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Biomedical subjects

V C Wright

Publications and source records attributed to V C Wright.

36 records · Page 2Linked to original sources
PubMed1984

Carbon dioxide laser surgery for cervical intraepithelial neoplasia.

During 1977-1983, 787 consecutive referred cases of CIN were treated by vaporization of a dome-shaped defect, by excision of a cylindrical specimen, or a combination of procedures where 48% were CIN III. Vaporization was used for 72% of CIN I, 76% of CIN II, and 64% of CIN III cases. Less than 15% of vaporization and all excision cases were done in hospital under anesthesia; 11% had delayed bleeding requiring attention (admission was required in 2%); 100% of CIN I, 96% of CIN II, and 96% of CIN III cases were cured. Persistent disease was diagnosed at the first (96%) or second (4%) visit. Subsequent treatment included laser and less than 1% hysterectomy. Overall cure for laser surgery was 99.5%. Sixty-eight patients subsequently became pregnant; outcomes were normally distributed. Treatment success is related to adequate volume of tissue removed.

Adult↗
PubMed1983

Laser surgery for cervical intraepithelial neoplasia: principles and results.

Four hundred twenty-nine consecutive cases of cervical intraepithelial neoplasia were managed by one of three techniques of carbon dioxide laser surgery: dome-shaped vaporization of ectocervical lesions, cylinder-shaped excision of endocervical disease, or a combination of the two in the case of ectocervical disease that extended into the lower cervical canal. Ninety-two patients (21.5%) had grade 1, 137 (31.9%) had grade 2, and 200 (46.6%) had grade 3 cervical intraepithelial neoplasia. The success rates subsequent to one surgical intervention were 97.8% for grade 1, 94.9% for grade 2, and 94.5% for grade 3 of the disease. Success for the entire patient population was 95.3% after the first treatment. A second treatment was required in 20 cases: 18 laser procedures and two hysterectomies. The overall success of laser surgery (one or two procedures) approached 100%. Complications were negligible. These findings suggest that these techniques are very effective in eliminating cervical intraepithelial neoplasia of all degrees when a planned approach is followed.

Carbon Dioxide↗
PubMed1982

Age at time of first intercourse v. chronologic age as a basis for Pap smear screening.

The Walton Report on cervical cancer screening programs recently recommended a new program for screening for cervical cancer based on chronologic age, calling for 3- and 5-year intervals between examinations. It recommended that such examinations be discontinued after 60 years of age. In a group of 232 routinely examined women (aged 18 to 47 years) in whom cervical intraepithelial neoplasia developed the timing of onset of the disease and the implications for screening were studied. The average age at the time of diagnosis was 30 years; in 20% of the patients the diagnosis had been made after age 35. The screening program recommended in the Walton Report would have been effective in diagnosing most cases (80%) in this sample by age 35 and all by age 60. However, when the patients were grouped according to age at the time of first intercourse, the diagnosis had been made after age 35 in only 13% of those who started having intercourse at age 15 to 17 years, 20% of those who started at age 18 to 19 years and 33% of those who started at age 20 years of later. When the times of diagnosis were expressed by number of years of intercourse the distributions became uniform in the same three groups; in 72% of all the patients the diagnosis had been made within the first 15 years of intercourse, in 88% it had been made within 20 years and in 100% it had been made by 30 years. These data suggest that a program based on number of years of intercourse may be more uniform and more efficient than one based on chronologic age, and that cytologic examinations should be concentrated during the time when most cases develop -- 6 to 20 years after the time of first intercourse.

Adolescent↗
PubMed1982

Laser surgery: using the carbon dioxide laser.

In 1917 Einstein theorized tha through an atomic process a unique kind of electromagnetic radiation could be produced by stimulated emission. When such radiation is in the optical or infrared spectrum it is termed laser (light amplification by stimulated emission of radiation) light. A laser, a high-intensity light source, emits a nearly parallel electromagnetic beam of energy at a given wavelength that can be captured by a lens and concentrated in the focal spot. The wavelength determines how the laser will be used. The carbon dioxide laser is now successfully employed for some surgical procedures in gynecology, otorhinolaryngology, neurosurgery, and plastic and general surgery. The CO2 laser beam is directed through the viewing system of an operating microscope or through a hand-held laser component. Its basic action in tissue is thermal vaporization; it causes minimal damage to adjacent tissues. Surgeons require special training in the basic methods and techniques of laser surgery, as well as in the safety standards that must be observed.

Humans↗
PubMed1982

The management of cervical intraepithelial neoplasia: the use of the carbon dioxide laser.

This report concerns the experience of an abnormal Pap smear clinic in treating cervical intraepithelial neoplasia (CIN). The CO2 laser was the primary treatment method in 283 consecutive cases during 1977-1981, which fulfilled the criteria for conservative management. Seven percent of cases were performed in hospital as out-patients; the remainder were performed in the clinic without anesthesia. The location and shape of the defect was individualized in each case to conform to the topography of the cervix. The basic configuration, however, was the same for all cases; a dome-shaped defect with a curved apex and straight sides of at least 6 mm in height. Laser surgery was well tolerated; few post-operative complications arose. The squamocolumnar junction reappeared in each case at the level of the external os, facilitating follow-up. Eleven cases (3.9%) exhibited persistent disease within 3 months of primary treatment. Thereafter no primary laser failures occurred. Follow-up in this series ranged from 18 to 36 months. Failure rates for CIN grades are as follows: CIN I, 1.3%; CIN II, 2.0%; CIN III, 7.3%. No case of persistent disease was of greater severity than was originally diagnosed. Ten of the 11 cases were successfully managed with repeat laser surgery, yielding an overall therapeutic success rate of 99.6%. These data indicate that laser surgery is the most efficacious conservative method for eradicating this disease.

Carbon Dioxide↗
PubMed1981

Carbon dioxide laser management of cervical intraepithelial neoplasia.

In this report we describe the use of the carbon dioxide laser for the outpatient management of cervical intraepithelial neoplasia (CIN). A comparison of treatment effectiveness for different grades of CIN is also included. Two hundred fifty-six cases were evaluated by colposcopy, cytology, and histopathology, treated by at least 5 to 6 mm of laser vaporization, and followed up for an average of 10.7 months. Follow-up examinations included cytology, colposcopy, and directed biopsy if a suspicious lesion was discovered. During the follow-up, 18 cases of persistent CIN were identified (7.0%). Most of these were successfully managed with repeat laser treatment. Overall success of laser surgery for CIN, one or two applications, was 97.6%. Few complications were encountered. Laser surgery appears to offer acceptable treatment effectiveness, early identification of persistent disease, and easy retreatment when required.

Carbon Dioxide↗
PubMed1981

The conservative management of cervical intraepithelial neoplasia: the use of cryosurgery and the carbon dioxide laser.

This study comprises 336 consecutive patients of whom 283 were candidates for conservative therapy involving either cryosurgery or the carbon dioxide laser for the management of cervical intraepithelial neoplasia (CIN). A total of 152 patients were treated first in the series with cryosurgery followed by 131 patients in the laser group. Distribution of disease classification within CIN groups was similar. The overall persistent disease after one treatment was higher in the cryo group (14.5 per cent) as compared to the laser group (3.1 per cent). Of particular significance is the high percentage of failures in the cryo treated group (25.0 per cent) with CIN III disease as compared to the CIN III laser treated group (7.7 per cent). The high persistent disease rate observed in the CIN III lesions treated by cryosurgery suggests that this modality be employed with caution in this disease classification.

Carbon Dioxide↗
PubMed1980

Use of a topical triple-antibiotic spray to reduce morbidity from pelvic infection after gynecologic operations.

To study the effect of a topical antibiotic spray in reducing postoperative morbidity when used during surgery, a randomized, double-blind study was done on 150 women who had a vaginal hysterectomy with or without colporrhaphy. The spray contained neomycin sulfate, polymyxin B sulfate and zinc bacitracin and was used in 75 patients; a placebo spray was used in the other 75 patients. The antibiotic spray significantly (P < 0.01) decreased the frequency of pelvic infections postoperatively--14.7% in the antibiotic group compared with 37.3% in the placebo group.

Aerosols↗
PubMed1978

Use of a topical antibiotic spray in vaginal surgery.

During vaginal hysterectomy with or without colporrhaphy a topical aerosol spray containing neomycin sulfate, polymyxin B sulfate and zinc bacitracin was used in 50 patients to decrease the change of postoperative pelvic infection; a placebo spray was used in another 50 patients. All patients were treated preoperatively with povidone iodine and postoperatively with nitrofurantoin and an antibacterial irrigating solution for the bladder if catheter drainage was necessary. The frequency of postoperative pelvic infection was 16% in the group sprayed with the antibiotic combination and 34% in the group sprayed with the placebo, a significant difference (P less than 0.05).

Administration, Topical↗
PubMed1976

Carcinoma of the vulva.

Carcinoma of the vulva often presents as a large ulcerating or fungating tumor with considerable destruction of the vulva and surrounding tissues. The area usually is very painful and foul smelling. Most such tumors are of the squamous-cell variety. Despite the degree of histologic differentiation, the lymph nodes are involved in more than 50% of the cases. The best therapeutic results are obtained with radical vulvectomy and groin node dissection "en bloc." Occasionally treatment should be modified in the geriatric patient because of associated medical problems. Various techniques are discussed. Since the disease is rare, best results are achieved by referral to a specialized treatment center.

Aged↗
PubMedDate not supplied

Intraepithelial neoplasia of the lower female genital tract: etiology, investigation, and management.

Lower genital tract neoplasia appears associated with certain types of the human papilloma virus. Surgical approaches using lasers and electricity are available to treat the clinical diseases and in turn provide good cosmetic and functional anatomy. The surgical method employed depends upon the anatomical and histological distribution of disease regardless of its site. Of the three areas (cervix, vagina and vulva), cervical intraepithelial neoplasia is the least difficult to cure. Vulvar intraepithelial neoplasia is the most difficult since recurrences can occur at any time and in some patients for many years.

Carcinoma in Situ↗