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Biomedical subjects

W B Jones

Publications and source records attributed to W B Jones.

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

Early invasive carcinoma of the cervix.

Ninety-two patients with early invasive carcinoma of the cervix (5 mm or less) treated between July 1977 and June 1990 are reviewed. Eighty patients had squamous cell carcinomas and 12 had adenocarcinomas. The diagnosis was established by conization in 77 of 92 (83.6%) patients. Thirty-six patients (39%) had a depth of stromal invasion of 1 mm or less, 32 patients (35%) between 1 and 3 mm, and 24 patients (26%) between 3 and 5 mm. Forty-four patients were treated with radical hysterectomy and bilateral pelvic lymphadenectomy (RHND). None of these patients had positive lymph nodes. Thirty-three patients were treated with conservative hysterectomy (CH), 4 with modified radical hysterectomy, and 2 with trachelectomy. Six patients received radiotherapy. Three patients were treated by conization only. Two patients developed in situ carcinoma (CIS) of the vagina 12 months after CH for lesions on conization that invaded less than 1 mm. In both cases the cone margins were positive, and in one a microscopic focus of CIS of the cervix was present at the resection margin of the hysterectomy specimen. A third patient developed an invasive lesion of the vagina 25 months after CH for a lesion that invaded 2.5 mm in a cone whose margins were not specified, but the hysterectomy margins were clear. All 3 patients were successfully retreated. The remaining patients are free of disease for a median follow-up of 51 months. The results of the study indicate that CH is adequate therapy for patients in whom the diagnosis of early invasive cervical cancer is established by conization with free margins and the depth of invasion is 3 mm or less. Although only 1 of 24 patients with invasion > 3 mm but < or = 5 mm had a CH, pathologic findings in 18 patients who had RHND suggest that CH would have been sufficient for these since there were no instances of spread to nodes or parametrium.

Adenocarcinoma↗
PubMed1993

Late recurrence of clear cell adenocarcinoma of the vagina and cervix: a report of three cases.

Three patients with clear cell adenocarcinomas who developed recurrent disease after a prolonged disease-free interval are presented. The first patient developed a recurrence in the lung 7 years and 3 months after wide local excision and pelvic radiotherapy for clear cell adenocarcinoma of the vagina. She then underwent thoracotomy and chemotherapy and has remained free of disease for more than 13 years after treatment of the recurrence. The second patient with clear cell adenocarcinoma of the vagina developed recurrent disease at the apex of the vagina 5 years after radical hysterectomy, bilateral pelvic lymphadenectomy, and partial vaginectomy. She then underwent exploratory laparotomy, partial vaginectomy, and vaginal irradiation and has been free of disease in follow-up for 6 months. The third patient underwent radical hysterectomy, bilateral pelvic lymphadenectomy, and total vaginectomy for clear cell adenocarcinoma of the cervix that also involved two-thirds of the vagina. Four years and 6 months after this operation, she underwent an exploratory laparotomy, with complete resection of recurrent disease in the abdomen in continuity with a left nephrectomy. Following surgery, she was treated with abdominal and pelvic radiotherapy and chemotherapy and remained clinically free of disease for 1 year, but subsequently developed an unresectable pelvic mass. Despite further chemotherapy, she died 5 years and 10 months after the initial diagnosis.

Abdominal Neoplasms↗
PubMed1993

Cutaneous larva migrans.

The case of cutaneous larva migrans presented here is typical for its mechanism and geographic location of infection, evolution of lesions, and prompt response to treatment. Except for pinworms, helminth infections are rarely thought of in emergency departments away from the areas where the parasites are especially prevalent. The several-day incubation period and modern-day ease of travel should place this illness on one's list of the differential diagnoses of pruritic lesions regardless of the location of practice. This case serves as a reminder that in a mobile society, diseases, as well as patients, can travel.

Adult↗
PubMed1993

Why "CARE"?

Explore the source record for details and available documents.

Contract Services↗
PubMed1993

Second-look laparotomy in carcinoma of the fallopian tube.

OBJECTIVE: To evaluate the role of second-look laparotomy following platinum-based chemotherapy in patients with fallopian tube cancer. METHODS: We conducted a retrospective chart review of 35 patients with tubal cancer who underwent a second-look laparotomy following cytoreductive surgery and platinum-based combination chemotherapy. RESULTS: The distribution by stage was as follows: I, three (9%); II, five (14%); III, 24 (69%); and IV, two (6%); one patient was inadequately staged. The tumor grade was recorded in 31 patients, and 80% of these were grade 2 or 3. Twenty-one of the 35 patients (60%) were found to be free of disease at second-look operation. Neither stage nor grade were predictive of findings at the second-look procedure, although none of the five patients with stage I disease and/or grade 1 tumor had disease found at second-look surgery. The absence of gross residual disease following primary surgery was the strongest predictor of disease-free status at second-look laparotomy (P < .01). With a mean follow-up of 50 months among the survivors, only four (19%) of the patients with no evidence of tumor at reexploration have had a recurrence. CONCLUSION: Second-look laparotomy provides useful prognostic information in patients with tubal cancer; approximately 80% of patients who have a negative second-look following platinum-based chemotherapy will remain disease-free.

Actuarial Analysis↗
PubMed1993

Second-look laparotomy in stage I ovarian cancer following comprehensive surgical staging.

OBJECTIVE: To evaluate the role of second-look laparotomy in patients with comprehensively staged stage I epithelial ovarian cancer. METHODS: We reviewed the medical records and obtained long-term follow-up on 54 stage I patients who had second-look laparotomies following complete surgical staging and chemotherapy. RESULTS: The distribution by stage was as follows: stage IA 18 (33%), stage IB two (4%), and stage IC 34 (63%). Eighteen patients (33%) had endometrioid tumors, 12 (22%) clear cell, 13 (24%) mucinous, eight (15%) serous, and three (6%) undifferentiated. Forty-four patients (82%) had grade 2 or 3 tumors. Thirty-eight (70%) were treated with platinum-based regimens and 16 (30%) received non-platinum regimens. At second-look laparotomy, tumor was identified in three women (5.5%). Stage, cell type, and grade did not predict the second-look laparotomy result, although no patient with a grade 1 tumor had a positive second-look laparotomy. With a mean follow-up of 48 months from second-look laparotomy, 11 women (22%) have had recurrences following negative second looks. Tumor grade was a strong predictor of recurrence following negative second-look laparotomy (P < .0001), with the risk of recurrence being 0% for grades 1 and 2 and 52% for grade 3. Substage, cell type, and chemotherapy type and duration did not predict recurrence. CONCLUSIONS: The likelihood of a positive second-look laparotomy is about 5% in well-staged stage I ovarian cancer. Patients with stage I, grade 3 tumors have a risk of recurrence of approximately 50% following negative second-look laparotomy.

Adult↗
PubMed1992

Randomized prospective trial of 5 versus 10 cycles of cyclophosphamide, doxorubicin, and cisplatin in advanced ovarian carcinoma.

Five versus ten cycles of cyclophosphamide, doxorubicin, and cisplatin (CAP) were compared in advanced ovarian carcinoma by a prospective randomized study of 78 patients, 41 receiving 5 cycles (CAP5) and 37 receiving 10 cycles (CAP10) of chemotherapy. Patients were stratified by histologic grade and size of residual disease. Cyclophosphamide, 600 mg/m2, doxorubicin, 40 mg/m2, and cisplatin, 100 mg/m2, were administered every 4 weeks for 5 or 10 cycles. Second-look laparotomy was performed to evaluate response and plan further therapy. CAP5 patients found a second-look laparotomy to have partially responded to chemotherapy were treated with 5 additional cycles of CAP. CAP10 was more toxic than CAP5 with respect to myelosuppression, hospital admissions for nadir fever, median elevation of creatinine, and degree of peripheral neuropathy. Median follow-up is 64 months. CAP5 and CAP10 were equivalent in surgically documented complete responses (34 versus 35%) and survival (P = 0.41). Twelve partial responders to CAP5 received additional CAP chemotherapy; one complete response resulted. We conclude that CAP5 is preferable to CAP10 in treatment of advanced ovarian cancer as it is equally effective and less toxic.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

Determination of gold-based antiarthritis drugs and their metabolites in urine by reversed-phase ion-pair chromatography with ICP-MS detection.

A sensitive method for the determination of gold-based drugs auranofin, myochrysine, and their metabolites has been developed. These gold-containing compounds were separated by reversed-phase ion-pair chromatography with tetrabutylammonium chloride as the ion-pairing agent. Gold-specific on-line detection utilized inductively coupled plasma mass spectrometry (ICP-MS). The separation conditions of pH, methanol content, concentration of the ion-pairing agent and ionic strength have been investigated. The detection limit for auranofin, the last peak in the chromatogram, was 0.3 ng. These methods were applied to the analysis of gold-containing species in urine from arthritis patients on auranofin, myochrysine or solganol therapy. The recovery of the total gold-containing species from urine was greater than 90%. Dicyanogold(I) anion, [Au(CN)2]-, was detected in the urine of several patients.

Auranofin↗
PubMed1991

Chemotherapy-induced neutropenia and fever in patients receiving cisplatin-based chemotherapy for ovarian malignancy.

Fifty-six episodes of chemotherapy-induced neutropenia and fever occurred in forty-three patients receiving cisplatin-based combination chemotherapy for ovarian cancer. All patients were treated with broad-spectrum antibiotics including gentamicin. Twelve of fifty-six episodes were associated with positive cultures; in six patients a single organism was isolated, and the other six patients had polymicrobial infection. The mean duration of antibiotic therapy was 6.5 days. One patient died of sepsis. Fifty-five episodes had a successful outcome. There was no antibiotic-related morbidity. Based on this review we recommend broad-spectrum antibiotic therapy for chemotherapy-induced neutropenia with fever. The regimen of gentamicin plus ticarcillin and clavulanic acid (ceftazidime for penicillin-allergic patients) is effective as initial therapy. Additional agents (i.e., vancomycin) may be necessary in culture-positive patients based on sensitivity testing of bacterial isolates. Gentamicin can be safely administered to patients receiving cisplatin-based chemotherapy without compromising ability to continue cisplatin therapy in subsequent treatment cycles.

Adult↗
PubMed1991

Intraperitoneal chemotherapy: analysis of complications with an implanted subcutaneous port and catheter system.

To determine the morbidity associated with delivery of intraperitoneal chemotherapy via subcutaneous semipermanent infusion catheters, we analyzed the data on 227 patients treated from April 1985 through December 1989. A total of 249 catheters were inserted and used to administer chemotherapy in these patients. There were 40 (17.6%) complications associated with the use of 230 original catheters, with 20 patients experiencing catheter inflow obstruction and 20 developing catheter-related infections; the latter group included 8 patients with bowel perforations. Although there was a trend toward an increase in catheter-related infections in association with large bowel surgery and appendectomies, sample size limited statistical analysis. There were 7 (36.8%) complications associated with the use of 19 replacement catheters. This rate was significantly increased (P = 0.03) when compared with the complication rate of original catheters. This system functions well and has an acceptable level of morbidity for delivery of intraperitoneal chemotherapy in gynecologic cancer patients.

Catheterization↗
PubMed1991

Cisplatin-based combination chemotherapy in carcinoma of the fallopian tube.

Forty-three cases of primary tubal adenocarcinoma were treated at Memorial Sloan-Kettering Cancer Center between 1979 and 1989. Thirty-eight patients who received cisplatin-based combination chemotherapy following primary surgery were reviewed. The mean patient age was 59 years, with 86% postmenopausal. Distribution by stage was as follows: I, 3 (7%); II, 4 (11%); III, 27 (71%); and IV, 4 (11%). Median follow-up from the time of diagnosis was 62 months (range, 5-132). Overall survival for all 38 patients by Kaplan-Meier analysis was 51% at 5 years. Excluding stage I, patients with no residual disease following surgery had a significantly higher 5-year survival (83%) than those left with gross residual disease (28%). Twenty-six patients underwent a second-look procedure. Of the 21 patients with advanced (stages III, IV) disease undergoing reexploration, 11 (52%) had a negative second-look and 10 (48%) were positive. Ten of the eleven patients with a negative second-look remain clinically free of disease with a median follow-up of 49 months. One patient with stage III disease had recurred after 47 months. Carcinoma of the fallopian tube appears to respond favorably to cisplatin-based multiagent chemotherapy. Patients with advanced-stage disease who achieve a negative second-look appear to have an improved possibility of remaining disease-free over similar-stage patients with ovarian cancer.

Adult↗
PubMed1990

Genetic origin of a trophoblastic choriocarcinoma.

Gestational choriocarcinoma can follow a term birth, a nonmolar abortion, or a complete hydatidiform mole. Among hydatidiform moles, heterozygous ones resulting from fertilization of an egg devoid of a nucleus by a diploid sperm (XY) or by dispermy (XX or XY) have been suggested to carry an increased predisposition to transformation to choriocarcinoma. Data on genetic analysis of choriocarcinoma are meager, being limited to cytogenetic analysis of a handful of established cell lines. Although the majority of these were heterozygous, antecedent pregnancies or molar tissues have not been investigated in any of them to clearly establish their genetic origin. We present here the results of a study of chromosomal heteromorphisms and DNA restriction fragment length polymorphisms in a choriocarcinoma, the host, her spouse, and her son from the antecedent pregnancy. Our data show that the choriocarcinoma in this case most probably arose from the product of the same fertilization that led to the antecedent pregnancy.

Adult↗
PubMed1990

Gestational trophoblastic disease: what have we learned in the past decade?

Hydatidiform moles can be classified into two distinct entities: complete and partial. Complete moles are androgenetically derived, are characterized by a predominance of the 46,XX karyotype, and are associated with a significantly higher incidence of malignant sequelae than are partial moles. A subset of complete moles resulting from dispermy are heterozygous (46,XY) and appear to be associated with the greatest risk of malignancy. Free subunits of human chorionic gonadotropin, beta core fragments, and acidic variants of human chorionic gonadotropin can now be readily measured by radioimmunoassays, fluoroimmunoassays, or isoelectric focusing techniques. Determination of these markers can be of value not only in monitoring response to therapy, but also as prognostic indicators. A subgroup of patients, traditionally classified as "high risk" or poor prognosis, who show poor responses to conventional combination chemotherapy have recently been designated as "ultra-high-risk" patients. They require more complex chemotherapy and possibly surgery and radiotherapy to achieve remission. The development of chemotherapy over the past decade, including the introduction of etoposide and cisplatin into current protocols and the treatment of patients with advanced gestational trophoblastic disease, are considered in this review.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

Intracerebral choriocarcinoma.

Nineteen patients with gestational trophoblastic disease (GTD) metastatic to the brain are reviewed. These patients constituted 9.0% of 210 [corrected] patients with GTD treated between November 1967 and December 1987. Four patients (21%) presented with primary neurological symptoms of GTD; four patients developed brain metastases during or after treatment with first drug(s) therapy; and 11 patients developed CNS metastases after resistance to initial chemotherapy. The initial chemotherapy in three of four patients who presented with brain metastases was with the combination of methotrexate, actinomycin D, and chlorambucil (MAC). Of the 15 patients who developed brain metastases after prior chemotherapy, 12 had received MAC at least once prior to the diagnosis of brain metastases, and in 5 patients, MAC was the first chemotherapy given after the diagnosis of brain metastases. All of the patients received whole-brain radiotherapy. Five of nineteen patients (26.3%) are living and well 4 to 15 years after the diagnosis of brain metastases. One of four patients (25%) who presented with brain metastases survived. These results suggest that MAC chemotherapy did not prevent the development of brain metastases in some of the patients and was less than optimal therapy in those whose brain tumor had become resistant to other cytotoxic agents.

Adult↗
PubMed1990

Aggressive chemosurgical debulking in patients with advanced ovarian cancer.

From July 1986 to June 1989, 43 evaluable patients with advanced ovarian cancer were treated on protocol with initial cytoreductive surgery, two courses of high-intensity intravenous Cytoxan (1000 mg/m2) and cisplatin (120-200 mg/m2) chemotherapy, and repeat debulking laparotomy in an effort to maximize response to a subsequent four cycles of intraperitoneal platinum-based chemotherapy. Two patients were stage IIIA, 2 stage IIIB, 28 stage IIIC, and 11 stage IV. Five tumors were grade 1, 9 grade 2, and 29 grade 3. Thirty-eight (88%) patients had bulky tumor (5-25 cm) found at first laparotomy; 25 of these had greater than 1-cm residual after initial debulking. Following two cycles of intensive intravenous chemotherapy 18 of these 25 had greater than 1-cm disease found at second laparotomy; 12 of 18 underwent secondary cytoreduction to less than 1 cm. Thus, 30 of these 38 (79%) patients entered the intraperitoneal phase of the protocol with less than 1-cm disease. Four patients had 2- to 5-cm tumor at initial laparotomy; two of four were debulked to less than 1-cm residual. All four were found to have less than 1-cm disease at second laparotomy. This combination regimen was well tolerated. There was one treatment-related death. In sum, 42 of 43 patients had tumor greater than 2 cm at staging laparotomy and 38 (88%) had large, bulky disease (5-25 cm); 34 of 43 (79%) entered the intraperitoneal phase of the protocol with optimal (less than 1-cm) disease. Aggressive chemosurgical cytoreduction in patients with bulky advanced ovarian cancer can leave a large proportion of patients with minimal residual disease and maximize their chances of responding to subsequent intraperitoneal chemotherapy.

Cisplatin↗
PubMed1990

Paget's disease of the vulva.

Thirty-six patients with Paget's disease of the vulva were reviewed. Median age of the patients at diagnosis was 64 years (range 41-84 years). Five patients (14%) had an associated invasive adenocarcinoma of the vulva at the time of diagnosis. Of 31 patients with superficial noninvasive Paget's disease, 28 were available for follow-up. Treatment of patients with superficial Paget's disease was surgical and based on the extent of disease. Procedures performed included total vulvectomy (25), wide local excision (4), and skinning vulvectomy with skin graft (1). The median follow-up was 108 months (range 6-266 months). Twenty-two of twenty-eight patients remained free of disease. Six patients have required multiple procedures for recurrent superficial Paget's disease. Treatment of Paget's disease of the vulva is surgical. Radical surgery is the preferred treatment of patients with an associated invasive adenocarcinoma; three of five patients with an invasive adenocarcinoma were long-term survivors. Patients with superficial Paget's disease of the vulva should be treated by local excision utilizing frozen-section margin evaluation as a guide to extent of excision. Only one patient with an initial diagnosis of superficial Paget's disease of the vulva developed invasive adenocarcinoma.

Adenocarcinoma↗
PubMed1989

Influence of secondary cytoreduction at the time of second-look laparotomy on the survival of patients with epithelial ovarian carcinoma.

The value of secondary cytoreductive surgery at the time of second-look laparotomy in patients with epithelial ovarian carcinoma is not established. Sixty-seven patients with residual carcinoma found at the time of second-look laparotomy performed at Memorial Sloan-Kettering Cancer Center between December 1, 1978, and May 30, 1986, were evaluated for survival relative to the success of secondary cytoreductive surgery. At second-look laparotomy, 17 patients had microscopic disease, 28 patients had disease less than 2 cm and 22 patients had disease greater than 2 cm. After secondary cytoreductive surgery 33 patients had microscopic disease, 26 patients had disease less than 2 cm, and 7 patients had disease greater than 2 cm (1 unknown). Five-year survival by Kaplan-Meier calculation was 62% for patients found to have microscopic disease at second-look laparotomy and 51% for patients whose disease was rendered microscopic by secondary cytoreductive surgery (P = 0.55). Patients left with gross disease (either less than or greater than 2 cm) had 5-year survivals of less than 10% (P = 0.013 compared with microscopic residual). Secondary cytoreductive surgery at the time of second-look laparotomy in patients with epithelial ovarian carcinoma may result in improved survival of patients who are reduced to microscopic residual disease.

Adult↗