Browse Health
Obstetrician & Gynecologist / Oncologist
10 years of experience
Accepting new patients


Education ?

Medical School Score
New York Medical College (2001)

Awards & Distinctions ?

Medical Honor Society - Alpha Omega Alpha, New York Medical College
Scholarship - Thirteenth Winter Meeting of the Society of Gynecologic Oncologists
Mayo Clinic, Certificate in Clinical and Translational Science
Award - The Sanford Sall, M.D. Award in Obstetrics and Gynecology, New York Medical College (2001)
Award - The Sanford Sall, M.D. Award in Obstetrics and Gynecology, New York Medical College
Medical Honor Society - Alpha Omega Alpha, New York Medical College (2001)
Scholarship - Thirteenth Winter Meeting of the Society of Gynecologic Oncologists (2008)
Speaker of the Month - Mayo Outreach to Students and Teachers, Mayo Clinic (2006)
Patients' Choice Award (2012)
Compassionate Doctor Recognition (2012)
University of Texas Southwestern Medical Center (2009 - Present)
Assistant Professor
Society of Gynecologic Oncology
American Board of Obstetrics and Gynecology

Affiliations ?

Dr. Richardson is affiliated with 6 hospitals.

Hospital Affiliations



  • UT Southwestern University Hospital - Zale Lipshy
    5151 Harry Hines Blvd, Dallas, TX 75235
    Top 25%
  • UT Southwestern University Hospital - St. Paul
    Medical Oncology
    5909 Harry Hines Blvd, Dallas, TX 75235
  • Parkland Hospital
  • University Hospital Zale Lipshy
  • UT Southwestern St. Paul Hospital
  • University Hospital St. Paul
  • Publications & Research

    Dr. Richardson has contributed to 61 publications.
    Title Competency-based Medical Education: Theory to Practice.
    Date December 2010
    Journal Medical Teacher

    Although competency-based medical education (CBME) has attracted renewed interest in recent years among educators and policy-makers in the health care professions, there is little agreement on many aspects of this paradigm. We convened a unique partnership - the International CBME Collaborators - to examine conceptual issues and current debates in CBME. We engaged in a multi-stage group process and held a consensus conference with the aim of reviewing the scholarly literature of competency-based medical education, identifying controversies in need of clarification, proposing definitions and concepts that could be useful to educators across many jurisdictions, and exploring future directions for this approach to preparing health professionals. In this paper, we describe the evolution of CBME from the outcomes movement in the 20th century to a renewed approach that, focused on accountability and curricular outcomes and organized around competencies, promotes greater learner-centredness and de-emphasizes time-based curricular design. In this paradigm, competence and related terms are redefined to emphasize their multi-dimensional, dynamic, developmental, and contextual nature. CBME therefore has significant implications for the planning of medical curricula and will have an important impact in reshaping the enterprise of medical education. We elaborate on this emerging CBME approach and its related concepts, and invite medical educators everywhere to enter into further dialogue about the promise and the potential perils of competency-based medical curricula for the 21st century.

    Title Competency-based Medical Education in Postgraduate Medical Education.
    Date December 2010
    Journal Medical Teacher

    With the introduction of Tomorrow's Doctors in 1993, medical education began the transition from a time- and process-based system to a competency-based training framework. Implementing competency-based training in postgraduate medical education poses many challenges but ultimately requires a demonstration that the learner is truly competent to progress in training or to the next phase of a professional career. Making this transition requires change at virtually all levels of postgraduate training. Key components of this change include the development of valid and reliable assessment tools such as work-based assessment using direct observation, frequent formative feedback, and learner self-directed assessment; active involvement of the learner in the educational process; and intensive faculty development that addresses curricular design and the assessment of competency.

    Title Robotic Pelvic and Aortic Lymphadenectomy for Endometrial Cancer: the Console Surgeon's Perspectives on Surgical Technique and Directing the Assistant.
    Date July 2010
    Journal Journal of Minimally Invasive Gynecology

    Our purpose is to describe and demonstrate basic console dissection techniques in robotic hysterectomy, aortic and pelvic lymphadenectomy for endometrial carcinoma, and efficient methods to direct the assistant.

    Title Which Factors Predict Bowel Complications in Patients with Recurrent Epithelial Ovarian Cancer Being Treated with Bevacizumab?
    Date June 2010
    Journal Gynecologic Oncology

    Increased rates of bowel perforation in patients with recurrent epithelial ovarian cancer (EOC) treated with bevacizumab have been reported, but the risk factors for this association are uncertain. We sought to identify factors associated with bowel perforation and fistula formation in recurrent EOC patients treated with bevacizumab.

    Title Outpatient Platinum-taxane Intraperitoneal Chemotherapy Regimen for Ovarian Cancer.
    Date December 2009
    Journal International Journal of Gynecological Cancer : Official Journal of the International Gynecological Cancer Society

    Intraperitoneal (IP) chemotherapy is associated with an improved survival at the expense of increased toxicity in optimally debulked ovarian cancer patients. We describe the toxicity profile of an outpatient regimen of an intravenous (IV) and IP taxane-platinum chemotherapy.

    Title Sustained Progression-free Survival with Weekly Paclitaxel and Bevacizumab in Recurrent Ovarian Cancer.
    Date November 2009
    Journal Gynecologic Oncology

    To determine efficacy, toxicity, and survival in patients with recurrent epithelial ovarian cancer (EOC) receiving combination of weekly paclitaxel and biweekly bevacizumab (PB).

    Title Metastatic Squamous Cell Carcinoma of the Vulva to the Lung Confirmed with Allelotyping.
    Date November 2009
    Journal International Journal of Gynecological Pathology : Official Journal of the International Society of Gynecological Pathologists

    A squamous-cell carcinoma (SCC) of the lung can be indistinguishable from metastatic SCC of gynecologic origin using common histopathologic techniques; however, establishing tumor origin can be clinically relevant. A patient with a Bartholin gland SCC was found to also have a pulmonary SCC, concerning for metastasis versus synchronous pulmonary primary. Hematoxylin and eosin and immunohistochemistry alone could not differentiate the lesion, and both tumors were human papilloma virus positive. Allelotyping for loss of heterozygosity established the pulmonary lesion as a rare event of vulvar pulmonary metastasis. The patient received palliative chemotherapy instead of curative treatment. Allelotyping for loss of heterozygosity is an effective tool to establish metastasis versus synchronous primary tumors in the presence of multiple lesions, helping to direct appropriate clinical management.

    Title A Detailed Analysis of the Learning Curve: Robotic Hysterectomy and Pelvic-aortic Lymphadenectomy for Endometrial Cancer.
    Date July 2009
    Journal Gynecologic Oncology

    To define the learning curve for robotic hysterectomy and pelvic-aortic lymphadenectomy for endometrial carcinoma.

    Title Paratubal Borderline Serous Tumors.
    Date March 2009
    Journal Gynecologic Oncology

    While ovarian borderline tumors are common, their fallopian tube counterparts are extremely rare. We describe the first case of a serous borderline paratubal tumor with a review of the literature on paratubal and tubal low malignant potential tumors.

    Title Influence of Intraoperative Capsule Rupture on Outcomes in Stage I Epithelial Ovarian Cancer.
    Date February 2009
    Journal Obstetrics and Gynecology

    To evaluate the effect of tumor capsule rupture on disease prognosis in stage I epithelial ovarian cancer.

    Title Spontaneous Rupture of the Oesophagus.
    Date September 2008
    Journal The British Journal of Surgery

    BACKGROUND: The aim of this study was to evaluate the diagnosis, management and outcome of patients with spontaneous rupture of the oesophagus in a single centre. METHODS: Between October 1993 and May 2007, 51 consecutive patients with spontaneous oesophageal rupture were evaluated with contrast radiology and flexible endoscopy. Patients with limited contamination who fulfilled specific criteria were managed by a non-operative approach, whereas the remainder underwent thoracotomy. RESULTS: The median time to diagnosis was 24 (range 4-604) h. Initial diagnosis was by contrast swallow in 18 of 24 patients, computed tomography in 15 of 17 and endoscopy in 18 of 18. There were no deaths among 17 patients who were managed non-operatively with targeted drainage, intravenous antimicrobials, nasogastric decompression and enteral nutrition. Of 31 patients who underwent primary thoracotomy and oesophageal repair (over a Ttube in 29), 11 died in hospital. Three patients could not be resuscitated adequately and did not have surgical intervention. CONCLUSION: Spontaneous oesophageal rupture represents a spectrum of disease. Accurate radiological and endoscopic evaluation can identify those suitable for radical non-operative treatment and those who require thoracotomy.

    Title Endoscopic Ultrasonography-detected Low-volume Ascites As a Predictor of Inoperability for Oesophagogastric Cancer.
    Date September 2008
    Journal The British Journal of Surgery

    BACKGROUND: Endoscopic ultrasonography (EUS) can detect low-volume ascites (LVA) not apparent on computed tomography. The aim of this study was to assess the importance of LVA for management of patients with oesophagogastric (OG) cancer. METHODS: Patients with LVA were identified from a prospective OG cancer unit database between January 2002 and January 2006. RESULTS: Of 1118 patients staged with OG cancer, 802 had EUS. The incidence of LVA was 8.4 per cent overall but fell to 6.5 per cent when those with metastases on computed tomography were excluded. Only patients with gastric and OG junction carcinoma had LVA. Staging laparoscopy in the 21 patients with LVA revealed that 11 (52 per cent) were inoperable. The remainder had laparotomy and complete (R0) resection was possible in only five (50 per cent). In 106 patients who had staging laparoscopy after EUS without LVA, 37 (34.9 per cent) were inoperable and 56 of the remaining 69 (81 per cent) had R0 resection. CONCLUSION: The presence of LVA on EUS is uncommon in patients with OG cancer but very important, being indicative of incurable disease in 76 per cent. This information will be helpful in counselling patients regarding management options and the low likelihood of potentially curative treatment.

    Title Human Inter-individual Variability in Metabolism and Genotoxic Response to Zidovudine.
    Date June 2008
    Journal Toxicology and Applied Pharmacology

    A mainstay of the antiretroviral drugs used for therapy of HIV-1, zidovudine (AZT) is genotoxic and becomes incorporated into DNA. Here we explored host inter-individual variability in AZT-DNA incorporation, by AZT radioimmunoassay (RIA), using 19 different strains of normal human mammary epithelial cells (NHMECs) exposed for 24 h to 200 microM AZT. Twelve of the 19 NHMEC strains showed detectable AZT-DNA incorporation levels (16 to 259 molecules of AZT/10(6) nucleotides), while 7 NHMEC strains did not show detectable AZT-DNA incorporation. In order to explore the basis for this variability, we compared the 2 NHMEC strains that showed the highest levels of AZT-DNA incorporation (H1 and H2) with 2 strains showing no detectable AZT-DNA incorporation (L1 and L2). All 4 strains had similar (> or =80%) cell survival, low levels of accumulation of cells in S-phase, and no relevant differences in response to the direct-acting mutagen bleomycin (BLM). Finally, when levels of thymidine kinase 1 (TK1), the first enzyme in the pathway for incorporation of AZT into DNA, were determined by Western blot analysis in all 19 NHMEC strains at 24 h of AZT exposure, higher TK1 protein levels were found in the 12 strains showing AZT-DNA incorporation, compared to the 7 showing no incorporation (p=0.0005, Mann-Whitney test). Furthermore, strains L1 and L2, which did not show AZT-DNA incorporation at 24 h, did have measurable incorporation by 48 and 72 h. These data suggest that variability in AZT-DNA incorporation may be modulated by inter-individual differences in the rate of induction of TK1 in response to AZT exposure.

    Title Transcriptional Profiles of Benzo(a)pyrene Exposure in Normal Human Mammary Epithelial Cells in the Absence or Presence of Chlorophyllin.
    Date May 2008
    Journal Mutation Research

    Benzo(a)pyrene (BP) exposure causes alterations in gene expression in normal human mammary epithelial cells (NHMECs). This study used Affymetrix Hu-Gene133A arrays, with 14,500 genes represented, to evaluate modulation of BP-induced gene expression by chlorophyllin in six NHMEC strains derived from different donors. A major goal was to seek potential biomarkers of carcinogen exposure and how they behave in the presence of a chemopreventive agent. NHMECs (passage 6 and 70% confluence) were exposed for 24h to either vehicle control, or BP, or chlorophyllin followed by BP and chlorophyllin together. BP exposure resulted in approximately 3-fold altered expression of 49 genes in at least one of the six NHMEC strains. When cells were exposed to chlorophyllin pre-treatment followed by BP plus chlorophyllin, expression of 125 genes was similarly altered. Genes in the functional categories of xenobiotic metabolism, cell signaling, cell motility, cell proliferation, cellular transcription, metabolism, cell cycle control, apoptosis and DNA repair were identified. Only CYP1B1 and ALDH1A3 were consistently up-regulated by approximately 3-fold in most of the cell strains (at least 4) when exposed to BP. Cluster analysis identified a suite of 13 genes induced by BP where induction was mitigated in the presence of chlorophyllin. Additionally, cluster analysis identified a suite of 16 genes down-regulated by BP where induction was partially restored in the presence of chlorophyllin.

    Title The Case for Treating Tobacco Dependence As a Chronic Disease.
    Date April 2008
    Journal Annals of Internal Medicine

    Smoking remains the leading cause of preventable death in the United States, yet it is still regarded by many as merely a bad habit. Most smokers want to quit but find it difficult. Behavioral counseling and pharmacotherapies are available, safe, and effective in the treatment of tobacco dependence. Nicotine replacement therapy effectively delivers nicotine in safer doses without exposure to the toxins and chemicals in cigarette smoke. The optimal duration of tobacco dependence treatment is unknown, and some smokers may require extended courses. For smokers using long-term cessation medications, health care providers should encourage treatment and insurance carriers should cover it. Both tobacco dependence and such conditions as diabetes are similar in their potential to exacerbate other diseases, their behavioral components of treatment, and their effectiveness of medications. Despite these similarities, treatments for diabetes are well covered by insurance, whereas tobacco dependence treatments are often limited. Tobacco dependence should share the status of other chronic illnesses, with effective treatments given as long as is necessary to achieve successful clinical outcomes.

    Title Panniculectomy Concurrent with Anterior Pelvic Exenteration for Recurrent Cervical Cancer.
    Date February 2008
    Journal Gynecologic Oncology

    BACKGROUND: Panniculectomy concurrent with gynecologic cancer surgery is safe and facilitates pelvic exposure in the morbidly obese patient. CASE: A 41-year-old morbidly obese female is diagnosed with recurrent adenocarcinoma of the cervix and has previously been treated with teletherapy and brachytherapy. She undergoes an anterior pelvic exenteration for curative intent. CONCLUSION: Panniculectomy at the time of pelvic exenteration is feasible. Morbidly obese patients with recurrent cervical cancer after treatment with pelvic radiation should be considered candidates for curative surgery.

    Title Comprehensive Gene Expression Profiling of Rat Lung Reveals Distinct Acute and Chronic Responses to Cigarette Smoke Inhalation.
    Date December 2007
    Journal American Journal of Physiology. Lung Cellular and Molecular Physiology

    Chronic obstructive pulmonary disease (COPD) is a smoking-related disease that lacks effective therapies due partly to the poor understanding of disease pathogenesis. The aim of this study was to identify molecular pathways that could be responsible for the damaging consequences of smoking. To do this, we employed Gene Set Enrichment Analysis to analyze differences in global gene expression, which we then related to the pathological changes induced by cigarette smoke (CS). Sprague-Dawley rats were exposed to whole body CS for 1 day and for various periods up to 8 mo. Gene Set Enrichment Analysis of microarray data identified that metabolic processes were most significantly increased early in the response to CS. Gene sets involved in stress response and inflammation were also upregulated. CS exposure increased neutrophil chemokines, cytokines, and proteases (MMP-12) linked to the pathogenesis of COPD. After a transient acute response, the CS-exposed rats developed a distinct molecular signature after 2 wk, which was followed by the chronic phase of the response. During this phase, gene sets related to immunity and defense progressively increased and predominated at the later time points in smoke-exposed rats. Chronic CS inhalation recapitulated many of the phenotypic changes observed in COPD patients including oxidative damage to macrophages, a slowly resolving inflammation, epithelial damage, mucus hypersecretion, airway fibrosis, and emphysema. As such, it appears that metabolic pathways are central to dealing with the stress of CS exposure; however, over time, inflammation and stress response gene sets become the most significantly affected in the chronic response to CS.

    Title Characteristics and Smoking Cessation Outcomes of Patients Returning for Repeat Tobacco Dependence Treatment.
    Date April 2007
    Journal International Journal of Clinical Practice

    Previous studies of tobacco dependence treatment have reported very low cessation rates among smokers who relapse and return to make a subsequent formal attempt to quit. This retrospective cohort study examined 1745 patients who attended a tobacco dependence clinic between 2001 and 2005, and the characteristics and outcomes of those who relapsed and returned for repeat treatment. Patients who returned for repeat treatment showed higher markers of nicotine dependence and were more likely to have a history of treatment for mental health problems than patients who attended the clinic for only one treatment episode. Among patients who relapsed and returned for repeat treatment, the 26-week abstinence rates were similar for each consecutive quit attempt (23%, 22% and 20%). Clinicians should encourage smokers who relapse after an initial treatment episode to return for treatment, and repeat treatment should focus on addressing high nicotine dependence and potentially co-occurring mental health problems in order to improve cessation outcomes.

    Title Postpneumonectomy Esophageal Fistula: a Combined Radiological-endoscopic Technique.
    Date December 2006
    Journal Diseases of the Esophagus : Official Journal of the International Society for Diseases of the Esophagus / I.s.d.e

    We report a case of a 70-year-old man who presented with a long-standing esophagocutaneous fistula following a pneumonectomy for aspergilloma. Major surgical procedures, including a pectoralis major flap reconstruction, a pedicled omental transposition and a radial forearm flap transposition, failed to obliterate the fistula. Seven years after initial surgery the esophagocutaneous fistula was successfully treated by means of a minimally invasive joint endoscopic and radiological technique. A radiographic catheter was passed through the fistula. The catheter and the guide wire were manipulated into the esophageal defect and into the upper esophagus. Under endoscopic vision, the catheter was then advanced over the guide wire and out of the patient's mouth. A T-tube was sutured to the catheter outside the mouth, pulled down through the esophagus, and into the esophageal defect and out through the chest wall, leaving the T-part of the tube within the esophagus. The patient made a good recovery and was discharged 7 days later. He was able to resume oral intake 3 weeks after the procedure.

    Title Risk Factors for Anastomotic Leak After Recto-sigmoid Resection for Ovarian Cancer.
    Date December 2006
    Journal Gynecologic Oncology

    OBJECTIVES: Anastomotic leak after recto-sigmoid (RS) resection for ovarian cancer (OC) is a life-threatening complication. Selection of patients for protective diverting stomas has been based on observations from the colorectal literature. Our objective was to identify primary risk factors for anastomotic leak in OC patients undergoing RS resection to better determine who would most benefit from protective diversion. METHODS: All patients with OC or primary peritoneal cancer who underwent a debulking procedure with RS resection between January 1999 and December 2004 were included. Retrospective chart review including review of operative notes, pathology reports, and medical records including follow-up visits was done. Cases with inadequate postoperative follow-up, primary end colostomies, or diverting stomas were excluded. RESULTS: 177 patients form our study cohort. There were a total of 12/177 anastomotic leaks (6.8%). The mean time to diagnosis of anastomotic leak was 19 days (range 4-32). The leak rate for primary debulking operations was 8.7% (10/115), whereas the leak rate in secondary debulking procedures was 3.2% (2/62) (NS, P = 0.22). In univariate analysis, only perioperative serum albumin was significantly associated with an increased risk of anastomotic leak (mean 3.4 g/dL vs. 2.4 g/dL, P = 0.002). Based on serum albumin, the leak rate was 6/29 (21%) for levels <3.0 g/dL and 2/58 (3.4%) for patients with albumin greater than or equal to 3.0 g/dL (OR 7.3, 95% CI 1.37-38.87). CONCLUSIONS: Low serum albumin is associated with an increased risk of anastomotic leak after RS resection for OC. Patients with a low albumin level may benefit from a protective diverting colostomy/ileostomy.

    Title Factors Associated with Quitting Smoking at a Tobacco Dependence Treatment Clinic.
    Date November 2006
    Journal American Journal of Health Behavior

    OBJECTIVE: To identify factors associated with successful quitting at a free tobacco treatment clinic. METHODS: A cohort study of the first 1021 patients who made a quit attempt. Baseline and treatment variables were recorded, and logistic regression was used to identify factors associated with abstinence at 4-week and 6-month follow-up. RESULTS: Three hundred twenty (31.3%) patients reported tobacco abstinence at 6 months. Several markers of low socioeconomic status and high nicotine dependence were predictive of poorer smoking cessation outcomes. Compliance with evidence-based treatment was associated with improved treatment outcome, as was older age and having more than 2 children. CONCLUSIONS: Efforts should be made to enhance treatment compliance among smokers with indicators of high nicotine dependence and low socioeconomic status.

    Title Ultrasound Guidance Improves the Adequacy of Our Preoperative Thyroid Cytology but Not Its Accuracy.
    Date July 2006
    Journal Cytopathology : Official Journal of the British Society for Clinical Cytology

    AIMS: Our thyroid cytology audit results of 1990-1995 showed an unsatisfactory rate of 43.1% and prediction of neoplasia with a sensitivity of 86.8%. Increasingly, ultrasound scan (USS)-guided core sampling for cytology is proving a valuable tool instead of freehand fine needle aspiration (FNA) or following unsatisfactory freehand FNA. We present the results of freehand FNA and USS-guided core samples for cytology in two separate patient groups in our centre. METHODS: Patients who had a thyroid resection and preoperative thyroid cytology in our institution between 1996 and 2002 were included. The histological diagnoses were correlated with the preceding cytology results. RESULTS: A total of 450 FNAs were performed on 394 patients. Freehand FNAs were performed for 348 (77.3%) samples and USS-guided core for 102 (22.7%) samples; 121 (26.8%) were repeat aspirates performed on 45 patients. Using aspiration cytology (AC) grading, freehand FNA was cytologically inadequate (AC0 or AC1) in 34.8% cases whereas USS-guided core was inadequate in 17.6% cases (P = 0.001). Freehand FNA (AC3, AC4, AC5) predicted neoplasia with a sensitivity of 83.2%, specificity of 46.6%, accuracy of 63.0%, positive predictive value of 56.0% and negative predictive value of 77.1%. USS-guided core sample for cytology (AC3, AC4, AC5) predicted neoplasia with a sensitivity of 93.5%, specificity of 26.0%, accuracy of 51.9%, positive predictive value of 43.9% and negative predictive value of 86.7%. CONCLUSIONS: Although USS-guided core provides more satisfactory specimens than freehand FNA, in our centre it does not provide increased accuracy.

    Title Pharmacotherapy and Smoking Cessation at a Tobacco Dependence Clinic.
    Date June 2006
    Journal Preventive Medicine

    BACKGROUND: Tobacco dependence medications are effective, and combinations may offer advantages. This study evaluates abstinence rates among smokers treated in a tobacco specialist clinic with individual and/or group counseling plus combination pharmacotherapy. METHODS: 790 smokers treated at the Tobacco Dependence Clinic in New Jersey from 2001-2003 and contacted 4 weeks after quit-date were studied. Patients received medications and behavioral interventions. Abstinence over the previous 7 days was evaluated at 4 weeks and 6 months. Patients lost to 6-month follow-up were considered still smoking. RESULTS: Overall, 36% of patients were abstinent at 6 months (20% who used no medications, 37% using one medication, 37% using 2 medications, 42% using 3 medications, and 42% using 4+ medications) (P = 0.017). 27% still used medications at 6 months, and had higher abstinence rates (65%) than those who stopped their medications (27%) (P < 0.001). Number of medications predicted abstinence at 4 weeks [adjusted odds ratios = 2.30 (95% CI; 1.27-4.18) for 1 medication, 4.78 (2.72-8.40) for 2 medications, 5.83 (2.98-11.40) for 3 medications, and 11.80 (4.10-33.95) for 4+ medications]. Increasing age, increasing level of education, longer time after waking to first cigarette, more than 7 clinical contacts, and more medications used were related to higher abstinence at 6 months. CONCLUSIONS: Smokers attending a specialist tobacco dependence treatment clinic who used more medications and for longer duration had higher abstinence rates.

    Title Ultrasound Scan-guided Core Sampling for Diagnosis Versus Freehand Fnac of the Thyroid Gland.
    Date May 2005
    Journal The Surgeon : Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

    BACKGROUND AND AIM: Freehand fine needle aspiration cytology (FNAC) is an obligatory investigation of the thyroid nodule. Between 5.0-43.1% of FNAC samples are reported as being initially unsatisfactory. In our unit, thyroid freehand FNAs are performed with a small needle (21 or 23G). Non-dominant nodules as part of multinodular goitres, difficult to palpate nodules or nodules with previously unsatisfactory freehand FNACs are sampled under ultrasound scan (USS) guidance with the larger 20G cutting core sampling technique. We aimed to compare the satisfactory sampling rate and safety of the two different methods. PATIENTS AND METHODS: Cytology forms were reviewed for 262 freehand FNACs and USS-guided core samples, performed in our unit over a two-year interval (1 July 1999 to 30 June 2001). RESULTS: Ultrasound-guided core samples for cytology were unsatisfactory (AC0-1) in 19/121 (15.6%) of the cases, compared with 66/141 (46.8%) of freehand FNACs (p value = < 0.0001). Ten out of eleven patients (91%) had a satisfactory USS-guided core after an unsatisfactory freehand FNA; 7/15 patients (46.7%) had satisfactory repeat freehand FNACs following an initial unsatisfactory freehand FNAC (p value = 0.0191). There were no complications as a result of either freehand FNAC or USS-guided core sampling. CONCLUSION: USS-guided cores provided more satisfactory samples for assessment than freehand FNACs. The USS-guided technique is safe despite the use of the larger cuffing needle. The USS-guided core sampling was also a useful tool for repeat thyroid nodule sampling after an unsatisfactory freehand FNAC.

    Title Prospective Study of Routine Contrast Radiology After Total Gastrectomy.
    Date August 2004
    Journal The British Journal of Surgery

    BACKGROUND: The practice of routine contrast radiology before recommencing oral nutrition after total gastrectomy is not evidence based. The aim of this prospective study was to evaluate the clinical role and timing of this investigation. METHODS: Seventy-six consecutive patients underwent total gastrectomy with a stapled oesophagojejunal anastomosis. A contrast swallow using non-ionic contrast and barium was performed routinely 5 and 9 days after surgery. The surgeon was blinded to the result of the first of these examinations. Patients with clinical evidence of a leak underwent contrast radiology and upper gastrointestinal videoendoscopy. RESULTS: Eight patients (11 per cent) developed a clinical leak from the oesophagojejunal anastomosis, seven before the first scheduled contrast swallow. Contrast radiology identified a leak in four of six patients. Endoscopy detected a leak in both patients with a false-negative swallow and in two patients who were not fit to undergo contrast radiology. Routine contrast radiology identified a subclinical leak in a further five patients (7 per cent), none of whom developed clinical signs. Four of seven in-hospital deaths were associated with an anastomotic leak. CONCLUSION: There is no role for routine contrast swallow after total gastrectomy with a stapled oesophagojejunal anastomosis, but patients with clinical suspicion of leakage should undergo urgent contrast radiology, plus endoscopy if the contrast examination is normal.

    Title Combined Percutaneous and Endoscopic Procedures for Bile Duct Obstruction: Simultaneous and Delayed Techniques Compared.
    Date October 2003
    Journal Hepato-gastroenterology

    BACKGROUND/AIMS: In patients with obstructive jaundice, when the endoscopic approach fails to achieve biliary drainage, percutaneous cannulation and combined endoscopic/percutaneous endoprosthesis insertion can be performed simultaneously or in stages. This study compared these two approaches. METHODOLOGY: Over a three-year period 41 patients were studied. All had obstructive jaundice for which endoscopic drainage had failed. In 22 patients (group 1) percutaneous transhepatic drainage was followed a few days later by combined endoscopic and percutaneous procedure. In 19 patients (group 2) the percutaneous transhepatic drainage and combined drainage were performed at the same session. In the multiple stage group the mean interval between the first endoscopic retrograde cholangiopancreatography and final combined procedure was 9 days (SD 5.2). The groups were similar for sex, underlying pathology and reasons for failure of endoscopic approach. Group 1 patients were older 73 vs. 65 years (p < 0.05). RESULTS: Patients in group 2 had a more rapid recovery and discharge home: mean 6 days, compared to mean 18 days from the initial procedure for group 1 (p < 0.001). Five patients died of their disease without leaving hospital (4 in group 1, 1 in group 2). In each group drainage failed in 1 patient. Complications were more common in group 1: 73% vs. 37% (p < 0.05). Pancreatitis (3 vs. 2) and septicemia (4 in group 1, 3 in group 2) were similar but group 1 had complications from the external drain: cholangitis and pyrexia in 4 patients, 3 bile leaks, and 1 catheter displacement. CONCLUSIONS: When endoscopic drainage alone fails, a combined percutaneous/endoscopic procedure should only be performed if it can be carried out simultaneously.

    Title Perforation of a Nonobstructing Gastro-oesophageal Carcinoma by Oblique-viewing Endoscopic Ultrasound Videoscope: a Need for a Safe Technique.
    Date March 2003
    Journal Endoscopy
    Title Combined Percutaneous-endoscopic Management of a Perforated Esophagus: a Novel Technique.
    Date December 2001
    Journal Gastrointestinal Endoscopy
    Title Diagnosis and Management of a Mediastinal Leak Following Radical Oesophagectomy.
    Date October 2001
    Journal The British Journal of Surgery

    BACKGROUND: The aim of this study was to evaluate the diagnosis, management and outcome of mediastinal leaks following radical oesophagectomy with a stapled intrathoracic anastomosis. METHODS: Some 291 consecutive patients underwent two-phase subtotal oesophagectomy with gastric interposition for malignancy. Patients with clinical suspicion of a leak were investigated with contrast radiology and flexible upper gastrointestinal endoscopy. RESULTS: Nineteen patients (6.5 per cent) developed a proven mediastinal leak at a median of 8 (range 3-30) days following surgery. Contrast radiology and flexible upper gastrointestinal endoscopy identified that 13 patients had an isolated leak from the oesophagogastric anastomosis and two had widespread leakage secondary to gastrotomy-line dehiscence. Endoscopy revealed a further four patients with gastric necrosis in whom contrast radiology was normal. In six patients the diagnosis of leakage followed an apparently normal routine contrast examination on day 5-8. All 13 isolated anastomotic leaks were managed non-operatively with targeted mediastinal drainage, intravenous antibiotics and antifungal therapy, nasogastric decompression and enteral nutrition; the mortality rate was 15 per cent (two of 13). Patients with gastrotomy dehiscence or gastric necrosis had a more severe clinical picture; they were managed with repeat thoracotomy and either revision of the conduit or resection and exclusion. Despite early intervention four of the six patients died. CONCLUSION: Routine postoperative contrast radiology cannot be recommended. On clinical suspicion of a leak patients require both contrast radiology and endoscopic evaluation. Isolated anastomotic leaks can be managed successfully with non-operative treatment, whereas more extensive leaks from the gastric conduit require revisional surgery which carries a high mortality rate.

    Title Tigrfams: a Protein Family Resource for the Functional Identification of Proteins.
    Date February 2001
    Journal Nucleic Acids Research

    TIGRFAMs is a collection of protein families featuring curated multiple sequence alignments, hidden Markov models and associated information designed to support the automated functional identification of proteins by sequence homology. We introduce the term 'equivalog' to describe members of a set of homologous proteins that are conserved with respect to function since their last common ancestor. Related proteins are grouped into equivalog families where possible, and otherwise into protein families with other hierarchically defined homology types. TIGRFAMs currently contains over 800 protein families, available for searching or downloading at Classification by equivalog family, where achievable, complements classification by orthology, superfamily, domain or motif. It provides the information best suited for automatic assignment of specific functions to proteins from large-scale genome sequencing projects.

    Title Genome Sequence of the Radioresistant Bacterium Deinococcus Radiodurans R1.
    Date December 1999
    Journal Science (new York, N.y.)

    The complete genome sequence of the radiation-resistant bacterium Deinococcus radiodurans R1 is composed of two chromosomes (2,648,638 and 412,348 base pairs), a megaplasmid (177,466 base pairs), and a small plasmid (45,704 base pairs), yielding a total genome of 3,284, 156 base pairs. Multiple components distributed on the chromosomes and megaplasmid that contribute to the ability of D. radiodurans to survive under conditions of starvation, oxidative stress, and high amounts of DNA damage were identified. Deinococcus radiodurans represents an organism in which all systems for DNA repair, DNA damage export, desiccation and starvation recovery, and genetic redundancy are present in one cell.

    Title Tn916 Transposition in Haemophilus Influenzae Rd: Preferential Insertion into Noncoding Dna.
    Date August 1998
    Journal Microbial & Comparative Genomics

    The availability of completely sequenced genomes has created an opportunity for high throughput mutational studies. Using the conjugative transposon Tn916, a pilot project was initiated to determine the efficiency of gene disruption in the first completely sequenced bacterium, Haemophilus influenzae Rd strain KW20. DNA was isolated from Tn916-mutagenized cells, and the point of transposon insertion was determined by inverse PCR, DNA sequencing, and mapping to the wild-type genome sequence. Analysis of the insertion sites at the nucleotide level demonstrated a biased pattern of insertion into regions rich in stretches of A's and T's. Although Tn916 integrated at multiple dispersed positions throughout the chromosome, 9 of 10 insertion events occurred in noncoding, intergenic DNA. It was determined that the intergenic DNA was over 5% more A + T-rich than that of protein coding sequences. This suggests that A + T-rich sequences similar to the Tn916 insertion site would be more likely to reside in the intergenic DNA. In an effort to identify other likely sites for transposon integration, a hidden Markov model of the consensus target insertion site was derived from the Tn916-H. influenzae junction fragments and searched against the entire genome. Eighty percent of the 30 highest-scoring predicted Tn916 target sites were from intergenic, nonprotein-coding regions of the genome. These data support the hypothesis that Tn916 has a marked preference for insertion into noncoding DNA for H. influenzae, suggesting that this mobile element has evolved to minimize disruption of host cell function on integration.

    Title Self-expanding Metal Stents in the Palliation of Small Bowel Stenosis Secondary to Recurrent Gastric Cancer.
    Date May 1998
    Journal Gastrointestinal Endoscopy
    Title The Complete Genome Sequence of the Hyperthermophilic, Sulphate-reducing Archaeon Archaeoglobus Fulgidus.
    Date December 1997
    Journal Nature

    Archaeoglobus fulgidus is the first sulphur-metabolizing organism to have its genome sequence determined. Its genome of 2,178,400 base pairs contains 2,436 open reading frames (ORFs). The information processing systems and the biosynthetic pathways for essential components (nucleotides, amino acids and cofactors) have extensive correlation with their counterparts in the archaeon Methanococcus jannaschii. The genomes of these two Archaea indicate dramatic differences in the way these organisms sense their environment, perform regulatory and transport functions, and gain energy. In contrast to M. jannaschii, A. fulgidus has fewer restriction-modification systems, and none of its genes appears to contain inteins. A quarter (651 ORFs) of the A. fulgidus genome encodes functionally uncharacterized yet conserved proteins, two-thirds of which are shared with M. jannaschii (428 ORFs). Another quarter of the genome encodes new proteins indicating substantial archaeal gene diversity.

    Title Postoperative Back Pain.
    Date December 1996
    Journal Postgraduate Medical Journal
    Title How Reliable Are Ultrasound Measurements of Renal Length in Adults?
    Date January 1996
    Journal The British Journal of Radiology

    Ultrasound assessment of patients with renal impairment commonly includes measurement of bipolar renal length. Reduction in length is considered to indicate chronic renal disease and is a factor in deciding whether to proceed to renal biopsy. To date, no published data are available on interobserver and intraobserver variation in sonographic renal length measurement in adults. Bilateral renal lengths were measured in 20 adult subjects, with no history of renal disease, by three experienced operators, on two separate occasions. Limits of agreement for replicate measurements by each ultrasonographer and for replicate measurements by each pair of ultrasonographers were determined. Values of repeatability (a measure of intraobserver variation) and reproducibility (a measure of interobserver variation) were calculated for all renal length measurements, and for right and left renal lengths separately. Results indicate that replicate renal length measurements differ by less than 1.85 cm in 95% of cases, and the magnitude of variations is similar when measurements are made by either single or different ultrasonographers, and are similar for right and left renal length measurements. This suggests that sonographic bipolar renal length measurements in normal adult kidneys are reasonably reliable. In diseased kidneys, however, in which identification of renal poles is difficult, interobserver and intraobserver variation may be much greater.

    Title Heparin Associated Thrombocytopenia.
    Date December 1995
    Journal The Journal of the Arkansas Medical Society
    Title Progression of an Inductive Signal Activates Sporulation in Dictyostelium Discoideum.
    Date August 1995
    Journal Development (cambridge, England)

    spiA, a marker for sporulation, is expressed during the culmination stage of Dictyostelium development, when the mass of prespore cells has moved partly up the newly formed stalk. Strains containing a full-length spiA promoter/lacZ fusion were stained for beta-galactosidase activity at intervals during development. The results indicate that expression of spiA initiates in prespore cells at the prestalk/prespore boundary (near the apex) and extends downward into the prespore mass as culmination continues. A spatial gradient of staining expands from the top of the prespore mass and intensifies until the front of activation reaches the bottom, whereupon the entire region stains darkly. The spiA promoter can be deleted to within 301 bp of the transcriptional start site with no effect on the relative strength, timing or spatial localization of expression. Further 5' deletions from -301 to -175 reduce promoter strength incrementally, although timing and spatial expression are not affected. Deletions to -159 and beyond result in inactive promoters. Treatment of early developmental structures with 8-Br-cAMP in situ activates the intracellular cAMP-dependent protein kinase (PKA) and precociously induces spiA expression and sporulation. The absence of an apparent gradient of staining in these structures suggest that PKA is equivalently activatable throughout the prespore region and that all prespore cells are competent to express spiA. Thus, we postulate that the pattern of expression of spiA reveals the progression of an inductive signal for sporulation and suggest that this signal may originate from the prestalk cells at the apex.

    Title Treatment of Right Hepatic Artery Injury by Percutaneous Embolisation.
    Date December 1994
    Journal Lancet
    Title Expression of Camp-dependent Protein Kinase in Prespore Cells is Sufficient to Induce Spore Cell Differentiation in Dictyostelium.
    Date November 1994
    Journal Proceedings of the National Academy of Sciences of the United States of America

    The activity of cAMP-dependent protein kinase (PKA) is required for proper development at several stages during the Dictyostelium life cycle. We present evidence that activation of PKA is rate-limiting for the differentiation of prespore cells to spores and that PKA activation may be the developmental trigger for sporulation. Strains that overexpress the gene encoding the catalytic subunit of PKA (PKAcat) or lack a functional regulatory subunit (rdeC strains) undergo rapid, heterochronic development. We show that overexpression of PKAcat in prespore cell is sufficient to directly induce expression of the spore maturation marker spiA and differentiation to spores, in a cell-autonomous manner. Moreover, overexpression of PKAcat in prespore cells can bypass a mutation that blocks an earlier developmental step to induce spiA expression. Our results suggest that the regulatory pathway in prespore cells between the activation of PKA and spiA induction/spore maturation is quite short and that PKAcat expression in prespore cells may mediate spore differentiation at the level of transcription. This induction of sporulation requires the prior activation of the prespore cell pathway. In addition, we show that beta-galactosidase activity expressed from a PKAcat promoter/lacZ reporter construct is highly enriched in the anterior prestalk A region during the tipped aggregate, slug, and early culminant stages and that this pattern switches abruptly to a prespore pattern at the time of spore maturation, supporting the proposed role of PKA in this process.

    Title Disruption of the Sporulation-specific Gene Spia in Dictyostelium Discoideum Leads to Spore Instability.
    Date July 1992
    Journal Genes & Development

    The spiA gene of Dictyostelium is expressed specifically in prespore cells and spores during culmination, the final stage of development during which prespore and prestalk cells undergo terminal differentiation to form spores and stalk. We have used homologous recombination to delete this gene and have characterized the resulting phenotype. The spiA- strains develop normally and produce spores that are indistinguishable from those of wild-type strains by transmission and scanning electron microscopy. Mutant spores have normal viability when assayed soon after the completion of development, but, as the spiA- spores age, they lose viability more rapidly than those of the spiA+ parent. The drop in viability is more pronounced when spores are submerged in dilute buffer at a concentration that does not allow germination; after 11 days submerged, the viability of spiA- spores is 10(5)-fold reduced, whereas that of the parent is decreased only 10-fold. Reinserting an intact copy of the spiA gene into a spiA- strain restores the stability of its spores. The product of the spiA gene, Dd31, was identified on Western blots as a 30-kD protein using an antibody raised against a fusion protein containing a portion of the coding sequence. Dd31 is associated with the inner face of spore coat fragments in a detergent-resistant manner. This location is consistent with its observed role in maintaining stability of the spores.

    Title A Prespore Gene, Dd31, Expressed During Culmination of Dictyostelium Discoideum.
    Date May 1991
    Journal Developmental Biology

    During culmination of Dictyostelium fruiting bodies, prespore and prestalk cells undergo terminal differentiation to form spores and a cellular stalk. A genomic fragment was isolated by random cloning that hybridizes to a 1.4-kb mRNA present during culmination. Cell type separations at culmination showed that the mRNA is present in prespore cells and spores, but not in prestalk or stalk cells. After genomic mapping, an additional 3 kb of DNA surrounding the original 1-kb fragment was cloned. The gene was sequenced and named Dd31 after the size of the predicted protein product in kilodaltons. Accumulation of Dd31 mRNA occurs immediately prior to sporulation. Addition of 20 mM 8-Br-cAMP to cells dissociated from Mexican hat stage culminants induced sporulation and the accumulation of Dd31 mRNA, while 20 mM cAMP did not. Dd31 mRNA does not accumulate in the homeotic mutant stalky in which prespore cells are converted to stalk cells rather than spores. Characterization of Dd31 extends the known temporal dependent sequence of molecular differentiations to sporulation.

    Title Proteolysis of Bacteriophage Phi X174 Prohead Protein Gpb by a Protease Located in the Escherichia Coli Outer Membrane.
    Date January 1989
    Journal Journal of Bacteriology

    The gene B protein (gpB) of bacteriophage phi X174 is required for prohead assembly and is removed from prohead during phage maturation. Protease activity was observed in isolated prohead which specifically cleaved gpB. Cleavage of gpB produced two fragments that had apparent molecular weights of 12,300 and 3,700 on sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Amino-terminal sequencing of the fragments confirmed that they resulted from the cleavage of gpB and identified the cleavage site as an Arg-Arg at amino acids 76 to 77 of the 120-amino-acid protein. gpB-specific protease activity was observed in both phi X174-infected and uninfected Escherichia coli extracts. This protease activity was localized to the outer-membrane fraction of uninfected cells. Protease activities present in the outer membrane and in isolated prohead produced identical fragments and had the same protease inhibition profile. The gpB-specific activity in uninfected cells was induced by growth at 42 degrees C and was inhibited by the protease inhibitors, 1,10-phenanthroline, EDTA, and N-ethylmaleimide.

    Title A Controlled Study of Palpatory Diagnostic Procedures: Assessment of Sensitivity and Specificity.
    Date July 1987
    Journal The Journal of the American Osteopathic Association
    Title Partial Maintenance of Testes and Accessory Organs in Blinded Hamsters by Homoplastic Anterior Pituitary Grafts or Exogenous Prolactin.
    Date January 1979
    Journal Life Sciences
    Title Neutrophil Accumulation in Vivo Following the Administration of Chemotactic Factors.
    Date June 1977
    Journal British Journal of Haematology

    Intravenously administered 51Cr-labelled homologous neutrophils accumulated at guinea-pig skin sites prepared by intradermal injection of factors derived from complement-activated serum, possessing in vitro chemotactic activity. There was a strong correlation between the in vitro potency of Sephadex G-100 fractions of the activated serum and their ability to evoke neutrophil accumulation in vivo. These experiments suggest that agents which are chemotactic for neutrophils in vitro also induce the localization of this cell in vivo.

    Title Microwave Irradiation and Brain Gamma-aminobutyric Acid Levels in Mice.
    Date September 1976
    Journal Life Sciences
    Title Chemotaxis for Human Monocytes by Fibrinogen-derived Peptides.
    Date July 1976
    Journal British Journal of Haematology

    Chemotactic activity for human peripheral blood monocytes was generated by the action of thrombin on human fibrinogen, a reaction known to release low molecular fibrinopeptides. Supernatants prepared by incubating Contortrix venom with fibrinogen, which cleaves the B peptide, were also chemotactic, whereas no activity was present in supernatants from Arvin venom, which cleaves peptides A, AP and AY. Thus fibrinopeptide B was chemotactic for the monocyte in addition to the neutrophil, as previously reported. Monocyte chemotactic activity was also generated by the action of plasmin on human fibrinogen and shown to be associated with the D and E fragments but not with a mixture of fragments X and Y. When plasmin digestion was stopped at time intervals up to 24 h, monocyte chemotactic activity corresponded with the appearance of the D and E fragments. The monocyte chemotactic activity, contained in a 24 h digest, eluted from Sephadex G-75 at VO, corresponding to the expected position of the D and E fragments whereas neutrophil chemotactic activity eluted with molecules of molecular size of approximately 30 000 daltons. Thus fragments D and E derived from plasmin digestion of fibrinogen attract the monocyte whereas only the small uncharacterized peptides were chemotactic for the neutrophil. These different profiles of chemotactic activity for the neutrophil and the monocyte in terms of plasmin digestion products of fibrinogen may be of significance in the events leading to the accumulation of these cells in vivo during fibrin deposition.

    Title Interdisciplinary Approach to the Study of Behavior in Related Mice Types.
    Date September 1974
    Journal Neurosciences Research
    Title Diagnosis and Management of Scrofula in Children.
    Date March 1974
    Journal Journal of Pediatric Surgery
    Title Combined Trisomy-18 and Congenital Rubella.
    Date October 1971
    Journal Southern Medical Journal
    Title Techniques and Materials for Passive Thermal Control of Rigid and Flexible Extravehicular Space Enclosures. Amrl-tr-67-128.
    Date November 1968
    Journal Amrl-tr. Aerospace Medical Research Laboratories (6570th)
    Title Research to Advance Extravehicular Protective Technology. Amrl-tr-66-250.
    Date October 1968
    Journal Amrl-tr. Aerospace Medical Research Laboratories (6570th)
    Title Study and Development of Materials and Techniques for Passive Thermal Control of Flexible Extravehicular Space Garments. Amrl-tr-65-156.
    Date February 1966
    Journal Amrl-tr. Aerospace Medical Research Laboratories (6570th)
    Title Local Correction of Extreme Stomal Prolapse Following Transverse Loop Colostomy.
    Journal Gynecologic Oncology

    BACKGROUND: Stomal prolapse is a common complication of transverse loop colostomies. Although rarely required, surgical correction is associated with potential morbidity. We describe a novel surgical approach to repair stomal herniation that aims to decrease perioperative morbidity. CASE: A 57 year-old patient with stage IVB adenocarcinoma of the cervix underwent a transverse loop colostomy for palliation of a rectovaginal fistula. Several months later, she presented with a large symptomatic stomal prolapse and elected local surgical correction. Under general anesthesia, we performed a revision of the colostomy with a stapling device. CONCLUSION: Although long-term data are lacking, this approach is easy, safe, and a reasonable alternative for palliative revision of a prolapsed colostomy stoma.

    Title Ca125 Decline in Ovarian Cancer Patients Treated with Intravenous Versus Intraperitoneal Platinum-based Chemotherapy.
    Journal Gynecologic Oncology

    OBJECTIVES: To compare the slope of CA125 decline in patients with optimally debulked epithelial ovarian cancer achieving a response to intravenous (IV) versus intraperitoneal (IP) platinum-based chemotherapy. The secondary objectives are to determine if the time to normal CA125 levels and time to nadir of CA125 differ between the groups. METHODS: Patients with primary stage III, optimally cytoreduced ovarian cancer were stratified as to whether platinum and taxane chemotherapy was administered entirely IV (IV group), or whether it was given IV and IP (IP group). Inclusion criteria included an elevated CA125 prior to surgery or first cycle chemotherapy and at least 1 month follow-up after completion of chemotherapy. All patients had a complete or partial response. In addition, IP patients had to have received at least 1 cycle of IP chemotherapy. Because of the large range of CA125 levels, raw CA125 values were natural log transformed and compared using repeated measures analysis of variance (ANOVA). RESULTS: 53 patients met inclusion criteria, 36 in the IV arm and 17 in the IP arm. The median number of chemotherapy cycles was 6 in both groups; the range was 5-9 in the IP arm and 6-10 in the IV arm. The median CA125 prior to surgery was 888 (range 45-5940) in the IP group and 1081 (range 58-19,440) in the IV group, p=0.55. After surgery but prior to chemotherapy, the median CA125 was 175.5 in the IP arm (range 10.8-4035) versus 233.5 (range 16.5-6890) in the IV arm, p=0.43. The median time to normalization of CA125 for the IP group was half the time of the IV group, 0.75 months (range 0 to 4.5) versus 1.5 months (range 0 to 6.25), p=0.15. The time to nadir was slightly faster in the IP arm as compared to the IV arm, 4.5 months (2-10.5) versus 6 months (2-14), p=0.13. The CA125 slopes were parallel, indicating that the CA125 levels declined at the same rate in both groups. However, the patients treated with IP chemotherapy had significantly lower CA125 levels over all the cycles, p=0.02. CONCLUSIONS: Contrary to the assumption that IP chemotherapy elevates CA125 levels due to peritoneal irritation, these results show a trend towards faster time to CA125 normalization and nadir, and significantly lower CA125 levels during therapy for patients responding to IP chemotherapy compared with patients responding to IV therapy.

    Title Combination Gemcitabine, Platinum, and Bevacizumab for the Treatment of Recurrent Ovarian Cancer.
    Journal Gynecologic Oncology

    OBJECTIVE: To describe the response rate (RR), progression-free survival (PFS), and toxicity profile of combination gemcitabine, platinum, and bevacizumab (GPB) for the treatment of recurrent epithelial ovarian cancer (EOC). METHODS: A chart review of all patients with recurrent EOC who were treated with D1, D15 GPB in a 28-day cycle at a single institution was performed. Standard doses were gemcitabine 1000 mg/m(2), cisplatin 30 mg/m(2) or carboplatin AUC 3, and bevacizumab 10 mg/kg. All patients were analyzed for toxicity. RR and PFS were assessed in all patients who received at least 2 cycles of GPB. RESULTS: Thirty-five patients were identified, and 33 received at least 2 cycles of GPB. The majority of patients (80%) were platinum sensitive. Patients received a median of 6 cycles of GPB (range 1-24). Sixteen patients (48%) had a complete response (CR), and 10 patients (30%) had a partial response (PR), for a total RR of 78%. An additional 5 patients (15%) had stable disease, and only 2 (6%) patients had progressive disease. The median overall PFS was 12 months (95% CI 7-15), with a median follow-up time of 10 months (2-22). Two patients (6%) had bowel perforations, and both survived. Hematologic toxicities were most common, with 29% and 14% of patients experiencing grade 3 or 4 neutropenia and thrombocytopenia respectively. CONCLUSIONS: The combination of GPB demonstrated excellent efficacy for the treatment of recurrent EOC. However, serious toxicities occurred, and the safety profile of this combination requires further study.

    Title Comparison of Multislice Computed Tomography and Endoscopic Ultrasonography with Operative and Histological Findings in Suspected Pancreatic and Periampullary Malignancy.
    Journal The British Journal of Surgery

    BACKGROUND: This study compared multislice computed tomography (MSCT) with endoscopic ultrasonography (EUS) in the diagnosis and staging of pancreatic and periampullary malignancy. METHODS: Data were collected prospectively on patients having MSCT and EUS for suspected pancreatic and periampullary malignancy. RESULTS: Eighty-four patients had MSCT and EUS, of whom 35 underwent operative assessment (29 resections). In assessing malignancy, there was no significant difference between MSCT and EUS, and agreement was good (82 per cent, kappa = 0.49); the sensitivity and specificity of MSCT were 97 and 87 per cent, compared with 95 and 52 per cent respectively for EUS (P = 0.264). For portal vein/superior mesenteric vein invasion, MSCT was superior (P = 0.017) and agreement was moderate (72 per cent, kappa = 0.42); the sensitivity and specificity were 88 and 92 per cent for MSCT, and 50 and 83 per cent for EUS. For resectability, there was no significant difference and agreement was good (78 per cent, kappa = 0.51). EUS had an impact on the management of 14 patients in whom MSCT suggested benign disease or equivocal resectability. CONCLUSION: MSCT is the imaging method of choice for pancreatic and periampullary tumours. Routine EUS should be reserved for those with borderline resectability on MSCT.

    Title The Detection of Differentially Expressed Micrornas from the Serum of Ovarian Cancer Patients Using a Novel Real-time Pcr Platform.
    Journal Gynecologic Oncology

    OBJECTIVE: To determine the utility of serum miRNAs as biomarkers for epithelial ovarian cancer. METHODS: Twenty-eight patients with histologically confirmed epithelial ovarian cancer were identified from a tissue and serum bank. Serum was collected prior to definitive therapy. Fifteen unmatched, healthy controls were used for comparison. Serum was obtained from all patients. RNA was extracted using a derivation of the single step Trizol method. The RNA from 9 cancer specimens was compared to 4 normal specimens with real-time PCR using the TaqMan Array Human MicroRNA panel. Twenty-one miRNAs were differentially expressed between normal and patient serum. Real-time PCR for the 21 individual miRNAs was performed on the remaining 19 cancer specimens and 11 normal specimens. RESULTS: Eight miRNAs of the original twenty-one were identified that were significantly differentially expressed between cancer and normal specimens using the comparative C(t) method. MiRNAs-21, 92, 93, 126 and 29a were significantly over-expressed in the serum from cancer patients compared to controls (p<.01). MiRNAs-155, 127 and 99b were significantly under-expressed (p<.01). Additionally, miRs-21, 92 and 93 were over-expressed in 3 patients with normal pre-operative CA-125. CONCLUSION: We demonstrate that the extraction of RNA and subsequent identification of miRNAs from the serum of individuals diagnosed with ovarian cancer is feasible. Real-time PCR-based microarray is a novel and practical means to performing high-throughput investigation of serum RNA samples. miRNAs-21, 92 and 93 are known oncogenes with therapeutic and biomarker potential.

    Title Robotic Hysterectomy and Pelvic-aortic Lymphadenectomy for Endometrial Cancer.
    Journal Obstetrics and Gynecology

    OBJECTIVE: To report the learning curve and outcomes after our first 105 patients underwent robotic hysterectomy and pelvic-aortic lymphadenectomy for the comprehensive staging of endometrial cancer. METHODS: We prospectively collected patient demographics, operative times, complications, pathologic results, and length of stay on all patients who underwent robotic hysterectomy pelvic-aortic lymphadenectomy for clinical stage I or occult stage II endometrial carcinoma. RESULTS: One hundred five patients at The Ohio State University between March 2006 and April 2008 underwent exploration with the intent of robotic hysterectomy pelvic-aortic lymphadenectomy. Ninety-two (87.6%) were completed robotically and 13 (12.4%) were converted. The probability of conversion was 15% (95% confidence interval [CI] 8.4-25.7), 24% (95% CI 12.4-39.9), 35% (95% CI 15.9-59.6), and 48% (95% CI 19.1-77.8) for a body mass index of 40, 45, 50, and 55 kg/m(2), respectively. The median body mass index was 34 kg/m(2) (range 19-58). In patients who underwent a robotic hysterectomy pelvic-aortic lymphadenectomy (n=79, 75%) or a robotic hysterectomy-pelvic lymphadenectomy (n=6, 5.7%), the average operating time from skin opening to closure was 242 minutes (+/-50 minutes). The median estimated blood loss was 99 mL (+/-83 mL). The median number of lymph nodes recovered was 29 (range 9-56), 21 (range 5-40) pelvic nodes and 9 (range 2-21) aortic nodes. The median length of stay was 1 night. After analysis of the data, we determined approximately 20 cases are needed to gain proficiency. CONCLUSION: Early experience demonstrates that robotic hysterectomy pelvic-aortic lymphadenectomy for endometrial cancer is feasible, with approximately 20 procedures needed to gain proficiency. LEVEL OF EVIDENCE: III.

    Title Abstinence and Psychological Distress in Co-morbid Smokers Using Various Pharmacotherapies.
    Journal Drug and Alcohol Dependence

    Existing trials of varenicline have typically excluded smokers with concurrent medical and psychiatric illnesses and no data exist comparing effectiveness of varenicline with combination pharmacotherapy. This study evaluated abstinence and psychiatric outcomes of various tobacco dependence medications, including varenicline.

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