recurrence in the skin bridge occurred in a woman who did not have an en bloc dissection, although there was no significant difference in the overall local recurrence rate between the groups. Further evaluation with larger numbers is required, but we suggest that an en bloc dissection using separate incisions may reduce the risk of isolated recurrence in the skin bridge, particularly in patients with advanced disease.

Adult

Outpatient loop diathermy conization as an alternative to inpatient knife conization of the cervix.

A knife cone biopsy of the cervix is usually performed as an inpatient procedure under general anesthesia and is associated with significant morbidity. Loop diathermy conization was performed under local anesthesia on colposcopy outpatients as an alternative to knife conization. In 33 consecutive patients studied the procedure was well tolerated, there were no operative complications, and a satisfactory specimen for histologic examination was obtained in every case. One case of unsuspected invasive cancer and two of suspected microinvasive cancer were diagnosed. The diagnosis of cervical precancer was made in 24 (73%) of the cases. The introduction of outpatient loop diathermy conization of the cervix instead of knife conization would decrease hospitalization costs, avoid the need for general anesthesia and potentially reduce short-term patient morbidity.

Adult

DES clinic--the first six months.

In October 1990 a DES (Diethylstilbestrol) clinic was established at the National Maternity Hospital, Dublin. We describe the results of the first six months of the clinic. During this time, 172 inquiries were received; 95 women were seen at the clinic, 16 were deemed to be DES--exposed and eight were classified as possibly DES exposed. Classical cervicovaginal signs of DES exposure were noted in 15 women, a further eight women showed cervical epithelial abnormalities at colposcopy, the history of in utero DES exposure was confirmed in eight cases. No cases of cervical intraepithelial neoplasia or vaginal clear-cell adenocarcinoma were detected. Pregnancy related problems possibly attributable to DES exposure were documented in six women.

Adenocarcinoma

Clinico-pathological findings in non-immune hydrops fetalis.

Non-immune hydrops fetalis is becoming a relatively more important cause of hydrops as the incidence of rhesus-related hydrops falls. We describe a series of 33 cases, occurring over a 7 year period covering most of the 1980's. We found a very wide range of aetiological factors, but cardiac conditions, both structural and dysrhythmic, formed the largest subgroup (12 cases, 36%). Seven cases (22%) remained idiopathic. Prognosis was very poor, with only 4 infants surviving. Outcome was best in the cases due to intra-uterine supraventricular tachycardia. Nineteen cases were detected antenatally, but except in the cases of fetal tachyarrhythmias, this had little effect on outcome.

Female

Distant metastases following surgical treatment of cervical carcinoma.

Fifty patients with early carcinoma of the cervix were treated by radical hysterectomy and pelvic lymphadenectomy. Twelve patients (24%) had positive nodes and received adjuvant pelvic radiotherapy. The mean duration of follow-up was seven years and all patients had at least four years follow-up. Five patients died from recurrence; four from isolated distant metastases and one from a pelvic side wall recurrence. The disease-free interval for patients with distant metastases was six months to two years and the metastases were to lung and bone.

Adult

Benign and malignant struma ovarii.

Three cases of struma ovarii are reported, two of which were benign, and one which was malignant. Immunoperoxidase studies confirmed that the tumors secreted triiodothyronine and thyroxine, but no carcinoembryonic antigen nor alpha-fetoprotein. In the case of the malignant struma ovarii, the patient's thyroid was histologically normal, and thus the possibility of a metastasis to the ovary from a primary thyroid carcinoma was excluded.

Aged