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Biomedical subjects

R G Wright

Publications and source records attributed to R G Wright.

At least 37 records · Page 2Linked to original sources
PubMed1993

Human papillomavirus DNA in glandular lesions of the uterine cervix.

AIMS: To assess the role of human papillomavirus in the pathogenesis of adenocarcinoma in situ, endocervical glandular dysplasia (a presumed precursor of adenocarcinoma) and endocervical glandular epithelial giant cell change. METHODS: Viral detection was carried out using an in situ hybridisation technique on paraffin wax sections. Biotinylated probes for human papillomavirus types 6/11, 16/18, 31/33/35 were used with a colorimetric detection system. RESULTS: Nine out of 21 (43%) cases of adenocarcinoma in situ contained human papillomavirus types 16/18, one of which was also positive for 31/33/35. Ten cases of glandular dysplasia and four cases of glandular epithelial multinucleation did not react with the probes used. CONCLUSIONS: These results indicate that while adenocarcinoma in situ is strongly associated with human papillomavirus infection, endocervical glandular dysplasia and glandular epithelial multinucleation are probably not associated with the virus.

Adenocarcinoma↗
PubMed1993

HPV DNA in oropharyngeal squamous cell cancers: comparison of results from four DNA detection methods.

Oropharyngeal squamous cell cancers (SCCs) were examined for human papillomavirus (HPV) related DNA sequences. The techniques employed were Southern blotting under stringent and non stringent conditions, dot blotting, primer directed gene amplification using the polymerase chain reaction (PCR), and in-situ hybridization. HPV 16 DNA was found in 4 of 30 tumor samples using PCR. HPV 16 DNA was found in 2 further tumors using in-situ hybridization. No HPV DNA could be found by Southern blot or dot blot in any tumor sample. The Southern blot assays were sensitive enough to detect clonally integrated HPV 16 DNA of length greater than 250 bp in the tumors. While HPV DNA is present in some oropharyngeal SCCs, there is no molecular evidence to support a causal association of HPV 16 gene products with continued tumor growth in oropharyngeal cancer.

Adult↗
PubMed1992

Post-irradiation cytology of cervical cancer patients.

The accuracy of cervicovaginal cytology following radiotherapy for cervical cancer is compromised by the anatomical and tissue changes resulting from irradiation. Collection of representative samples may be more difficult, and benign radiation changes, post-irradiation dysplasia, and the frequent occurrence of repair cells and active stromal cells in post-irradiation smears may cause diagnostic problems. Nevertheless, cytology is a valuable tool for the detection of locally recurrent cervical cancer. It is simple and economical to perform at the time of clinical follow-up examination, and may detect occult tumour recurrence. Awareness of the cellular changes resulting from irradiation, and the varied composition of post-irradiation smears may lead to more accurate interpretation of the cytological findings.

Carcinoma, Squamous Cell↗
PubMed1992

Invasive squamous cell carcinoma of the vulva: behaviour and results in the light of changing management regimens. A review of clinicohistological features predictive of regional lymph node involvement and local recurrence.

Ninety-nine patients with carcinoma of the vulva were referred to the Gynaecologic Oncology Unit, Royal Brisbane Hospital, over 10 years. Ninety of these patients had a squamous cell carcinoma (SCC). They were assessed by the 1969 FIGO clinical staging. Each stage was related to nodal involvement, size, depth, histological grade, lymphvascular space involvement, perineural permeation and multifocal disease site. The operability rate was 85%. Treatment was individualized in line with recent philosophies for more conservative surgery where appropriate. Mortality was 2.6%. Five-year survival of surgically treated patients was 60.3%; node negative patients 100%, and node positive patients 25.2%. After adjustment for stage and size, the only other independent statistically significant feature was perineural penetration. Local recurrence was more likely with increased stage and size, unclear margins and multifocal involvement. It is important to note that medically unfit patients who had vulvectomy alone and who later developed positive nodes had 100% mortality. This group of patients significantly decreases survival rates, confirming the importance of carrying out inguinofemoral lymphadenectomy at the time of initial surgery. Morbidity was decreased by conservative surgery. Lymphoedema remains the most common chronic complication. No significant difference was shown in local recurrence between different types of surgery, wide excision, hemivulvectomy, simple vulvectomy or radical vulvectomy (22%), confirming the safety of the more conservative approach of recent years.

Adult↗
PubMed1991

Recurrent benign mixed tumor of the vagina.

Recurrence of benign mixed tumors has not previously been reported. The case presented here describes this phenomenon 8 years after the original diagnosis was reported in this journal [D. W. Buntine, P. R. Henderson, and J. S. G. Riggs, Gynecol. Oncol. 8, 21-26 (1979)]. There has been no further recurrence in the 3 years since the recurrent tumor was removed. Careful follow-up of large primary benign mixed tumors of the vagina is recommended.

Female↗
PubMed1991

The accuracy of cervicovaginal cytology in the detection of recurrent cervical carcinoma following radiotherapy.

The accuracy of cervicovaginal cytology testing in the detection of recurrent cervical carcinoma was investigated by correlating clinical and histology records with cytology smear results for two groups of patients. All patients had been treated with radiotherapy, with or without pelvic surgery, for carcinoma of the uterine cervix. Abnormal cervicovaginal smear results were present for 45.7% (32/70) of patients with histologically diagnosed recurrent cervical carcinoma including a correct prediction of recurrent cervical carcinoma in 32.8% (23/70) of cases. A cytologic diagnosis of recurrent carcinoma was present for 48.9% (23/47) of cases with local recurrence. The positive predictive value for a histologic diagnosis of recurrent cervical carcinoma after a positive cytology report for a group of 61 patients was estimated to be 98.4%. A cytologic diagnosis of locally recurrent cervical carcinoma preceded clinical signs in 15/61 (24.6%) of cases. These results indicate that although cervicovaginal cytology after radiotherapy for cervical cancer does not have high sensitivity it is a reliable test for the diagnosis of local recurrence. Cytologic examination of the vaginal vault or cervix after treatment may thus provide an early diagnosis of tumor recurrence or persistence, in some cases prior to the onset of clinical signs.

Adenocarcinoma↗
PubMed1991

Squamous cell carcinoma arising in a case of vulvitis granulomatosa or vulval variant of Melkersson-Rosenthal syndrome.

A case of vulvitis granulomatosa or the vulval variant of Melkersson-Rosenthal syndrome (MRS) in a young adult patient with systemic lupus erythematosus is presented. She also had evidence of cervicovulvovaginal human papilloma virus (HPV) infection. Nine years later she developed a squamous cell carcinoma (SCC) of the vulva. HPV 6/11 was found by DNA in situ hybridization within a vulval condyloma as well as within the carcinoma. This case is unusual in that SCC associated with HPV 6/11 developed in her vulva affected by MRS rather than in the cervix, where SCC was more likely to occur considering this patient's age.

Adult↗
PubMed1991

A clinicopathological study of adenocarcinoma in situ of the cervix. The influence of cervical HPV infection and other factors, and the role of conservative surgery.

Adenocarcinoma in situ (ACIS) of the uterine cervix is an increasingly recognized disease. Thirty-seven cases were reviewed to determine the effect of HPV, marital status, parity, smoking habit and age on the topography and behaviour of this lesion. Using a commercial probe, 25% of 28 lesions tested were positive for HPV 16/18. The presence of HPV and a history of smoking appeared to exert no significant influence upon the topography and behaviour of ACIS. Nulliparity and a history of never being married was associated with a significant reduction in the incidence of coexisting CIN lesions. Age less than 36 years was associated with a significant reduction in the proximal linear extent of ACIS. While hysterectomy is probably the definitive treatment for ACIS of the cervix, there is an important place for conservative management by conization alone. Patients younger than 36 years are most likely to be desirous of retained fertility and appear to have the lesions most amenable to conservative surgery.

Adenocarcinoma↗
PubMed1990

Papillary carcinomas of the endometrium.

A retrospective study of patients with papillary endometrial carcinomas was performed. Of 761 patients with endometrial carcinomas treated at the Royal Brisbane Hospital between 1982 and 1989, 19 (2.4%) had papillary endometrial carcinoma (PEC) and 21 (2.8%) had papillary serous endometrial carcinoma (SPEC). Patients were similar in age and parity but survival was significantly poorer in cases of SPEC than PEC. Patients with SPEC had a 47% 3-year survival with surgically documented localized disease. Recurrences were mainly outside the field of adjuvant radiotherapy. It thus appears that local treatment is not sufficient and some form of systemic treatment is required.

Adenocarcinoma, Papillary↗
PubMed1990

Demonstration of two ovarian tumor-associated antigens in primary and metastatic breast, gastric, and colonic tumors.

The presence of two ovarian tumor-associated antigens (TAAs) defined by monoclonal antibodies BC3 and CC4 in primary and metastatic breast, gastric, and colonic malignant tumors was determined by immunohistochemistry. The BC3 TAA was present in all gastric, colonic, and breast tumors, typically with a large proportion of tumor cells expressing antigen. The CC4 TAA was present in most of these tumors, generally with a lower proportion of tumor cells expressing antigen compared with that of BC3. Both of these TAAs were found in some epithelial cells in normal breast, stomach, and colon, however, the location of the two TAAs in normal tissue was different. With the use of both antibodies, an increase in the number of tumor cell-positive lymph nodes was found in patients with breast, gastric, colonic, and ovarian tumors, including detection of micrometastases in nodes from patients considered node negative on purely morphologic grounds. Immunohistochemical detection of micrometastases derived from adenocarcinomas appears to be superior to purely morphologic detection.

Adenocarcinoma↗
PubMed1990

Comparative in situ hybridisation study of juvenile laryngeal papillomatosis in Papua New Guinea and Australia.

A comparative study of cases of juvenile laryngeal papillomatosis from Papua New Guinea (n = 3) and Brisbane, Australia (n = 9) was carried out. In situ hybridisation reactions for human papillomavirus (HPV) types 6 and 11 occurred in 11 cases. All three cases from Papua New Guinea and eight from Australia gave positive signals. A negative reaction was observed in one Australian case. The intensity of the reaction was strong in seven cases, moderate in one, and weak in three. An equivocal reaction was also noted with probes for types 16 and 18, and types 31, 33, and 35 in two cases from Australia and one from Papua New Guinea. It is concluded that as similar staining patterns and intensities occurred in cases from both areas, the aetiology is the same. The equivocal reactions noted in three cases were probably due to cross hybridisation rather than multiple infection.

Child↗
PubMed1989

Defining and measuring stabilization of patients during 4 years of intensive community support.

The first 4 years of an intensive community support program were evaluated in terms of key variables of patient stabilization. Patients (N = 196) had previously demonstrated an inability to manage themselves without repeated and/or lengthy hospitalizations. During program participation, there were significant reductions in hospital days and events (80%), jail incarcerations and charges, billings per patient, and stressful events. Patients reported increased satisfaction both with their lives and the program. The results support the value of continued multidimensional and multimethod examinations of patient stabilization.

Activities of Daily Living↗
PubMed1987

Patterns of case management activity in an intensive community support program: the first year.

Changes in activity patterns of 12 case managers over the first year of an intensive community support program are described and a method and format for the collection and analysis of time budget data in case management are presented. During the first six months of the program case managers recorded the predominant activity for each 15 minute period throughout the day. Mean values of proportional time were 35.3% for direct services, 40.3% for indirect services, and 24.4% for nonclinical services. The relatively high (64.7%) combination of indirect and nonclinical services deserves careful consideration in program cost analysis.

Adolescent↗
PubMed1987

The Pap smear revisited.

Papanicolaou smear screening for cervical cancer has become an established practice in most developed countries. This is because the cervix is relatively accessible to investigation and treatment, and early stages in the morphogenesis of cervical cancer are both recognizable and easily treated. The Pap smear is a valid test. It is simple, relatively inexpensive, reliable, and free of risk. Although the test has far from perfect sensitivity, it has high specificity, and false-positive results are rare. In most reported series, the majority of false-negative results have been found to be attributable to collection errors rather than laboratory errors. Despite the importance of Pap smear screening, controlled prospective trials have not been undertaken to determine its efficiency in reducing cervical cancer incidence and mortality. However, countries with well-organized programmes, wide population coverage and correct follow-up appear to have had some impact on mortality from cervical cancer. Nevertheless, coverage of high-risk groups, particularly women over 40 years of age, remains the greatest problem. Recommendations on the frequency of testing vary considerably. Statistical models indicate triennial testing may deliver almost all of the effectiveness of annual testing at a substantially reduced cost, but the numerous reports of false-negative results argue strongly in favour of annual screening. It is possible that these problems may be solved in the future by increasing the sensitivity of the test and/or by the use of additional tests.

Female↗